Reporting of Aboriginal people in health data collections in NSW

The accurate reporting of Aboriginal people in administrative data sets is essential to effectively monitor progress towards closing the gap in Aboriginal health outcomes. Improving the reporting of Aboriginal people in NSW Health’s data collection systems is a key priority under the National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes.¹

The National best practice guidelines for collecting Indigenous status in health data sets documents the recommended national approach for collecting and recording accurate information on the Aboriginal status of clients.² Self-report in response to a standard question is described as the most accurate means of ascertaining whether a person is Aboriginal or not. The question is: Are you (is the person) of Aboriginal or Torres Strait Islander origin?

In NSW, there is under-reporting of Aboriginal people across a range of health data collections and systems. In the NSW Admitted Patient Data Collection it is estimated that the level of correct reporting is 90.7%.³ The under-reporting of Aboriginal people in NSW Health’s data collection systems may be attributed to a range of factors, including a lack of staff awareness and training, staff reluctance to ask the question, client reluctance to answer the question, staff perceptions about whether people want to identify as Aboriginal, lack of privacy when answering the question, limited data validation and follow-up of missing information, and inadequate data management systems.⁴ Aboriginal people’s willingness to disclose their Aboriginal status and administrative staff preparedness to ask the question also depends on the existence of a culturally safe environment.

The Australian Council on Healthcare Standard Evaluation and Quality Improvement Program (EQuIP 5) requires all hospitals to demonstrate action on standards aimed at improving Aboriginal identification. This requirement provides an opportunity to support system-wide improvement in Aboriginal health and hospital data. A national pilot project in five hospitals has demonstrated that using a continuous quality improvement framework to improve the culture of hospitals for Aboriginal people can result in improving identification of Aboriginal people in health data sets.⁵

NSW Health currently has a number of activities underway to improve the accuracy of reporting of Aboriginal people in administrative datasets:

• The Centre for Aboriginal Health is reviewing the policy on identification of Aboriginal people to ensure it is consistent with the National Best Practice Guidelines and supports the EQuIP5 accreditation framework, and will support Local Health Districts in the implementation and monitoring of the revised policy.⁶ NSW Health is also working collaboratively with the Australian Institute of Health and Welfare to conduct the 2011 Admitted Patient Indigenous Status Survey in NSW.

• The Centre for Epidemiology and Evidence is investigating the feasibility of using record linkage to estimate the under-reporting of Aboriginal people on routinely collected NSW Health datasets. The project uses linked records from a number of data collections, and has developed algorithms to enhance Aboriginal identification within each data collection.

• The NSW Hospital Identification Project, currently being developed by the Centre for Aboriginal Health, aims to demonstrate the effectiveness of a continuous quality improvement framework in improving the cultural competency of eight hospitals. The project aims to address the under-reporting of Aboriginal people by adopting a system-wide approach that goes beyond staff training and improvements in administrative systems to include initiatives that promote the cultural competency of each hospital.

Improved identification will lead to more accurate reporting of disease and risk factors among Aboriginal people and stronger evaluation on health system performance in closing the gap, which in turn will support the delivery of more effective, sustainable and culturally appropriate health services for Aboriginal people in NSW.