The findings of the CareTrack study highlight what we need to target if we want to lead the world in better health delivery, write the study's authors Bill Runciman and Jeffrey Braithwaite.
OPINION: The publication this week of the landmark CareTrack study into the quality of healthcare in Australia will inevitably be interpreted by some as bad news.
As its lead authors, we'd argue otherwise. It is, in fact, a potentially powerful blueprint for change.
The study, published in the Medical Journal of Australia, found that our health care system is good, but not good enough.
In 57 per cent of encounters with healthcare providers - doctors, hospital staff and allied health professionals - Australians are receiving care in line with best practice based on the latest evidence, that is, "appropriate care".
But that leaves a large number of consultations in which our healthcare services are falling short.
As an Australian patient, you are likely to face discrepancies in the quality of care provided for different medical conditions and in the quality of care delivered by different healthcare providers.
For some conditions like coronary artery disease, you have very high likelihood of being treated according to best practice. In others such as obesity, antibiotic use and alcohol dependence, less than a third of healthcare providers are providing appropriate care. For individual healthcare providers, the appropriate care results ranged from 32 per cent of encounters to 86 per cent.
What, then, is the good news? The CareTrack study, the first of its kind in Australia and only the second in the world, tracked the treatment received by a statistically representative group of patients over two years for 22 common conditions, representing over 40 per cent of Australia's disease burden.
For the first time, nationwide research has identified where we are getting it right and, similarly, where we are falling short. That means we can now begin to recalibrate our healthcare system to achieve better results, both for patients and for administrators charged with stretching our health dollars further.
How? Firstly, it's clear that where we have run high-profile awareness campaigns around conditions such as heart failure and blood pressure, Australians are largely getting appropriate care, almost across the board. That's partly because patients, as well as health care practitioners, are well informed about their conditions, which offers us a way forward in areas of underperformance.
Secondly, by identifying areas of weakness, we are also identifying areas of significant wastage, additional costs and, sometimes, unnecessary suffering. For example, the over-prescription of antibiotics, particularly for sinus and throat infections, is a huge waste of money.
Then there are surgical site infections. The CareTrack study found that in 84 per cent of cases, antibiotics known to achieve a six-fold reduction in wound infections were administered too late. Surgical site infections currently cause much avoidable suffering and cost us $750,000 a day.
Imagine the opportunities, then, for smarter spending that our study offers. Australia, like most of the world's ageing, affluent, industrial nations, is facing steadily increasing healthcare costs currently tracking towards 10 per cent of GDP. Now also consider the tools that have just become available to help us target underperforming areas of healthcare delivery.
We are now commencing work to draw up simple standards for the basic care of common conditions, to be constantly revised and updated. Old standards will be effectively retired and replaced with up-to-date tools that can be centrally updated and downloaded electronically.
Ultimately, our health should be in our hands. Literally.
On July 1, the Personally Controlled Electronic Health Record became available to patients in Australia. This will give everyone an unprecedented opportunity to manage and track their own electronic records. The potential is clear.
E-health records, for patients who participate, will enable the easy monitoring of delivery of appropriate care against indicators of best practice. We now need to connect this new knowledge in ways that improve our health outcomes.
Patients could also carry personalised health guidance and information in mobile phone apps, for example. We are not suggesting randomly "googled" health facts, but nationally approved healthcare apps developed by experts and endorsed by the relevant national bodies and health departments.
These will enable patients to follow guidelines for their own care for chronic conditions like asthma and diabetes. They will also connect information back to their clinicians, adding important day-to-day information to their electronic health record.
The only study similar to CareTrack was in the United States some 10 years ago, and this showed an average of 55 per cent of Americans receiving recommended care. This suggests there's plenty of room for improvement in modern healthcare systems worldwide.
Australians enjoy an excellent universal healthcare system. We are already in the top five of the OECD countries for life expectancy and perceptions of well-being. We now know what we need to target if we want to lead the world in better health delivery.
Bill Runciman is Professor of Patient Safety & Healthcare Human Factors, University of South Australia. Professor Jeffrey Braithwaite is Director of the Australian Institute of Health Innovation at UNSW.
This opinion piece first appeared in The Drum