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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: Unwarranted clinical variations in radical prostatectomy (RP) procedures are frequently reported, yet less attention is given to the variations in associated costs. This issue can further widen disparities in access to care and provoke questions about the overall value of the procedure. The present paper aimed to delve into the disparities in hospital, medical provider and out-of-pocket costs for RP procedures in Australia, discussing plausible causes and potential policy opportunities. Methods: A retrospective cohort study using Medibank Private claims data for RP procedures conducted in Australian hospitals between 1 January 2015 and 31 December 2020 was undertaken. Results: Considerable variations in both medical provider and out-of-pocket costs were observed across the country, with variations evident between different states or territories. Particularly striking were the discrepancies in the costs charged by medical providers, with a notable contrast between the 10th and 90th percentiles revealing a substantial difference of A$9925. Hospitals in Australia exhibited relatively comparable charges for RP procedures. Conclusions: Initiatives such as enhancing transparency regarding individual medical provider costs and implementing fee regulations with healthcare providers may be useful in curbing the variations in RP procedure costs. What is known about the topic? Unwarranted clinical variations in radical prostatectomy procedures are well documented in the literature; however, variations in cost are less widely reported. What does this paper add? This paper aims to highlight the cost variations in radical prostatectomy procedures in Australia, discussing their plausible causes, implications and proposing potential policy opportunities. What are the implications for practitioners? Excessive fees imposed by medical providers may contribute to inequalities in healthcare access. Enhancing transparency of individual medical provider costs and implementing fee regulations may be useful in controlling unwarranted variations in procedure costs. This article belongs to the Special Issue: Value-based Healthcare. [ABSTRACT FROM AUTHOR]

Objective: Clinician's experiences of providing care are identified as a key outcome associated with value-based healthcare (VBHC). In contrast to patient-reported experience measures, measurement tools to capture clinician's experiences in relation to VBHC initiatives have received limited attention to date. Progressing from an initial 18-item clinician experience measure (CEM), we sought to develop and evaluate the reliability of a set of 10 core clinician experience measure items in the CEM-10. Methods: A multi-method project was conducted using a consensus workshop with clinicians from a range of NSW Health local health districts to reduce the 18-item CEM to a short form 10-item core clinician experience measure (CEM-10). The CEM-10 was deployed with clinicians providing diabetes care, care for older adults and virtual care across all districts and care settings of New South Wales, Australia. Psychometric analysis was used to determine the internal consistency of the tool and its suitability for diverse clinical contexts. Results: Consensus building sessions led to a rationalised 10-item tool, retaining the four domains of psychological safety (two items), quality of care (three items), clinician engagement (three items) and interprofessional collaboration (two items). Data from four clinician cohorts (n = 1029) demonstrated that the CEM-10 four-factor model produced a good fit to the data and high levels of reliability, with factor loadings ranging from 0.77 to 0.92, with Cronbach's alpha (range: 0.79–0.90) and composite reliability (range: 0.80–0.92). Conclusions: The CEM-10 provides a core set of common clinician experience measurement items that can be used to compare clinician's experiences of providing care between and within cohorts. The CEM-10 may be supported by additional items relevant to particular initiatives when evaluating VBHC outcomes. What is known about the topic? Clinician experience of providing care is an outcome of interest for health systems and services internationally who are implementing value-based care initiatives. Review evidence indicates that measurement of clinician's experience of providing care should address experiences of being able to deliver quality care, collaborate with colleagues, experience psychological safety and engagement in decision-making in the workplace. What does this paper add? The paper reports the development of the short form clinician experience measure (CEM-10) and its initial validation in four value-based healthcare initiatives of NSW Health. What are the practical implications for practitioners? The CEM-10 can be used as a core set of items embedded within evaluations of value-based care initiatives to benchmark and examine experiences across clinician cohorts. This article belongs to the Special Issue: Value-based Healthcare. [ABSTRACT FROM AUTHOR]

Objectives: This study explored the familiarity, perceptions and confidence of Australian radiology clinicians involved in reading screening mammograms, regarding artificial intelligence (AI) applications in breast cancer detection. Methods: Sixty-five radiologists, breast physicians and radiology trainees participated in an online survey that consisted of 23 multiple choice questions asking about their experience and familiarity with AI products. Furthermore, the survey asked about their confidence in using AI outputs and their preference for AI modes applied in a breast screening context. Participants' responses to questions were compared using Pearson's χ 2 test. Bonferroni-adjusted significance tests were used for pairwise comparisons. Results: Fifty-five percent of respondents had experience with AI in their workplaces, with automatic density measurement powered by machine learning being the most familiar AI product (69.4%). The top AI outputs with the highest ranks of perceived confidence were 'Displaying suspicious areas on mammograms with the percentage of cancer possibility' (67.8%) and 'Automatic mammogram classification (normal, benign, cancer, uncertain)' (64.6%). Radiology and breast physicians preferred using AI as second-reader mode (75.4% saying 'somewhat happy' to 'extremely happy') over triage (47.7%), pre-screening and first-reader modes (both with 26.2%) (P < 0.001). Conclusion: The majority of screen readers expressed increased confidence in utilising AI for highlighting suspicious areas on mammograms and for automatically classifying mammograms. They considered AI as an optimal second-reader mode being the most ideal use in a screening program. The findings provide valuable insights into the familiarities and expectations of radiologists and breast clinicians for the AI products that can enhance the effectiveness of the breast cancer screening programs, benefitting both healthcare professionals and patients alike. What is known about the topic? Artificial intelligence (AI) holds promise in providing computer-aided detection in health care, however, current research suggests that standalone AI applications in clinical practice fall short of matching the accuracy of a single radiologist. What does this paper add? The study showed a significant preference among clinicians for using AI as a supplementary tool, serving as a second-reader. Such an integrated approach, where AI aids in flagging suspicious areas on mammograms or offers automatic classification, reflects the ideal cooperation between breast screening readers and AI systems. What are the implications for practitioners? These insights shed light on clinicians' familiarity with and expectations of AI tools that can boost the effectiveness of breast screening programs. [ABSTRACT FROM AUTHOR]

Objective: To explore the training needs of the home care workforce in supporting the social and emotional wellbeing (SEWB) of Aboriginal and Torres Strait Islander peoples receiving aged care services through the Home Care Package (HCP) Program. Methods: A mixed-methods design including (1) a focus group and interview with coordinators of HCP Program services for Aboriginal and Torres Strait Islander peoples across metropolitan and rural South Australia in April and June 2022, and (2) a desktop review of training, professional development opportunities and resources for existing and pre-entry workforce addressing the SEWB of Aboriginal and Torres Strait Islander peoples in aged care across the Vocational Education Training and higher education sectors in South Australia, the Australian Indigenous HealthInfoNet, the Department of Health and Aged Care website and aged care email alerts between December 2021 and September 2022. Results: Five themes representing workforce training needs were identified: cultural safety, trauma-informed care, case management, compliance with funding rules and preferred formats for training. The desktop review identified a paucity of formal training, professional development and resources within the context of addressing the SEWB of Aboriginal and Torres Strait Islander peoples in aged care. Conclusions: These findings suggest that ongoing practice-based professional development learning opportunities are needed within organisations to enhance peer-learning and support. These need to be available together with dedicated formal training programs and practical resources on meeting Aboriginal and Torres Strait Islander peoples' SEWB in aged care. What is known about the topic? Supporting social and emotional wellbeing is an important aspect of delivering quality aged care for Aboriginal and Torres Strait Islander peoples. What does this paper add? Insights into workforce training needs which support the social and emotional wellbeing of Aboriginal and Torres Strait Islander peoples in home-based aged care. What are the implications for practitioners? Ongoing practice-based learning opportunities, training and resources are needed to enhance peer-learning and support workforce in supporting Aboriginal and Torres Strait Islander peoples' social and emotional wellbeing in aged care. [ABSTRACT FROM AUTHOR]

Objectives: Cardiac rehabilitation (CR) provides evidence-based secondary prevention for people with heart disease (HD) (clients). Despite HD being the leading cause of mortality and morbidity, CR is under-utilised in Australia. This research investigated healthcare systems required to improve access to CR in rural and remote areas of North Queensland (NQ). Methods: A qualitatively dominant case study series to review management systems for CR in rural and remote areas of NQ was undertaken. Data collection was via semi-structured interviews in four tertiary hospitals and four rural or remote communities. An audit of discharge planning and CR referral, plus a review of community-based health services, was completed. An iterative and co-design process including consultation with healthcare staff and community members culminated in a systems-based model for improving access to CR in rural and remote areas. Results: Poorly organised CR systems, poor client/staff understanding of discharge planning and low referral rates for secondary prevention, resulted in the majority of clients not accessing secondary prevention, despite resources being available. Revised health systems and management processes were recommended for the proposed Heart: Road to health model, and given common chronic diseases risk factors it was recommended to be broadened into Chronic disease: Road to health. Conclusion: A Chronic disease: Road to health model could provide effective and efficient secondary prevention for people with chronic diseases in rural and remote areas. It is proposed that this approach could reduce gaps and duplication in current healthcare services and provide flexible, client-centred, holistic, culturally responsive services, and improve client outcomes. What is known about the topic? Cardiac rehabilitation is known to improve health outcomes and reduce hospitalisations, but referrals and attendance are low (30%). What does this paper add? A revised systems-based model for improved access to secondary prevention for people with heart and related chronic diseases in rural and remote areas of North Queensland is proposed: Chronic disease: Road to health. What are the implications for practitioners? A functional system from hospitalisation to local healthcare services has been designed to improve access to secondary prevention. Staff require support and education to improve skills, better manage care and improve job satisfaction. [ABSTRACT FROM AUTHOR]

Objective: The study examined emergency department (ED) presentations, unplanned hospitalisations and potentially preventable hospitalisations in older people receiving long-term care by type of care received (i.e. permanent residential aged care or home care packages in the community), in Australia in 2019. Methods: A retrospective cohort study was conducted using the Registry of Senior Australians National Historical Cohort. Individuals were included if they resided in South Australia, Queensland, Victoria or New South Wales, received a home care package or permanent residential aged care in 2019 and were aged ≥65 years. The cumulative incidence of ED presentations, unplanned hospitalisations and potentially preventable hospitalisations in each of the long-term care service types were estimated during the year. Days in hospital per 1000 individuals were also calculated. Results: The study included 203,278 individuals accessing permanent residential aged care (209,639 episodes) and 118,999 accessing home care packages in the community (127,893 episodes). A higher proportion of people accessing home care packages had an ED presentation (43.1% [95% confidence interval, 42.8–43.3], vs 37.8% [37.6–38.0]), unplanned hospitalisation (39.8% [39.6–40.1] vs 33.4% [33.2–33.6]) and potentially preventable hospitalisation (11.8% [11.6–12.0] vs 8.2% [8.1–8.4]) than people accessing permanent residential aged care. Individuals with home care packages had more days in hospital due to unplanned hospitalisations than those in residential care (7745 vs 3049 days/1000 individuals). Conclusions: While a high proportion of older people in long-term care have ED presentations, unplanned hospitalisations and potentially preventable hospitalisations, people in the community with home care packages experience these events at a higher frequency. What is known about the topic? Unplanned hospitalisations and emergency department presentations are frequent and burdensome for older people receiving long-term aged care. What does this paper add? While unplanned hospitalisations and emergency department presentations were high in all people receiving long-term care, these events were higher in people receiving home care packages than those in residential aged care. What are the implications for practitioners? Further efforts to address the high unplanned hospitalisations and emergency department presentations experienced by the increasing number of older adults accessing home care packages are required to allow this population to remain at home successfully. This article belongs to the Special Issue: Value-based Healthcare. [ABSTRACT FROM AUTHOR]

