EXPLANATORY STATEMENT
Issued by the authority of the Minister for Health and Ageing
HEALTH INSURANCE ACT 1973
DECLARATION OF QUALITY ASSURANCE ACTIVITY
UNDER SECTION 124X
QAA No. 2/2011
Part VC of the Health Insurance Act 1973 (the Act) creates a scheme to encourage efficient quality assurance activities. Those activities help to ensure the quality of health services that are funded by the Government, through Medicare benefits, the Pharmaceutical Benefits Scheme, Public Hospitals and/or Health Program Grants. The scheme encourages participation in such activities by protecting certain information from disclosure, and also by providing some protection from civil liability to certain persons engaged in those activities in good faith, in respect of those activities.
In order for Part VC to apply to an activity, the Minister must make a Declaration pursuant to Section 124X of the Act, that the activity described in the Declaration is a quality assurance activity to which Part VC applies. Regulations 23C to 23G of the Health Insurance Regulations 1975 (the Regulations) set out the public interest criteria that must be met by quality assurance activities in order to be declared under the section 124X.
This Declaration has effect from the day after registration on the Federal Register of Legislative Instruments. Section 124X(4) of the Act prescribes that, unless sooner revoked, this determination ceases to be in force at the end of 5 years after the instrument of declaration was signed.
The purpose of the Declaration is to declare nine quality assurance activities qualified privilege activities under section 124X of the Health Insurance Act 1973.
An overview of the activities for which the Declaration is made is contained in the Attachment.
Before the Minister can make a declaration, certain requirements must be met.
Firstly, the Minister must be satisfied that the persons engaged in the activity are authorised to do so as described in paragraph 124X(3)(a) of the Act.
All the activities contained in the Attachment (Items 1 to 9) meet the requirement as the persons engaged in them are authorised either by associations of health professionals or research institutions.
Secondly, paragraph 124X(3)(b) of the Act provides that the Minister must be satisfied that it is in the public interest to have Part VC of the Act apply to the activity. In doing so, the Minister must have regard to criteria prescribed by the Regulations. The criteria relevant to the activities are in regulations 23C, 23D and 23E or 23F and 23G. All the activities meet the relevant criteria prescribed by the Regulations.
CONSULTATION
Consultations regarding the applications for declaration were undertaken in March 2011. This included obtaining advice on the potential value of declaring the activities as quality assurance activities for the purposes of the Act, the methodology used to conduct the activities, and whether the application met the criteria required for declaration, in particular those criteria relating to whether it is in the public interest to declare the activities.
Those consulted included members of the Qualified Privilege Advisory Group, which includes an external clinician; a legal expert; a quality manager working in the field of health care quality assurance; and a consumer representative.
The declaration of the activities will not result in any direct or substantial indirect effect on business.
The Declaration is a legislative instrument for the purposes of the Legislative Instruments Act 2003.
ATTACHMENT
Details of the Declaration of Quality Assurance Activity under section 124X of the Health Insurance Act 1973 – QAA 2/2011
1 Name of Declaration
This section provides that the name of this instrument is the Declaration of Quality Assurance Activity under section 124X of the Health Insurance Act 1973 – QAA 2/2011.
2 Commencement
This section provides for the Declaration to commence the day after registration on the Federal Register of Legislative Instruments. Section 124X of the Act prescribes that, unless soon revoked, this declaration ceases to be in force at the end of five years after the instrument of declaration was signed.
Item [1] Oesophago-Gastric Cancer and Gastrointestinal Stromal Tumour Audit
Oesophago-Gastric Cancer and Gastrointestinal Stromal Tumour Audit is being conducted on behalf of the Australian and New Zealand Gastric and Oesophageal Surgeons Association (ANZGOSA) by the Royal Australasian College of Surgeons. The Audit will collect and store clinical and pathological data for patients undergoing surgery for oesophago-gastric cancer or gastrointestinal tumour. Data submitted by practicing members of ANZGOSA to a secure online database will be used both as a self assessment toll for individual surgeons and as a resource for ANZGOSA to establish benchmarks and clinical guidelines for surgical care in this area.
The objectives will be achieved in three ways:
- surgeon self-assessment;
- using the data and published evidence to establish benchmarks and guidelines for best practice; and
- publishing peer-reviewed research papers on the treatment of upper gastrointestinal cancer.
Once guidelines are developed for treatment, the Audit may also be used to monitor the uptake of these guidelines through the addition of key quality indicators to the assessment arm of the Audit.
Item [2] Australasian Vascular Audit
Australasian Vascular Audit is carried by Australian and New Zealand Society of Vascular Surgery (ANZSVS). The Audit aims to capture all private and public vascular surgery procedures performed in Australia and New Zealand including both open and endovascular procedures. All data will be captured at the time of operation and again after discharge. The data will be published in a peer-reviewed journal to outline the steps in establishing this audit, as well as the results. The outcome of the audit process as well as any lessons will be included.
