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Objective: To examine variation in pressure injury (PI) incidence among long-term aged care facilities and identify resident- and facility-level factors that explain this variation.Design: Longitudinal incidence study using routinely-collected electronic care management data.Setting: A large aged care service provider in New South Wales and the Australian Capital Territory, Australia.Participants: About 6556 people aged 65 years and older who were permanent residents in 60 long-term care facilities between December 2014 and November 2016.Main Outcome Measure: Risk-adjusted PI incidence rates over eight study quarters.Results: Incidence density over the study period was 1.33 pressure injuries per 1000 resident days (95% confidence interval (CI) = 1.29-1.37). Funnel plots were used to identify variation among facilities. On average, 14% of facilities had risk-adjusted PI rates that were higher than expected in each quarter (above 95% funnel plot control limits). Ten percent of facilities had persistently high rates in any three or more consecutive quarters (n = 6). The variation between facilities was only partly explained by resident characteristics in multilevel regression models. Residents were more likely to have higher-pressure injury rates in facilities in regional areas compared with major city areas (adjusted incidence rate ratio = 1.25, 95% CI = 1.04-1.51), and facilities with persistently high rates were more likely to be located in areas with low socioeconomic status (P = 0.038).Conclusions: There is considerable variation among facilities in PI incidence. This study demonstrates the potential of routinely-collected care management data to monitor PI incidence and to identify facilities that may benefit from targeted intervention. [ABSTRACT FROM AUTHOR]

Background: People who live in aged care homes have high rates of illness and frailty. Providing evidence-based care to this population is vital to ensure the highest possible quality of life.Objective: In this study (CareTrack Aged, CT Aged), we aimed to develop a comprehensive set of clinical indicators for guideline-adherent, appropriate care of commonly managed conditions and processes in aged care.Methods: Indicators were formulated from recommendations found through systematic searches of Australian and international clinical practice guidelines (CPGs). Experts reviewed the indicators using a multiround modified Delphi process to develop a consensus on what constitutes appropriate care.Results: From 139 CPGs, 5609 recommendations were used to draft 630 indicators. Clinical experts (n = 41) reviewed the indicators over two rounds. A final set of 236 indicators resulted, mapped to 16 conditions and processes of care. The conditions and processes were admission assessment; bladder and bowel problems; cognitive impairment; depression; dysphagia and aspiration; end of life/palliative care; hearing and vision; infection; medication; mobility and falls; nutrition and hydration; oral and dental care; pain; restraint use; skin integrity and sleep.Conclusions: The suite of CT Aged clinical indicators can be used for research and assessment of the quality of care in individual facilities and across organizations to guide improvement and to supplement regulation or accreditation of the aged care sector. They are a step forward for Australian and international aged care sectors, helping to improve transparency so that the level of care delivered to aged care consumers can be rigorously monitored and continuously improved. [ABSTRACT FROM AUTHOR]

Purpose Patient transportation is an important component of health-care delivery; however, the quality and safety issues relating to non-emergency patient transport services have rarely been discussed compared with the transport of emergency patients. This systematic review examines the factors associated with the quality and safety of non-emergency transport services. Data sources Medline, Pre-Medline, CINAHL and Embase databases were searched for publications between 1990 and September 2009. Study selection Articles investigating non-emergency hospital transport services. Data extraction Study characteristic and outcome data were abstracted by one author and reviewed by a second and third author. Results Twelve articles from seven countries were included. Five studies examined issues relating to the structure of transport services, which focused on the use of policies and protocols to assist the transfer process. All studies addressed factors associated with the transfer process such as communication, appropriateness of personnel, time to arrange transfers, and the safety and efficiency of the process. Outcomes were measured in one study. Conclusions Communication, efficiency and appropriateness are key factors that are advanced as impacting on the quality and safety of non-emergency transport services. Standardization of the non-emergency transport process shows promise in reducing risk and increasing efficiency. Applying information and communication technology to improve the quality of transport services has received little attention despite its potential benefits. Patient outcomes in relation to quality and safety of transport services are rarely measured. Available evidence suggests that safety of non-emergency patient transfers is sometimes compromised due to poor standardization and failures in communication processes. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to use routinely collected electronic medicines administration (eMAR) data in residential aged care (RAC) to investigate the quality use of medicines.Design: A cross-sectional analysis of eMAR data.Setting: 71 RAC facilities in New South Wales and the Australian Capital Territory, Australia.Participants: Permanent residents living in a participating facility on 1 October 2015.Intervention: None.Main Outcome Measures: Variation in polypharmacy (≥5 medications), hyper-polypharmacy (≥10 medications) and antipsychotic use across facilities was examined using funnel plot analysis.Results: The study dataset included 4775 long-term residents. The mean resident age was 85.3 years and 70.6% of residents were female. The median facility size was 60 residents and 74.3% were in metropolitan locations. 84.3% of residents had polypharmacy, 41.2% hyper-polypharmacy and 21.0% were using an antipsychotic. The extent of polypharmacy (69.75-100% of residents), hyper-polypharmacy (38.81-76.19%) and use of antipsychotic medicines (0-75.6%) varied considerably across the 71 facilities.Conclusions: Using eMAR data we found substantial variation in polypharmacy, hyper-polypharmacy and antipsychotic medicine use across 71 RAC facilities. Further investigation into the policies and practices of facilities performing above or below expected levels is warranted to understand variation and drive quality improvement. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate how well general practitioners (GPs) manage and respond to laboratory results for patients with diabetes mellitus (DM) and cardiovascular disease (CVD).Data Sources: MEDLINE, CINAHL, Embase, EBM reviews, ProQuest and Scopus.Study Selection: Peer-reviewed journal articles published between 2000 and 2015 that assessed GPs' management of laboratory results for patients with DM or CVD.Data Extraction: Study design and demographics, laboratory tests and key findings relating to GP management of laboratory results were extracted from studies.Results Of Data Synthesis: Thirteen articles were included, comprising seven studies which utilized surveys, four observational studies, one cohort study and one randomized controlled trial. Findings indicate that GPs often overestimate the risk of complications associated with DM and CVD based on laboratory results and have unrealistically high expectations regarding the precision of laboratory tests. Considerable variation existed in the use of repeat testing for diagnostic confirmation and in GPs' identification of the difference between two consecutive results required to indicate a change in patient condition. GPs also often failed to initiate appropriate treatment for patients with DM and CVD based on laboratory results. Feedback to GPs about their test ordering patterns and educational messages on laboratory results improved clinical outcomes.Conclusion: Evidence about how well GPs manage results and its impact on patient outcomes remains weak and inconclusive. This review identified a number of areas where interventions could support GPs to improve the interpretation and management of laboratory test results, including feedback to GPs and educational messages on test result reports. [ABSTRACT FROM AUTHOR]