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Objective: Clinical care ratios are used to quantify and benchmark the activity of allied health professionals. This study aims to review previous recommendations and identify what variables may influence them. Method: Data was collected from the core allied health professions (audiology, nutrition and dietetics, occupational therapy, physiotherapy, podiatry, prosthetics and orthotics, psychology, social work and speech pathology) across eight Australian hospitals. Data for 113 staff who were casual or from smaller professions (audiology, podiatry, prosthetics and orthotics and psychology) were excluded due to insufficient numbers for analysis. The remaining data were analysed according to profession, seniority (tiers 1, 2 and 3) and employment status (permanent versus casual staff). A two-way ANOVA was performed to assess the association of clinical care ratios with tier, profession, employment status and gender. Results: Data from 1246 staff from the five larger professions at participating hospitals were analysed. There were no interactions between profession and gender (P = 0.185) or employment status (P = 0.412). The relationship between clinical care ratio and profession was modified by tier (interaction term, P = 0.014), meaning that differences in clinical care ratios between professions depended on the tier. Conclusion: This research has confirmed that clinical care ratios are a useful tool in workload management and determining staffing levels for allied health professionals. The recommendations from this research provide a starting point that can be finessed with reference to profession, model of care, workforce structure, governance and training requirements. This will lead to increased staff wellbeing and improved patient outcomes. What is known about this topic? Clinical care ratios are a useful tool to quantify, monitor and compare workloads of allied health professionals. What does this paper add? This paper confirms that clinical care ratios are a useful workforce planning tool and that when developing roles and models of care, clinical care ratios need to be incorporated into staffing requests and considered as part of workload management tools. What are the implications for practitioners? Clinical care ratios enable the quantification and benchmarking of direct and clinical support activity components of a workload and can be used when planning new services and reviewing current services. [ABSTRACT FROM AUTHOR]

Objective: HealthPathways is a web-based platform designed for use during a consultation to offer health professionals locally agreed information to support clinical and referral decision making. This study aimed to investigate whether access to specific HealthPathways pages in the North Coast New South Wales (NSW) region increased during specific critical events. High pageviews is used as a proxy for platform usefulness, and/or trust as a source of up-to-date information. Methods: Data were extracted from Google Analytics from December 2015 to December 2021. Descriptive statistics were generated for the total number of pageviews for all pages by month and year (2015–2021); for the top 15 most viewed pages in 2019, February–March 2020 inclusive (early COVID-19 pandemic period), 10–24 March 2021 (North Coast NSW region local disaster declaration period) and 26 June–11 October 2021 (NSW COVID-19 lockdown period); and for monthly pageviews for the Influenza Immunisation pathway (2016–2021). Results: Access to specific pages in HealthPathways increased alongside the occurrence of critical events affecting the region. Spikes in access to specific pages were seen during COVID-19 lockdown periods, during natural disasters, as well as during the annual influenza season. Conclusions: HealthPathways is viewed as a useful and trusted source of information for health professionals in the North Coast NSW region. HealthPathways provides an opportunity for timely dissemination of information during critical events, including natural disasters and emergencies. What is known about the topic? Evidence from New Zealand suggests that HealthPathways is viewed as a useful and trusted source of information by health professionals during critical and emergency events, and when information needs are subject to frequent change. What does this paper add? This paper provides evidence in the Australian context that health professionals access specific pages in HealthPathways at higher rates during critical and emergency events. What are the implications for practitioners? HealthPathways has the capacity to provide timely and accurate information to health professionals during critical and emergency events, as well as to identify their emerging information needs. [ABSTRACT FROM AUTHOR]

