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Data development


There are well documented problems with the quality and availability of data about Aboriginal and Torres Strait Islander health issues. These limitations include the quality of data on all key health measures including mortality and morbidity, uncertainty about the size and composition of the Aboriginal and Torres Strait Islander population and a paucity of available data on other health-related issues such as access to health services.

The following information has been provided by the jurisdictions to provide information on action being undertaken in relation to data development.

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Australian Government

The Australian Government is committed to improving the availability of good quality Aboriginal and Torres Strait Islander health data. Through the National Advisory Group on Aboriginal and Torres Strait Islander Health Information Development (NAGATSIHID), the Australian Government is actively engaged with key stakeholders, state and territory Governments, the ABS and the AIHW to improve the availability of quality Aboriginal and Torres Strait Islander health data. Further, the Health Performance Framework has established priorities for data development linked to policy objectives.

In July 2009, COAG committed to a range of activities to improve the quality of Aboriginal and Torres Strait Islander data, including an Australian Government commitment of $46.4 million over four years to June 2013 under the NIRA (COAG, 2008). This work covers the key datasets required for NIRA Indigenous reporting, e.g. mortality, morbidity, perinatal data and population estimates. Jurisdictions have committed to undertaking the work outlined under Schedule F to the NIRA, in liaison with the AIHW and the ABS.

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Data development projects already completed

The 2016 Census of Population and Housing has continued the 2011 targeted strategy of improved identification and enumeration of the Aboriginal and Torres Strait Islander population. This included strong engagement prior to the Census event through the ABS’ established Indigenous Engagement Managers/Officers network and use of local Aboriginal and Torres Strait Islander regional champions to encourage high levels of participation. Field staff recruitment processes also targeted local people with local knowledge and strong ties to their communities.

Although the Census ‘digital first’ strategy was rolled out across Australia, Aboriginal and Torres Strait Islander people living in remote towns with large Indigenous populations and those living in discrete Indigenous communities were generally counted through a personal interview process. Various support arrangements were also provided to populations living in other places to ensure everyone had the opportunity to be counted.

The Post Enumeration Survey (PES) provides a national process to assess the efficacy and coverage of the Census count. In 2016, the PES sample was increased by 20% in general population areas. This is expected to deliver an improvement to net under or over count statistics for both the general population and the Aboriginal and Torres Strait Islander population. The PES sample also included dwellings from remote communities in NSW, Qld, SA, WA and NT, similar to the numbers collected in the 2011 PES.

The PES will consolidate the 2011 methodological innovation including: continuing use of Automated Data Linkage; and effective collection of Indigenous status of all persons living in the responding dwelling.

The ABS currently has a 6-yearly cycle for the Indigenous Social Surveys and Health Surveys. The timing of these surveys is scheduled in order to provide 3-yearly estimates for key statistics collected in both surveys. The ABS has released findings from the 2014–15 NATSISS. Analytical commentary, an Infographic highlighting summary results, EXCEL data tables of key results, and a range of explanatory materials are available on the ABS website free of charge. Microdata has also been released through a Confidentialised Unit Record File and a Survey TableBuilder product. Information about these products are also available on the ABS website.

The AIHW released the National best practice guidelines for collecting Indigenous status in health data sets in April 2010. The AIHW’s National Indigenous Data Improvement Support Centre (NIDISC) was established to support jurisdictions and service providers to implement the guidelines.

The AIHW has also published reports on the assessment of the quality of Indigenous identification in labour force data collections, community services data collections, the National Cancer Registry, the National Diabetes Register, the national Key Performance Indicator data collection and in hospital separations data.

The AIHW’s 2013 report The inclusion of Indigenous status on pathology request forms outlines work towards the inclusion of Indigenous status on pathology request forms as a way to improve Indigenous identification in national cancer, communicable disease and cervical screening registries.

The ABS and AIHW in partnership with jurisdictions developed national best practice guidelines for linking data relating to Indigenous people. The guidelines for linking Indigenous data covered linkage methods and protocols, privacy protocols, quality standards, and procedures. The National Best Practice Guidelines for Data Linkage Activities Relating to Aboriginal and Torres Strait Islander People (AIHW & ABS, 2012) were released on 9 July 2012. Two attachments to the Guidelines were released on 14 June 2013. The attachments review the current and recent body of data linkage activities relating to Aboriginal and Torres Strait Islander people, along with a thematic listing of these activities. In describing and comparing data linkage practices to date, these documents provide an evidence base for the national data linkage guidelines.

Updated posters and brochures encouraging Aboriginal and Torres Strait Islander identification in response to the Standard Indigenous question are available from the ABS. Requests can be made using the following email ( Separate materials have been developed for service providers, as well as for the Aboriginal and Torres Strait Islander population.

ABS remains committed to a program of strong engagement with Aboriginal and Torres Strait Islander communities and representative bodies which directly impacts the quality of data outputs. The ABS Indigenous Community Engagement Strategy (ICES) is the main vehicle for delivering this program. Within ICES, the Indigenous Engagement Managers (IEMs) and Officers (IEOs) play a central role in:

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Ongoing data development projects

ABS and AIHW work in partnership with jurisdictions to lead analysis of the level of Indigenous identification in key datasets, including a baseline report and ongoing five-yearly studies to monitor identification over time. States and territories have agreed to adopt the standard Indigenous status question and recording categories on data collection and information systems for key data sets. States and territories have agreed to improve Aboriginal and Torres Strait Islander data collection procedures in key data collections including implementation of the Best Practice Guidelines.

States and territories have agreed to develop and implement a programme to raise the Aboriginal and Torres Strait Islander community’s awareness about the importance of identifying as Indigenous.

The ABS works with the Registries of Births, Deaths and Marriages (RBDMs) through the National Civil Registration and Statistics Improvement Committee (NCR SIC). The aim of this committee is to improve harmonisation of data collection across jurisdictions, improve coordination between agencies and connect more strongly with other stakeholders. Information on vital events from the RBDMs is an important input to Australia’s demographic statistics.

The NCR SIC has engaged with government (Department of Human Services and Digital Transformation Office) around opportunities to enhance capture of birth registrations through inter-agency cooperation and potentially through data sharing.  Strengthening cross-sectoral coordination between government agencies (including information sharing) would enhance registration coverage, and population counts for Aboriginal and Torres Strait Islander people as well as reduce the overall administrative burden on new parents.

The ABS will again link 2016 Census records with death registrations to improve the level of Aboriginal and Torres Strait Islander identification in death records. Past linkage projects have underpinned more accurate estimates of Aboriginal and Torres Strait Islander life expectancy.

