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Demonstrating Performance: A Primer for Expenditure Reviews (June 2008)

Appendix 1: What Could a Credible ‘Performance Story’ Look Like?

Appendices 1 and 2 present complementary perspectives on what could and should be reported to demonstrate the performance. Neither perspective is prescriptive. What it is sensible to report about major interventions, and what can be measured, will vary. But the absence of performance information will raise questions about why leaders place high reliance on the major intervention as part of their strategy and intervention mix.

  Health Strategy
(Treatment Focus)
Regulation / Taxation / Inspection Rehabilitative
Education
Needs
Being Met
Targets reduced death and debility from larger cause of ill health; we know who is most at risk (because?) Targets selected persons or agents least prone to voluntary compliance; incident rates known Targets individuals with > $10,000 future cost if left untreated; clear rehab goal
Efficient
and Cost Effective
Delivered at same or lower real cost vs. prior years; no output or mix of outputs was available with higher VfM. Emerging technology will soon allow us to … Real compliance costs kept low; real enforcement costs kept low; total costs << net regulatory/tax gain; volume being adjusted in response to incidence rates, etc Delivered at same or lower real cost vs. prior years; high cost-effectiveness modelled (assumptions supported by impact measures); no more cost-effective output known
Quantity
and
Quality
Q and Q were maintained; high patient satisfaction; low 90 day mortality rate vs. prior years/other DHB Investigations as contract; similar or lower complaint rates vs. prior years; high risk persons aware of higher risk of detection Delivery met specification 95% of time; 80% of starters complete programme; core messages retained by 80% completers after 30 days
Coverage 90% of treatments went to people most at risk and/or experiencing most debility; waiting times for crucial treatment(s) same or lower Detection rate of unwanted events falling; this may be due to (a) poor targeting or (b) improved deterrence.  Impact measures suggest (b) not cause; reviewing (a) 95% spaces on course filled with people meeting or exceeding entry criteria, and likely to respond to rehab; targeting model validated (or being improved by …)
Impact Using evidence-based ‘best’ practices endorsed by NZGG. Indicators show reduced incidence in target groups; high risk-adjusted survival rates for patients Incident rate in high risk target group is unchanged, but would deteriorate without attention (testing by reducing volume in area X).  (Alternate approach being piloted in Y to test impact) Z% fewer bad outcomes vs. comparison groups; most CBRs as predicted; some rehab programmes under-performing - will modify / adjust programme mix

CBR: Cost Benefit Ratio. Q and Q: Quantity and Quality. DHB: District Health Boards. NZGG: New Zealand Guideline Group

Intensive Rehab Programmes Are Effective (Must Adjust Mix)
Intensive Rehab Programmes Are Effective (Must Adjust Mix).

 

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