Australian Government response to Review of cardiovascular disease programs

Foundation recommendations

Page last updated: April 2011

F1.
Use the National Health and Medical Research Council (National Institute of Clinical Studies) to manage the development and review of new and existing national clinical practice guidelines for CVD.
F2.
Work strategically with the National Institute of Clinical Studies (NICS) within the NHMRC to improve uptake of nationally standardised clinical guidelines across general practice, acute and community care.
F3.
Support the work of the Australian Commission on Safety and Quality in Health Care (ACSQHC) to validate its draft operating principles and technical standards for Australian Clinical Quality registries.
F4.
Develop an implementation plan for general practice to support the implementation of Absolute Risk Assessments (ARA) to identify people at risk of heart disease, stroke, diabetes, and kidney disease and then address their risk factors through a program involving on-going management.
F5.
Hospitals to be required to undertake and report the results of biennial audits of CVD services (heart attack and stroke) in acute and post-acute care.
F6.
Investigate the benefits of including CVD risk factors in a national health survey and investigate the benefits and costs of including biomedical risk assessments such as blood and urine collection and analysis.
F7.
Include specific CVD indicators, including Absolute Risk Assessment, in datasets for national and jurisdictional performance accountability frameworks.


F1. Use the National Health and Medical Research Council (National Institute of Clinical Studies) to manage the development and review of new and existing national clinical practice guidelines for CVD.
F2. Work strategically with the National Institute of Clinical Studies (NICS) within the NHMRC to improve uptake of nationally standardised clinical guidelines across general practice, acute and community care.

Government response

The government recognises the importance of clinical guidelines in translating evidence into practice, to improve the safety and quality of health care. This has been demonstrated through the leading role of the National Health and Medical Research Council (NHMRC), direct support for the development and uptake of guidelines related to CVD, and the emphasis on national standards and performance in national health reforms.

The NHMRC sets standards for the development and review of guidelines, to ensure that they are based on the best available scientific evidence and make clear recommendations for health professionals practising in an Australian health care setting. The NHMRC approves externally developed guidelines that meet the relevant requirements. The NHMRC recommends that all guidelines be reviewed every five years. The Office of NHMRC develops some clinical practice guidelines on behalf of the Department of Health and Ageing on request.

The National Institute of Clinical Studies, as part of NHMRC, works to improve health care by getting the best available evidence from health and medical research into everyday practice.

The NHMRC established a National Clinical Practice Guidelines Portal to improve access to high quality, evidence-based clinical practice guidelines via a single entry point. This was launched in February 2010 and currently includes nine CVD related guidelines. The relevant website is www.clinicalguidelines.gov.au. This website also includes the NHMRC's Australian Guidelines in Development Register, which aims to improve guideline quality and reduce duplication of guidelines.

The Heart Foundation and NHMRC have partnered to create the Acute Coronary Syndromes Resource Exchange. This web page www.emergencycare.nhmrc.gov.au/gateway enables health professionals across Australia to share tools and resources aimed at improving the uptake of Acute Coronary Syndromes guideline recommendations.

In December 2009, the NHMRC released a stroke care information package designed to improve care for people presenting to the emergency department with acute stroke and transient ischaemic attack. The stroke care package is based on the National Stroke Foundation (NSF) Clinical Guidelines for Acute Stroke Management and aims to support greater guideline uptake in emergency departments.

The NHMRC also contributes to the evidence base for CVD clinical practice guidelines, through its funding of research. In 2009, the NHMRC invested more than $106 million into research on cardiovascular disease, up from $92 million in 2008. With a $74 million increase in funding since 2000, NHMRC funding to cardiovascular disease has increased at an annualised rate of 23% over the decade. Top of page

Since 2007, the Department of Health and Ageing has directly funded work on guidelines related to CVD, including the CVD complications of diabetes. This has included:
  • Clinical Guidelines for Stroke Management 2010 (National Stroke Foundation)
  • CVD absolute risk management guidelines (under development by the National Stroke Foundation, on behalf of the National Vascular Disease Prevention Alliance)
  • three specific guidelines on the cardiovascular complications of diabetes and diabetic foot guidelines (under development by the Baker IDI Heart and Diabetes Institute)
  • a discussion paper outlining an improved collaborative model for the development of CVD clinical guidelines (National Heart Foundation, 2010) and
  • a review of the 2003 Clinical Practice Guidelines for the Management of Overweight and Obesity (risk factors that can influence the burden of CVD) to be undertaken by the NHMRC.
The government is currently considering a proposal from National Heart Foundation seeking $2 million over five years to trial and evaluate the collaborative model for the development of CVD clinical guidelines. The government expects to consult with key stakeholders including the NHMRC, the Australian Commission for Safety and Quality in Health Care (ACSQHC) and the National Stroke Foundation in appraising this proposal.