Funding has been secured for the next National Aboriginal and Torres Strait Islander Health Survey which will collect data through the 2018–19 financial year on the health outcomes of Aboriginal and Torres Strait Islander peoples. First results are scheduled to be released in December 2019.

Under Schedule F of the National Indigenous Reform Agreement (NIRA), jurisdictions undertook to implement the National best practice guidelines for collecting Indigenous status in health data sets (the Guidelines) across the health sector by December 2012.

The AIHW conducted an extensive investigation of the implementation of the Guidelines and published its findings in the Towards Better Indigenous health data report in 2013. The report documented implementation activities across jurisdictions and sectors, collected status information about the sectors and datasets in scope, and identified barriers and facilitators to implementation.

As part of this investigation, the AIHW identified the general practice sector as a high priority for efforts to improve the recording of Indigenous status, because it has a unique role in providing access to health measures specific to Aboriginal and Torres Strait Islander people, as well as in providing input to data collections. The AIHW conducted national stakeholder workshops on the identification of Indigenous status in general practice in 2011 and 2012, and published its consolidated findings in the Taking the next steps: identification of Aboriginal and Torres Strait Islander status in general practice report in 2013.

The AIHW has advanced the recommendations of the Taking the next steps report through its development of the online Indigenous health check (MBS 715) data tool. This innovative tool draws together 715 MBS billing data and Indigenous population data to show numbers of health checks and usage rates (the proportion of Indigenous people who have had a health check). These are presented at national, jurisdiction, Primary Health Network, peer group and Medicare Local levels, and the tool displays make it easy to compare numbers and rates across different areas and over time.

The AIHW provides continuing support for better Indigenous identification through NIDISC. The NIDISC helpdesk provides advice and assistance to health providers on issues relating to the collection and recording of Indigenous status. NIDISC also supports better Indigenous data collection by providing resources and training materials.

As part of the NIRA, the Council of Australian Governments (COAG) agreed that the Australian Department of Health in partnership with the state and territory health departments and in collaboration with the AIHW, would develop a set of national key performance indicators (KPIs) for Indigenous specific primary health care services. The AIHW receives funding from the Department of Health to collect, manage and report on the nKPIs.

The scope of services providing nKPI data has increased over time. In the trial collection in February 2012, only services participating in the Australian Government’s Healthy for Life programme submitted data (about 80 services). In January 2013, the scope expanded to include all Indigenous primary health services funded by the Australian Government. Data from over 200 organisations are now collected every six months.

The nKPIs are designed to enable monitoring of the contribution of Indigenous primary health care services in achieving Closing the Gap targets. They can also be used to help improve the delivery of primary health care for Aboriginal and Torres Strait Islander people and to improve health outcomes. The nKPIs focus on the processes of care provided by health services and clinical outcomes.

Twenty-four indicators were given in-principle endorsement by AHMAC in early 2011. Implementation and collection of these indicators has been staged over a three-year period, with 11 indicators implemented in 2011–12 and further eight in 2012–13. By December 2015, data were collected against 22 indicators with the remaining 2 indicators are planned for implementation in 2017.

The AIHW in collaboration with the Australian Institute of Family Studies delivered the Closing the Gap Clearinghouse. The Clearinghouse is an online collection of research and evaluation evidence on what works to overcome Indigenous disadvantage, focusing on 7 subject areas: early childhood; schooling; health; economic participation; healthy homes; safe communities; and governance and leadership. It supported policy-makers and service providers involved in overcoming Indigenous disadvantage by providing access to and synthesising the evidence on particular topics.  The contract for the Clearinghouse ended in June 2014. All resources and publications currently on the website continue to be publicly available, however no new material is being added.

The AIHW’s Enhanced Mortality Database (EMD) project aimed to improve information on Indigenous status on the registered deaths data set by linking it to several additional data sources that contain information on deaths and Indigenous identification—namely admitted hospital records, perinatal records and residential aged care data. The enhanced data enable more accurate estimates of Aboriginal and Torres Strait Islander mortality and life expectancy, to be made.

A final report on the results of the project, Trends in Indigenous mortality and life expectancy: evidence from the Enhanced Mortality Database, 2001–2013, was published by the AIHW in December 2016. A permanent and ongoing AIHW data collection, the Enhanced Indigenous Mortality Data Collection, is now being established based on the EMD project methodology to extend and continue this work.

The AIHW Linked Perinatal, Births, Deaths Dataset Project aims to create a national, ongoing, linked perinatal, birth and death dataset for the purposes of obtaining more accurate estimates of Indigenous infant and child mortality and analysing the factors affecting infant and child health outcomes in Australia. Infant and child mortality rates are important markers of population health.

At the national level, aggregate data demonstrate that there are significant differences in infant and child mortality rates within Australia by factors such as Indigenous status, socio-demographics and maternal health status, but these factors are not able to be analysed simultaneously as they are dispersed across a range of different data sources.

An initial dataset is being created by linking unit record level data across jurisdictions from perinatal data collections, birth records, and death records covering all births from 2003 to 2010, and deaths within this birth cohort occurring up to age 5 years. National linkage including all relevant births and all deaths occurring up to mid-2016 was completed in late 2016 and the resulting data are now being analysed. The first report from the project, which uses unlinked perinatal data to examine factors associated with poor birth outcomes, will be published by the AIHW in early 2017.

The National Prisoner Health Data Collection was first conducted in 2009, based on a set of indicators aligned to the National Health Performance Framework, and designed to monitor the health of prisoners. Subsequent data collections were held in 2010, 2012 and 2015. The collection provides information on the health of people entering prison (prison entrants), health conditions managed at prison clinics, medications administered at the clinics, the health of people about to be released from prison (prison dischargees), and operations of the clinics. Major reports relating to each data collection have been released by the AIHW, supplemented by smaller bulletins focused on important topics such as mental health. All of these reports include analysis of the health of Aboriginal and Torres Strait Islander prisoners.

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AIHW is working with the states and territories in the development of an enhanced Perinatal National Minimum Data Set:

The Implementation Plan for the National Aboriginal and Torres Strait Islander Health Plan commits to the development and implementation of a data development plan to establish new measures. The data development is to occur during the lifetime of the Implementation Plan, with the new measures to be monitored in future Implementation Plans.
The AIHW has provided the Australian Government Department of Health with advice regarding potential data development, and what work may be required to establish new measures for monitoring and goal setting for the Implementation Plan.

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The Australian Capital Territory

ACT Health continues to work to strengthen Aboriginal and Torres Strait Islander health data quality. Activities include:
A policy and data standard mandating that staff ask patients if they wish to identify as Aboriginal and/or Torres Strait Islander, based on the AIHW’s ‘one simple question could help you close the gap’ campaign were updated in 2015.

