Building a Client Cohort Study for ACC NZ Sally_Faisandier ACHRF 2014

Presented by: Date:

Building a client cohort study for ACC, NZ A presentation to the 2014 ACHRF, Melbourne

19 November, 2014 Sally Faisandier

What is the Client Cohort Study?

Overall goal How: To design and implement a longitudinal study Who: ACC clients with entitlement cover What: Interaction between client characteristics and their experiences of ACC processes (claims management, injury treatment, rehabilitation) and return to work or independence and everyday life Outcome: To inform ACC about ‘what works’ to maximise their recovery.

2

Copyright (c) ACC Sally Faisandier / ACC Research, NZ

The Client Journey

3


Study timelines & data collection points

4

Sally Faisandier / ACC Research, NZ Copyright (c) ACC Sally Faisandier / ACC Research, NZ

5


Study Objectives

1. Understanding the on-going impact of an injury

How do previous injuries impact the current presentation?

How does an injury affect a client’s ability to engage in treatment and rehabilitation?

2. Understanding clients’ experience of ACC processes along their recovery journey

How many, and what type of interactions do clients have with ACC?

To what extent are client expectations met?

3. Identifying factors that enhance early return to work or independence

What factors lead to a ‘typical’ recovery process?

What works for which groups under what kind of circumstances?

4. Identifying factors that inhibit early return to work or independence

Why do some clients with the same type of injury, not recover as well as others?

What factors hamper a client’s recovery process?

Objectives Key Questions

Preparing for the study

1. What do we already know, and where are the areas of need? 2. What is available through the analysis of ACC contact notes

and documents? 3. How might previous trajectories and client characteristics

inform the topics and methods for the study? 4. Would the Ministry of Health, Work & Income and Inland

Revenue Department agree to share data for linking with ACC data and survey data, if clients agree? Quick answer - yes

5. What are the burning issues for ACC currently? What are the key issues for the business that could be informed by this study?

6


1. Stocktake & gap analysis

What do we already know? 64 recent ACC research reports show 3 major themes: 1) Importance of a person-centred approach – including context &

cultural background 2) Outcomes are impacted by clear, proactive & transparent

communication – with clients, plus other stakeholders. 3) Greater collaboration across all agencies is needed at key

transition phases, to reduce complexity & the burden of injury. Much is known about: the customer experience a wide range of customer groups by injury type, and their demographics.

7


Stocktake & gap analysis (contd) Selected findings of interest: it is difficult to distinguish between the natural aging process,

and the impact of an injury it is important to allocate relevant staff with the right skill mix

for the complexity of a claim cultural background and beliefs are inseparable from an

impact of injury an early start and more proactive case management for

those who will need it impacts on the client experience – especially for Māori and Pacific people

there is a need to better understand how ACC processes are operationalized, and how to monitor them

co-morbidities and secondary health conditions impact outcomes – especially for spinal cord injury, and older people 8

Copyright (c) ACC Author/Unit

Stocktake & gap analysis (contd)

Where are the areas of need?

characteristics of the clients themselves not well documented an understanding of the on-going impact of an injury the barriers and facilitators to return to work or return to

independence and everyday life the link between ACC service provision and client outcomes outcome measures have not used valid, reliable and

standardised tools it is not yet clear what works, for who, and in what circumstances.

9


2. Exploratory qualitative analysis

What is available from the analysis of contact notes & documents? (Data analysis gives us numbers but does not tell us why). Information on the client record (party record): Personal details (age, gender, ethnicity, NHI, etc) Contact information (address, email, best method, etc) All their previous & current claims All communications / contact with the client All documents from or to the client All tasks on client’s claims Relationships (married, parents, etc) Health and living details Payments 10


Exploratory qualitative analysis (contd) Selected findings of interest: Of 14 cases who were receiving weekly compensation: Time waiting for a decision: An average of 19 days Case Owners decided about weekly compensation in 10 cases;

Branch Medical Advisors & Cultural Advisors each decided on 2. 6 Applications AND Claims both came from the GP 1st payment: Between 6-10 working days. For 4 claimants >

6wks Most delays were waiting for an ACC003 Earning Certificate

from the employer. One client expressed ‘concern’ about the delay, and another

was not happy that they needed to repeat themselves to ACC Only one client was recorded as having support, which was

family. 11

Copyright (c) ACC Author/Unit

3. Exploratory data analysis

How might typical trajectories and client characteristics inform the topics and methods for the study?