We present a case study on the design and implementation of a value-based bundled package of care for patients with early-stage breast cancer treated in the private health sector in Australia. Value-based healthcare is an essential change to how we deliver healthcare, shifting the focus from paying for individual services provided to a focus on the health outcomes gained over a full cycle of care. The Australian health system has unintentionally created barriers to value-based cancer care through fragmented care pathways and complex funding arrangements where patients can unexpectedly encounter high out-of-pocket costs. A team of clinicians, service providers, health systems and funding experts, private health insurers and consumers have collaborated to design and pilot a complete bundled package of care for breast cancer patients which aims to address these challenges. With 40 patients recruited to date, early evaluation results show positive patient experience of 'joined-up' care and financial transparency. This case study provides a high-level overview of the approach taken to design and implement the Breast Cancer Bundle and the lessons learned for its expansion in both public and private settings. What is known about this topic? Enabling value-based healthcare is essential to improve healthcare, focusing on outcomes gained over a full cycle of care. Patients diagnosed with cancer frequently report care to be disjointed and the cause of financial stress, thus can particularly benefit from value-based care models. What does this paper add? This case study describes the design and implementation of a bundled package of care for patients with early-stage breast cancer treated in the private health sector in Australia. What are the implications for practitioners? Lessons learned through this process provide considerations for expansion of this model of care. This article belongs to the Special Issue: Value-based Healthcare. [ABSTRACT FROM AUTHOR]

Objectives: The aims of the study were to investigate discrepancies between general practitioners' paper medication orders and pharmacy-prepared electronic medication administration charts, back-up paper charts and dose-administration aids, as well as delays between prescribing, charting and administration, at a 90-bed residential aged care facility that used a hybrid paper-electronic medication management system. Methods: A cross-sectional audit of medication orders, medication charts and dose-administration aids was performed to identify discrepancies. In addition, a retrospective audit was performed of delays between prescribing and availability of an updated electronic medication administration chart. Medication administration records were reviewed retrospectively to determine whether discrepancies and delays led to medication administration errors. Results: Medication records for 88 residents (mean age 86 years) were audited. Residents were prescribed a median of eight regular medicines (interquartile range 5-12). One hundred and twenty-five discrepancies were identified. Fortyseven discrepancies, affecting 21 (24%) residents, led to a medication administration error. The most common discrepancies were medicine omission (44.0%) and extra medicine (19.2%). Delays from when medicines were prescribed to when they appeared on the electronic medication administration chart ranged from 18 min to 98 h. On nine occasions (for 10% of residents) the delay contributed to missed doses, usually antibiotics. Conclusion: Medication discrepancies and delays were common. Improved systems for managing medication orders and charts are needed. [ABSTRACT FROM AUTHOR]

Objectives: Integrated respiratory and palliative care services for people with advanced lung disease provide disease-orientated care until the end of life, alongside symptom management and discussions about future care. This study aimed to explore patient, caregiver and general practitioner perspectives of an integrated respiratory and palliative care service, to understand which components of the service were considered valued and effective. Methods: We approached patients, caregivers and general practitioners, to participate in semi-structured phone interviews. A grounded theory approach guided data collection and qualitative analysis. Results: Between July and December 2019, 10 patients, eight caregivers and five general practitioners completed interviews. The overarching theme was that of valuing integrated care – the provision of disease-orientated care along with palliative care. Four other major themes emerged: Valuing communication and engagement between patient, caregiver and healthcare professionals – who spoke of 'growing this plan together'; the delivery of person-centred care – where physicians 'actually listen and you are not treated like a number'; the reality of action plan use in serious illness – while many found plans 'certainly' do help, others described when they were simply 'too ill to do the action plan'; and finally, divergent preferences for discussions about future care – while some patients felt this subject was 'better left alone', caregivers consistently reported their preference was to 'make a plan.' Conclusion: Consumer perspectives highlight the service was valued for delivering personalised care with high communication standards. Similar services should appreciate the usefulness and limitations of action plan use in advanced lung disease, and be sensitive to potential diverging preferences of the patient and caregiver when discussing future care. What is known about the topic? Integrated respiratory and palliative care services for people with advanced lung disease may improve quality of life and decrease acute healthcare utilisation and cost. What does this paper add? This paper adds to our understanding of patients', caregivers' and general practitioners' perspectives of this integrated care model. Participants highly valued this integrated service for providing person-centred care. Participants outlined both the effectiveness and limitations of action plan use in advanced lung disease, and of diverging preferences between patients and caregivers for discussions about future care. What are the implications for practitioners? The integration of disease-orientated care along with the provision of palliative care is highly valued from a consumer perspective. [ABSTRACT FROM AUTHOR]

Objective: Phase II cardiac rehabilitation (CR) reduces cardiovascular risk factors, morbidity and mortality after a cardiac event. Traditional Australian CR programs are located in metropolitan areas and delivered by an expert, multidisciplinary team. Referral and uptake barriers for people living in rural and remote locations are significantly affected by geographical isolation. This scoping review aimed to explore how phase II CR services in rural and remote Australia are being delivered. Methods: A scoping review was conducted to obtain all published literature relating to CR service delivery for people living in rural and remote Australia. A literature search of the following databases was performed in December 2021: Cumulative Index to Nursing and Allied Health Literature, Embase, the Physiotherapy Evidence Database, and PubMed. Results: Six articles met the inclusion criteria. Study designs varied and included mixed methods, cross-sectional design and narrative review. Overall, literature relating to CR programs in rural and remote Australia was limited. Three themes were apparent: (1) barriers to the delivery of phase II CR in rural and remote Australia remain; (2) community centre‐based programs do not reach all people in rural and remote Australia; and (3) alternative models of CR are underutilised. Conclusions: Phase II CR programs in rural and remote Australia do not align with current recommendations for service delivery. The use of technology as a primary or adjunct model of delivery to support people living in rural and remote Australia needs to be further developed and implemented. Further research exploring barriers to the uptake of alternative models of CR delivery is recommended. What is known about the topic? After a cardiac event, people living in rural and remote Australia face many barriers to cardiac rehabilitation (CR) attendance. What does this paper add? This paper demonstrates the need to improve CR service access provision in rural and remote Australia via alternate models of delivery. What are the implications for practitioners? Exploring barriers to and facilitators of the uptake of hybrid models of delivery is recommended to ensure that CR services reach and support all people living in rural and remote Australia after a cardiac event. [ABSTRACT FROM AUTHOR]

Objectives: To examine: the impact of the coronavirus disease 2019 (COVID-19) pandemic on access to health services by middle-aged and older Australians; and the use of telehealth services during the COVID-19 pandemic and its ongoing usefulness. Methods: A cross-sectional survey was conducted among participants who completed the COVID-19 supplement in the 45 and Up Study 2020 Survey. Multivariable logistic regression analysis was used to examine the association between socio-demographic characteristics and health conditions with missed/delayed access to health services, changes in health outcomes resulting from missed/delayed access, and use of telehealth services. Results: Data for 45 071 participants were analysed (56% female, 72% aged ≥65 years). Almost half (42.2%) reported they had missed/delayed access to health care due to COVID-19; mainly for dental services (26.1%), visits to a general practitioner (GP) (16.3%) and specialists (12.6%). Missed/delayed visits to GPs and specialists were more likely among females, participants from non-English-speaking backgrounds, with disability/illness, living in outer regional/remote areas or with chronic health conditions. People with a disability or high/very high psychological distress were twice as likely to report worse health as a result of missed/delayed care. Half (48.0%) the study participants used telehealth during the COVID-19 pandemic and 81.9% indicated telehealth would be useful post-pandemic. Conclusions: The COVID-19 pandemic impacted access to healthcare services, particularly for people with a disability, and chronic or mental health issues who also reported worse health. This may account for their higher use of telehealth services as an alternate way of accessing health care. Ongoing evaluation of telehealth services for vulnerable groups post-pandemic is required. What is known about the topic ? The COVID-19 pandemic has had a significant impact on healthcare usage and access. What does this paper add? This paper identifies the impact of access to health care during the COVID-19 pandemic on vulnerable subgroups within middle-aged and older Australians, including those with chronic and mental health issues. Telehealth is an acceptable way to facilitate access to services for these groups. What are the implications for practitioners? Practitioners are strategically positioned to provide alternatives to face-to-face visits during times of limited access and identify those who are in most need of additional care by way of telehealth intervention. [ABSTRACT FROM AUTHOR]

Objective: To examine implicit bias in employees at a cancer centre using an Australian race (Aboriginal–white) Implicit Association Test (IAT), in an attempt to understand a potential factor for inequitable outcomes of First Nations Australians cancer patients. Methods: All employees at an Australian cancer centre were invited to take part in a web-based, cross-sectional study using an Australian race IAT. The results were analysed using Welch t-tests, linear regression and ANOVA. Results: Overall, 538/2871 participants (19%) completed the IAT between January and June 2020. The mean IAT was 0.147 (s.d. 0.43, P < 0.001, 95% CI 0.11–0.18), and 60% had a preference for white over First Nations Australians. There was no significant mean difference in IAT scores between sub-groups of gender, age or clinical/non-clinical employees. 21% of employees (95% CI 17.65–24.53) had moderate to strong preference for white over First Nations Australians, compared to 7.1% with moderate to strong preference for First Nations over white Australians (95% CI 5.01–9.09). Conclusions: Inequitable cancer survival for First Nations patients has been well established and cancer is now the leading cause of mortality. This paper documents the presence of racial bias in employees at one cancer centre. We argue that this cannot be understood outside the history of colonialism and its effects on First Nations Australians, healthcare workers and our society. Further research is required to evaluate measures of racism, its effect on health care, and how to eliminate it. What is known about this topic? Australian cancer care providers deliver inequitable access and outcomes for First Nations Australians. Systemic and personal racism experienced by First Nations patients are thought to contribute to these inequities. What does this paper add? This paper documents the presence of cancer centre employee racial bias and reiterates the need for further research to document the effect of racism on cancer care outcomes for First Nations patients. What are the implications for practitioners? Healthcare practitioners, similar to other Australians, have implicit bias against First Nations Australians. Previous studies suggest that the presence of bias affects treatment options and outcomes for people of colour. In order to eliminate racism and associated inequities in cancer care services, multi-faceted anti-racism approaches are required. [ABSTRACT FROM AUTHOR]