The ACT Patient Administration System has the Aboriginal and Torres Strait Islander identification question as a mandatory field. All pathology forms and all out patient collection stations within the hospital collect the information. A process to capture complaint statistics from Aboriginal and/or Torres Strait Islander patients of the Canberra Hospital has been developed.

The Patient Master Index (PMI) supports the use of a single unique patient identifier across all ACT Health service areas. This helps to ensure patient records can be linked across services to provide continuity of care.  Aboriginal and Torres Strait Islander identification data is collected and stored within the PMI, and historical information is retained for management and reporting purposes.

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New South Wales

Under the NIRA, NSW has committed to data quality improvement activities that will improve the accuracy and reliability of Closing the Gap reporting.

A summary of key activities includes:

NSW Health has adopted the standard ABS Indigenous status question and recording categories, and has issued this revision to the NSW Health system to mandate that the standard question is incorporated into all data collection forms and information systems for key data sets.

NSW Health has employed a Project Officer Aboriginal Data Quality to the Health Systems Information & Performance Reporting Branch. The position supports the development of policies, protocols and strategies to enhance the quality of health data pertaining to the Aboriginal population of NSW. The position is responsible for routine data profiling of data collections to identify data quality issues. It is also responsible for supporting the State-wide implementation of data quality processes and programmes and will support the development of data collection standards.

Respecting the Difference: An Aboriginal Cultural Training Framework for NSW Health outlines a mandatory cultural training framework for all staff working in health, and includes information on collecting Indigenous status information.

NSW Health has completed a project titled Improved Reporting of Aboriginal and Torres Strait Islander people on population datasets using record linkage. The project:

  1. developed methods for improving reporting of Aboriginal and Torres Strait Islander peoples on population datasets using record linkage
  2. described the improvements in reporting achieved by record linkage; and
  3. explored the impact of any changes in reporting due to record linkage on a selection of indicators of health status and health service utilisation.

The method is being used to monitor the level of reporting of Aboriginal people on selected administrative datasets. Information on the quality of reporting of Aboriginal people is available on the Health Stats NSW website for public and private hospital morbidity data, the Emergency Department Data Collection and the Perinatal Data Collection.

Local Health Districts (LHDs) are implementing initiatives to raise awareness about the importance of identifying as an Aboriginal person. The programmes are designed and implemented locally. An example includes:

The Mid-North Coast LHD has implemented the MTEC ‘Closing the Gap’—Innovation in Emergency Departments project that aims to create a better patient journey for Aboriginal people using the hospital and to reduce the number of ‘Did Not Wait’ patients. It is focused on the Emergency Department (ED) environment, training of staff on identification, getting clinicians involved in cultural awareness programmes, and addressing barriers that prevent people from waiting. Various strategies are included e.g. amusements for children, information on why identification is important, resources, posters including a triage poster, DVD, and cultural awareness information. The District has also established a new ‘ALERT’ system, where the Aboriginal Liaison Officer receives a message that an Aboriginal patient is in ED. The programme has shown a reduction of ‘Did Not Wait’ patients in ED by about 50%.

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The Northern Territory

The Northern Territory (NT) Department of Health (DoH) has rolled out a number of eHealth initiatives that will have major implications for the use and collection of data. These improvements assist in the provision of seamless care for health consumers. Brief outlines for these initiatives are as follows:

NT My eHealth Record service transition to national My Health Record

The NT My eHealth Record service has been operating since 1st July, 2005 and ensured access to important health information was available with consent 24 hours daily and is still operating today. As of 30 June 2016 over 71,000 consumers have been registered, including an estimated 85 percent of Aboriginal and Torres Strait Islander peoples living in rural and remote communities in the NT.

Currently 132 health centres participate and contribute to the NT My eHealth Record including correctional facilities and public hospitals in the NT, Aboriginal Community Controlled Health Organisations (ACCHOs) in South Australia and public hospitals in the Kimberley region of WA. As of June 2016, Kimberley hospitals only send data to the national My Health Record.

NT My eHealth Record statistics for June 2016—1,448 authorised clinical users accessed, over 81,000 documents viewed and 121,773 events sent, as part of providing ongoing health care.

The NT My eHealth Record has been transitioning to the national My Health Record (previously known as the Personally Controlled eHealth Record PCEHR) for the last few years, with all NT Health health care facilities and majority of NT Aboriginal Medical Services registered to participate in the national My Health Record. Documents that can be sent from NT health care facilities include Shared Health Summaries, Event Summaries, ED Discharge and Inpatient Discharge Summaries, Diagnostic Imaging Reports (first jurisdiction in Australia) and Specialist Letters. Projects are underway to send public hospital pathology reports and the ability to view prescription and dispense information.

The national My Health Record statistics for June 2016—536 clinical users accessed, 536 documents viewed and 21,250 events sent, as part of providing ongoing health-care. As of 30 June 2016, 37,535 individuals registered for a national My Health Record and 188 sites registered for My Health Record in the NT, with 48 sites recording activity.

Due to the current status of private pathology negotiations at the national level, the NT will continue to utilise the My eHealth Record service (which currently receives NT private pathology reports) for the benefit of consumers and clinical users until such time that private pathology can be sent to the national My Health Record. Once available the NT will consider transitioning to national My Health Record system.

Both eHealth records have proven to be of major benefit for mobile populations, and people from rural and remote areas accessing services in regional towns or cities. This is achieved by ensuring up-to-date information is easily accessible at the point of care, regardless of whether that is at a remote health centre operated by DoH or an ACCHO, or at a public hospital in a regional or major urban centre. Urban GP’s, allied health professionals and pharmacies have also commenced participating in the national My Health Record.

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Secure Electronic Messaging Service

Secure Electronic Messaging Service (SEMS) ensures that specific information regarding clinical referrals can be communicated electronically securely between service providers. This assists in a seamless care in relation to managing transition from GPs/health centres to appointments with specialists or hospital outpatient clinics. Electronic medications and discharge summary information is forwarded by hospitals to communities of residence, so that information is available locally for consumers on their return to country.

In early 2016, a project was successfully completed to improve outpatient referral and appointment management at Alice Springs Hospital with the aim of all referrals being undertaken electronically using SEMS. In April 2013, DoH commenced using the National Health Services Directory (NHSD) as its electronic address book for secure messaging. The NHSD directories provide information for a range of health services including allied health, hospital and community services to support health professionals to coordinate ongoing care for patients with chronic and complex conditions. Currently, DoH is in the process of updating the NHSD with outpatient clinic information collected from the five DoH public hospitals starting with Gove District Hospital and is soon to be followed by Tennant Creek Hospital.

