DHB Shared Services

Membership list, meeting minutes and key messages (including an update from the most recent meeting that was held on 26 July) can be found by clicking here.

The Governance Group next meets in Wellington on Friday 29 October 2010.

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Advisory Group

The third Advisory Group meeting for 2010 was held on 17 August in Wellington. Additional DHB and clinical representatives appointed at the last Governance Group meeting joined existing members to complete the Advisory Group composition - 17 out of 19 members attended.

There was productive discussion on a range of topics – in particular:

confirming of the second phase of CVD and Diabetes indicators that will be submitted to the Governance Group for endorsement;
changing the breast screening indicator age band to align with the National Screening Unit age band;
confirming the methodology to be used to prioritise indicators and assign weightings;
reviewing processes to identify ways in which the timeliness of information provided to DHBs and PHOs can be improved;
noting the package of information to be used for PHO level public reporting; and
considering an Outcomes Based approach for funding.

Recommendations to Governance Group are being prepared and will be submitted for consideration at their 29 October meeting.

Information about the Advisory Group (including a full membership list) can be found by clicking here.

The Advisory Group next meets in Wellington on Tuesday 30 November 2010.

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Indicator Activities

Breast Screening

Data for both the Total and High Need population indicators are now included in the monthly reports which are provided to PHOs.

Monthly reports (which also includes data pertaining to the cervical screening and influenza indicators) are available on the 25^th of each month and report on the screening | vaccination activities which occurred in the previous month. All reports can be located on the Nexus website under each PHOs individual site.

All enquiries may be directed to PHOPerformance@dhbnz.org.nz

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CVD and Diabetes

Work continues regarding the development of indicators which focus on the treatment and management of patients with Diabetes or patients who have had a CVD event (or are at risk of having a CVD event). System fixes to address issues identified with the screening and coding of patients have been implemented and there has been notable improvement in performance reported for the Ischaemic CVD and Diabetes indicators across all PHOs.

The Programme acknowledges that the CVD and Diabetes prevalence estimates calculated for some PHOs are far too low which is resulting in many PHOs now achieving more than 100% achievement. The Ministry of Health is in the process of developing new prevalence estimates for the 2010/11 year and the Programme expects these estimates to be better aligned with each PHOs actual enrolled population.

New minimum payment thresholds for the Phase One CVD and Diabetes indicators will apply from the performance period 1 July 2010 (due to be reported in January 2011) as follows:

Ischaemic CVD detection – increased from 5% to 40%
CVDRA – increased from 5% to 20%
Diabetes detection – increased from 5% to 40%
Diabetes follow up after detection – increased from 5% to 20%

All enquiries may be directed to Natasha.Maraku@dhbnz.org.nz

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Immunisations for 2 Year Olds - Transition to NIR

In April 2010, the Governance Group endorsed the Programme’s request to transition to using data sourced from the National Immunisation Register (NIR) to measure PHO performance for the 2 year old immunisation indicator (instead of using PHO Service Utilisation Report data). This transition has been agreed to take place from 1 January 2011 on the proviso that an analysis be undertaken to identify reasons for some variations that have been identified between the two data sources. This analysis is almost complete and so far findings reveal that a number of PHOs fare far better using data sourced from the NIR rather than the current data source.

Although the Programme will not fully transition until findings of the analysis are presented to the Governance Group in October, details of an approach as to how those PHOs who wish to be measured against NIR data earlier are being discussed with DHBs. The Programme does not want PHOs to be disadvantaged because immunisation efforts are not being accurately reflected in the data that is currently being sent. Further information regarding the early transition will follow.

All enquiries may be directed to PHOPerformance@dhbnz.org.nz

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Influenza Vaccinations for > 65 Year Olds

Payments for PHOs that now achieve their annual target within the first six month measurement period will be brought forward and made in November rather than May of the following year. This change improves the timeframe within which payment for this indicator is made and will apply from the performance period commencing 1 January 2010. Where PHOs have not met their targets at the end of the first six month measurement period, the opportunity will still exist to meet targets at the end of the annual measurement period. Payments in these instances will be made in May of the following year as normal.

All enquiries may be directed to PHOPerformance@dhbnz.org.nz

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Smoking

Three of the four smoking indicators will be funded next year. These indicators are:

% of eligible population that have ever had a smoking status recorded;
% of current smokers who have been given brief advice in the last 12 months; and
% of current smokers who have been given or referred to cessation support services in the last 12 months.

¼ of the funding will be apportioned to the activity of recording smoking status with the remaining ¾ of funding allocated to the provision of brief advice and cessation support. Although the amount of funding that will be made available is still being discussed, the target setting methodology that will be applied to indicator i, is as follows:

PHO baseline coverage rate (x)	x < 40%	40 ≤ x < 70%	70 ≤ x < 90%
Expected annual improvement	20% point gain to maximum of 48%	10% point gain to maximum of 77%	5% point gain to maximum of 94.5%

Indicator ii (% of current smokers) will remain as information only.