Background: The majority of allied health services are delivered by small, private practices in the primary care setting with limited government funding. During the coronavirus disease 2019 (COVID-19) lockdowns these practices were subject to the same health orders as any other private business with only 'essential services' permitted to remain open. Research aim: We set out to understand the impact of the COVID-19 pandemic, and associated public health measures, on the financial viability of private allied health practices. Methods: Thirteen semi-structured interviews were conducted with primary care allied health practice owners and managers in Sydney. Data were analysed thematically. Findings: All of the interviewees reported experiencing the stress of balancing precarious finances caused by reduced and/or fluctuating patient demand. Patients' reluctance to seek care was compounded by ambiguity around whether allied health services were 'essential'. Manual therapies were particularly vulnerable to financial stress because their capacity to transition to telehealth and access to government funding were limited. Conversely, psychologists reported demand for their services exceeded what they could provide. Study implications: The findings are indicative of primary care allied health's peripheral status in Australia's primary care landscape. Greater priority to the funding and integration of primary care allied health is needed in primary care policy. What is known about the topic? Most allied health services in Australia are delivered by small, private practices in the primary care setting with limited government funding. What does this paper add? The findings indicate that allied health has a peripheral status in Australia's primary care landscape. What are the implications for practitioners? Greater priority to the funding and integration of allied health is needed in primary care policy. [ABSTRACT FROM AUTHOR]

Objective: High-quality end-of-life care involves addressing patients' physical, psychosocial, cultural and spiritual needs. Although the measurement of the quality of care associated with dying and death is an important component of health care, there is a lack of evidence-based, systematic processes to examine the quality of dying and death of patients in hospital settings. Our purpose was to develop a systematic appraisal framework (QualDeath) for reviewing the quality of dying and death for patients with advanced cancer. The objectives were to: (1) explore the evidence regarding existing tools and processes related to appraisal of end-of-life care; (2) examine existing practices related to appraisal of quality of dying and death in hospital settings; and (3) develop QualDeath with consideration of potential acceptability and feasibility factors. Methods: A co-design multiple methods approach was used. For objective 1, a rapid literature review was undertaken; for objective 2 we carried out semi-structured interviews and focus groups with key stakeholders in four major teaching hospitals; and for objective 3 we interviewed key stakeholders and held workshops with the project team to reach consensus. Results: We developed QualDeath, a framework to assist hospital administrators and clinicians to systematically and retrospectively review the quality of dying and death for patients expected to die from advanced cancer. It offers four levels of potential implementation for hospitals to select from and incorporates medical record review, multidisciplinary meetings, quality of end-of-life care surveys and bereavement interviews with family carers. Conclusions: The QualDeath framework provides hospitals with recommendations to formalise processes to evaluate end-of-life care. Although QualDeath was underpinned by several research methods, further research is needed to rigorously explore its impact and test its feasibility. What is known about the topic? The Australian Commission on Safety and Quality in Health Care explicitly directs Australian hospitals and healthcare services to review the quality of end-of-life care provided against planned goals of care. However, there is a lack of evidence-based, systematic processes to examine the quality of dying and death of cancer patients in hospital settings. What does this paper add? QualDeath provides a framework that enables hospitals to implement a systematic approach to appraising the quality of dying and death for cancer patients. What are the implications for practitioners? QualDeath is underpinned by the principle that hospital clinicians should be evaluating the quality of care provided for every patient who dies. This provides an opportunity for reflecting on and improving the quality of care provided, as well as acknowledging examples of high-quality end-of-life care. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to identify factors associated with an emergency department (ED) length of stay ≥4 hours (h) and hospital admission for people with a mental health problem brought in by police. Methods: We undertook a retrospective, observational cohort study of state-wide adult ED mental health presentations brought in by police from 1 January 2012 to 31 December 2017. We used multivariable logistic regression to determine factors associated with an ED length of stay ≥4 h and hospital admission. Results: In total, 9325 ED presentations with a mental health problem brought in by police to Queensland EDs were included. Factors most strongly associated with an ED length of stay ≥4 h included an Australasian Triage Score (ATS) of 1, an age of 85 years or older, night shift arrival and subsequent hospital admission. For hospital admission, an ATS of 1, an age of 85 years or older and an ED length of stay ≥4 h were the strongest factors. Conclusion: Findings indicate opportunities for targeted mental health models of care to better support people brought in by police to an ED. Such models should involve ED, pre-hospital providers (police and ambulance) and mental health services to support early intervention and potentially reduce the likelihood of a long ED length of stay and subsequent hospital admission. What is known about the topic? Some people with mental health problems are brought in by police to an emergency department (ED). People brought in by police are recognised as having poorer health profiles compared to other arrival modes. What does this paper add? Several patient and clinical factors influence ED length of stay and hospital admission for people with a mental health problem brought in by police, indicating a need for targeted health care that addresses these factors. What are the implications for practitioners? This study justifies the need to develop specialised pre-hospital models of care and embed early assessment processes in an ED for people with mental health problems brought in by police. [ABSTRACT FROM AUTHOR]

Objective: Adverse incident research within residential aged care facilities (RACFs) is increasing and there is growing awareness of safety and quality issues. However, large-scale evidence identifying specific areas of need and at-risk residents is lacking. This study used routinely collected incident management system data to quantify the types and rates of adverse incidents experienced by residents of RACFs. Methods: A concurrent mixed-methods design was used to examine 3 years of incident management report data from 72 RACFs in New South Wales and the Australian Capital Territory. Qualitative thematic analysis of free-text incident descriptions was undertaken to group adverse incidents into categories. The rates and types of adverse incidents based on these categories were calculated and then compared using incidence rate ratios (IRRs). Results: Deidentified records of 11 987 permanent residents (aged ≥65 years; mean (±s.d.) age 84 ± 8 years) from the facilities were included. Of the 60 268 adverse incidents, falls were the most common event (36%), followed by behaviour-related events (33%), other impacts and injuries (22%) and medication errors (9%). The number of adverse incidents per resident ranged from 0 (42%) to 171, with a median of 2. Women (IRR 0.804; P < 0.001) and residents with low care needs (IRR 0.652; P < 0.001) were significantly less likely to adverse incidents compared with men and residents with high care needs respectively. Conclusion: This study demonstrates that data already collected within electronic management systems can provide crucial baseline information about the risk levels that adverse incidents pose to older Australians living in RACFs. What is known about the topic?: To date, research into aged care adverse incidents has typically focused on single incident types in small studies involving mitigation strategies. Little has been published quantifying the multiple adverse incidents experienced by residents of aged care facilities or reporting organisation-wide rates of adverse incidents. What does this paper add?: This paper adds to the growing breadth of Australian aged care research by providing baseline information on the rates and types of adverse incidents in RACFs across a large and representative provider. What are the implications for practitioners?: This research demonstrates that the wealth of data captured by aged care facilities' incident management information systems can be used to provide insight into areas of commonly occurring adverse incidents. Better use of this information could greatly enhance strategic planning of quality improvement activities and the care provided to residents. [ABSTRACT FROM AUTHOR]

Objectives: We set out to examine the volume, scope and quality of research related to First Nations peoples' perceptions of, and experiences with, child rearing and/or parenting programs. Methods: We systematically reviewed the literature published between 2000 and 2020. Sixty-eight studies identified through electronic databases and references lists met inclusion criteria. Results: The study found an 8% increase in publications in the field each year (P -value = 0.002), mostly conducted in Australia with Aboriginal and Torres Strait Islander people (n = 29, 41%). Scope included positive and negative experiences relating to: parenting from adult (n = 19 studies) and teenager (n = 4) perspectives; and pregnancy, antenatal and postnatal care from the perspective of adults (n = 23) and teenagers (n = 2). Descriptive studies included qualitative (n = 40; 58%), quantitative (n = 8, 12%) or mixed methods (n = 7, 10%). Thirteen experimental studies reported the development, acceptability and/or effectiveness of programs (19%), of which three met the Cochrane Effective Practice and Organisation of Care design criteria. Conclusions: Despite an overall increase in volume, research efforts do not demonstrate a clear scientific progression. Further methodologically rigorous studies examining child rearing and/or parenting programs developed in collaboration with First Nations populations are needed. What is known about the topic? Examining research output, effectiveness and acceptability of existing existing parenting and child rearing programs for First Nations parents can inform research priorities and service development.. What does this paper add? Rigorous research to inform the development and evaluation of parenting programs is limited. Strengths-based, community-wide approaches should integrate community identities, expertise and resources, encourage ownership and engagement, and build capacity.. What are the implications for practitioners? Continued efforts are necessary to develop programs uniquely informed by, and tailored to, First Nations parents. [ABSTRACT FROM AUTHOR]

Objective: The harmful use of alcohol is a global issue. This study aimed to describe and compare the profiles, emergency department (ED) clinical characteristics, and outcomes of alcohol-related ED presentations (ARPs) and non-alcohol-related ED presentations (NARPs). Methods: A multi-site observational study of all presentations to four EDs between 4 April 2016 and 31 August 2017, was conducted. Routinely collected ED clinical, administrative and costings data were used. Classification of ARPs were prospectively recorded by clinicians. Analysis was performed at the presentation, rather than person level. Univariate tests were undertaken to compare demographics, ED clinical characteristics and outcomes between ARPs and NARPs. Results: A total of 418 051 ED presentations occurred within the 17-month study period; 5% (n = 19 875) were ARPs. Presentations made by people classified as ARPs were younger, more likely to be male, present on weekends or at night, and arrive by ambulance or police compared to NARPs. Compared with NARPs, ARPs had a longer median ED length of stay of over 20 min (95% CI 18–22, median 196 min vs 177 min, P < 0.001), a 5.5% (95% CI 4.9–5.3) lower admission rate (36% vs 42%, P < 0.001), and a AUD69 (95% CI 64–75) more expensive ED episode-of-care (AUD689 vs AUD622, P < 0.001). Conclusion: Clinically meaningful differences were noted between alcohol-related and non-alcohol-related ED presentations. The higher cost of care for ARPs likely reflects their longer time in the ED. The healthcare and economic implications of incidents of alcohol-related harm extend beyond the ED, with ARPs having higher rates of ambulance and police use than NARPs. What is known about the topic? The harmful use of alcohol is a major health issue globally contributing to morbidity and mortality. What does this paper add? The demographic profile, clinical characteristics, and outcomes of people presenting to emergency departments with alcohol-related harm differ to people arriving for other reasons. What are the implications for practitioners? Indicating alcohol as a cause of an ED presentation, as standard practice, may foster quality assurance/improvement activities. [ABSTRACT FROM AUTHOR]

Objective: Out-of-pocket (OOP) costs could act as a potential barrier to accessing specialist services, particularly among low-income patients. The aim of this study is to examine the link between OOP costs and socioeconomic inequality in specialist services in Australia. Methods: This study is based on population-level data from the Medicare Benefits Schedule of Australia in 2014–15. Three outcomes of specialist care were used: all visits, visits without OOP costs (bulk-billed services), and visits with OOP costs. Logistic and zero-inflated negative binomial regression models were used to examine the association between outcome variables and area-level socioeconomic status after controlling for age, sex, state of residence, and geographic remoteness. The concentration index was used to quantify the extent of inequality. Results: Our results indicate that the distribution of specialist visits favoured the people living in wealthier areas of Australia. There was a pro-rich inequality in specialist visits associated with OOP costs. However, the distribution of the visits incurring zero OOP cost was slightly favourable to the people living in lower socioeconomic areas. The pro-poor distribution of visits with zero OOP cost was insufficient to offset the pro-rich distribution among the visits with OOP costs. Conclusions: OOP costs for specialist care might partly undermine the equity principle of Medicare in Australia. This presents a challenge to the government on how best to influence the rate and distribution of specialists' services. What is known about the topic? Higher out-of-pocket (OOP) costs act as a potential barrier to accessing specialist services, particularly among low-income patients. What does this paper add ? This study finds that inequality in Medicare-funded specialist care in Australia is greater for the visits incurring OOP costs, whereas there is almost no inequality in services without OOP costs. What are the implications for practitioners? OOP costs in the use of specialist care might partly undermine the equity principle of Medicare in Australia. This presents a challenge to the government on how best to influence the rate and distribution of specialists' services. [ABSTRACT FROM AUTHOR]