Primary Care Information System

In 2013–14, Primary Care Information System (PCIS) was implemented into the DoH Alcohol Mandatory Treatment Facilities in Central Australia followed by those in the Top End to follow early in 2014–15. In 2013–14, PCIS was also implemented in Renal Services with the Chronic Disease Nurses in the Top End and Central Australia being the first users in December 2013, followed by the Peritoneal Dialysis unit in April 2014 and Hemodialysis units in Tiwi and Palmerston throughout 2015, Nightcliff in January, and Katherine May, of 2016.

Healthy School Age Kids Care Plan

In partnership with Primary Care Information System (PCIS), Central Australian Health Services have developed a new care plan for school age children in remote communities, Healthy School Age Kids (HSAK) Care Plan. It provides the recalls in the PCIS electronic health record for annual preventative health checks for school kids aged five to 14 years. The plan has progressed from an idea in early December 2015 to roll out in July 2016 with trials by all NTG clinics in Central Australia and Barkly by the end of 2016. There are 1,800 children throughout Central Australia and Barkly to be commenced on the HSAK Care Plan in July in one of the fastest roll outs of a new Care Plan.

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NT Cardiac

The NT Integrated Cardiac Network is one component of the Australian Government’s Health and Hospitals Fund Program, which has the aim of improving access to essential services for as many people as possible living in rural, regional and remote areas, and to help close the gap in health outcomes between city and country populations. DoH has been working with NT Cardiac on the Integrated Cardiac Network Project (ICN). The ICN project seeks to provide an easily accessible, high quality, patient focused, specialist cardiac service in the NT through the purchase, installation and integration of specialised cardiac equipment across NT Health and AMSANT member health networks.

The broad DoH project objectives are:

The Pen Computer Systems Clinical Audit Tool (Pen CAT) has been integrated with PCIS data in the DoH data warehouse. The Pen CAT is used to analyse and report on clinical information from primary health care systems. It translates data into statistical and graphical information that is easy to understand and action. This allows practitioners to assess and improve both the quality and completeness of patient information. This benefits a primary health care practice by assisting with ongoing accreditation and providing opportunities to grow practice income. The emphasis of the tool is to enable practice staff to take specific action to improve patient coverage in chronic disease management and prevention.

Other benefits of the Pen CAT include:

Statistics required for the Australian Primary Care Collaboratives (APCC) Programme and the Commonwealth Department of Health Future Directions Key Performance Indicators for Divisions are able to be easily identified and collated by the Pen CAT.

The PCIS Team works closely with clinical reference groups and programme areas to continually develop new and update existing care plans to reflect best practice standards and Central Australian Rural Practitioners Association (CARPA) protocols. PCIS facilitates extensive coded clinical data collection for each service episode with the capacity to capture all required national Aboriginal and Torres Strait Islander health performance indicator data. These data sets are used to improve the delivery of primary health care services by supporting continuous quality improvement (CQI) activity among service providers. These data sets also support policy and planning at the national and state/territory level by monitoring progress and highlighting areas for improvement.

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Aboriginal Health Key Performance Indicator (AHKPI) project

Initiated by the Northern Territory Aboriginal Health Forum (NTAHF), the aim of the AHKPI project is to develop a structure for collection and reporting of 21 agreed Key Performance Indicators (KPIs) that cover both Department of Health (DoH) Remote Health Centres and ACCHOs. The project is managed co-operatively by DoH, the Commonwealth Department of Health and Aboriginal Medical Services Alliance Northern Territory (AMSANT) under the auspices of the NTAHF banner and maintains the NT Aboriginal Health KPI collection covering the government and non-government sectors to improve the quality and robustness of data for use in service planning and management through continuous quality improvement.

The goal of the system is to contribute to improving primary health care services for Aboriginal Australians in the NT by building capacity at the service level and the system level to collect, analyse and interpret data that will:

Processes for data collection from the various organisations information systems have been defined and developed, and data delivery from all NT community health centres commenced on 1 July 2009. Reports are produced bi-annually, six weeks after end-of-financial and calendar years. The AHKPI definitions go through continuous cycles of quality improvement with approved changes to the existing NT AHKPI definitions, or new KPIs completed twice a year.

East Arnhem Health Services Delivery Area (EAHSDA) Communicare Project

Between August 2011 and January 2012 the Commonwealth and NT Department of Health jointly funded the implementation of Communicare (now known as HealthConnex) into the four EAHSDA centres of Yirrkala, Ramingining, Milingimbi and Gapuwiyak. Yirrkala health centre transitioned to Miwatj Aboriginal Health 1 July 2012 and remains on the DoH Central East Arnhem Database in support of a central East Arnhem database and the spirit of regionalisation. On 30 June 2016 Miwatj Health assumed operational and administrative responsibility for Milingimbi Health Centre now known as Malmaldharra Health Centre. In the interest of continuity and improvement in health care provision to the patients of the clinic, NT Health has agreed to provide Miwatj Health with a copy of the electronic patient records from the NT Systems which pertain to patients of the clinic.

TeleHealth NT

TeleHealth NT is a comprehensive telehealth network with over 62 telehealth enabled health centres in major cities and towns, regional areas and remote locations. The model of care for TeleHealth NT is enabling equitable access to integrated telehealth services to be delivered across the Northern Territory.

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Burden of Disease and Injury in Aboriginal and Torres Strait Islander People in Queensland

The Queensland Government has a bipartisan commitment to closing the gap in health status and life expectancy between Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians and much work has been undertaken on this path.

In recent years in Queensland, significant effort has been directed to quantify and understand the characteristics of the health gap between Aboriginal and Torres Strait Islander peoples and other Australians. Measuring improvement in health outcomes against established benchmarks and better targeting health services and interventions have been the primary objectives of this work.

The first complete national assessment of the burden of disease in the Aboriginal and Torres Strait Islander population was released in 2007 (reference year 2003) (Vos et al. 2007). Equivalent results have been generated for Queensland by combining burden of disease analysis for whole-of-Queensland (Qld Health et al. 2008a; Qld Health 2008b) with the results of the national Indigenous study (Vos et al. 2007) to provide 2003 and 2006 broad estimates for Aboriginal and Torres Strait Islander Queenslanders (Qld Health et al. 2008a; Qld Health et al. 2008b).

