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Alcohol and Other Drugs

Outcome

Young people experience less alcohol and drug related harm and receive appropriate support

Measure

Alcohol-Related Emergency Department (ED) Presentations for 10-24 year olds

Type

National indicator for alcohol and other drugs domain

Relationship(s) to other frameworks

  • Mandatory Question Guidelines – Alcohol Question
  • Pilot study on alcohol-related ED presentations – the mandatory question was asked and recorded in 6 DHBs
  • Alcohol in our lives – Law Commission Report

Rationale

Idenfitying and monitoring alcohol-related ED presentations enables DHBs to better understand the contribution of excessive alcohol consumption to emergency department presentations for young people. It is a starting point to encourage DHBs to move toward more extensive screening, brief intervention and referrals (including to primary care) . It also supports appropriate public health responses.

The Mandatory question is “Is alcohol associated with this event?” Possible answers are: Yes, No, Unknown and Secondary (eg. passenger in car driven by drunk driver, or victim of violence where alcohol is involved).

A Capital and Coast DHB (CCDHB) study showed that 40% of all alcohol-related ED presentations are under 20 years (for CCDHB) and that the majority of harm come from the purchase of alcohol through off-licenses. Underlying mood disorder is very common with young people presenting with alcohol-related admission. There are also linkages with self-harm and violence to others.

Eligible population

Total ED presentations for young people aged 10 to 24 years by DHB of service

Measure status

In development

Measure definition

Numerator

Number of alcohol-related Emergency Department presentations (identified as yes or unknown) for young people aged 10 to 24 serviced in DHB hospitals.

Denominator

Number of Emergency Department presentations for young people aged 10 to 24 serviced in DHB hospitals.

National target

-

Local target

Improvement milestones to be decided by District Alliances

Data Sources

  • National Non-Admitted Patient Collection (NNPAC) – ED presentations, including alcohol-related ED presentations are a mandatory question for all DHBs from 1 July 2017. Measure has been piloted in 6 DHBs in 2016/17.
  • Estimated NZ resident population with Statistics NZ projections (consistent with the Population based funding formula)
  • World Health Organisation population
  • Primary Health Organisation Enrolment Collection

Data extracted from data sources

  • Quarterly extracts for ED presentations in financial year from the National Non-Admitted Patient Collection (NNPAC)
  • Quarterly extracts from the Primary Health Organisation Enrolment Collection

Data availability

The Ministry of Health will release NHI level data to both DHBs and PHOs for their relevant population on a quarterly basis.

  • Data includes NHI, DHB rates and trends over time by age group, gender, ethnicity and deprivation.
  • Data for DHBs is for the latest 12 months where data is available in the NNPAC and made available publicly every quarter.
  • When the data is broken down into some sub-groups, the numbers can be small and should be treated with caution.

Measure calculation process

The total number of ED presentations including the ones with an alcohol association flag as ‘yes’ and ‘unknown’ will be extracted and used to calculate the rates.

Relationship(s) to other measures

It is a part of the Youth System Level Measure. Also links to self-harm hospitalisations indicator

Measure development notes

  • Some DHBs are just utilising the ‘unknown’ field. Some DHBs are using the ‘unknown’ field extensively (over 50% of attendances).– Reasons given include: ED overwhelm, ethical issues (e.g. no intervention to follow up). Potential to start counting unknowns as Yes, whilst encouraging DHBs to code appropriately.
  • Currently, no outcomes data can be accessed associated with this question. Measure gives quantitative data only.
  • Training on implementing the mandatory question was provided to the 6 pilot DHBs. There is currently no planned training to DHBs for the roll out.
  • CCDHB has found that many young people presenting to ED and recorded as positive for alcohol association were not enrolled in primary care. They thought they were still assigned to the family GP, whereas enrolment had actually lapsed. This has made referrals for intervention difficult.


Measure testing/piloting: This measure has been assigned a status of In Development for a period of 12 months during which time, the sector will ‘test/use’ the measure as it is currently defined and provide feedback to the SLM Team. Modifications to the measure definition may be made, prior to its status being updated to Active from 1 July 2018.
Only 6 pilot DHBs will currently have data for this measure. Each DHB of service (i.e. hospital provider) will capture and provide services to multiple DHBs of domicile (i.e. where the patients reside). The current measure is therefore set to present the results in DHB of service view until data is completed for all DHBs. Once sufficient data is provided by all DHB (intention by 1 July 2018), this measure will be reviewed and finalised.
Implementation timeline: Measure is scheduled to move from a status of ‘in development’ to ‘active’ on 1 July 2018.
Reporting frequency: The Ministry will be responsible for gathering data and releasing information to DHBs and PHOs on a quarterly basis.
Measure implementation group: TBC



Template: System Level Measure Template