Item [3] Rural Procedural Audit
The Rural Procedural Audit will be conducted by the Royal Australasian College of Surgeons (RACS). The audit will support rural procedural specialists to collect audit data which will be added to the data base established during the previous project, the Rural Craft Group Audit project. The data base has been used to develop standards for five key surgical procedures against which rural specialists can benchmark their practice: cholecystectomy, colorectal cancer, inguinal hernia, breast cancer and thyroid. Specialists from approximately fifteen rural hospitals as well as individual specialists from rural and remote areas across Australia will be invited to submit data during this project. Participating specialists will receive an individualised report comparing their procedural outcomes against the established benchmarks.
Item [4] Tech Watch – Evaluating of Safety of Clinical Software in General Practice
This Tech Watch – Evaluating the safety and clinical software in general practice will be conducted by the Australian Institute of Health Innovation, University of New South Wales. This activity will undertake a nation-wide examination of patient safety incidents involving the use of clinical software in general practice in Australia. The examination
of the safety of using clinical software will be done by measuring the types of patient safety incidents associated with the use of clinical software and the mechanisms behind computer-related problems in general practice. Respondents will be asked a series of questions about patient safety incidents e.g. the type of task being performed; response to clinical software; outcome of the clinical situation). Demographic information about the General Practitioners such as sex, age, country of medical training, practice location and type of prescribing package will be gathered at the end of the interview. Patient safety incident data will be analysed to provide evidence about the causes, consequences and outcomes of patient safety incidents associated with the use of clinical software in clinical practice. Reports will be prepared for publication.
Item [5] Australian and New Zealand Paediatric Intensive Care (ANZPIC) Registry
The activity will be conducted by the Australian and New Zealand Intensive Care Society (ANZICS) Centre of Outcome and Evaluation (CORE) and the ANZICS Paediatric Study Group. In this activity data on individual episodes of care for paediatric patients within Paediatric Intensive Care Units (ICUs) and General ICUs are submitted to the ANZPIC Registry on a six-monthly basis. Individual site reports are produced which detail mortality, standardised mortality ratios, length of stay in the ICU as well as demographic and diagnostic information. The main objective of the activity is to provide participating intensive care units with quality of care reports describing efficacy and efficiency of care in their unit compared to similar units in the region. Reports to sites include individual and comparative data. An annual report will also be produced.
Item [6] Australian and New Zealand Intensive Care Adult Patient Database
This activity will be conducted by the Australian and New Zealand Intensive Care (ANZICS) Centre for Outcome and Resource Evaluation (CORE). In this activity data on individual episodes of care within Adult ICUs are submitted to the Adult Patients Database (APD) on a quarterly basis. The data will be analysed and will undergo a number of quality checking procedures. Reports are produced which detail mortality, standardised mortality ratios, severity of illness scores and length of stay in the ICU and in hospital. These are subsequently sent back to individual ICUs and jurisdictional liaison committees and are made available via the internet through a secure portal. In addition an annual report, specific regional reports and ad hoc reports in response to specific queries will be produced. The main objective of the activity is to provide feedback to government bodies and intensive care units about demographics and outcomes of patients admitted to ICUs in Australia, which in turn allows comparative performance between individual ICUs to be assessed.
Item [7] “My CPD” Program of the Royal Australasian College of Physicians (RACP)
The activity is an online program designed as a quality assurance activity to assist the competence and performance of health professionals by allowing participants to plan, record and reflect on their professional development needs as part their pursuit towards lifelong professional learning. Fellows of the RACP participating in the activity are expected to reflect on their activities. Reflection enables participants to gain insight into the educational value of an activity and critically think about current practices to identify areas for future learning. This may involve recording personal feelings, perceived mistakes made (by themselves and others) or success achieved, lessons learned and suggestions to improve future outcomes in the health care environment.
Item [8] Professional Qualities Reflection (PQR) of the Royal Australasian College of Physicians (RACP)
The activity is designed specifically for the RACP trainees. The purpose of the activity is for trainees to record the development of ideas and insights that may impact on their medical professionalism through the process of reflection. It allows trainees to revisit an experience and extract learning principles through the process of guided critical reflection (review, evaluation and discussion). Learning outcomes of the reflective process are used to enhance future practice.
Item [9] Quality and Accreditation Program of the Royal Australian and New Zealand College of Radiologists (RANZCR)
The activity provides a framework for the development and implementation standards of practice for medical imaging services. These standards are implemented through a series of quality assurance processes, some of which involving imaging practices’ submission of data to RANZCR for expert peer review. Participating radiologists obtain professional expert feedback and advice to support their continuous quality improvement processes in medical imaging. The part of the activity where practices seek accreditation from NATA Medical Imaging Accreditation against RANZCR Standards, according to each practice’s scope of services is run independently by NATA, and is not subject of this application for qualified privilege.