Objectives: Accreditation to standards developed by the Royal Australian College of General Practice provides assurance to the community of the quality and safety of general practices in Australia. The objective of this study was to conduct an empirical evaluation of the 5th edition standards. Minimal empirically driven evaluation of the standards has been conducted since their publication in 2020. Methods: Data encompass consecutive Australian general practice accreditation assessments between December 2020 and July 2022 recorded from a single accrediting agency. Met and not met compliance (binary) scores for 124 indicators evaluated at the site visit were recorded. A subset of indicators derived from a selection of existing and consistently non-conformant indicators within each criterion was generated. Concordance between the indicator subset and the criterion was assessed to determine the predictive ability of the indicator subset in distinguishing practices who are conformant to the entire criterion. Results: A total of 757 general practices were included in the analysis. On average, 113.69 (s.d. = 8.16) of 124 indicators were evaluated as conformant at the site visit. In total, 52 (42%) indicators were required to obtain a true positive conformity rate above 95% for all criterions of the standards. For criterion 1 (General Practice 1) conformity to the entire criterion (nine indicators; >95% true positive rate) could be obtained by including 2/9 indicators (C1-1a and C1-2a). Conclusion: Our results identified that indicator non-conformity was driven by a small proportion of indicators and identifying a subset of these consistently non-conformant indicators predicted a true positive rate above 95% at the criterion level. What is known about the topic? Minimal empirical evaluation of the 5th edition standards for accreditation have occurred since their implementation. What does this paper add? Our findings suggest that more than half of the indicators currently do not adequately distinguish practices at the site assessment. What are the implications for practitioners? These findings may suggest that a review of individual indicators and the standards structure is required. [ABSTRACT FROM AUTHOR]

Objective: There is a need to undertake more proactive and in-depth analyses of general practice accreditation processes. Two areas that have been highlighted as areas of potential inconsistency are the self-assessment and surveyor assessment of indicators. Methods: The data encompass 757 accreditation visits made between December 2020 and July 2022. A mixed-effect multilevel logistic regression model determined the association between attempt of the self-assessment and indicator conformity from the surveyor assessment. Furthermore, we present a contrast of the rate of indicator conformity between surveyors as an approximation of the inter-assessor consistency from the site visit. Results: Two hundred and seventy-seven (37%) practices did not attempt or accurately report conformity to any indicators at the self-assessment. Association between attempting the self-assessment and the rate of indicator non-conformity at the site visit failed to reach statistical significance (OR = 0.90 [95% CI = 1.14–0.72], P = 0.28). A small number of surveyors (N = 9/34) demonstrated statistically significant differences in the rate of indicator conformity compared to the mean of all surveyors. Conclusions: Attempt of the self-assessment did not predict indicator conformity at the site visit overall. Appropriate levels of consistency of indicator assessment between surveyors at the site visit were identified. What is known about the topic? There is a need to undertake more proactive and in-depth analyses of the general practice accreditation process and outcomes to improve the quality and safety within this healthcare sector. What does this paper add? Attempt of the self-assessment does not predict indicator conformity at the site visit overall, and appropriate levels of consistency of indicator assessment between surveyors at the site visit were identified. What are the implications for practitioners? We present empirical evidence as to the consistency of assessment with general practice accreditation to inform future standards and (re)accreditation assessments. [ABSTRACT FROM AUTHOR]

Objective: Long specialist out-patient waitlists are common in public health facilities, but not all patients require consultation with a medical specialist. Studies of single allied health primary contact services have shown they provide timely, appropriate care and reduce demand on medical specialist out-patient waitlists. This study evaluated the collective benefits across multiple allied health primary contact services and models to determine their clinical effectiveness, safety, timeliness of care and impact on medical specialist out-patient waitlists. Method: Using a prospective observational study design, data were collected and analysed for patients attending 47 allied health primary contact services in Queensland public hospitals over a 2-year period. Outcomes reported are global status, adverse events, wait times and impact on medical specialist out-patient waitlists. Results: In all, 10 634 patients were managed in and discharged from the allied health services. Most adult patients (80%) who attended at least two consultations reported an improvement in health status. No adverse events were attributed to the model of care. Approximately 68%, 44% and 90% of urgent, semi-urgent and non-urgent out-patients respectively were seen within clinically recommended time frames. Between 35% and 89% of patients were removed from out-patient waitlists without medical specialist consultation across the service models. Conclusions: Allied health primary contact services provide safe, effective and timely care. The impact on medical specialist out-patient waitlists varied depending on service model and pathway characteristics. What is known about this topic?: Most studies of allied health primary contact services have focused on the management of patients on orthopaedic specialist out-patient waitlists by a physiotherapist. These studies of either individual services or groups of services with the same model cite benefits, including reduced waiting times, high levels of patient and referrer satisfaction, improved conversion to surgery, cost-effectiveness and more effective utilisation of medical specialists. What does this paper add?: This paper highlights that, collectively, allied health primary contact services are safe, effective and provide timely care. The proportion of patients independently managed and removed from various medical specialist out-patient waitlists and the services involved are reported, demonstrating the variety of service models. This study reports outcomes for primary contact services for which there is a dearth of published literature, including dietician services for patients on gastroenterology waitlists, speech pathology and audiology services for patients on ear, nose and throat waitlists, occupational therapy hand services for patients on orthopaedic waitlists and physiotherapy led pelvic-health services for patients on gynaecology waitlists. Possibilities for efficiency gains are identified and discussed. What are the implications for practitioners?: Health service managers should consider allied health primary contact services as a viable option to increase specialist out-patient capacity. Service model characteristics that maximise impact on medical specialist out-patient waitlist management are highlighted to inform resource allocation. [ABSTRACT FROM AUTHOR]

