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Background From 2014–2019, the Centre of Research Excellence in Integrated Quality Improvement (CRE-IQI) was evaluated as an innovation platform focusing on continuous quality improvement in Indigenous Australian primary health care. Although social network analysis (SNA) is a recognised method for evaluating the functioning, collaboration and effectiveness of innovation platforms, applied research is limited. This study applies SNA to evaluate the CRE-IQI’s functioning as an innovation platform. Methods Two surveys (2017, 2019) were conducted using social survey and network methods. Survey items covered respondent characteristics, their perceptions of the CRE-IQI’s performance, its impact and sociometric relationships. Members’ relationship information was captured for the CRE-IQI at three timepoints: start (retrospectively), mid-term, and final year on three network types (knew, shared information, collaborated). SNA software was used to compute standard network metrics such as diameter, density and centrality, and develop visualisations. Survey and network results were workshopped by members to develop improvement strategies. Results The response rate was 80% in 2017 and 65% in 2019, n = 49 and 47 respectively. Between 2017 and 2019 respondents’ mean ratings of the CRE-IQI’s functioning and achievements in meeting its goals increased. They perceived the CRE-IQI as multi-disciplinary, having effective management and governance, and incorporating Indigenous research leadership, representation and ways of working. Respondents recognised high levels of trust amongst members, rated ‘good communication and coordination with participants’ highly, and ‘facilitating collaboration’ as the CRE’s most strongly recognised achievement. In collaboration and information sharing networks, average path length remained low in 2017 and 2019, indicating good small-world network properties for relaying information. On average, respondents shared information, and collaborated, with more CRE members in 2017 than 2019. However, in both 2017 and 2019 there were new collaborations and information sharing outside of direct collaborations. CRE-IQI outcomes included: evidence generation; knowledge transfer and skills development in quality improvement; research capacity building, career development; mentoring; grant support; development of new projects; health service support; and policy impact. Conclusion This study shows the utility of network analysis in evaluating the functioning, and collaboration, at individual, organisational and health system levels, of an innovation platform, and adds to our understanding of factors enabling successful innovation platforms.

ObjectivesThough multidisciplinary research networks support the practice and effectiveness of continuous quality improvement (CQI) programmes, their characteristics and development are poorly understood. In this study, we examine publication outputs from a research network in Australian Indigenous primary healthcare (PHC) to assess to what extent the research network changed over time.SettingAustralian CQI research network in Indigenous PHC from 2002 to 2019.ParticipantsAuthors from peer-reviewed journal articles and books published by the network.DesignCoauthor networks across four phases of the network (2002–2004; 2005–2009; 2010–2014; 2015–2019) were constructed based on author affiliations and examined using social network analysis methods. Descriptive characteristics included organisation types, Indigenous representation, gender, student authorship and thematic research trends.ResultsWe identified 128 publications written by 308 individual authors from 79 different organisations. Publications increased in number and diversity over each funding phase. During the final phase, publication outputs accelerated for organisations, students, project officers, Indigenous and female authors. Over time there was also a shift in research themes to encompass new clinical areas and social, environmental or behavioural determinants of health. Average degree (8.1), clustering (0.81) and diameter (3) indicated a well-connected network, with a core-periphery structure in each phase (p≤0.03) rather than a single central organisation (degree centralisation=0.55–0.65). Academic organisations dominated the core structure in all funding phases.ConclusionCollaboration in publications increased with network consolidation and expansion. Increased productivity was associated with increased authorship diversity and a decentralised network, suggesting these may be important factors in enhancing research impact and advancing the knowledge and practice of CQI in PHC. Publication diversity and growth occurred mainly in the fourth phase, suggesting long-term relationship building among diverse partners is required to facilitate participatory research in CQI. Despite improvements, further work is needed to address inequities in female authorship and Indigenous authorship.

To determine if mobile videoconferencing technology can facilitate the discharge of low-acuity patients receiving in-home care without compromising short-term health outcomes.A 6-month trial commenced in July 2015 with 345 patients considered unsuited to Criteria Led Discharge (CLD) receiving in-home care included as participants. Nurses providing clinical support to patients in their homes were supplied with a tablet computer (Apple iPad) with Internet connectivity (Telstra 4G Network) and videoconferencing software (Cisco Jabber for Telepresence). Device usage data combined with hospital admission records were collected to determine (a) instances where a telemedicine-facilitated discharge occurred and (b) if the accepted measure of short-term health outcomes (readmission within 28 days) was adversely affected by this alternative method.Telemedicine technology facilitated the discharge of 10.1% (n = 35) of patients considered unsuitable for CLD from the Hospital in the Home model during the trial period. Statistically insignificant differences in rates of readmission between patients discharged in person versus those participating in the telemedicine-supported model suggest that the clinical standards of the service have been maintained.The results of evaluating telemedicine support for nurses providing low-acuity in-home care indicate that patients may be discharged remotely while maintaining the existing clinical standards of the service.

Objective This study sought to estimate and observe the risks imposed on patients as they travel to hospital for referred treatment. Factors such as distance and remoteness were compared to understand how they affect this risk. Methods This study focused on Queensland residents attending specialist out-patient appointments in a Queensland public hospital throughout 2016. Deidentified information on all recipients of a specialist out-patient appointment in 2016 (n=2946584) were included in the study. This study also contained a theoretical component: using a data model to estimate the number of fatalities that could be expected from a travelling population of this size and complexity. The modelling results were compared with the frequency of actual fatalities among individuals travelling to receive treatment, as determined by a review of the Queensland Police Road Database. The data model and empirical values from police reports were used to independently measure what risk, if any, individuals travelling to obtain specialist out-patient treatment are exposed to. Differences between the model and observed values were evaluated using statistical tests. Results A direct relationship between increasing remoteness and travel risk was established in both the model and observed data (CV(RMSD)=0.660773). Conclusion Fatal risk is present in any road journey regardless of distance, duration or the purpose of travel. Individuals living in regional and remote Queensland are exposed to a larger risk than those living in the major cities of Queensland when travelling to obtain public health care. What is already known on this subject? Road safety remains one of Australia’s most serious public health issues, with 1295 road-related fatalities recorded throughout Australia in 2016. Although the potential dangers of road travel are well understood, extended journeys by road to attend hospital appointments are often undertaken despite available alternatives to travel in some instances. What this paper adds? Travelling to attend medical appointments exposes a patient to a small but potentially catastrophic risk that can be observed in state road crash data. This risk is measurably greater for individuals in regional Queensland. What are the implications for practitioners? Clinical models of care that reduce patient travel may represent a new standard in patient safety when of the risks associated travel are considered.