Objectives: To identify features of mental health services that affect the uptake of services among parents of children with chronic medical conditions, to inform the design of pathways into mental health care. Methods: A discrete choice experiment in which participants made choices between hypothetical mental health services described in terms of service features: cost, wait time, provider knowledge of chronic medical conditions, recommendations, opening hours, and travel time. Participants were parents of children attending The Royal Children's Hospital outpatient clinics for the management of a chronic medical condition who completed the online survey between August 2020 and January 2021. The uptake of mental health services with differing features was predicted based on regression models examining the relationship between choice and service features, and accounting for participant characteristics and unobserved heterogeneity. Results: The sample comprised 112 parents, of whom 52% reported unmet needs. The most influential service features were wait times, cost, recommendation from medical specialists, and mental health provider knowledge of chronic medical conditions. Predicted uptake of a realistic service showed inequalities across income, parental education, and single parent status. A service comprising preferred features was predicted to eliminate these inequalities. Conclusions: Reducing cost and wait time for mental health services could reduce unmet need among children with chronic medical conditions. Specific approaches to tackle the high levels of unmet needs in this group include equipping medical specialists to recommend mental health providers and training mental health providers on the impacts of chronic medical conditions on children. Offering preferred services could increase uptake and reduce inequalities in mental health care. What is known about the topic? Children with chronic medical conditions have high rates of unmet need for mental healthcare. Qualitative research has indicated features of mental health services that may be important to consider in service design to address these unmet needs. What does this paper add? A detailed understanding of parents' preferences for features of mental health services for children with chronic medical conditions, including their importance and prediction of uptake under different scenarios. What are the implications for practitioners? Parents preferred services with recommendation from specialists, mental health providers who understand the impact of chronic conditions, lower cost, and shorter wait time. Offering preferred mental health services is predicted to significantly reduce unmet needs and reduce inequalities in care. [ABSTRACT FROM AUTHOR]

Objective: This study assessed the impact of the COVID-19 pandemic on emergency departments (EDs) in South Australia, measured by changes in the number and casemix of patients in the system over time. Methods: Data from the South Australia Emergency Department Dashboard, updated every 30 min, were analysed for the period 4 October–21 December 2020. The Dashboard reports live counts of the number and type of patients in each of the six adult metropolitan public EDs in Adelaide, South Australia. Results: There was a significant difference in the mean daily average occupied ED capacity before and during two distinct increases in COVID-19 cases in South Australia. An increase in COVID-19 cases coincided with a decrease in patients in EDs (Pearson's r = –0.93 and –0.67; P < 0.001 for both). Presentations in Australasian Triage Scale (ATS) Categories 2–5 decreased during these periods, whereas ATS Category 1 stayed constant. Mental health patients continued to present to the ED, despite the overall drop in ED presentations. Conclusions: During the two periods of COVID-19 case growth in South Australia, there was a significant drop in the number of patients presenting to the major public EDs and a change in the casemix of patients over time. What is known about the topic?: EDs in Australia often operate at or over capacity, with frequent reports of ambulance ramping, access block and long waiting times. There have been reports internationally of significant declines in ED presentations throughout the COVID-19 pandemic. What does this paper add?: This paper uses a novel publicly available data source that is available in real time to contribute a new perspective from South Australia, which has experienced two distinct periods of strict restrictions and lockdown. The research showed that the number of mental health presentations remained consistently high, despite a significant overall decline in ED occupancy. What are the implications for practitioners?: This study demonstrates that South Australians are accessing emergency medical treatment differently in response to the COVID-19 pandemic. In the context of an overall decline in presentation numbers, the number of mental health-related presentations has not changed significantly, suggesting that this trend should be closely monitored. The findings corroborate the national concern that unwell people have avoided accessing emergency medical care during the pandemic, leading to worse outcomes and increased need for healthcare resources at a later date. It will be important to monitor and quickly detect further changes in ED usage using real-time data as the pandemic evolves, as well as in any future significant health crises. [ABSTRACT FROM AUTHOR]

Objective: MindStep™ is an Australian low-intensity cognitive behaviour therapy (LICBT) program for individuals with mild-to-moderate symptoms of anxiety and depression. UK-produced LICBT guided self-help (GSH) materials were originally used in the MindStep™ program. In 2017, Australian LICBT GSH materials were developed to better suit Australian users. This study explored whether the Australian-produced materials continued to achieve the benchmark recovery rates established in the UK and maintained in recent Australian studies. Methods: Binomial logistic regression was conducted using retrospective client data, including the Patient Health Questionnaire-9 and the Generalised Anxiety Disorder 7-item scale, between 2016 and 2019. Results: During time periods in which the Australian-produced materials were used, equivalent rates of reliable recovery and improvement were achieved compared with time periods in which the UK-produced materials were used. Australian-trained LICBT coaches, using Australian-produced LICBT GSH materials, achieve client recovery rates of up to 60%, reliable improvement rates of 58% and reliable recovery rates of 46% (with the probability of recovery increasing with client age). Conclusions: These findings are particularly pertinent with COVID-19 changing the landscape of mental health service delivery, requiring greater flexibility in the use of teleservices to ensure access to effective mental health care for populations that may already experience problems with isolation, access and service engagement. What is known about the topic?: LICBT is an acceptable, feasible and effective treatment approach for people experiencing mild-to-moderate anxiety and depression in Australia. LICBT GSH materials used with clients in Australia originated from the UK. However, according to guidelines, LICBT GSH materials should be contextualised to suit the audience they are being used with. What does this paper add?: This paper demonstrates that LICBT GSH materials tailored to an Australian context can be used in place of UK-produced materials because they yield equivalent and consistent therapeutic outcomes. Although contextualising the LICBT GSH materials for health services users was important, it is likely that the evidence-based cognitive behaviour therapy techniques sitting 'under the hood' of these materials are most important to ensure successful therapeutic outcomes. What are the implications for practitioners?: As we face unprecedented challenges following 2020, the physical, social, psychological and economic impacts of life-changing events must not inhibit access to treatments for common mental health conditions. It is anticipated that more non-traditional, alternative providers of mental health services will be needed to scale-up and respond to increasing demand. This paper shows that the provision of telephone-based LICBT in Australia, by trained coaches using Australian-produced GSH materials, is an evidenced-based support pathway that can reduce the access gap to treatments. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to quantify the direct and indirect costs of asthma and allergic rhinitis (AR) for 2018 in Tasmania. Methods: We used publicly available data, and Tasmanian-specific values where available, to estimate direct and indirect costs of both diseases. Direct costs included outcomes such as emergency department (ED) presentations, hospitalisations, general practice visits and medication use. Indirect costs included premature mortality and lost productivity. Results: Direct health impacts for both conditions combined included 1454 ED presentations, 682 hospitalisations, 72 446 general practice visits and 7122 specialist visits. Indirect health impacts included 13 deaths and between 483 000 and 2.8 million days of lost productivity. Total costs ranged between A$126.5 million and A$436.7 million for asthma and between A$65.3 million and A$259.7 million for AR. Per-person annual costs ranged between A$1918 and A$6617 for asthma and between A$597 and A$2374 for AR. Conclusions: The main financial burden due to asthma and AR was related to productivity losses from presenteeism and absenteeism. The magnitude of the economic impacts of AR and asthma warrants further analysis to produce a national-level assessment. Such analyses could identify cost-effective interventions that produce highest benefits for the management of these conditions in our community. What is known about the topic?: Allergic respiratory diseases, and particularly asthma and AR, pose a significant health burden, with effects including asthma-related hospital admissions, significant pharmaceutical expenditure and lost workforce and school education productivity. Australia, and particularly Tasmania, has a high prevalence of these conditions, but no recent studies have appraised or estimated their health impacts and costs. What does this paper add?: This paper proposes a unique and transparent costing model that allows the costs of these conditions to be estimated while accounting for restrictions in data availability. The model is used to provide the first comprehensive costings of asthma and AR in Tasmania, Australia. We identified that the estimated health costs are dominated by productivity losses from presenteeism and absenteeism, and that total per person costs are higher for a person with asthma compared to one with AR. What are the implications for practitioners?: This analysis has the potential to guide cost-effective interventions by identifying where the highest benefits may be obtained when managing these conditions in our community. [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]

Objectives: To assess whether adding clinical information and written discharge documentation variables improves prediction of paediatric 30-day same-hospital unplanned readmission compared with predictions based on administrative information alone. Methods: A retrospective matched case-control study audited the medical records of patients discharged from a tertiary paediatric hospital in Western Australia (WA) between January 2010 and December 2014. A random selection of 470 patients with unplanned readmissions (out of 3330) were matched to 470 patients without readmissions based on age, sex, and principal diagnosis at the index admission. Prediction utility of three groups of variables (administrative, administrative and clinical, and administrative, clinical and written discharge documentation) were assessed using standard logistic regression and machine learning. Results: Inclusion of written discharge documentation variables significantly improved prediction of readmission compared with models that used only administrative and/or clinical variables in standard logistic regression analysis (χ217 = 29.4, P = 0.03). Highest prediction accuracy was obtained using a gradient boosted tree model (C-statistic = 0.654), followed closely by random forest and elastic net modelling approaches. Variables highlighted as important for prediction included patients' social history (legal custody or patient was under the care of the Department for Child Protection), languages spoken other than English, completeness of nursing admission and discharge planning documentation, and timing of issuing discharge summary. Conclusions: The variables of significant social history, low English language proficiency, incomplete discharge documentation, and delay in issuing the discharge summary add value to prediction models. What is known about the topic?: Despite written discharge documentation playing a critical role in the continuity of care for paediatric patients, limited research has examined its association with, and ability to predict, unplanned hospital readmissions. Machine learning approaches have been applied to various health conditions and demonstrated improved predictive accuracy. However, few published studies have used machine learning to predict paediatric readmissions. What does this paper add?: This paper presents the findings of the first known study in Australia to assess and report that written discharge documentation and clinical information improves unplanned rehospitalisation prediction accuracy in a paediatric cohort compared with administrative data alone. It is also the first known published study to use machine learning for the prediction of paediatric same-hospital unplanned readmission in Australia. The results show improved predictive performance of the machine learning approach compared with standard logistic regression. What are the implications for practitioners?: The identified social and written discharge documentation predictors could be translated into clinical practice through improved discharge planning and processes, to prevent paediatric 30-day all-cause same-hospital unplanned readmission. The predictors identified in this study include significant social history, low English language proficiency, incomplete discharge documentation, and delay in issuing the discharge summary. [ABSTRACT FROM AUTHOR]