Objective: This study investigated the delivery of guideline-recommended services for the management of acute rheumatic fever (ARF) and rheumatic heart disease (RHD) in Australian primary healthcare centres participating in the Audit and Best Practice for Chronic Disease (ABCD) National Research Partnership project. Methods: ARF and RHD clinical audit data were collected from 63 Aboriginal centres in four Australian jurisdictions using the ABCD ARF/RHD audit tool. Records of up to 30 patients treated for ARF and/or RHD were analysed per centre from the most recent audit conducted between 2009 and 2014. The main outcome measure was a quality of ARF and RHD care composite indicator consisting of nine best-practice service items. Results: Of 1081 patients, most were Indigenous (96%), female (61%), from the Northern Territory and Queensland (97%) and <25 years of age (49%). The composite indicator was highest in the 0–14 year age group (77% vs 65–67% in other age groups). Timely injections and provision of client education are important specific areas for improvement. Multiple regression showed age >15 years to be a significant negative factor for several care indicators, particularly for the delivery of long-acting antibiotic injections and specialist services in the 15–24 year age group. Conclusions: The results suggest that timely injection and patient education are priorities for managing ARF and RHD, particularly focusing on child-to-adult transition care. What is known about the topic?: The burden of rheumatic fever and RHD in some Aboriginal communities is among the highest documented globally. Guideline-adherent RHD prevention and management in primary health care (PHC) settings are critically important to reduce this burden. Continuous quality improvement (CQI) is a proven strategy to improve guideline adherence, using audit cycles and proactive engagement of PHC end users with their own data. Previously, such CQI strategies using a systems approach were shown to improve delivery of ARF and RHD care in six Aboriginal health services (three government and three community controlled). What does this paper add?: This paper focuses on the variation across age groups in the quality of ARF and/or RHD care according to nine quality of care indicators across 63 PHC centres serving the Aboriginal population in the Northern Territory, Queensland, South Australia and Western Australia. These new findings provide insight into difference in quality of care by life stage, indicating particular areas for improvement of the management of ARF and RHD at the PHC level, and can act as a baseline for monitoring of care quality for ARF and RHD into the future. What are the implications for practitioners?: Management plans and innovative strategies or systems for improving adherence need to be developed as a matter of urgency. PHC professionals need to closely monitor adherence to secondary prophylaxis at both the clinic and individual level. RHD priority status needs to be assigned and recorded as a tool to guide management. Systems strengthening needs to particularly target child-to-adult transition care. Practitioners are urged to keep a quick link to the RHDAustralia website to access resources and guidelines pertaining to ARF and RHD (https://www.rhdaustralia.org.au/arf-rhd-guideline, accessed 3 October 2019). CQI strategies can assist PHC centres to improve the care they provide to patients. [ABSTRACT FROM AUTHOR]