All enquiries may be directed to Natasha.Maraku@dhbnz.org.nz

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Prioritisation and Weightings of Indicators

A methodology to determine the prioritisation of new indicators that are to be introduced to the Programme (alongside other indicators which already exist in the Programme), has been developed by the Programme’s Advisory Group in consultation with Health Economists form the Ministry of Health. The methodology sees each indicator group (i.e. breast cancer, cervical cancer, influenza, immunisation, cardiovascular disease, diabetes and smoking) assessed according to the following criteria:

Extent of current inequalities;
Health gain per unit cost of activities; and
Effort required to implement the indicator.

The amount of funding allocated for each indicator group depends on the result of this prioritisation process. Within each indicator group funding is then weighted towards those indicators which are focused on better clinical outcomes for patients (rather than those focused on structures or processes).

Governance Group endorsement of the methodology is being sought at their 29 October meeting.

All enquiries may be directed to Natasha.Maraku@dhbnz.org.nz

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Reporting

PHO Level Public Reporting

The first PHO level public reports were published by the Programme on 10^th September. Thanks to all PHOs that contributed positively to this release. Many lessons have been learned from this process and the public reporting of PHO-level results will be refined for future releases.

The Programme welcomes your feedback on how to improve the reports and reporting process for both PHO and DHB level public reporting.

All comments should be returned to PHOPerformance@dhbnz.org.nz before the end of September.

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Reasonableness Reporting

Now that PHO level public reporting has commenced, it is even more important that data being reported by the Programme is accurate. Please familiarise yourselves with the Reasonableness Reporting process and ensure that you verify the appropriate datasets when requested to, within the required timeframes. Failure to do so could result in the Programme inadvertently reporting incorrect performance.

Emails are sent via the PHO Performance mailbox to PHOs when the reasonableness of data is required to be verified.

All enquiries may be directed to PHOPerformance@dhbnz.org.nz

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Timeliness of Reporting

The Programme is currently reviewing its datasets and processes to identify where the frequency and timeliness of data collection can be increased to improve the timeliness of data reported back to DHBs and PHOs.

This analysis is in its early stages.

All enquiries may be direct to Shane.Kerr@dhbnz.org.nz

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Quarterly Reporting

The Programme’s next series of DHB, PHO and Ministry of Health performance reports and scorecards are due to be posted to Nexus at the end of October. These reports will report PHO performance against indicator targets to 30 June 2010. This is a performance cycle and resulting payments will be made to PHOs on 15 November 2010.

Any enquiries may be directed to PHOPerformance@dhbnz.org.nz

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Other

Contacts

Please remember to notify the Programme of any changes to staff which you have appointed as key Programme contacts. A recent ‘ring around’ of DHBs and PHOs found that a number of listed contacts were no longer employed within the expected organisations.

Remember that nominated Programme contacts are able to access all Programme information pertaining to your organisation - including performance indicator information, data sets and payment details.

If you would like to review or update your list of key contacts for the Programme, please email PHOPerformance@dhbnz.org.nz for further information.

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Nexus Trouble Shooting

Following are some commonly asked Nexus questions and answers and basic troubleshooting steps. If you are encountering more specific issues please email PHOPerformance@dhbnz.org.nz for specialised assistance.

	Issue	Solution
1.	I’m having problems logging into the Nexus website – it says that I do not have access?	You will need to adjust the security settings in your web browser and add the DHBNZ Nexus website: https://extranet.dhbnz.org.nz as a trusted site. To adjust or check your security settings, you need to: Go to Tools (on the top menu in Internet Explorer) and click on Internet Options. Go to the Security tab and make sure the https://extranet.dhbnz.org.nz is listed as a trusted site. Note: If you have a locked-down environment, you will need to contact your IT person in your organisation to set this up.
2.	My computer is running slow – how can I take to fix it?	There could be a number of reasons why your computer is running slow. Please contact your IT person before contacting the Programme to firstly check that it is not an internal issue.
3.	Once I’ve logged in, I need to re-enter my login and password details whenever I want to open a file – what can I do so that I only have to enter my verification details once?	When you log into Nexus, prior to clicking OK, tick the “Remember my password” box.
4.	How do I change my password?	To change your password, you need to: i. Click on this link http://extranet.dhbnz.org.nz/help/HowdoI/ChangePassword ii. Type in your current password. iii. Then type in your new password (noting the following password requirements): Cannot be changed more than once in a 24 hour period Cannot containall or part of your account name Must have a minimum of 7 characters formatted as follows - 1 uppercase, 4 lowercase, 2 digits a non-alphanumeric
5.	It will not let me enter my name into the login box to gain access?	This could be due to your permission levels or login details have not been activated or not setup properly. Please contact the Programme

The Nexus User Guideline can be located by clicking here.