INTERPRETACIÓN DE RESULTADOS

The Northern Territory OBIP was signed in 2010. It included an agreement to populate a schedule with specific activities to improve data quality in the Northern Territory, to be finalised as soon as possible during 2010. The Northern Territory advised this schedule has not been finalised to date. However, the actions in relation to Indigenous data are essentially complete, with the proviso that initiatives regarding community awareness of the national standard Indigenous status question and staff training are ongoing. The ABS has offered to assist with this training.

Schedule F overarching data quality improvement projects

The Northern Territory has implemented the national standard Indigenous status question, including in CareSys and Primary Care Information System, the medical information systems collecting and managing health data in the territory. Indigenous identification procedures used in recording categories on data collection forms and information systems for key data sets in the Northern Territory conform with national standard approaches.

Indigenous status is also collected through the My eHealth Record (the rebranded Shared Electronic Health Record), which also assists with evaluating the effectiveness of the service.

Improvements specific to data collections Admitted patient care data

Jurisdictions contribute information for collection at the national level; for example, through the National Hospital Morbidity Database. Jurisdiction level efforts to improve Indigenous data quality in their admitted patient care data may impact only at jurisdiction level or may also affect contributions from which national collections, such as the National Hospital Morbidity Database, are generated. The Northern Territory advised the procedures used in asking the national standard Indigenous status question conform to the ABS approach.

Demographic details of clients are held within central data sets and are used by most departmental data sets. The Northern Territory has developed a Hospital Registration Number, with which clients can be tracked across the territory, from hospitals to community health services. Northern Territory public hospital pathology reports have a Hospital

Registration Number which can be linked to demographic variables including Indigenous status.

The recording of Indigenous status in Northern Territory public hospitals has been

recognised as being of high quality (Foley et al. 2012). At each visit to any Northern Territory hospital, the patient/guardian is asked whether or not they identified themselves or their child as Aboriginal or Torres Strait Islander or both Aboriginal and Torres Strait Islander.

The information is then entered into the Client Master Index module in the Hospital Information System (known as the CareSys system). The hospital attendance/visits and patient demographic details for each attendance are extracted by the Data Warehouse for reporting purposes.

The Northern Territory has conducted data quality surveys of demographic information in client record data on three occasions. All three survey reports have been published and are available in both hard copy and on the Northern Territory Health website. These surveys involved validation of client records by face-to-face interviews with hospital admitted patients. The quality of Indigenous status data in each of the three surveys was 94% (1997),

Department found ‘the high level of accuracy recorded in previous Northern Territory surveys had been maintained. The level of accuracy for each data item in 2011 was sex (99%), Indigenous status (98%), country of birth (97%), district of residence (91%), year of birth (89%) and date of birth (83%)’(Foley et al. 2012).

National Perinatal Data Collection

For newborn babies, the mother’s Indigenous status is asked directly of the mother. The mother’s Indigenous status is then entered into the Client Master Index module in the Hospital Information System. The newborn Indigenous status will then default with the mother’s Indigenous status in the Maternity module in the Hospital Information System.

Northern Territory provides data to the National Perinatal Data Collection on an annual basis, including Indigenous status of the baby and smoking during pregnancy.

Australian Cancer Database

The Northern Territory noted pathology request forms include a field for Indigenous status but this is rarely completed. As noted above, the Hospital Registration Number developed by the Northern Territory enables all clients to be tracked throughout the territory, from hospitals to community health services. Northern Territory public hospital pathology reports use the Hospital Registration Number and this can be linked to Indigenous status against the patient data in the source system. The Northern Territory also advised the new Cancer

(Registration) Act 2009 extended existing requirements for cancer notifications from pathology results and death certificates to include diagnosis during hospital admission.

There are also new powers to oblige medical practitioners to complete missing information on notifications. Indigenous status is validated against the Department of Health electronic client information system.

4.9 Discussion

As required by the NIRA, all jurisdictions have developed OBIPs which commit to data improvement activities, and all are engaged in various data improvement activities relevant to Guidelines implementation (Table 4.1). Gaining a cohesive national picture of the status of Guidelines implementation, however, has proved challenging for a number of reasons.

• Firstly, Indigenous data quality improvement efforts predate the NIRA and the

requirements of Schedule F. Existing strategies and programs may not readily fit within new reporting mechanisms, despite their relevance and importance.

• Secondly, connections between commitments included in the NIRA Schedule F and concrete project delivery are sometimes difficult to trace. For example, while all OBIPs recognise the importance of data quality improvements, only the Tasmanian agreement includes specific reference to the NIRA requirement to implement the Guidelines by December 2012. Some other jurisdictions have specific data quality schedules or plans, while some have moved forward on data quality work through different means.

• Thirdly, while responsibilities for COAG processes and national level agreements are generally situated within central agencies, responsibilities for health data improvements rest with health agencies, Indigenous-specific agencies or both.

• Finally, while some jurisdictional activities align directly with particular data quality improvement projects under Schedule F of the NIRA, others are less specific and are

A closer alignment of on-the-ground data quality improvement projects with the high-level commitment to Guidelines implementation may address these issues. Such strengthened alignments would assist in developing a more robust national picture of the progress of Guidelines implementation and in identifying sectors and data sets in need of additional support.

It is, however, clear that a range of activities have occurred in all jurisdictions, ranging from training of front-line staff and review of existing policies, to aligning data collection

processes with the Guidelines. Given the challenges of ensuring and maintaining Guidelines-compliant processes, there is scope for further improvements through more systematised and holistic approaches. For example, additional gains may be supported by providing periodic refresher courses (as well as introductory training), ensuring software (as well as paper forms) is Guidelines-compliant, and moving towards accreditation processes that prioritise collection of Indigenous status. Greater coordination, including information sharing, between responsible agencies across jurisdictions may enhance these

implementation processes.

Table 4.1: Summary of OBIP status and implementation, all jurisdictions

Jurisdiction OBIP signed OBIP data quality commitments Status of OBIP data quality commitments

New South Wales February 2011 Develop Schedule of Agreed Data Quality

Improvements Completed

Victoria November 2010 Establish Data Quality Improvements

Subcommittee Completed

Queensland February 2011 Establish Data Quality Improvements

Working Group by June 2011 Completed Develop Queensland Bilateral Action Plan for

Improving Data Quality by July 2011 Completed Establish a monitoring and reporting

framework to enable the OBIP Board of Management to monitor progress of data quality improvements against agreed timelines

Completed

Western Australia September 2012 Establish Data Quality Improvement Working

Group to OBIP Governance Committee Begun October 2012 Develop Western Australian Action Plan for

Improving Data Quality Begun October 2012

Establish monitoring and reporting framework to enable the OBIP Governance Committee to monitor progress of data quality improvements against agreed timelines

Begun October 2012

South Australia January 2010 OBIP Working Group in train Underway Tasmania March 2011 Develop joint Action Plan for prioritising and

improving data quality, setting out the details of data improvements, activities and timelines

Underway

Establish a Data Quality Improvement

Subcommittee Completed

Australian Capital

Territory March 2012 Implement specific measures under the Agreed Data Quality Improvements (Schedule F of NIRA); set these out in a schedule attached to the OBIP within 6 months of its being agreed

Schedule under development

Northern Territory 2010 Populate a schedule with specific activities to improve data quality in the Northern Territory as soon as possible during 2010

Schedule under development