Objective: This article critically appraises the range of personal, professional and social factors that affect the choice of speciality across medical students, prevocational doctors, general practice registrars and general practitioners. Methods: This qualitative study applied constructs from the fields of decision theory and career theory to better understand the complex nature of choosing a speciality. In all, 47 in-depth interviews were conducted with participants at different stages of their career cycle. The data was codified and analysed using NVivo to identify key factors that influenced speciality choice. Results: The research identified 77 individual findings influencing general practice as a choice of medical speciality. These were distilled into a matrix to show that factors such as money, prestige and peer interaction did not have a compelling effect, whereas clinical and academic role models, flexibility, work–life balance, scope of practice, connection with patients, training environment and practical opportunities did. Conclusion: The findings indicate that the decision in relation to the choice of medical speciality is a complex cognitive process that is undertaken within a personal, social and professional context particular to each individual. What is known about the topic?: Current literature aims to quantify changes in attitudes towards choice of speciality or the effect of particular variables in isolation while ignoring the complexity of this decision process and how the numerous variables compare with each other. What does this paper add?: The present study is the first intergenerational research on this topic in the Australian context and the paper dismisses the role of prestige and remuneration as key drivers of choice in picking general practice as a speciality, noting that money is merely a 'hygiene factor'. What are the implications for policy makers?: A policy framework outlining 10 key principles is presented to assist policy makers seeking to affect workforce outcomes by applying policy levers to influence doctors' choice of speciality. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study is to describe the experience of developing key performance indicators (KPIs) for Sydney Children's Hospital Network (SCHN), the largest paediatric healthcare entity in Australia. Methods: Beginning with a published methodology, the process of developing KPIs involved five phases: (1) identification of potential KPIs referencing the organisational strategic plan and pre-existing internal and external documents; (2) consolidation into a pragmatic set; (3) analysis of potential KPIs against selection criteria; (4) mapping these back against the strategic plan and management structure; and (5) presentation to key stakeholders to ensure suitability and traction. Consistent with the strategic plan, a subset of indicators was selected to address quality of care for children from priority populations. Results: A pragmatic list of 60 mandated and 50 potential KPIs was created from the 328 new and 397 existing potentially relevant KPIs generated by the executive team. Of these, 20 KPIs were selected as the most important; 65% were process measures. The majority of mandated KPIs were process measures. Of the KPIs selected to highlight inequities, there were proportionately more outcome measures (44% outcome, 27% process). Less than one-third could currently be measured by the organisation and were thus aspirational. Conclusion: Developing a KPI suite requires substantial time, effort and organisational courage. A structured approach to performance measurement and improvement is needed to ensure a balanced suite of KPIs that can be expected to drive an organisation to improve child health outcomes. Future directions for SCHN include a systematic approach to implementation beyond the mandated KPIs, including KPIs that reflect equity and improved outcomes for priority populations, development of meaningful measures for the aspirational KPIs, adding structure KPIs and measurement of changes in child health outcomes related to the development of this KPI process. What is known about the topic?: Health services are increasingly required to demonstrate accountability through KPIs. There is a body of literature on both theoretical frameworks for measuring performance and a long list of possible measures, however developing a meaningful suite of KPIs remains a significant challenge for individual organisations. What does this paper add?: This paper describes lessons learned from the practical, pragmatic application of a published methodology to develop a suite of KPIs for the largest paediatric healthcare entity in Australia. It provides a select list of the highest-level KPIs selected by the organisation to stimulate further discussion among similar organisations in relation to KPI selection and implementation. What are the implications for practitioners?: Developing and implementing a suite of meaningful KPIs for a large organisation requires courage, an understanding of health informatics, stakeholder engagement, stamina and pragmatism. The process we describe can be replicated and/or modified as needed, with discussion of key lessons learned to help practitioners plan ahead. [ABSTRACT FROM AUTHOR]