The Australian Government has provided a range of funding support to improve the uptake of clinical guidelines associated with CVD, including the CVD complications of diabetes, through the Royal Australian College of General Practitioners, the Rural Health Education Foundation, and the Australian Primary Care Collaboratives Program, which supports general practices in improving patient care, including a major focus on coronary heart disease.

The government also acknowledges the importance of easy-to-access information sources for clinical guidelines and pathways that clinicians can use in their everyday work. The government funds the Practice Incentives Program (PIP) to improve the quality and safety of healthcare delivered by GPs, and has included a requirement for electronic decision support for GPs.

Through national health reform the government will also make a landmark $466.7 million investment over two years in the key components of an electronic health record system. This investment will allow all Australians to have access to a personally controlled electronic health record. The initial rollout of the personally controlled electronic health record focuses on providing the patient's health information at the point of care, when authorised by the patient. The clinician's existing electronic decision support tools could then provide appropriate guidance based on the patient's health information. Top of page

Improved clinical governance is also a key feature of the government's reforms, including the development and use of clinical guidelines and reconnecting clinicians as partners in planning and delivering healthcare. The reforms reflect a strong and increasing focus on quality and safety in health care and include:
  • a National Performance Authority
  • lead clinician groups to advise on clinical care and standards, and to develop and encourage the use of evidence-based clinical guidelines and national standards and
  • a permanent and expanded role for the Australian Commission for Safety and Quality in Health Care (ACSQHC).
These reforms, coupled with new funding arrangements will provide a supportive framework for implementation of evidence based guidelines and national clinical standards at the local level.

The government's health reform agenda is giving consideration to a strategic and systematic national approach to the development and updating of clinical guidelines and their uptake in practice, including the future role of the Australian Commission for Safety and Quality in Health Care (ACSQHC).

For example, under its expanded role, the ACSQHC will develop and disseminate clinical safety and quality standards and guidelines in the areas of hospitals, mental health and primary care. This will include identifying priority areas and commissioning and managing the development and quality assurance of clinical safety and quality standards and guidelines. The clinical guidelines will be developed by clinical experts and endorsed by the National Health and Medical Research Council (NHMRC). The government will consult with the ACSQHC on the opportunity to address CVD standards and indicators as part of the government's consideration of the National Heart Foundation's guidelines proposal. However, work on the expanded role of the ACSQHC may not begin until the 2012-13 financial year. Top of page

F3. Support the work of the Australian Commission on Safety and Quality in Health Care (ACSQHC) to validate its draft operating principles and technical standards for Australian Clinical Quality registries.

Government response

The government's health reforms on national standards, performance and clinical governance reflect a strong and increasing focus on quality and safety in health care.

On 20 April 2010, the Council of Australian Governments (COAG) National Health and Hospitals Agreement agreed to continue the Australian Commission for Safety and Quality in Health Care (ACSQHC) as a permanent body with an expanded role in order to develop national clinical safety and quality standards.

The National Health and Hospitals Network Bill 2010 (the bill) provides the framework for the establishment of the ACSQHC as a permanent authority with expanded functions. The bill was passed by the Australian Parliament on 21 March 2011.

The ACSQHC has tested and validated the draft Operating Principles and Technical Standards for Australian Clinical Quality Registries. The Australian Cardiac Procedures Registry and the Australian Stroke Clinical Registry were two of the six Clinical Quality Registries engaged to test and validate the Operating Principles and Technical Standards, with pilot funding of approximately $1 million and $0.5 million respectively. The pilots are now complete.

The ACSQHC has revised the draft Operating Principles and Technical Standards, based on the final reports of the pilot sites and an independent external evaluation. The revised principles and standards can be used by stakeholders to assess the feasibility and value of specific registries established to improve the quality and safety of cardiac procedures.

It is anticipated that in 2011 ACSQHC will develop a costed technical infrastructure plan for Australian Clinical Quality Registries. Top of page

F4. Develop an implementation plan for general practice to support the implementation of Absolute Risk Assessments (ARA) to identify people at risk of heart disease, stroke, diabetes, and kidney disease and then address their risk factors through a program involving on-going management.

Government response

The Australian Government acknowledges the importance of primary care in preventive health.

The government is funding the National Stroke Foundation, on behalf of the National Vascular Disease Prevention Alliance (NVDPA) to develop CVD absolute risk management guidelines, to complement the NVDPA's existing NHMRC-endorsed CVD absolute risk assessment guideline. This project is due to be completed in February 2012. These clinical guidelines will support general practitioners to help prevent "first ever" cardiovascular disease events, using an absolute risk approach. The Department of Health and Ageing is currently considering a draft version of the guidelines, which are undergoing public consultation.