12


Purpose: Sample size determination The structure of ACC claims, by reporting

on demographic, socio-economic and injury profiles

Rehabilitation, treatment and entitlement profiles of claims

Disparities in service uptake among client groups

Timeframes and claims duration

NZ Population vs Entitlement Claims


Claims to ACC do not reflect the same demographics of the NZ population Even though Asian, Maori and Pacific groups represent ≈ 44%

of the NZ population under the age of 15yrs, only about 18% of all entitlement claims to ACC come from this group. All the rest come from NZ Europeans.

For claims from NZers over the age of 85, 98% come from NZ Europeans – unlike the NZ population.

In the 16-44 year-old range, Maori and Pacific claims match their populations better, but Asians are still significantly under-represented.

We do not know the reasons for these differences.

Most common diagnoses

From a count of 1,014 claims: Burns…………………………… 12 Concussion / Brain Injury…..... 18 Fracture / Dislocation………………………………………….. 420 Soft Tissue Injury……………………………………………..... 388 Infected / Non-Infected Laceration…………………………... 109 Other…………………………………………………………….. 67 All……………………………………………………………….1,014

14


Entitlement claims lodged in 1 day Mean StdDev Mean StdDev

Asian 7 5 Amputation/ Enucleation 2 1European 86 58 Burns (Burn, Corrosive Injury, Scald) 2 1Māori 21 13 Concussion/ Brain Injury 3 2Other 9 6 Foreign Body In Orifice/Eye 1 1Pacific 9 7 Fracture/ Dislocation 43 32

Gradual Onset (not Disease/ Infection) 1 1Female 41 27 Hernia 1 1Male 90 60 Infected/ Non-Infected Laceration, Puncture Wound, 13 8

Other 5 20_15 2 1 Soft Tissue Injury (Contusion, Internal Organ, Strain) 64 4216_24 29 22 Unknown 2 425_44 52 3545_64 43 2765_74 6 475_84 2 185plus 1 1


Weekly Compensation Days

0 5 10 15 20

1 - 1011 - 2021 - 3031 - 4041 - 5051 - 6061 - 90

91 - 120121 - 180181 - 240241 - 300Over 300

% of Claims

Wee

kly

Com

pen

sati

on

Day

s

0 5 10 15 20 25 30 35 40% of Cost


Vocational Rehabilitation Days

0 5 10 15 20 25

1 - 1011 - 2021 - 3031 - 4041 - 5051 - 6061 - 90

91 - 120121 - 180181 - 240241 - 300Over 300

% of Claims

Vo

cati

on

all R

ehab

ilita

tio

n D

ays

0 5 10 15 20 25% of Cost


Elective Surgery Odds Ratio Estimates

Point Estimate 95% Confidence Limits

Age: 0_15 vs 45_64 0.792 0.580 1.082

16_24 vs 45_64 0.724 0.679 0.772

25_44 vs 45_64 0.963 0.916 1.013

65_74 vs 45_64 0.849 0.749 0.963

75 plus vs 45_64 0.178 0.140 0.226

Gender: Male vs Female 1.126 1.073 1.181

Quintile: 1 vs 5 1.482 1.375 1.598

2 vs 5 1.320 1.225 1.423

3 vs 5 1.269 1.178 1.367

4 vs 5 1.179 1.095 1.269

Ethnicity: Asian vs Māori 0.906 0.786 1.045

European vs Māori 1.382 1.286 1.486

Other Ethnicity vs Māori 1.215 1.068 1.383

Pacific Peoples vs Māori 1.243 1.102 1.401


5. Consultation with key stakeholders

What are some key issues for the business that could be informed by this study? Consider the impact of many injuries over people’s long lives Socioeconomic status as an indicator Break down orthopaedic into shoulders, knees, spines Include Māori, Pacific, elderly, children Unpack ‘Asian’ into sub-groups Include sensitive claims, serious injury, elective surgery

Other projects across the business: ‘Project Assist’ (for Sensitive Claims) New psychosocial screening tool in Akl Medical assessments initiatives TBI strategy

The study could evaluate such projects

19

Concluding comments

There is still a lot of work to do, but we do know the following: 1. The gap analysis shows that we need to know more about the

ongoing impact of an injury, and what enhances or hampers recovery.

2. Analysis of client records will provide us with significant insights that reduce the need for asking claimants about those things

3. If claimants consent, we can learn a lot by linking data between government agencies

4. There are already differences to be noted between claimants from different levels of socioeconomic status, ethnicity, age etc. Further analysis is warranted.

5. Many (not all) of our internal stakeholders are supportive of the study, and believe that it will assist their work.


20

Documents

Building a Client Cohort Study for ACC NZ Sally_Faisandier ACHRF 2014