Objective: To examine the impact of telehealth policy changes on general practitioner (GP) consultation activity in Australia, during the coronavirus disease 2019 (COVID-19) pandemic, from January 2019 to December 2021. Methods: An interrupted time-series analysis was conducted to analyse the impact of two major policy changes, introduced through the Medicare Benefits Schedule (MBS), on GP consultation (in-person, videoconference, telephone) activity. The first policy change was the introduction of additional COVID-19 telehealth funding through the MBS on 30 March 2020. The second policy change was the limitation on telephone consultation length to under 20 min on 1 July 2021. The rate of GP telehealth provision and activity was compared between pre-and post-intervention periods, separated by these MBS policy changes. Results: After the first policy change, there was a significant increase in telehealth provision, with a simultaneous decrease in in-person consultations (P < 0.0001). However, telehealth provision decreased in the months following this first policy change (P < 0.0001), while in-person activity increased. After the second policy change, the initial videoconference provision increased (P < 0.0001). However, all telehealth activity decreased afterwards. In the months following the second policy change, the decrease in monthly activity for in-person (P = 0.700), telephone (0.199) and videoconference (P = 0.178) consultations was not significant. Conclusions: The introduction of additional telehealth funding and limitations on telephone consultation length encouraged the initial provision and growth of telehealth services. However, these policy changes did not sustain the long-term upward trajectory of telehealth activity. Telehealth policies should increase opportunities for appropriate and sustainable GP telehealth services. What is known about the topic? The COVID-19 pandemic was a catalyst for increased telehealth provision by general practitioners (GPs). Since COVID-19, the Australian Government have invested in telehealth by increasing reimbursement opportunities through the Medicare Benefits Schedule (MBS) and making multiple telehealth policy changes. What does this paper add? This study examined the impact of MBS telehealth policy changes on GP consultation activity in Australia over 3 years during COVID-19. What are the implications for practitioners? Telehealth funding is necessary for service viability. However, funding alone is unlikely to encourage increased videoconference use and is unlikely to promote long-term telehealth provision. Future telehealth policies should increase opportunities for appropriate and sustainable GP telehealth services. [ABSTRACT FROM AUTHOR]

Objective: Implementing the routine collection of patient reported outcome measures (PROMs) is key to improving healthcare quality and patient satisfaction. The implementation process can be strengthened through staff and patient co-design. The aim of this project was to develop a set of Australian PROM implementation recommendations ('AusPROM') to guide rapid translation into practice. Methods: Staff working across 29 Australian private hospitals participated in the project. The hospitals provided elective surgery and spanned each state and territory of Australia. Staff engaged in a Delphi technique to develop the AusPROM, which involved three iterative focus groups. To ensure full disclosure, staff were also provided with additional project-related data sources throughout the Delphi technique. This included data from a patient focus group (patient co-design), patient survey, technical feasibility testing, 3 months of pilot testing (four sites), 3 months of national implementation (29 sites) and global evidence. This process ensured that staff and patient feedback was used to co-design the three iterations of the AusPROM recommendations until the final agreed version was established. Results: A total of 22 AusPROM recommendations were included in the final iteration. The recommendations covered the domains of PROM characteristics, healthcare organisation characteristics, external influences, staff and patient characteristics, and facilitators to implementing AusPROMS in routine practice. Conclusion: The AusPROM recommendations offer practical considerations for the implementation of PROMs in hospitals. The iterative nature of the Delphi technique ensured that staff and patient co-design were central to the development of the AusPROM recommendations. What is known about the topic? Patient reported outcome measures (PROMs) are key to improving healthcare quality and patient satisfaction. What does this paper add? Practical considerations have been presented to support the implementation of PROMs in hospitals. What are the implications for practitioners? Knowing that the Australian PROM implementation recommendations (AusPROM) have been co-designed by hospital staff and patients, for hospital staff and patients, may help health services engage in PROM implementation. [ABSTRACT FROM AUTHOR]

Objectives: To describe the burden of disease and hospitalisation costs in children with common infections using statewide administrative data. Methods: We analysed hospitalisation prevalence and costs for 10 infections: appendicitis, cellulitis, cervical lymphadenitis, meningitis, osteomyelitis, pneumonia, pyelonephritis, sepsis, septic arthritis, and urinary tract infections in children aged <18 years admitted to hospital within New South Wales, Australia, using an activity-based management administrative dataset over three financial years (1 July 2016–30 June 2019). Results: Among 339 077 admissions, 28 748 (8.48%) were coded with one of the 10 infections, associated with a total hospitalisation cost of AUD230 905 190 and a per episode median length-of-stay of 3 bed-days. Pneumonia was the most prevalent coded infection (3.1% [ n = 10 524] of all admissions), followed by appendicitis (1.61%; n = 5460), cellulitis (1.22%; n = 4126) and urinary tract infections (0.94%; n = 3193). Eighty per cent of children (n = 22 529) were admitted to a non-paediatric hospital. Mean costs were increased 1.18-fold per additional bed-day, 2.14-fold with paediatric hospital admissions, and 5.49-fold with intensive care unit admissions, which were both also associated with greater total bed-day occupancy. Indigenous children comprised 9.7% of children admitted with these infections, and mean per episode costs, and median bed-days were reduced compared with non-Indigenous children (0.84 [95% CI 0.78, 0.89] and 3 (IQR: 2,5) vs 2 (IQR: 2,4), respectively. Conclusions: Infections in children requiring hospitalisation contribute a substantial burden of disease and cost to the community. This varies by infection, facility type, and patient demographics, and this information should be used to inform and prioritise programs to improve care for children. What is known about the topic? Infections contribute an important source of paediatric hospital admissions, but the population burden of these infections and nature of associated hospitalisations are not well understood. What does this paper add? Ten infectious conditions contributed to almost 10% of all paediatric hospitalisations, and costs were increased with additional bed-days, paediatric hospital admission, and intensive care use. What are the implications for practitioners? This information should be used to prioritise areas of care for hospitalised children, with potential for benchmarking and focusing resources within areas of need. [ABSTRACT FROM AUTHOR]

Objective: To explore the perceptions of rural health professionals who use telehealth services for cardiovascular health care, including the potential role of telehealth in enhancing services for this patient group. Methods: Semi-structured interviews were conducted with ten rural health professionals across a range of disciplines, including medicine, nursing and allied health. All study participants were based in the same rural region in New South Wales, Australia. Results: Participant responses emphasised the importance of including rural communities in ongoing dialogue to enhance telehealth services for cardiovascular care. Divergent expectations about the purpose of telehealth and unresolved technology issues were identified as factors to be addressed. Rural health professionals highlighted the importance of all stakeholders coming together to overcome barriers and enhance telehealth services in a collaborative manner. Conclusion: This study contributes to an evolving understanding of how health professionals based in regional Australia experience telehealth services. Future telehealth research should proceed in collaboration with rural communities, supported by policy that actively facilitates the meaningful inclusion of rural stakeholders in telehealth dialogue. What is known about the topic?: Telehealth is frequently discussed as a potential solution to overcome aspects of rural health, such as poor outcomes and limited access to services compared with metropolitan areas. In the context of telehealth and cardiovascular disease (CVD), research that focuses on rural communities is limited, particularly regarding the experiences of these communities with telehealth. What does this paper add?: This paper offers insight into how telehealth is experienced by rural health professionals. The paper highlights divergent expectations of telehealth's purpose and unresolved technological issues as barriers to telehealth service delivery. It suggests telehealth services may be enhanced by collaborative approaches that engage multiple stakeholder groups. What are the implications for practitioners?: The use and development of telehealth in rural communities requires a collaborative approach that considers the views of rural stakeholders in their specific contexts. To improve telehealth services for people living with CVD in rural communities, it is important that rural stakeholders have opportunities to engage with non-rural clinicians, telehealth developers and policy makers. [ABSTRACT FROM AUTHOR]

Objective: Men who experience homelessness in Australia often have complex health and social issues, including the trimorbidity of concurrent mental illness, substance use disorders and physical health conditions. These men tend to have poor health outcomes, and present challenges to healthcare systems. To improve system responsiveness and patient outcomes, the perspectives of marginalised groups need to be understood. Methods: Five focus groups were conducted with 20 men in a homeless men's hostel, exploring their experiences of seeking and receiving health care, and views about improving these. An inductive thematic analysis was undertaken. Results: Several participants expressed gratitude for care provided for life-threatening physical illness and trauma. However, negative experiences of health system responses were more frequently reported. Four emerging themes all made securing effective 'tickets of entry' to health care more difficult: dismissive care, care fragmentation, inconsistent medical management of pain and inadequate acknowledgement of psychological distress. Conclusions: Improvements are needed in care integration and the de-escalation of potentially confrontational interactions. Effective, safe and compassionate system responses to presentations of psychological distress and pain should be collaboratively developed. Some current responses may entrench stigma, further traumatising vulnerable patients. What is known about the topic?: Men who experience homelessness have poor health outcomes and present challenges to healthcare systems. What does this paper add?: This paper describes healthcare experiences and insights of men who are experiencing homelessness in Australia. These men reported experiencing dismissive care, care fragmentation, inconsistent, inadequate and/or unsafe prescribing for pain and inconsistent and/or ineffective responses to psychological distress. What are the implications for practitioners?: Changes are needed in health system responses, informed by the experiences and insights of marginalised people, to break cycles of trauma and exclusion. [ABSTRACT FROM AUTHOR]

Objectives: This study examined the risk factors for non-participation in a developmental surveillance program in a population in south-west Sydney with a high proportion of culturally diverse and socioeconomically disadvantaged people. Methods: Data from 850 and 625 12- and 18-month-old children respectively from the Watch Me Grow (WMG) birth cohort were used for this study. Logistic regression models were used to assess risk factors for 12- and 18-month non-attendance at Well Child Visits, as well as non-completion of the developmental surveillance questionnaire Parents' Evaluation of Developmental Status (PEDS) in the child's personal health record (PHR). Results: Independent risk factors for non-attendance at Well Child Visits were female sex of the child (odds ratio (OR) 12 months 1.5; 95% confidence interval (CI) 1.0–2.3), mother's country of birth Australia (OR 18 months 1.8; 95% CI 1.2–2.7), annual household income less than A$25 001 (OR 12 months 1.8; 95% CI 1.0–3.2) and residing in a socioeconomically disadvantaged neighbourhood (OR 12 months 1.7; 95% CI 1.1–2.5). Independent risk factors for non-completion of PEDS in those who did not attend the Well Child Visit compared with those who did attend and did complete PEDS were household annual income at birth less than A$25 001 (OR 12 months 3.9; 95% CI 1.9–8.1) and residing in a socioeconomically disadvantaged neighbourhood (OR 12 months 2.1 (95% CI 1.2–3.7) and OR 18 months 2.0 (95% CI 1.2–3.6)). Conclusions: In this population, children exposed to socioeconomic disadvantage are less likely to have attended a Well Child Visit and to have a completed PEDS in their PHR at 12 and/or 18 months of age. What is known about the topic?: Developmental problems are common in early childhood, and children from socioeconomically disadvantaged households are at higher risk. Universal developmental surveillance programs may be effective at early identification of children at risk of developmental problems. Early childhood interventions, when accessed, can lessen the effects of developmental problems in later years. What does this paper add?: This paper highlights that children exposed to socioeconomic disadvantage in early childhood who are at higher risk of having developmental problems are also at higher risk of missing out on early identification by non-participation in universal developmental surveillance. What are the implications for practitioners?: A more equitable model of developmental surveillance should include a framework of proportionate universalism to ensure optimal engagement of high-risk population groups. [ABSTRACT FROM AUTHOR]