Under the Slashing Medicare Red Tape initiative, the government rationalised ten existing health assessments items into four new time based items commencing May 2010. The new Medicare items include provision of appropriate preventive health care including the 45 year old health assessment and the older person's health check. The simplified health assessment items help people including those at risk of CVD to gain access to vital prevention advice and ease red tape burden on GPs allowing them to spend more time with their patients.

The government has announced that it will provide $30 million to pilot coordinated diabetes care from 1 July 2011 over the next three to four years. The Coordinated Care for Patients with Diabetes program is targeted at patients with diagnosed diabetes and is focused on managing care, thus helping to reduce the risk of patients progressing to CVD and other complications of diabetes.

Reforms are also focussing on early intervention and prevention to take pressure off other parts of the health system. The Commonwealth will tackle the lifestyle related risks that cause chronic disease — targeting smoking and binge drinking, in particular. The government has made a commitment of $872 million over six years under the COAG National Partnership Agreement on Preventive Health — the largest single commitment to health promotion by an Australian government.

The establishment of the Australian National Preventive Health Agency (ANPHA) on 1 January 2011 was a key milestone in this stream of health reform. The agency will lead the fight against preventable diseases through preventive health initiatives targeting obesity, along with alcohol, tobacco and other substance abuse, and will be the government's leading adviser on preventive health issues. Top of page

F5. Hospitals to be required to undertake and report the results of biennial audits of CVD services (heart attack and stroke) in acute and post-acute care.

Government response

The government's hospital reforms call for strong national standards and transparent reporting in the health system and improved clinical governance.

Although hospital performance information is already published by states and territories, it is only relevant to the jurisdiction to which the data relates. There are also differences between states and territories in the scope and data definitions, and in the presentation and accessibility of the information.

Transparency is a key feature of the government's reform of the health system. This will be driven through the publication of nationally consistent performance information about individual hospitals to be delivered by the planned National Performance Authority.

As an interim arrangement, the Australian Institute of Health and Welfare (AIHW) is publishing hospital-level performance information on the MyHospitals website, which was launched in December 2010.

Performance reporting in the MyHospitals website ensures a nationally consistent approach to providing information directly to consumers on the services provided by their local hospital as well as information on how the hospital performs.

The publication of higher level, consistent performance information about hospitals will support the ability of states and territories to publish selected performance information at the jurisdictional level. It is expected that as national hospital reporting evolves, first on the MyHospitals website and then in further work of the National Performance Authority, jurisdictional reporting will also evolve to present additional complementary local context and reporting.

Consumers, including those with CVD, will benefit in practical ways through hospital level reporting, as well as from the improvements in system performance that will be driven by hospital level reporting. Top of page

F6. Investigate the benefits of including CVD risk factors in a national health survey and investigate the benefits and costs of including biomedical risk assessments such as blood and urine collection and analysis.

Government response

The Australian Government has committed $51.92 million over four years for the delivery of the first Australian Health Survey in partnership with the Australian Bureau of Statistics and the National Heart Foundation. The Australian Health Survey will collect information on a number of health indicators including diet, physical activity and prevalence of chronic disease risk factors. The survey will include a biomedical component where blood and urine samples will be collected from consenting survey participants and analysed for markers of chronic disease and nutrition status. The survey will commence in 2011.

The Australian Health Survey combines the existing ABS National Health Survey and National Aboriginal and Torres Strait Islander Health Survey undertaken every three and six years respectively, with two new surveys: the National Nutrition and Physical Activity Survey and the National Health Measures Survey (NHMS).

The main chronic disease biomarkers to be measured in the NHMS relate to cardiovascular disease, type-2 diabetes and chronic kidney disease, as these conditions together contribute significantly to disease burden and mortality in Australia and share many lifestyle-related risk factors. The ability to link the data on chronic diseases collected in the NHMS to the data collected at the AHS household interview (such as dietary intake, physical activity habits, use of medications and health services) will provide valuable information to better understand chronic disease risk factors and determinants of health.

Given the useful information expected from the survey the government will contribute up to an additional $1 million to support the measurement of biomarkers for CVD and other chronic diseases. It is expected that this contribution to the survey will result in the production of invaluable data and evidence that will also inform CVD related policy considerations and implementation strategies. Top of page

F7. Include specific CVD indicators, including Absolute Risk Assessment, in datasets for national and jurisdictional performance accountability frameworks.

Government response

The Australian Government notes that the Australian Commission for Safety and Quality in Health Care (ACSQHC) National Indicators Project, undertaken by the AIHW, has identified 55 indicators to improve safety and quality, including six CVD indicators (AIHW 2009, Towards national indicators of safety and quality in health care).

The Australian Health Survey, to commence in 2011, will collect data on risk factors, including CVD related risk factors.

Such indicators will be available to be utilised by the National Performance Authority (NPA), and in the overarching Performance and Accountability Framework (PAF). Under agreed arrangements the NPA is expressly required to report on selected clinical quality and safety indicators drawn from those developed by the ACSQHC.