The 2008 Queensland Government commitment to close the gap in health status and life expectancy between Aboriginal and Torres Strait Islander peoples and non-Indigenous Queenslanders (Queensland Government, 2008), along with the recent development of experimental life tables for Indigenous Queenslanders by remoteness for 2005–07 (unpublished), provided the impetus to refresh the burden of disease and injury estimates for Queensland’s Aboriginal and Torres Strait Islander peoples.

In 2012, Queensland Health undertook a refresh of burden of disease and injury results specifically for Queensland’s Aboriginal and Torres Strait Islander people (reference year 2007). This study is the first comprehensive description of the burden of disease in Queensland’s Aboriginal and Torres Strait Islander population. The results aid prioritisation of health programmes, services and policies by highlighting areas with the largest health loss and those with the largest potential for health gain.

Queensland is currently finalizing a 2011 update of the 2003 and 2012 study. This update includes revised mortality inputs utilizing updated cause and sex specific mortality inputs and life tables at a remoteness level for Queensland. This study also includes revised risk factor modelling utilizing output from the 2012–13 National Aboriginal and Torres Strait Islander Health Survey. Estimates for the 2007 study have been backcast based on new inputs for the 2011 study to create to comparative time points. Additionally, the 2011 study has estimates available at sub-jurisdictional level (Queensland Hospital and Health Service region). There is also scope to derive estimates from any geography which can be aggregated from SA2. The 2011 small area Indigenous Burden of Disease estimates for Queensland are due for release in early 2017.

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Quantifying the cost of excess hospitalisations for Indigenous Queenslanders

Aboriginal and Torres Strait Islander people in Queensland have higher morbidity and mortality rates compared with the non-Indigenous population. Higher rates of morbidity and mortality are present and have been since an Indigenous identifier has been included in Queensland morbidity and mortality data collections in the mid-1990s.

Significant work from researchers working outside Queensland Health, and from public and population health staff from within Queensland Health, has gone into quantifying the health gap for Aboriginal and Torres Strait Islander peoples in Queensland using morbidity and mortality data sets. This has included publicly accessible research that clearly documents morbidity and mortality differentials for Aboriginal and Torres Strait Islander peoples across a wide variety of conditions including chronic disease, namely cardiovascular disease, chronic respiratory disease, Type 2 diabetes, mental illness, accident and injury and child and maternal health.

However, less work has been undertaken around quantifying the financial impact of the burden of disease for Aboriginal and Torres Strait Islander peoples. Queensland Health is currently undertaking a project to estimate the cost of excess hospital separations for Aboriginal and Torres Strait Islander people in Queensland (who are hospitalised at almost twice the rate of non-Indigenous Australians).

Due to differences in casemix cost weights, the key drivers of the health gap (mental disorders, cardiovascular disease, diabetes mellitus, chronic respiratory disease and cancer) may not necessarily equal the key drivers of excess hospital cost, hence the need to understand cost implications of excess hospitalisations.

The key aim of this work is to support the focused purchasing of activity which addresses both the health gap and the key drivers of excess cost to ensure that Department of Health in Queensland is in a position where it could significantly reduce health disadvantage for Aboriginal and Torres Strait Islander people.

The analysis will also contribute to meeting the two key COAG targets of closing the gap in life expectancy by 2033 and halving the gap in child mortality by 2018, as well as reducing the financial impact of the health gap on the system.

Small area estimates at a Hospital and Health Service region were released in October 2016 and will be available for downloading from the Queensland Health website in late 2016.

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Indigenous health performance management

Queensland Hospital and Health Service Performance Management

The Queensland Department of Health has for the last four years managed the performance of its Hospital and Health Services (HHS) through service level agreements which contain a suite of health performance indicators across a number of domains, including two Aboriginal and Torres Strait Islander health indicators—Discharge Against Medical Advice (DAMA) and Potentially Preventable Hospitalisations (PPH).

From 2016–17 onwards all key performance indicators across all domains in HHS service agreements (where data are of sufficient quality) will be disaggregated by Indigenous status. This will provide the Queensland Government with a significant opportunity to fine tune efforts to close the gap in Indigenous health outcomes.

Strategic policy performance monitoring:

The Queensland Government has developed a number of strategy/policy documents targeting specific disease priority areas over the last two years:

Each of these strategies has significant performance reporting components across a number of tiers. An essential component of all Queensland Government strategy and policy documents which aim to address Indigenous health differentials is the need for robust evaluation of the impact of policies and investment through appropriate performance frameworks.

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Aboriginal and Torres Strait Islander Better Cardiac Care Collaborative Data Linkage Project Queensland

There are disproportionately higher rates of cardiac disease risk factors, more complex health needs, higher hospitalisation rates and poorer health outcomes for Aboriginal and Torres Strait Islander people compared with other Australians. Despite a greater burden of cardiac disease, Aboriginal and Torres Strait Islander people have lower usage rates of primary and secondary preventive and acute cardiac care services. As a result, cardiovascular disease is the leading cause of fatal burden, contributing 22% to Aboriginal and Torres Strait Islander mortality in Queensland.

By linking Queensland and Commonwealth health administrative datasets, this project aims to:

It is proposed that these investigations will also include comparison of service delivery and health outcomes based on patient:


The purpose of the project is to: identify gaps within the continuum of care across the primary, secondary and acute health sectors for Aboriginal and Torres Strait Islander people with IHD (ICD-10-AM code: I20-I25), stroke (ICD code: I63), CHF (ICD Code: I50), ARF/RHD (ICD code: I00-I02, I05-I09); and describe the epidemiology of ARF/RHD within Queensland over an extended period. This information will be used for health service planning and establishment of targets for future evaluation and monitoring purposes.


Over the period 2010–11 to 2015–16:

Over the period 2000 to 2016:

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South Australia

Improving Aboriginal and Torres Strait Islander Identification

The ABS was funded through SA Health’s Council of Australian Governments investment to develop a training package for recording the Indigenous identifier in health data collections; as well as training staff who manage data and/or perform data entry about the importance of collecting the Indigenous identifier information; the correct way of asking the standard question and recording the response; and strategies for dealing with special circumstances, such as determining the Indigenous status of children and patients who are unconscious. The training targeted frontline staff working across hospital sites in metropolitan Adelaide and regional communities, as well as various mainstream primary care services throughout SA. This training approach was informed by the AIHW’s Best Practice Guidelines for Collecting Indigenous Status. The first state-wide training programme concluded in late 2011. Over 430 frontline staff attended training sessions held in 40 locations spread through the state.

SA Health has also indicated that it supports feeding this initiative into the AIHW and ABS National Data Linkage Project on Indigenous identification. SA Health continues to operate a case mix payment system, which applies a 30% loading to hospital separations of Aboriginal and Torres Strait Islander peoples, and this provides an incentive for improved Indigenous identification.