Objective: In light of concerns surrounding neoliberal government approaches to addressing Aboriginal disadvantage, this project examined how Elders consider the Closing the Gap programs for improving community health outcomes. Methods: A participatory action research project was undertaken in collaboration with eight Elders from a remote Aboriginal community in Australia's island state of Tasmania. The findings emerged from thematic analysis of individual interviews and yarning circles. Results: The Closing the Gap programs were seen by Elders as having instrumental value for addressing Aboriginal community disadvantage. However, the programs also represented a source of ongoing dependency that threatened to undermine the community's autonomy, self-determination and cultural foundations. The findings emerged to represent Elders attempting to reconcile this tension by embedding the programs with cultural values or promoting culture separately from the programs. Ultimately, the Elders saw culture as the core business of community well-being and effective program delivery. Conclusion: The findings are reflective of tensions that arise when neoliberal policies are imposed on Aboriginal ways of knowing, being and doing. The Elders premised cultural well-being as the key determinant of Aboriginal community health. What is known about the topic?: Closing the Gap represents successive neoliberal policy responses of Australian governments to address ongoing Aboriginal disadvantage. What does this paper add?: Closing the Gap programs were recognised by Aboriginal Elders for providing the community with improved services, but also a threat to the community's cultural foundations and self-determination. The findings illustrate ongoing tensions between neoliberal principles and Aboriginal cultural values. What are the implications for practitioners?: More effective Closing the Gap approaches require greater collaboration between policy stakeholders and community Elders. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to describe the prevalence of cognitive impairment in hospital inpatients, the associated need for assistance with activities of daily living (ADL) and carer perceptions of hospital care. Methods: A prospective cross-sectional observational study was conducted in a large metropolitan teaching hospital in Brisbane, Australia. Participants were inpatients aged ≥65 years and their carers. Cognitive impairment was measured by clinician auditors using the validated 4 'A's test (4AT), with a score >0 indicating cognitive impairment (1–3, probable dementia; >3, probable delirium). The need for supervision and/or assistance with ADL was recorded from daily nursing documentation. Carers were invited to complete a brief questionnaire. Results: In all, 92 of 216 older inpatients (43%) had cognitive impairment, including 52 (24%) with probable delirium. The need for supervision and/or assistance with ADL increased significantly with 4AT score. Fifty-two carers of patients with cognitive impairment reported feeling welcome and that care was safe. They identified opportunities for better information, greater support and more inclusion of carers. Conclusions: Cognitive impairment is common in older inpatients and is associated with increased care needs. Workforce planning and health professional training need to acknowledge the needs of patients with cognitive impairment. There are opportunities for greater support and more involvement of carers. What is known about the topic?: Cognitive impairment due to delirium and dementia increases with age, and is common in older medical and surgical inpatients. However, cognitive impairment remains under-recognised by healthcare staff. Australian guidelines now recommend routine screening using valid tools, and including carers, when appropriate, when assessing, caring for and communicating with people with cognitive impairment. What does this paper add?: This cross-sectional study using the validated 4AT showed 43% of hospital inpatients aged ≥65 years had cognitive impairment. Participants with cognitive impairment had higher care needs and much longer hospitalisations. Carers of people with cognitive impairment reported unmet information needs in hospital and had limited involvement in assessment and care. What are the implications for practitioners?: Cognitive impairment is common in older inpatients. Hospitals and healthcare professionals must be prepared and equipped to recognise cognitive impairment, and address the accompanying patient and carer needs. [ABSTRACT FROM AUTHOR]

Objective. Chronic pain and cardiovascular disease (CVD) have a high disease burden. This research aimed to understand whether Australian primary health networks (PHNs) are recognising the need for the prevention of these conditions by investigating what local health and service issues have been identified. Methods. Separate sets of needs assessments were analysed for chronic pain and CVD for all 31 PHNs using a document analysis approach. Framework analysis was undertaken to ascertain the types of health and service issues, prevention-related issues and supporting data sources identified, as well as to quantify the number of PHNs identifying these issues. Results. Fewer PHNs identified health issues for chronic pain (n = 13) compared with CVD (n = 30), with the most common being disease prevalence and burden supported by National Health Survey data. Service issues were identified by fewer than half the PHNs (n = 13 for each disease), which were largely informed by stakeholder consultation and related to service integration, service accessibility and health professional training. Prevention-related issues were frequently identified for CVD (n = 26), but not chronic pain (n = 3). Conclusions. This paper highlights the need for a greater focus on chronic pain- and CVD-related issues by PHNs. This could be supported nationally by recognising chronic pain and risk factors in national datasets and PHN performance frameworks, and locally via greater stakeholder consultation to inform PHN population health planning. [ABSTRACT FROM AUTHOR]

Objective: This study assessed the effect of the frequency of general practitioner (GP) visitation in the 12 months before a 21% consumer copayment increase in the Pharmaceutical Benefits Scheme (PBS; January 2005) on the reduction or discontinuation of statin dispensing for tertiary prevention. Methods: The study used routinely collected, whole-population linked PBS, Medicare, mortality and hospital data from Western Australia. From 2004 to 2005, individuals were classified as having discontinued, reduced or continued their use of statins in the first six months of 2005 following the 21% consumer copayment increase on 1 January 2005. The frequency of GP visits was calculated in 2004 from Medicare data. Multivariate logistic regression models were used to determine the association between GP visits and statin use following the copayment increase. Results: In December 2004, there were 22 495 stable statin users for tertiary prevention of prior coronary heart disease, prior stroke or prior coronary artery revascularisation procedure. Following the copayment increase, patients either discontinued (3%), reduced (12%) or continued (85%) their statins. Individuals who visited a GP three or more times in 2004 were 47% less likely to discontinue their statins in 2005 than people attending only once. Subgroup analysis showed the effect was apparent in men, and long-term or new statin users. The frequency of GP visits did not affect the proportion of patients reducing their statin therapy. Conclusions: Patients who visited their GP at least three times per year had a lower risk of ceasing their statins in the year following the copayment increase. GPs can help patients maintain treatment following rises in medicines costs. What is known about the topic?: Following the 21% increase in medication copayment in 2005, individuals discontinued or reduced their statin usage, including for tertiary prevention. What does this paper add?: Patients who visited their GP at least three times per year were less likely to discontinue their statin therapy for tertiary prevention following a large copayment increase. What are the implications for practitioners?: This paper identifies the important role that GPs have in maintaining the continued use of important medications following rises in medicines costs. [ABSTRACT FROM AUTHOR]

Objective: Heart failure (HF) is associated with increased morbidity and mortality. A significant proportion of HF patients will have repeated hospital presentations. Effective integration between general practice and existing HF management programs may address some of the challenges in optimising care for this complex patient population. The Heart Failure Integrated Care Project (HFICP) investigated the barriers encountered by primary healthcare providers in providing care to patients with HF in the community. Methods: Five general practices in the St George and Sutherland regions (NSW, Australia) that employed practice nurses (PNs) were enrolled in the project. Participants responded to a printed survey that asked about their perceived role in the management of HF patients and their current knowledge and confidence in managing this condition. Participants also took part in a focus group meeting and were asked to identify barriers to improving HF patient management in general practice, and to offer suggestions about how the project could assist them to overcome those barriers. Results: Barriers to effective delivery of HF management in general practice included clinical factors (consultation time limitations, underutilisation of patient management systems, identifying patients with HF, lack of patient self-care materials), professional factors (suboptimal hospital discharge summary letters, underutilisation of PNs), organisation factors (difficulties in communication with hospital staff, lack of education regarding HF management) and system issues (no Medicare rebate for B-type natriuretic peptide testing, insufficient Medicare rebate for using PN in chronic disease management). Conclusions: The HFICP identified several barriers to improving integrated management for HF patients in the Australian setting. These findings provide important insights into how an HF integrated care model can be implemented to strengthen the working relationship between hospitals and primary care providers in delivering better care to HF patients. What is known about the topic?: Multidisciplinary HF programs are heterogeneous in their structures, they have low patient participation rates and a significant proportion of HF patients have further presentations to hospital with HF. Integrating the care of HF patients into the primary care system following hospital admission remains challenging. What does this paper add?: This paper identified several factors that hinder the effective delivery of care by primary care providers to patients with HF. What are the implications for practitioners?: The findings provide important insights into how an HF integrated care model can be implemented to strengthen the working relationship between tertiary health facilities and primary care providers in delivering better care to HF patients. [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 study gathered information from public hospital chief medical officers to better understand underlying mechanisms through which public reporting affects institutional behavioural change and decision making towards quality improvement. Methods: This qualitative study used thematic analysis of 17 semistructured, in-depth interviews among a peak group of medical directors representing 26 health services in Victoria, Australia. Results: The medical directors indicated a high level of in-principle support for public reporting of identifiable, individual clinician-level data. However, they also described varying conceptual understanding of what public reporting of performance data is. Overall, they considered public reporting of individual clinicians' performance data a means to improve health care quality, increase transparency and inform consumer healthcare decision making. Most identified caveats that would need to be met before such data should be publicly released, in particular the need to resolve issues around data quality and timeliness, context and interpretation and ethics. Acknowledgement of the public's right to access individual clinician-level data was at odds with some medical directors' belief that such reporting may diminish trust between clinicians and their employers, thus eroding rather than motivating quality improvement. Conclusions: Public reporting of identifiable individual healthcare clinicians' performance data is an issue that merits robust research and debate given the effects such reporting may have on doctors and on hospital quality and safety. What is known about the topic?: The public reporting of individual clinician-level data is a mechanism used in some countries, but not in Australia, for increasing health care transparency and quality. Clinician-level public reporting of doctors' performance attracts contention and debate in Australia. What does this paper add?: This paper informs debate around the public reporting of individual clinician-level performance data. Among a discrete cohort of senior hospital administrators in Victoria, Australia, there was strong in-principle support for such public reporting as a means to improve hospital quality and safety. What are the implications for practitioners?: Before public reporting of individual clinician performance data could occur in Australia, resolution of issues would be required relating to legality and ethics, data context and interpretation, data quality and timeliness. [ABSTRACT FROM AUTHOR]