Objectives: To ascertain Australian multistate prevalence and incidence of five commonly collected clinical indicators of aged-care home quality and to measure associations between these clinical indicators and levels of care needs and consumer and staff satisfaction. Methods: A retrospective analysis of national audit data collected from 426 facilities between 2015 and 2016 was performed. Regression models were used to examine associations between five clinical indicators (falls, pressure injury, physical restraint, unplanned weight loss and polypharmacy) and level of care needs measured by the Aged Care Funding Instrument (ACFI) and consumer and care staff survey responses. Results: With the exception of polypharmacy, commonly collected negative clinical outcomes were rare events. Compared with care homes with <25% of residents having high-level care needs (high ACFI), homes with 25<75% high-ACFI residents had more occurrences of all negative clinical outcomes except pressure injury. Homes with ≥75% high-ACFI residents reported the highest rates of polypharmacy (odds ratio 1.48, 95% confidence interval 1.39 – 1.57). Falls, unplanned weight loss and pressure injury were inversely associated with satisfaction scores adjusted for residents' level of care needs. Conclusions: This first Australian study of multistate clinical indicator data suggests interpretation of clinical indicators of aged-care home quality requires consideration of the level of residents' care needs. What is known about the topic?: Many Australian aged-care providers use quality indicators (QI) through benchmarking companies or in-house programs. The five most widely used aged-care clinical QIs in Australia are falls, pressure injury, physical restraint, unplanned weight loss and polypharmacy. Prevalence and incidence of these QIs are highly variable among Australian studies. A consistent message in the international literature is that residents' clinical characteristics influence QI outcomes at baseline and may continue to influence outcomes over time. Study of associations between Australian aged-care home characteristics and QI outcomes has been limited. What does this paper add?: This is the first Australian study of multistate clinical QI data. It is also the first to consider the level of resident care needs in the interpretation of clinical QI outcomes and exploration of the association between level of consumer and staff satisfaction and QI outcomes. What are the implications for practitioners?: Understanding the connections between aged-care home characteristics, consumer and staff perceptions and clinical QIs is crucial in the meaningful interpretation of QI outcomes in context. With the recent introduction of the National Aged Care Quality Indicator Program, it is timely to review national policy, to gauge current quality of care and the measure of care quality in the sector, and to develop directions for possible research to inform and resolve debates regarding the potential influence and unplanned effects that such a program may have. [ABSTRACT FROM AUTHOR]

Care coordination models have developed in response to the recognition that Australia's health and welfare service system can be difficult to access, navigate and is often inefficient in caring for people with severe and persistent mental illness (SPMI) and complex care and support needs. This paper explores how the Australian Government's establishment of the Partners in Recovery (PIR) initiative provides an opportunity for the development of more effective and efficient models of coordinated care for the identified people with SPMI and their families and carers. In conceptualising how the impact of the PIR initiative could be maximised, the paper explores care coordination and what is known about current best practice. The key findings are the importance of having care coordinators who are well prepared for the role, can demonstrate competent practice and achieve better systemic responses focused on the needs of the client, thus addressing the barriers to effective care and treatment across complex service delivery systems. [ABSTRACT FROM AUTHOR]

This paper examines the response of a regional body, the Institute for Urban Indigenous Health (IUIH), coordinating Aboriginal community controlled health organisations (ACCHOs) in south-east Queensland, to research evidence as they prioritise and plan services in response to internal economic and organisational factors, as well as external policy change. An event-based analysis of a quarterly management meeting of the IUIH allowed an exploration of how the IUIH uses a range of evidence to respond to the challenges faced within the Aboriginal community controlled health sector. The study identified three distinct but interconnected processes: (1) identifying evidence for change; (2) exploring and reframing this evidence; and (3) the application of this evidence at different levels of policy and practice. These processes were evident in each of the three major agendas addressed during the meeting, namely navigating current political change, reforming the ACCHO business model and reframing the available evidence for advocacy. The result has been the emergence of a new service delivery model, in which evidence supports accountability, change management, self-sufficiency and attempts to redefine community control. [ABSTRACT FROM AUTHOR]