SA Pathology (trading as IMVS Pathology) provides a comprehensive diagnostic pathology service delivered via a network of 18 state-wide laboratories and more than 71 patient collection centres. It is the sole provider of pathology in the public hospital sector and a major provider to the private GP and specialist market. The SA Department for Health and Ageing and SA Pathology have recently completed the first part of the project to address ‘Aboriginal Identification Requirements in Pathology Systems’.

The initial emphasis of the project has been to ensure the Indigenous Identifier is included on pathology forms. This involved extensive consultation with SA Pathology providers and other jurisdictional providers. This enabled information sharing and identifying lessons learnt from other jurisdictions implementing similar projects, and resulted in the Indigenous Identifier being introduced into pathology forms as well as metropolitan-based hospital systems. While pathology forms have been addressed, a greater emphasis is now on linking the Indigenous identification data to an IT solution, as this is a significant gap requiring attention. The procurement of SA Pathology’s new Laboratory Information System, which aims to be implemented from early 2016, is a key IT solution that will integrate the Indigenous Identifier information, and enable the appropriate use of captured data.

Further project work is being undertaken to review the downstream impacts on affected registries, which include input and advice from ACCHOs, GP Clinics, Medicare Locals and Well Women’s Screening programmes. SA Health is determining how best to ensure systems provide consistent and continuous transfer of Aboriginal identification data across SA Health. Additional systems training will be required to support staff to collect information.

In 2007, SA participated in the National Audit of Indigenous Identification in Public Hospitals project, coordinated by the AIHW. Surveys were conducted in metropolitan and regional hospitals across SA, and the results contributed to reports from other jurisdictions to calculate adjustment factors to be applied to hospital separations data for Expenditure on Health reporting. A follow-up audit was conducted in 2011. The audit independently verified the Indigenous status of a sample of patients in selected metropolitan and country hospitals through face-to-face interviews. The results were matched against data held in hospital systems, to assess the quality of identification by hospital staff. More than 1,250 patient interviews were conducted during the audit. An estimated 91% of Indigenous patients were correctly identified, an increase of 4 percentage points compared with the 2007 audit. SA’s completeness rate of 91% was the third highest nationally, behind the NT and WA. SA was only one of four state/territories to report an improvement in the identification of Indigenous people between the two audits.

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Aboriginal and Torres Strait Islander Life Expectancy Measures

The SA Strategic Plan tracks improvements in key outcomes over time. Life expectancy for Aboriginal South Australians continues to be one of these key outcomes. SA Health produces a life expectancy estimate for SA, in the absence of the AIHW and ABS producing an estimate.

Data sets

Having identified the need for improvements in the way that the health sector describes and measures primary health care activities, SA has established an Out-of-Hospital Services Minimum Data Set, which includes the National Data Dictionary definition of ‘Indigenous status’, represents the agreed core elements that are collected for describing out-of-hospital care services in SA. A central repository of out-of-hospital services data has been operational for several years covering: community health, community mental health, public dental services, drug and alcohol services, child and family services, district nursing services and palliative care. One use is the measurement of the use of the above services by Aboriginal and Torres Strait Islander peoples.

SA has recently established a patient level collection on outpatient department services. The collection includes the Indigenous Status data item as per the national standard.

Cancer Data and Aboriginal Disparities (CanDAD)

The University of South Australia; South Australian Health and Medical Research Institute (SAHMRI); Aboriginal Health Council of South Australia; Cancer Council SA; Beat Cancer Project; SA NT DataLink; and SA Health are partnering in research that addresses the related issues of CanDAD. Governance for this important initiative is led by Professor Alex Brown, a prominent Aboriginal health researcher, Professor David Roder, an eminent cancer epidemiologist, and an Aboriginal Community Reference Group who are resolved that the data be used for health and health-system improvement.

CanDAD has two components, the first of which is the Advanced Cancer Data System Pilot (ACaDS). ACaDS seeks to develop an integrated, comprehensive cancer monitoring system with a particular focus on Aboriginal people in SA. This brings together cancer registry, hospital, radiotherapy, clinical and screening data to comprehensively monitor cancer trends, cancer management and survival. In collaboration with AIHW the integration of PBS data from the Commonwealth is also being sought.

Uniquely, CanDAD is also striving to incorporate Aboriginal patients' experiences with cancer and cancer services to guide continuous service improvement, community engagement, advocacy and outcomes research, providing data infrastructure for health services, population research, and for training Aboriginal (and non-Aboriginal) researchers.

The purposeful relating of accurate registry and administrative data alongside narratives of Aboriginal people with cancer will facilitate assessment of existing service quality and appropriateness, secular trends in cancer risk, burden and determinants will highlight areas of immediate need and provide a robust system for performance monitoring and evaluation. Even at an early stage in its course, CanDAD is providing Aboriginal specific input to the developing Statewide Cancer Control Plan 2016–2020.

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The Aboriginal Health Landscape: Identifying and monitoring Aboriginal health disparities in South Australia

The Aboriginal Health Landscape is a population health initiative funded by the Wardliparingga Aboriginal Research Unit of SAHMRI. The aim of Landscape is to provide and report on health-related risk factor prevalence, health outcomes and social determinants of health of Aboriginal people compared with non-Aboriginal people at small area levels of geography that combined comprise the state of SA. Recent reports on health outcomes and the social determinants of health for Aboriginal people in SA, present only state or regional level information. Information related to more localised areas may be more meaningful and useful to local needs.

Broad questions:

This piece of work will provide an up-to-date baseline health profile so we can collaboratively target and monitor our efforts in service provision, research, and policy settings. The information would be available to assist Aboriginal communities, government and non-government service providers with:

It will also assist communities and organisations with determining research priorities.

An Advisory Group will govern the Landscape project. It will comprise of Aboriginal people in SA who can provide advice and guidance on what and how health information is reported and interpreted from a health service, local community or local government perspective. A Technical Panel will be formed to provide advice and guidance on technical aspects of data analysis and reporting for the Landscape project. Both will be convened prior to 2015 and data custodian representation will be sought from SA Health.

Twenty individual Landscapes have been defined based on where Aboriginal and non-Aboriginal people in SA live. Each Landscape has between 1,000–2,000 Aboriginal residents, as identified in the 2011 census. Several custodians in SA Health have provided data and negotiations are continuing and will commence with additional custodians.