Objective: The aims of this study were to profile the most common complaints and to examine whether any demographic factors are associated with receiving a complaint for five health professions in Australia. Methods: A national cohort study was conducted for all complaints received for medicine, nursing/midwifery, dentistry, pharmacy and psychology from 1 July 2012 to 31 December 2013 (18 months). Data were collected from the Australian Health Practitioner Regulation Agency (AHPRA), the New South Wales (NSW) Health Professional Councils' Authority and the NSW Health Care Complaints Commission. The frequency and risk of complaints were summarised for the five professions and by demographic information. Results: There were 545 283 practitioners registered with AHPRA between 1 July 2012 and 31 December 2013, consisting of 20 935 dentists, 101 066 medical practitioners, 363 040 nurses/midwives, 28 370 pharmacists and 31 872 psychologists. During the study period there were 12 616 complaints, corresponding to an annual rate of 1.5 per 100 practitioners. Complaints were most common for doctors and dentists (5% per annum per practitioner) and least common for nurses/midwives (0.5% per annum per practitioner). Sex (P < 0.01), age (P < 0.01) and country of birth (P < 0.01) were all associated with risk of complaint. The most common complaints were clinical care (44% of all complaints), medication (10%) and health impairment of the practitioner (8%). Types of complaints varied by profession, sex and age. Conclusions: The risk of a complaint is low, but varies by profession and demographics. The types of complaints also vary by profession and demographics. Differences between professions is most likely driven by their different work tasks and work environments. What is already known on this subject?: Although complaints are summarised annually from state and national health regulators, no overall national summary of complaints across professions exists. Thus, it is difficult to examine which complaints are most common, how professions differ from each other or what factors may be associated with risk and type of complaint. Previous studies have primarily focused on a single profession, such as medicine, where, for example, the number of prior complaints, sex, doctor speciality and age have been found to be associated with recurrent complaints. What does this paper add?: This paper is the first of this kind to provide a national summary of all complaints from five of the most common health professions in Australia. We found that regardless of profession, men were at least twice as likely to have a complaint made against them than women. We also found that the types of complaint differed between men and women. There were similarities across professions for the most common types of complaints, but clear differences between professions were also noted. Not surprising, clinical care was typically the most common type of complaint for the five professions, but somewhat surprising was the inclusion of health impairment as one of the most common types of complaints. What are the implications for practitioners?: Identifying the most common complaints, and the factors associated with these, may assist practitioners to understand their risk(s) of complaint and could potentially assist educators and regulators develop education programs that help reduce complaints. [ABSTRACT FROM AUTHOR]

Objective: Analytical techniques are being implemented with increasing frequency to improve the management of surgical departments and to ensure that decisions are well informed. Often these analytical techniques rely on the validity of underlying statistical assumptions, including those around choice of distribution when modelling uncertainty. The aim of the present study was to determine a set of suitable statistical distributions and provide recommendations to assist hospital planning staff, based on three full years of historical data. Methods: Statistical analysis was performed to determine the most appropriate distributions and models in a variety of surgical contexts. Data from 2013 to 2015 were collected from the surgical department at a large Australian public hospital. Results: A log-normal distribution approximation of the total duration of surgeries in an operating room is appropriate when considering probability of overtime. Surgical requests can be modelled as a Poisson process with rate dependent on urgency and day of the week. Individual cancellations could be modelled as Bernoulli trials, with the probability of patient-, staff- and resource-based cancellations provided herein. Conclusions: The analysis presented herein can be used to ensure that assumptions surrounding planning and scheduling in the surgical department are valid. Understanding the stochasticity in the surgical department may result in the implementation of more realistic decision models. What is known about the topic?: Many surgical departments rely on crude estimates and general intuition to predict surgical duration, surgical requests (both elective and non-elective) and cancellations. What does this paper add?: This paper describes how statistical analysis can be performed to validate common assumptions surrounding surgical uncertainty. The paper also provides a set of recommended distributions and associated parameters that can be used to model uncertainty in a large public hospital's surgical department. What are the implications for practitioners?: The insights on surgical uncertainty provided here will prove valuable for administrative staff who want to incorporate uncertainty in their surgical planning and scheduling decisions. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to determine the effect of a broad range of common mental disorders and their comorbidity on health-related quality of life and functional disability. Methods: In all, 2734 Australians aged ≥18 years, recruited from the general community via Facebook during August–December 2014, completed an online survey assessing demographic characteristics, nine mental disorders, suicidal ideation and attempt. Outcome measures were health-related quality of life (assessed using the Assessment of Quality of Life (AQoL)-4D measure and functional disability (days out of role). Results: Overall, 53.1% of the sample met criteria for at least one mental disorder. Participants with each of the 11 mental health problems had significantly lower mean AQoL-4D scores and significantly greater functional disability compared with not having the disorder (P < 0.001). A monotonic decrease in quality of life and an increase in functional disability were observed with an increased total number of comorbid disorders (P < 0.001). Accounting for disorder prevalence, annual economic burden for each mental disorder was estimated to be in the range of A$870 million–A$17 billion. Conclusions: Mental disorders negatively affect health-related quality of life and functional disability, exacerbated by increased comorbidity. The economic burden to participants and employers estimated in this study is of concern, and highlights the importance of evidence-based treatment and prevention approaches. What is known about the topic?: Mental disorders are associated with poorer health-related quality of life, increased functional disability and increased economic costs. What does this paper add?: This paper furthers our understanding of the associations of nine mental disorders, suicidal ideation and suicide attempts with quality of life in an Australian setting, highlighting the considerable economic implications of these associations. Further, it reveals that comorbidity of mental disorders exacerbates reductions in quality of life and increased functional disability. What are the implications for practitioners?: The economic burden associated with lost productivity and quality of life for individuals with mental disorders is considerable. Therefore, prioritising funding to prevention and treatment using evidence-based approaches will have significant effect in terms of economic productivity and personal well-being for individuals. [ABSTRACT FROM AUTHOR]

Objective: This study explored the current activities of a sample of Australian private health insurance (PHI) funds to support the care of people living with chronic conditions, following changes to PHI legislation in 2007 permitting funds to cover a broader range of chronic disease management (CDM) services. Methods: A qualitative research design was used to gather perspectives from PHI sector representatives via semistructured interviews with eight participants. The interview data were analysed systematically using the framework analysis method. Results: Three main types of activities were most commonly identified: (1) healthcare navigation; (2) structured disease management and health coaching programs; and (3) care coordination services. These activities were primarily conducted via telephone by a combination of in-house and third-party health professionals. PHI funds seem to be taking a pragmatic approach to the type of CDM activities currently offered, guided by available data and identified member need. Activities are focused on people with diagnosed chronic conditions exiting hospital, rather than the broader population at-risk of developing a chronic condition. Conclusions: Despite legislation permitting PHI funds to pay benefits for CDM services being in place for more than 10 years, insurers are still in an early stage of implementation and evaluation of CDM activities. Primarily due to the regulated scope of PHI coverage in Australia, participants reported several challenges in providing CDM services, including identifying target groups, evaluating service outcomes and collaborating with other healthcare providers. The effectiveness of the approach of PHI funds to CDM in terms of the groups targeted and outcomes of services provided still needs to be established because evidence suggests that population-level interventions that target a larger number of people with lower levels of risks are likely to have greater benefit than targeting a small number of high-risk cases. What is known about the topic?: Since 2007, PHI funds in Australia have been able to pay benefits for a range of out-of-hospital services, focused on CDM. Although a small number of program evaluations has been published, there is little information on the scope of activities and the factors influencing the design and implementation of CDM programs. What does this paper add?: This paper presents the findings of a qualitative study reporting on the CDM activities offered by a sample of PHI funds, their approach to delivery and the challenges and constraints in designing and implementing CDM activities, given the PHI sector's role as a supplementary health insurer in the Australian health system. What are the implications for practitioners?: Current CDM activities offered by insurers focus on health navigation advice, structured, time-limited CDM programs and care coordination services for people following a hospital admission. There is currently little integration of these programs with the care provided by other health professionals for a person accessing these services. Although the role of insurers is currently small, the movement of insurers into service provision raises considerations for managing potential conflicts in having a dual role as an insurer and provider, including the effectiveness and value of services offered, and how these programs complement other types of health care being received. [ABSTRACT FROM AUTHOR]

Objectives: The aims of this study were to determine the costs of hospital-acquired pressure injuries (HAPIs) in one local health district in Australia and compare the costs and consequences of an intervention-based program with current practice to reduce HAPI incidence and prevalence. Methods: A retrospective cost–consequence analysis was conducted using HAPI incidence rate per occupied bed days, point prevalence rates, Australian Refined-Diagnosis Related Group (AR-DRG) costs and the costs of the program to reduce the HAPI rate. Data were analysed for two phases: preprogram implementation (1 June 2015–1 June 2016) and postprogram implementation (1 August 2016–31 July 2017). Results: The HAPI intervention-based program resulted in a 51.4% reduction in the incidence of HAPI (from 1.46 per occupied bed day in 2014 to 0.71 per occupied bed day in 2017) and a 71.6% reduction in the prevalence of HAPI (from 6.7% in 2014 to 1.9% in 2017). The occurrence of HAPI added an average cost of A$3332 per episode, such that the overall program, including implementation, reduced costs by A$837 387. The greatest cost reduction was due to the cessation of washable and disposable underpads. The largest contributor to the cost of HAPI prevention was for education and training regarding HAPI prevention initiatives. Conclusions: The HAPI intervention-based program halved the incidence and substantially reduced the prevalence of HAPI, with a 23.1% cost saving compared with the previous approach to preventing HAPIs. What is known about the topic?: HAPIs are costly to the individual, the organisation and health system. The prevention of HAPIs is a priority in Australia. There is limited research on the economic effect of HAPIs and the costs and consequences for hospitals of implementation strategies to reduce their incidence. What does this paper add?: This paper informs health policy and decision makers about the costs and consequences for a local health district of a program to reduce and prevent HAPIs. This paper reports the economic effect of HAPIs, including hospital episode costs per HAPI and length of stay, on one local health district. What are the implications for practitioners?: This cost–consequence analysis has shown that the program to reduce HAPIs resulted in a reduction in expenditure and positive patient outcomes. Such a program is potentially transferable to other healthcare settings. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to compare robotic versus laparoscopic colorectal operations for clinical outcomes, safety and cost. Methods: A retrospective cohort study was performed of 213 elective colorectal operations (59 robotic, 154 laparoscopic), matched by surgeon and operation type. Results: No differences in age, body mass index, median American Society of Anesthesiologists score or presence of cancer were observed between the laparoscopic or robotic surgery groups. However, patients undergoing robotic colorectal surgery were more frequently male (P = 0.004) with earlier T stage tumours (P = 0.02) if cancer present. Procedures took longer in cases of robotic surgery (302 vs 130 min; P < 0.001), and patients in this group were more frequently admitted to intensive care units (P < 0.001). Overall length of stay was longer (7 vs 5 days; P = 0.03) and consumable cost was A$2728 higher per patient in the robotic surgery group. Conclusion: Robotic colorectal surgery appears to be safe compared with current laparoscopic techniques, albeit with longer procedure times and overall length of stay, more frequent intensive care admissions and higher consumables cost. What is known about the topic?: Robotic surgery is an emerging alternative to traditional laparoscopic approaches in colorectal surgery. International trials suggest the two techniques are equivalent in safety. What does this paper add?: This is an original cohort study examining clinical outcomes in Australian colorectal robotic surgery. The data suggest it may be safe, but this paper demonstrates key issues in the implementation and audit of novel surgical technologies in relatively low-volume centres. What are implications for practitioners?: In our study, patients undergoing robotic colorectal surgery at a single centre in Australia had equivalent measured clinical outcomes to those undergoing laparoscopic surgery. However, practitioners may counsel patients that robotic procedures are typically longer and more expensive, with a longer overall hospital admission and a higher likelihood of intensive care admission. [ABSTRACT FROM AUTHOR]