Objective The aim of this paper was to describe the process undertaken to develop a non-medical (advanced allied health extended role) botulinum toxin A prescription and injection project for adults with upper and lower limb spasticity secondary to an acquired brain injury. The hypertonicity clinic in the present study was located in a metropolitan public hospital in Queensland where multidisciplinary services are provided by a rehabilitation specialist and an advanced occupational therapist and physiotherapist. Methods The process of developing the model included establishing potential benefits for the role extension project and documentation of a project plan. Results Project outcomes included the development of a relevant governance structure, a research evidence-based project evaluation framework, a draft research ethics application, delineation of the key eligibility criteria and competencies required for physiotherapist and occupational therapist prescribers, and a final project report. Conclusion Non-medical prescribing has the potential to increase patient access to botulinum toxin A injection for the management of focal spasticity. A process that supports early patient engagement, extensive consultation with relevant stakeholders, a strong governance structure, a high-quality research project and a long lead time may maximise the potential for successful completion of advanced allied health role extension projects, including prescription and injection of botulinum toxin A. [ABSTRACT FROM AUTHOR]

From an organisational point of view, professional support is an important aspect of clinical governance and a tool for maximising service delivery quality. As a key factor in staff retention and recruitment, access to professional support is also regarded as an important tool for facilitating workforce growth in a competitive health workforce market. While some work units provide appropriate professional support such as in-service, professional supervision is a key challenge for a large organisation employing many health professionals to ensure equitable and relevant access to finite professional support resources. The goal of this paper is to describe the Professional Support Program designed and implemented by Queensland Health. This program seeks to support professionals who may not previously have had optimal engagement in professional support and to enhance the quality of professional support activities available. Evaluation indicates that the Professional Support Program has been successful in facilitating participation in, and quality of professional support activities. [ABSTRACT FROM AUTHOR]

Objective To determine the participant entry criteria used by Australian-based pulmonary rehabilitation programs and the factors that influence selection. Methods This cross-sectional observational study invited all program coordinators listed on the Australian Lung Foundation's pulmonary rehabilitation database in November 2009. Results The response rate was 40.5% (79/195), with 58% of respondents reporting a waiting list. Forty respondents reported prioritising referrals due to: disease severity (75%), requirement for medical procedure (70%), upon medical request (60%) or participant's likelihood to benefit (55%). Fifty-eight respondents reported using entry criteria to select participants, which was mainly for safety reasons and performance-based expectations. All 58 respondents used at least one exclusion criterion in selecting their participants, compared with only 25 programs using inclusion criteria. Increased demand on individual programs was related to prioritising referrals (P <; 0.001) and was reported by 12 programs as a reason for using participant entry criteria. Conclusions Program coordinators commonly prioritise referrals and use participant entry criteria to manage clinical demand with performance-based expectations an important consideration. The inclusion criteria that identify participants more likely to benefit from pulmonary rehabilitation are less commonly used in the performance-based selections. What is known about the topic? Pulmonary rehabilitation is an essential component of chronic lung disease management due to the high-quality evidence demonstrating that these programs can improve participants' exercise capacity, dyspnea and quality of life. However, access to pulmonary rehabilitation is severely limited in Australia with <;1% of individuals with moderate to severe chronic obstructive pulmonary disease able to participate in these programs each year. Prior to the present study it was unknown how Australian pulmonary rehabilitation coordinators manage this demand on their programs. What does this paper add? Program coordinators commonly prioritise referrals and use participant entry criteria to select participants, with performance-based expectations an important consideration. Although higher demand and waiting list pressure appear to influence these performance-based considerations, programs do not report using the existing evidence identifying responders to pulmonary rehabilitation in selecting participants for program inclusion. This finding is a reflection of the inadequate evidence identifying which individuals are more likely to benefit from pulmonary rehabilitation. What are the implications for practitioners? With the current healthcare resources in Australia, pulmonary rehabilitation programs cannot meet the burden of all people with chronic obstructive pulmonary disease. Therefore the selection of participants considered most likely to benefit from pulmonary rehabilitation programs will continue to occur. Better criteria are needed to improve participant selection to ensure timely access to individuals that are most likely to benefit from pulmonary rehabilitation. [ABSTRACT FROM AUTHOR]

