Statewide Rural and Remote Clinical Network Assoc Prof Alan Bruce Chater Chair Second Atlas of healthcare variation Cellulitis COPD “UTI” – incl Glomerulonephritis Diabetes Heart failure AMI complication s ABORIGINAL AND TORRES STRAIT ISLANDER SIEFA FACILITIES Hospital and Health Services rural and remote facilities The Torres and Cape HHS Community Clinics* Inner Cluster Thursday Island Horn Island (Ngurupai) Near Western Cluster Badu Island Kubin(Moa Island) St Pauls (Moa Island) Mabuiag Island Central Cluster Yam Island (Iama) Yorke Island (Masig) Coconut Island (Poruma) Warraber Island (Sue) Eastern Cluster Darnley Island (Erub) Murray Island (Mer) Stephen Island (Ugar) Top Western Cluster Boigu Island Saibai Island Dauan Island Northern Peninsula Cluster Bamaga Injinoo New Mapoon Seisia Umagico * Community clinics that operate on weekdays may not operate five days per week Map does not include regional and metropolitan hospitals and health facilities Current as at 26 April 2017 HOUSE PRICES QH DATA • QH Data – Where treated – Can link to other data – Can isolate to treating facility Cf • Atlas – Where from Analytics Team, Patient Safety and Quality Improvement Service, Department of Health, Queensland ISSUES • Disadvantage – Socioeconomic – Sanitation and disease – Life style – Smoking – Obesity – Scurvy (barcoo – Geographical access – Medicare access – Indigenous – Skin conditions – scabies, tinea, strep – Secondary conditions » PSGN – renal » Rheumatic fever – cardiac • Quality – Distance – Danger of discharge – Diagnosis – Time e.g. overnight stay vs technology e.g. CT – Double counting – Transfers • Clinical variation DISTANCE TO SERVICE INDIGENOUS SMOKING AND DISTANCE BMI? DIET OR EXERCISE? SOCIO-ECONOMIC INDEXES FOR AREAS (SEIFA) MEDICARE SPEND OVERCOMES SEIFA? “UTI” AMI Counted (appropriately) at the country hospital e.g. lysis and stabilisation and city hospital e.g. stent QUINOLONES (FIRST ATLAS) DILEMMA • Causality • Context – service, distance, diagnostic • Continuity – across and within services • Conscience – patient centred care • Connection – local or where lives • Clinical context • Counting – double • Clinical variation • Consultation with rural • Clinician feedback • Clinical change • Comparison with peers .