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New Brunswick Health System Report Card: Access Challenges Remains despite Increase in Number of Providers

January 16, 2012
Moncton, NB (NBHC) – The New Brunswick Health Council (NBHC) is releasing its second Health System Report Card, an important tool that measures the quality of health services being delivered in the province.   This tool provides an overall appreciation of how New Brunswick fares among other provincial jurisdictions.
The Report Card produces letter grades, much like a school report card would, according to the six dimensions of quality the NBHC must report on: Accessibility, Appropriateness, Effectiveness, Efficiency, Equity and Safety. An overall grade was calculated for each dimension from a combination of relevant indicators. Most of the indicators are based on high-cost or high-volume program and service areas and reflect the four sectors of care: Primary Health, Acute Care, Supportive/Specialty (commonly known as “Continuing Care”), and Palliative or End of life Care.
 “The number of indicators in this year’s report card has more than doubled, going from 48 to 111,” says NBHC CEO Stéphane Robichaud. “We have been able to cover more areas, due in part to the results of our Primary Health Care survey and to increased collaboration with system stakeholders, and we now have a more balanced picture.” 
This year’s report card displays grade improvements in some areas and lower grades in others. However, the current overall performance grade is a “C” and shows no change from last year.
Accessibility shows an improved grade, mainly due to an increase in the number of regular medical doctors and to reduced wait times for access to specialists and diagnostic tests.  On the other hand, having access to mental health services or getting an appointment with a doctor within 24 to 48 hours remains problematic. It is also important to note that when it comes to access to care, there are no noticeable differences when it comes to income, language of service or whether one lives in a rural or urban area.
Appropriateness measures how well New Brunswick is performing in providing the necessary screening or preventative care. This year’s grade of D is lower than the previous C, indicating that we could do better when it comes to relevant or evidence-based tests, like Pap tests, blood sugar testing, cholesterol measurements and body weight measurements, which can all have a significant impact on New Brunswickers’ health outcomes.
Effectiveness and Efficiency measure the achievement of the best possible results or outcomes, and the best use of the resources.  There was no change in either grade this time around; there are significant indicators at the system level for these dimensions that highlight areas for quality improvement, like preventable hospitalizations (or Ambulatory Care Sensitive Conditions), and acute care beds being used by people that have completed the acute care phase of their treatment (Alternate Level of Care days). 
The Report Card also includes the Safety dimension, with a grade of B. Last year’s grade of A only reflected on one indicator, as opposed to 14 this year, which better reflects the overall dimension. The Safety dimension looks at readmission rates, which could be decreased by improving communication with patients, for example, by better explaining the instructions and effects related to medications prior to patients being discharged and with better follow-up.
Finally, if we look at the Equity dimension, there are issues that need to be addressed regarding Accessibility for Aboriginal persons. “There are discrepancies between Aboriginal and non-Aboriginal persons when we look at access to a family doctor and access to Primary Health Care in general, which translate to inequities in care,” says Robichaud. 
The report also includes the following observations:


·         At the patient or citizen level,there needs to be a focus on overall “patient first” philosophy for any health services delivery and actively engaging the citizens of New Brunswick in being well.
·         At the hospital services level, improved communication, increased responsiveness of staff to patients, use of detailed discharge plans, timely follow-up appointments and medication reconciliation can improve quality and outcomes.
·         At the system level,some strategies identified in the literature to improve systemic failures include: improving accessibility in community for primary care, better synergy for population health initiatives across departments, integrated delivery system (IDS), electronic medical records (EMRs) and better patient follow-through plans (improved access to identified “at risk, vulnerable populations” to community programs and services).
The complete Report Card is available online at http://www.nbhc.ca/what-we-do/care-experience-2011

The NBHC has been established as an independent organization that measures, monitors and evaluates New Brunswick’s health care system performance, population health and to engage citizens in the improvement of health service quality.


New Brunswick Health Council: Christine Paré, 506-869-6714, christine.pare@nbhc.ca