Background. Evaluation of the social and economic outcomes of health research funding is an area of intense interest and debate. Typically, approaches have sought to assess the impact of research funding by medical charities or regional government bodies. Independent research institutes have a similar need for accountability in investment decisions but have different objectives and funding, thus the existing approaches are not appropriate. Methods. An evaluation methodology using eight indicators was developed to assess research performance across three broad categories: knowledge creation; inputs to research; and commercial, clinical and public health outcomes. The evaluation approach was designed to provide a balanced assessment across laboratory, clinical and public health research. Results and discussion. With a diverse research agenda supported by a large number of researchers, the Research Performance Evaluation process at the Murdoch Childrens Research Institute has, by necessity, been iterative and responsive to the needs of the Institute and its staff. Since its inception 5 years ago, data collection systems have been refined, the methodology has been adjusted to capture appropriate data, staff awareness and participation has increased, and issues regarding the methodology and scoring have been resolved. Conclusions. The Research Performance Evaluation methodology described here provides a fair and transparent means of disbursing internal funding. It is also a powerful tool for evaluating the Institute's progress towards achieving its strategic goals, and is therefore a key driver for research excellence. What is known about the topic? Increasingly, research funders are seeking to evaluate the impact and outcomes of research spending in order to inform policy decisions and guide research funding expenditure. However, in most instances, research evaluation activities are not undertaken by the organisation conducting the actual research and may not meet their practical needs. What does this paper add? The paper outlines a research performance evaluation methodology specifically tailored to the needs of the medical research institute conducting the research being evaluated, as a way of evaluating research performance to drive strategic goals and disburse internal funds. What are the implications for practitioners? This paper provides a clear approach to internal research evaluation using a process that meets the needs of the organisation actually conducting the research, and provides institutional data for strategic planning activities. [ABSTRACT FROM AUTHOR]

Monitoring hospital performance using patient safety indicators is one of the key components of healthcare reform in Australia. Mortality indicators, including the hospital standardised mortality ratio and deaths in low mortality diagnosis reference groups have been included in the core national hospital-based outcome indicator set recommended for local generation and review and public reporting. Although the face validity of mortality indicators such as these is high, an increasing number of studies have demonstrated that there are concerns regarding their internal, construct and criterion validity. Use of indicators with poor validity has the consequence of potentially incorrectly classifying hospitals as performance outliers and expenditure of limited hospital staff time on activities which may provide no gain to hospital quality and safety and may in fact cause damage to morale. This paper reviews the limitations of current approaches to monitoring hospital quality and safety performance using mortality indicators. It is argued that there are better approaches to improving performance than monitoring with mortality indicators generated from hospital administrative data. These approaches include use of epidemiologically sound, clinically relevant data from clinical-quality registries, better systems of audit, evidence-based bundles, checklists, simulators and application of the science of complex systems. [ABSTRACT FROM AUTHOR]

Clinical indicators using routinely collected International Statistical Classification of Diseases, Australian Modification (ICD-10-AM) data offer promise as tools for improvement of quality. The ICD-10-AM is the coding system used by Australian administrators to summarise information from the clinical record to describe a patient's hospital encounter. The use of anaesthesia complications as coded by this system has been proposed by two jurisdictions as a monitor of the quality of anaesthetic services. We undertook a review of cases identified by such indicators in a large tertiary hospital. Our results indicate the anaesthesia indicator dataset proposed by the Victorian and Queensland Health departments appears to have little clinical or quality improvement relevance. What is known about the topic? Quality assurance relies on reviewing performance, highlighting issues and eliminating or minimising the identified risks. Case or risk identification in the medical arena relies heavily on self reporting, which has many flaws. A system not dependent on self reporting that was reliable would be a positive development in the pursuit of quality improvement. What does this paper add? ICD-AM-10 coding was used to identify complications attributable to anaesthesia as defined by the coding system. The cases identified were then reviewed for the clinical accuracy of this information. The clinical coding was accurate, but the clinical case load so identified did not accurately reflect real incidents of anaesthesia-related complications. The ICD AM 10 codes, as they relate to anaesthesia complications, do not provide a reliable method of identifying cases that contribute to anaesthetic quality assurance activities. What are the implications for practitioners? Anaesthesia quality assurance continues to be dependent on self reporting of relevant cases. Coded data do not provide an adequate substitute for the self reporting mechanisms. [ABSTRACT FROM AUTHOR]