Australia would need to make a serious investment over the next 10 years to meet the same standards of clinical information required to improve quality of care as other countries, according to Professor Leonard Gray AO (pictured above), the Director of the Centre for Health Services Research (CHSR) at the University of Queensland.
Prof Gray – who is a Professor in Geriatric Medicine – made the comments during an almost an hour-and-a-half panel session with Professor Leon Flicker AO (pictured below), a Professor of Geriatric Medicine at the University of Western Australia and Consultant Geriatrician at the Royal Perth Hospital, around the viability of introducing outreach services to provide specialist care and rehabilitation services in residential care.
Prof Gray – who has served as a board member and research contributor to InterRAI, an international organisation that aims to improve quality of care through a standardised approach to recording clinical information for 20 years – says its systems mean that one set of data can be used to support clinical decision-making as well as service planning, case mix development, payment arrangements and quality measures.
“The only publicly available reported quality measures in the world at the moment are produced by InterRAI systems and that’s namely in Canada, the US and recently New Zealand has started publishing performance measures for its systems,” he explained to Senior Counsel Assisting Richard Knowles. “And so, things like how many people are in pain, how many people lost weight, how many people lost function in the last three months are all available on public websites in those countries. We are so far away from that here.”
His statement was enough to grab Commissioner Lynelle Briggs’ attention.
“To implement that approach in Australia, what would be required in terms of commitment and time frame?” she asked.
Prof Gray says they are starting to work with some providers here to help record their information, but not all providers have seen the benefits.
“Some of them like this idea,” he replied. “Others see it as just another Government burden responsibility. This approach works well when it’s the software and the training is well customised to the needs of the care providers. Not just the Government saying that you will now collect 300 data points and we will tell you something about it in three years from now.”
However, the program takes serious time and money to implement.
“Even if we didn’t use InterRAI and said we were going to use structured information so that we understood who lives in facilities and we could measure what happens, it’s still a five to 10-year investment,” Prof Gray stated. “So New Zealand is about 10 years into this and this year they started representing their quality measures aggregate a few weeks ago and that’s – that’s been a well-organised process as far as I can see, so it’s a serious long-term investment one has to make.”
The pair were supportive of the Royal Commission’s proposition to expand outreach services for specialists and rehabilitation into residential care nationally – but were adamant that it would not mean residents wouldn’t need access to GPs.
“You need more sophisticated care and not less sophisticated care,” Prof Gray said. “And I think that’s forgotten. It’s thought of we don’t do anything anymore because the person is in the last year of their life but, in fact, the symptoms are really difficult to deal with, they’ve got multiple problems that need balancing.”
To ensure providers continue to facilitate access, the Professors say the roles and responsibilities of providers, services and the various Governments need to be clearly defined under a national framework, best placed in the National Health Reform Agreement currently being nutted out by the Government and States and Territories.
Prof Gray also suggested providing primary care be made part of the accreditation standards for aged care providers – so there are no excuses for ‘dropping the ball’.
“There’s a responsibility for the facilities to make sure that this happens, that they – they can’t just devolve it off to somebody else,” he said.
The Professors also jointly called for an overhaul of the information framework in aged care so data can be shared with both hospital and GP systems, arguing it would cut down on families needing to answer repetitive questions, assist providers in their service planning needs and improve quality of care.
“If you don’t know much about the residents, for example, how many people in aged care facilities have severe uncontrolled pain at the moment?” Prof Gray asked rhetorically. “We will be interested in that. How many are taking opioids for pain and how well are they working? I don’t think anybody’s got a clue and I know it’s a huge issue so how do we get a handle on that. These all depend on robust information and if you design a system well the information that’s used by clinicians to support their interactions and can be doubled up to be used by administrators.”
Prof Flicker – who also appeared at the Broome hearings in June into the needs of people living in rural and remote areas including Aboriginal and Torres Strait Islander people – added the idea of linking data systems was first conceived of 15 years ago under the National Action Plan, but it’s needed more than every today because some parts of the system are now impossible to link.
“Might I ask why are those elements becoming more difficult to link at this very time?” Commissioner Lynelle Briggs questioned.
“I think at present it’s because of just software mismatch,” he answered.
Is that support then for a universal software system – not only for aged care providers, but across the whole health system?