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Data sharing

The Aboriginal Health Council of South Australia (AHCSA) Inc. has been funded since 2010 for two data sharing initiatives under SA Health’s COAG investment: the Enhancement of Information and Management in the Aboriginal Community Controlled Health Sector in SA; and the Audit and Best Practice for Chronic Disease (ABCD) project (funded since 2011). AHCSA is the peak body for Aboriginal health in SA representing Aboriginal Community Controlled Health and Substance Misuse Organisations and Aboriginal Health Advisory Committees at a state and national level.

The Enhancement of Information and Management in the Aboriginal Community Controlled Health Sector in SA was initially used to develop a set of standard Patient Information Management System procedures and templates across ACCHOs to achieve standardised and consistency of data. This project included the investigation and implementation of methods for cross-sectoral data sharing between the ACCH Sector.

This programme continued to receive further funding in 2013–14 and 2014–16 and specifically targets patient information systems at the local health service level to lead to better patient outcomes. The programme will continue to provide health information support to the AHCSA Public Health and Primary Health Care programmes with implementation of processes relating to PIMS across the ACCH Sector to enable continuous quality improvement and programme evaluation. AHCSA will continue to advise ACCHOs on how to best optimise their PIMS supportive of clinical governance, including AGPAL Accreditation, reporting obligations, accessing Medicare revenue, quality improvement initiatives and aspects of health service management.

Some of the Key Performance Indicators include:

The ABCD project was initially funded from 2011–13 then 2013–14 and funding ceased from SA Health although the National Research Partnership has continued.

ABCD NRP background

Over the past two decades there has been growing use of continuous quality improvement (CQI) initiatives within Australian Aboriginal and Torres Strait Islander primary health care with the aim of improving the quality of care and improving health outcomes.

Fifteen SA primary health care services participated in the ABCD National Research Partnership (2010–14), and supported to implement a CQI initiative and to participate in a regionally relevant research project that supports the process of embedding CQI in every day practice. Since its inception (2011), the SA project was set up to conduct research around local CQI implementation activities. A regional research project emerged from these initial activities with the participating primary health care services that aimed to understand the barriers and enablers to CQI to identify strategies to strengthen its effectiveness in the South Australian setting.

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Recording Indigenous status information is mandatory in core Tasmanian hospital administration systems, including for admitted, emergency department, non-admitted and maternity patients. The National best practice guidelines for collecting Indigenous status in health data sets is the primary resource used in Tasmania to support data recording, collection and reporting practices.

Caution must be exercised in comparing Tasmanian Indigenous identification with that of other jurisdictions due to variations in data quality, particularly hospitalisations data. The Tasmanian Perinatal Data Collection now contains good quality data on Indigenous identification, with the proportion of mothers to be identified as Indigenous matching the proportion of women identifying as Indigenous in population estimates in the community. Tasmania’s main challenge in monitoring improvements in Indigenous health continues to focus on data quality issues for hospitalisation records, and work on improving Indigenous identification in hospital datasets is ongoing. Indigenous identification in Tasmanian private hospitals remains very low.

The tripartite Framework Agreement Tasmanian Aboriginal Health and Wellbeing 2016–2020 was finalised in early 2017 pending endorsement from all parties, the Tasmanian and Australian Governments and the Tasmanian Aboriginal Centre. The Framework Agreement will provide a platform for all partners to work together on shared priorities to improve the health and wellbeing of Tasmanian Aboriginal people.

A Tasmanian Aboriginal Health Forum, consisting of the parties to the Framework Agreement, has been established. The Forum is a key mechanism to deliver on the aims of the Framework Agreement and to foster collaborative planning, information sharing and partnership approaches to improve Aboriginal health outcomes.

Annual work plans will be developed under the Framework Agreement, which will set priorities for collaboration to be progressed by the Forum. Members of the Forum have agreed that one of the key priorities for collaboration is to improve health data for Tasmanian Aboriginal people. Tasmania is working toward the ability to measure and improve employment opportunities and outcomes for Aboriginal and Torres Strait Islander people. In the Department of Health and Human Services, a data improvement program has re-established opportunities for new employees to identify as being of Aboriginal and/or Torres Strait Islander origin through the job application process in Page-Up. Further opportunities for existing employees to make such an identification will become available when the self-service module of the human resource information system, Empower, is implemented in the near future.

The Department of Health and Human Services (DHHS) has two full-time equivalent Priority Populations Officers who work as part of the Health Improvement team. The Priority Population Officers work to support those groups in the community more likely to suffer poorer health outcomes when compared with other groups, with a particular focus on Aboriginal health and multicultural health. Workforce development is one key focus area of the roles, and includes providing access to cultural competency training. In 2014, an E-learning Aboriginal & Torres Strait Islander Cultural Competency training module was launched for all DHHS and Tasmanian Health Service employees. This resource is designed to help develop cultural competency of the department and staff and support cultural safety for Aboriginal clients accessing health and human services. The module includes a section dedicated to the collection of Indigenous status information.

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Data collection

In Victoria, Aboriginal and Torres Strait Islander status is a mandatory field in all major health datasets. The Victorian Admitted Episodes Dataset (VAED), the Victorian Emergency Minimum Dataset (VEMD), and the Victorian Perinatal Data Collection (VPDC) contain good-quality data on Indigenous identification. Aboriginal identification is also collected through the Alcohol and Drug Information System (ADIS), infectious diseases (PHESS), aged care (Commonwealth Home Support and ACAS) and community health direct care databases.

The Aboriginal population of Victoria forms a small proportion of a large, mainly urban population. Correct identification of Aboriginal people in Victoria is challenging in all datasets.

Measures to improve data

Improving Care for Aboriginal and Torres Strait Islander Patients (ICAP) programme includes 30% case-mix co-payment to hospitals for acute, sub-acute and mental health patients identified as Aboriginal. The programme encourages an outcomes focus leading to improved identification and health care.

Victorian hospital datasets include two additional fields in the standard Indigenous status question: ‘Question unable to be asked' and 'Patient refused to answer’. The addition of these fields has enabled the Department of Health to identify instances of misuse of either field very quickly. This has contributed to the improving rate of Aboriginal identification.

Changes in access to data systems have also meant that more frequent monitoring of Aboriginal hospital separations is possible, and errors can be discovered and rectified.

In January 2009, the VPDC allowed the recording of the Indigenous status of babies as separate from the mother. This has enabled the large proportion of Aboriginal babies born in Victoria who have an Aboriginal father and non-Aboriginal mother to be recorded as Aboriginal. The quality of the data recorded in this dataset has been improving each year. In 2014 the Aboriginal Newborn Identification Project targeted particular maternity hospitals to improve identification of Aboriginal mothers and babies.