Objective: Allied health structures and leadership positions vary throughout Australia and New Zealand in their design and implementation. It is not clear which organisational factors support allied health leaders and professionals to enhance clinical outcomes. The aim of this project was to identify key organisational contexts and corresponding mechanisms that influenced effective outcomes for allied health professionals. Methods: A qualitative realist evaluation was chosen to describe key aspects of allied health organisational structures, identify positive outcomes and describe how context and processes are operationalised to influence outcomes for the allied health workforce and the populations they serve. Results: A purposive sample of nine allied health leaders, five executives and 49 allied health professionals were interviewed individually and in focus groups, representing nine Queensland Health services. Marked differences exist in the title and focus of senior allied health leaders' roles. The use of a qualitative realist evaluation methodology enabled identification of the mechanisms that work to achieve effective and efficient outcomes, within specific contexts. Conclusions: The initial middle range theory of allied health organisational structures in Queensland was supported and extended to better understand which contexts were important and which key mechanisms were activated to achieve effective outcomes. Executive allied health leadership roles enable allied health leaders to use their influence in organisational planning and decision-making to ensure allied health professionals deliver successful patient care services. Professional governance systems embed the management and support of the clinical workforce most efficiently within professional disciplines. With consistent data management systems, allied health professional staff can be integrated within clinical teams that provide high-quality care. Interprofessional learning opportunities can enhance collaborative teamwork and, when allied health professionals are supported to understand and use research, they can deliver positive patient and business outcomes for the health service. What is known about the topic?: A collective allied health organisational structure encourages engagement of allied health professionals within healthcare organisations. Organisational structures commonly include management and leadership strategies and service delivery models. Allied health leaders in Queensland work across a range of senior management levels to ensure adequate resources for sufficient suitably skilled professional staff to meet patient needs. What does this paper add?: Literature to date has described how allied health professionals operate within organisational structures. This paper examines key aspects of allied health management, governance and leadership, together with mechanisms that support allied health professionals to deliver effective clinical and business outcomes for their local community. What are the implications for practitioners?: Health service executives and allied health leaders should consider supporting executive allied health leadership roles to influence strategic planning and decision-making, as well as to deliver outcomes that are important to the health service. When allied health leaders implement integrated professional and operational governance systems, executives described allied health professionals as influential in supporting team-based models of care that add value to the business and improve outcomes for patients. When allied health leaders use consistent data management, executives reinforced the benefit of aligning activity data with financial costs to monitor, recognise and reimburse appropriate clinical interventions for patients. When allied health leaders support allied health workforce capability through educational and research opportunities, clinicians can use research to inform their clinical practice. [ABSTRACT FROM AUTHOR]

Objective: Although there is some research on women's choice of birthplace, most of this research has been conducted overseas. This study explored factors influencing the decision to use public or private maternity services within regional Australia. Methods: This cross-sectional study consisted of a community-based, anonymous, online questionnaire focused on factors influencing a woman's choice of birth location and included adult females who had given birth in the past 2 years within two regional areas. Descriptive statistics were used to analyse demographic characteristics and factors influencing decisions regarding birthplace. Pearson's Chi-squared test was used to compare public and private births for multiple variables. Binary logistic regression was used to determine the odds ratio for each potential factor based on whether participants with private health insurance (PHI) elected to birth in the public or private regional hospitals. Open coding was used to group responses to open ended questions into themes. Results: Data from 510 questionnaires were analysed. The three most frequently reported factors influencing a woman's decision about birthplace were financial reasons, the ability to choose their doctor and not having PHI. Women with PHI who opted for birth in the public system were almost four-fold more likely to select access to intensive care services and 2.6-fold more likely to select a preference for a low-intervention birth as one of their top five most influential factors. The results highlight that women want access to midwifery continuity of care. Conclusion: This study provides insights into the factors influencing a woman's complex decision about where and with whom to birth and how health insurance affects that decision, an area where there is a paucity of peer-reviewed literature. This research highlights the importance of being able to choose one's doctor and the desire for access to midwife-led models of care, and provides evidence to advocate for improved access to additional models of care in the private sector. What is already known?: The viability of regional private maternity hospitals is in question because, once the birth rate goes below a certain threshold, providing private obstetric service becomes unviable. Closure of regional private hospitals means less choice in regional areas. Minimal information is available about the factors influencing a woman with PHI to give birth in the public system, and much of the evidence is anecdotal. What does this paper add?: This study provides insight into how PHI status and other factors influence a woman's decision to birth in the public versus private sector, an area where there is a paucity of peer-reviewed literature. It also highlights a desire from women for access to midwifery continuity of care in the private system. What are the implications for practitioners?: This research provides evidence to advocate for improved access to additional models of care, especially for midwifery-led care in the private sector. [ABSTRACT FROM AUTHOR]

Objectives: This study evaluated multiple computed tomography (CT) workforce models to identify any implications on efficiency (length of stay, scan frequency and workforce cost) and scanning radiographer interruptions through substituting or supplementing with a trained CT assistant. Methods: The study was conducted in a CT unit of a tertiary Queensland hospital and prospectively compared four workforce models, including usual practice: Model 1 used an administrative assistant (AA) and one radiographer; Model 2 substituted a medical imaging assistant (MIA) for the AA; Model 3 was usual practice, consisting of two radiographers; and Model 4 included two radiographers, with a supplemented MIA. Observational data were collected over 7 days per model and were cross-checked against electronic records. Data for interruption type and frequency, as well as scan type and duration, were collected. Annual workforce costs were calculated as measures of efficiency. Results: Similar scan frequency and parameters (complexity) occurred across all models, averaging 164 scans (interquartile range 160–172 scans) each. The median times from patient arrival to examination completion in Models 1–4 were 47, 35, 46 and 33 min respectively. There were between 34 and 104 interruptions per day across all models, with the 'assistant role' fielding the largest proportion. Model 4 demonstrated the highest workforce cost, and Model 2 the lowest. Conclusion: This study demonstrated that assistant models offer similar patient throughput to usual practice at a reduced cost. Model 2 was the most efficient of all two-staff models (Models 1–3), offering the cheapest workforce, slightly higher throughput and faster examination times. Not surprisingly, the additional staff model (Model 4) offered greater overall examination times and throughput, with fewer interruptions, although workforce cost and possible role ambiguity were both limitations of this model. These findings may assist decision makers in selecting the optimal workforce design for their own individual contexts. What is known about the topic?: Innovative solutions are required to address ongoing health workforce sustainability concerns. Workforce substitution models using trained assistants have demonstrated numerous benefits internationally, with translation to the Australian allied health setting showing promise. What does this paper add?: Building on existing research, this study provides clinical workforce alternatives that maintain patient throughput while offering cost efficiencies. This study also quantified the many daily interruptions that occur within the CT setting, highlighting a potential clinical risk. To the best of our knowledge, this study is the first to empirically test the use of allied health assistants within CT. What are the implications for practitioners?: Role substitution in CT may offer solutions to skills shortages, increasing expenditure and service demand. Incorporating appropriate assistant workforce models can maintain throughput while demonstrating implications for efficiency and interruptions, potentially affecting staff stress and burnout. In addition, the assistant's scope and accepted level of interruptions should be considerations when choosing the most appropriate model. [ABSTRACT FROM AUTHOR]

Objective: The delivery of public out-patient services is an essential part of complex healthcare systems, but the contribution of public out-patient services is often ill defined and poorly evaluated. The aim of this study was to identify and better understand those factors that may affect the performance of out-patient services to provide health service managers, clinicians and executives with a conceptual framework for future decision-making processes. Methods: The present qualitative research involved five exploratory case studies. These case studies were conducted across two specialties at hospitals in the Metro North Hospital and Health Service in Queensland. Data were obtained from 38 interviews and 15 focus groups, and were analysed to identify common themes. Further analysis helped identify the most significant factors and build a conceptual framework for understanding the relationships between those factors and their effect on performance. Results: Across both specialties there were 10 factors (scheduling, performance, service framework, categorisation or prioritisation of patients, internal and external stakeholders, resources, service demand, culture, system challenges and medical stakeholders) identified that may affect the performance of out-patient services. These factors were condensed into five core domains: culture, stakeholders, resources, demand and system reform. Conclusion: Strategies to address the five core domains identified may provide a framework for sustainable improvement in the delivery of out-patient services. What is known about the topic?: The provision of specialist out-patient services is an essential element of health service delivery. Access to specialist services in the public sector is challenging because of the escalating demand associated with an increasing and aging demographic. The factors that may affect the delivery of out-patient services need to be addressed for long-term sustainable improvement. What does this paper add?: This paper provides a conceptual framework grounded in rigorous qualitative data analysis for understanding the internal and external factors that affect waiting times for specialist out-patient services. The results of this qualitative research indicate that there are five core domains that may influence waiting times in the public out-patient setting. When these domains are addressed at the strategic, tactical and operational levels, they have the potential to provide significant improvement in the delivery of out-patient services. What are the implications for practitioners?: This paper guides the attention of relevant stakeholders towards the five core domains identified (culture, stakeholders, resources, demand and system reform) that influence the performance of waiting times at the operational, tactical and strategic levels within the public hospital setting. [ABSTRACT FROM AUTHOR]

Objective: Since Australia initiated national open disclosure standards in 2002, open disclosure policies have been adopted in all Australian states and territories. Yet, research evidence regarding their adoption is limited. The aim of the present study was to determine the frequency with which patients who report an adverse event had information disclosed to them about the incident, including whether they participated in a formal open disclosure process, their experiences of the process and the extent to which these align with the current New South Wales (NSW) policy. Methods: A cross-sectional survey about patient experiences of disclosure associated with an adverse event was administered to a random sample of 20 000 participants in the 45 and Up Study who were hospitalised in NSW, Australia, between January and June 2014. Results: Of the 18 993 eligible potential participants, completed surveys were obtained from 7661 (40% response rate), with 474 (7%) patients reporting an adverse event. Of those who reported an adverse event, a significant majority reported an informal or bedside disclosure (91%; 430/474). Only 79 patients (17%) participated in a formal open disclosure meeting. Most informal disclosures were provided by nurses, with only 25% provided by medical practitioners. Conclusions: Experiences of open disclosure may be enhanced by informing patients of their right to full disclosure in advance of or upon admission to hospital, and recognition of and support for informal or bedside disclosure for appropriate types of incidents. A review of the open disclosure guidelines in relation to the types of adverse events that require formal open disclosure and those more suitable to informal bedside disclosure is indicated. Guidelines for bedside disclosure should be drafted to assist medical practitioners and other health professionals facilitate and improve their communications about adverse events. Alignment of formal disclosure with policy requirements may also be enhanced by training multidisciplinary teams in the process. What is known about the topic?: While open disclosure is required in all cases of serious adverse events, patients' experiences are variable, and lack of, or poor quality disclosures are all too common. What does this paper add?: This paper presents experiences reported by patients across New South Wales in a large cross-sectional survey. Unlike previous studies of open disclosure, recently hospitalised patients were identified and invited using data linkage with medical records. Findings suggest that most patients receive informal disclosures rather than a process that aligns with the current policy guidance. What are the implications for practitioners?: Experiences of open disclosure may be enhanced by informing patients of their right to full disclosure in advance of or upon admission to hospital, and recognition of and support for informal or bedside disclosure for appropriate types of incidents. [ABSTRACT FROM AUTHOR]