Jesse Whitehead
This project aims to better understand the role of rural hospitals in the health system, with a particular focus on the Waikato region. Approximately 19% of New Zealand residents rely on rural health services, but the relationship between rural hospitals, access to health care, and improved health outcomes is not well understood in NZ. Recent health sector reforms offer an opportunity to rethink the planning of services, with a stronger ‘locality’ based approach. This requires a better understanding of how demand for rural hospital services – and associated workforce pressures – change over time, the extent to which these fluctuations are driven by visitors to a region, and how patients make choices about when and where to use rural or ‘Tertiary’ hospitals.
Our two research questions are: (1) how and why does rural hospital utilisation vary over time; and (2) how and why are rural hospitals ‘bypassed’ for Waikato Hospital?
These questions will be examined through quantitative data analysis using two years (2017-2019) of national administrative data collected by the Ministry of Health – namely the National Minimum Data Set (NMDS) and the National Non-admitted Patient Collection (NNPAC). First, we will map ED presentations and hospital discharges for rural hospitals each month across the period and assess whether a ‘seasonal’ effect exists, whether ‘visitor’ hospitalisations contribute to seasonal variation, and identify key regions that contribute to ‘visitor’ hospitalizations in the Waikato region. Next, we will use these same datasets to focus on patients who reside within rural hospital catchments, but whose first presentation is at Waikato hospital, and examine possible reasons for this ‘rural hospital bypass’ behaviour.
The findings of this project will have the potential to impact health policy, planning, and the delivery of health services in rural areas including workforce. Specifically, this project will provide research evidence that identifies and describes the variation in workload pressures in rural hospitals, that will allow health funders (Te Whatu Ora) to more accurately and equitably target funding and workforce recruitment in rural hospitals to meet workload demands. This project will provide a platform for further rural hospital service delivery evaluation to better understand the extent to which rural hospitals improve access to healthcare, improve health outcomes and improve health equity for rural communities,
This project aims to improve our understanding of how demand for rural hospital services (and associated workforce pressures) change over time, and better understand the role of rural hospitals within health ‘localities’. We will do this by using routinely collected health data to examine whether rural hospitals have seasonal ‘surges’ in ED presentations and hospital discharges, and the possible reasons why people living in rural areas travel past their local rural hospital to access tertiary hospital service such as Waikato Hospital. This research will help to improve policy, planning and service delivery by highlighting variation in workforce.
The findings of this project will have the potential to impact health policy, planning, and the delivery of health services in rural areas including workforce. Specifically, this project will provide research evidence that identifies and describes the variation in workload pressures in rural hospitals, that will allow health funders (Te Whatu Ora) to more accurately and equitably target funding and workforce recruitment in rural hospitals to meet workload demands. This project will provide a platform for further rural hospital service delivery evaluation to better understand the extent to which rural hospitals improve access to healthcare, improve health outcomes and improve health equity for rural communities, particularly for Māori and also for Pacific peoples. This could include further work to develop specific Māori health interventions with Māori health providers that currently sit outside Te Whatu Ora, but are integral parts of locality networks.
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