The Cancer Underscreened Recruitment Program aims to increase the participation and recording of Aboriginal people in cervical, breast and bowel screen programs. The Department of Health and Human Services and PapScreen Victoria have developed a system for recording and reporting the Aboriginal status of women participating in pap screens. A pilot study has been completed and was successful in training nurses to collect Aboriginal status. The system will be extended to GP providers. The identification of Aboriginal status in all cancer screening systems is being investigated.

Work to encourage GPs to record Aboriginal status has continued. This has been assisted by the use of the Aboriginal health check, Medicare item 715, which requires identification as Aboriginal.

Victoria participated in the audit of hospital inpatient data coordinated by AIHW in 2011. The same methodology has since been used subsequently to audit 2 individual hospitals and assist them to develop strategies for improvement. A large scale audit is planned for 2016.

New measures for monitoring Victorian health services’ cultural responsiveness and cultural safety for Aboriginal people have been developed through the Koolin Balit Evaluation (2015–16) and are being implemented from 2016, both by individual hospitals and state-wide by government.

Research is being conducted to develop methods for measuring and monitoring two critical areas identified through the Koolin Bali Evaluation as critical for Aboriginal health improvement: Aboriginal people’s experience of care (work is investigating expanding upon the long-running Victorian Healthcare Experience Survey); and Aboriginal people and communities’ connection to place and culture as a critical social determinant of health.

The Victorian Aboriginal Community Controlled Health Organisation has reached formal agreement with all of its member organisations to contribute to a central data warehouse which will be used to monitor client outcomes and inform service development within ACCHOs, amongst other applications.

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Data improvement across multiple government departments

The Victorian Aboriginal Child Mortality Study, based at the University of Melbourne, has brought together birth and death information from the VPDC and the RBDM to ascertain the number of Aboriginal babies born between 1988 and 2008, and the number and causes of death for Aboriginal children who died during this period. The linked datasets have also provided an assessment of the coverage of the individual datasets. The final Report was released in December 2015. There is scope for the same methodology to be used as part of a continuing process of improving identification of Aboriginal child deaths.

The Victorian Auditor-General’s Office reviewed the access of Aboriginal people to mainstream services in Victoria and recommended improvements in data and reporting, which will be implemented by the relevant departments.

The Department of Health and Human Services and the Commission for Aboriginal Children and Young People conducted a project examining the needs of Aboriginal children in out-of-home care, which will include a review of the datasets relevant to these children and their ability to identify Aboriginal children in out-of-home care. All health datasets are included.

The Victorian Aboriginal Affairs Report provides an update on progress against specific targets and measures within the Victorian Aboriginal Affairs Framework 2013–18. Health-related targets include perinatal mortality, low birthweight, smoking in pregnancy, self-reported health status, psychological distress, obesity, current tobacco use, intentional self-harm, and alcohol consumption.

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Western Australia

“Data, evidence and research” are identified as one of the six priority areas in the WA Aboriginal Health and Wellbeing Framework 2015–2030. Under this priority area, a number of strategic activities were identified. These include: improving data and evidence about what works in Aboriginal health; involving Aboriginal people and communities in the research agenda; and implementing strategies to address the under-identification of Aboriginal people.

In WA, Aboriginal and Torres Strait Islander status is collected in a range of health data collections, including the Admitted Patient Data Collection, the Emergency Department Data Collection, the Non-admitted Data Collection (which includes data on outpatient care), the Notifiable Disease Data Collection, the WA Health and Well Being Surveillance System, the Midwives Data Collection, the Breast Screening Data Collection, the Mental Health Data Collection and the Cancer Registry. It is also stored on ABS Mortality data held by the Department of Health. The data item that identifies Aboriginal and Torres Strait Islander people is a mandatory part of the data provision specification.

The Western Australian Department of Health (WA Health) collects data on Indigenous status in accordance with the ABS Indigenous status question, under the National best practice guidelines for collection Indigenous status in health datasets. The basis for the question is the national standards set out in the National Health Data Dictionary, Metadata Online Registry (METeOR) and the WA Health Hospital Morbidity Data System Reference Manual.

The WA Health Hospital Morbidity Data System Reference Manual, which sets out the rules for collection of inpatient data, states the following:

To improve and maintain the quality of information entering into the hospital morbidity data collection system, each WA Health Service Provider will have a Patient Administration System administrator, and a liaison office whose role is to train staff on how to interpret data elements for entry to the system. This includes training staff on how to properly ask the Indigenous status question.

The current redevelopment of the Mental Health Data Collection also offers opportunities to enable better identification of Aboriginal people in the Patient administration system that underpins this Collection.

WA Health has adopted two items in its Midwives Data Collection i.e. smoking during pregnancy and antenatal care. These two data items will be available for reporting by Aboriginality in 2016. Furthermore, a chapter on Aboriginal mothers and babies has now been included as a regular part of WA Health Mothers and Babies Annual Report.

WA Health and the Australian Bureau of Statistics, together with the Telethon Kids Institute conducted a cross agency data linkage and analysis project “Getting Our Story Right” (GOSR) to explore and develop different methods for deriving Indigenous status from multiple data sources. Using the resources of the WA Data Linkage System, the project examined the impact of these methods on a sample of health and educational outcomes among the Indigenous population.

The study compared various methods of calculating Indigenous status across multiple data sources and made recommendations about the best use of existing information resources as it pertains to measuring the gap in Indigenous disadvantage. Linked data was drawn from collections held by WA Health, WA Department of Education, the Registry of Births, Deaths and Marriages and the Telethon Kids Institute. Representatives from these organisations were consulted and gave their support. The study also received endorsement from the WA Health Human Research Ethics Committee and the Western Australian Aboriginal Health Ethics Committee.

Based on the work of the GOSR project, the WA Health Data Linkage Branch has created an Indigenous Status Flag. A validated algorithm was used to create this flag for each individual with one or multiple data records held in one or multiple WA government administrative datasets. Data recipients must note that their project could receive data for an individual where data sets provided report an Indigenous Status of NO but the Indigenous Status Flag is YES. The Indigenous Status Flag indicates what status is indicative of a person from all available collections or records and therefore may be different to what is reported in a specific record or collection.

WA Health has used the GOSR Indigenous status flag in the epidemiological and statistical analysis and reporting. Such a flag is also made available to researchers who have applied to have access to WA Data Linkage System.

From 2017–18, WA Health has agreed to the inclusion of Discharge Against Medical Advice (DAMA) as a new performance indicator into its mainstream reporting cycle. The DAMA indicator measures the proportion of Aboriginal patients who leave hospital without being formally discharged by a physician. The proportion for Aboriginal patients is much higher than for the non-Aboriginal patients. Surveillance of this indicator will also enable monitoring of the related data quality.

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