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Objectives: This study aimed to compare clinical outcomes for patients admitted to Hospital in the Home (HITH) and traditional (bricks-and-mortar) hospitals and explore patient and carer experiences. Methods: A mixed methods approach including triangulation of quantitative and qualitative data was used. Quantitative outcomes were compared using augmented inverse propensity weighting to adjust for differences in patient characteristics between groups. Qualitative data was collected by focus groups and interviews and analysed using reflexive thematic analysis. The study took place in metropolitan Adelaide and one adjacent regional health network in 2020–22. Participants were patients discharged from either hospital setting with 1 of 22 eligible diagnoses. Hospital administrative data informed a comparison of outcomes that included mortality, rate of emergency department re-presentations and re-admissions, length of stay and incidence of complications. Results: Patients treated in HITH were less unwell than traditional hospital patients. There were no safety or quality concerns identified in the clinical outcomes. Of 2095 HITH patients, the in-patient mortality rate was 0.2%, and 2.3% experienced a return to a bricks-and-mortar hospital during the HITH admission. For HITH patients, the mortality rate after 30 days was lower (−1.3%, 95% CI −2 to −0.5, P = 0.002), as were re-presentations in 28 days (−7.2%, 95% CI −9.5 to −5, P < 0.0001), re-admissions in 28 days (−4.9%, 95% CI −6.7 to −3.2, P < 0.001) and complications (−0.6%, 95% CI −0.8 to −0.5, P < 0.001). Interviews of 35 patients and six carers found that HITH was highly accepted and preferred by patients. HITH was perceived to free up resources for other, more acutely unwell patients. Conclusions: HITH was preferred by patients and at least as effective in delivering quality health care as a traditional hospital, although the potential for unobserved confounding must be acknowledged. What is known about the topic? Appropriate patient selection is critical for safe and effective Hospital in the Home (HITH) services that deliver positive patient experiences. HITH research predominantly reports on hospital-specific outreach services. What does this paper add? A HITH program spanning metropolitan and adjacent regions was safe for patients but confounding likely impacts estimates of effectiveness. Patients accepted and preferred HITH and understood its impact on the health system. Perceived gaps in service quality were tolerated because of benefits of being at home including enhanced self efficacy. What are the implications for practitioners? Patients, referrers and funders can be reassured that HITH is safe, which will further enhance the program's acceptability. [ABSTRACT FROM AUTHOR]

A need exists to improve end-of-life care for people with advanced dementia, by integrating available services. Stakeholders on the Central Coast of New South Wales united to co-design an improved model of care that would integrate care across care settings. The aim of this project was to co-design a model of integrated, person-centred palliative care for people with dementia at the end of life. This case study describes seven co-design workshops which took place in 2023 to develop a program logic model. Workshops were run in a hybrid format, with stakeholders attending in person and online. Workshops were attended by an average of 26 stakeholders including people and carers with lived experience of dementia, healthcare workers from hospital and community-based services (public and private), primary care clinicians, and participants from the not-for-profit sector and academia. Stakeholders developed a shared mission and purpose and identified priority areas for improving palliative care for people with advanced dementia. This led to the development of a program logic model, which included components relating to education for people with dementia, carers, and professionals, care coordination and referrals, and regular multidisciplinary case conferences. Feedback on the model from a new audience identified areas for improvement. The stakeholder group participated in a survey to evaluate the effectiveness of the co-design. The survey found that stakeholders were satisfied with the model of care the group developed. This project highlighted the value of adopting a co-design approach with stakeholders to develop a new model of care. What is known about the topic? The impact and sustainability of integrated palliative care models for people with advanced dementia depends on how well these models can respond and adapt to the context in which they are implemented. What does this paper add? Applying KA McKercher's (2020) principles of co-design, this case study presents a model of care developed by a diverse group of dementia and palliative care stakeholders. What are the implications for practitioners? Co-design principles can bring together a diverse range of stakeholders to develop new models of care that benefit people with dementia and their carers. [ABSTRACT FROM AUTHOR]

Aim: To evaluate a community‐based psychological health and well‐being programme for nurses and midwives. Design: Mixed methods programme evaluation. Methods: Four studies were included: observational descriptive study (cross‐sectional survey) of the health, well‐being and experiences of previous programme participants (Study 1); observational exploratory prospective cohort study (longitudinal survey) of health, well‐being and experiences of participants who engaged in the programme from 2020 to 2023 (Study 2); qualitative descriptive study (interviews) of experiences and perceptions of nurses and midwives who have engaged with the programme as participants or clinicians (Study 3); observational descriptive study (cross‐sectional survey) of experiences and perceptions of programme stakeholders (Study 4). Surveys included validated measures. Data were collected online. Descriptive, repeated measures and thematic analyses were conducted. Results: One‐hundred and fifteen participants completed Study 1: 20% (n = 23) reported stress in the severe‐to‐extremely severe category; 22% (n = 25) reported psychological distress in the moderate‐to‐severe category. Thirty‐one programme participants were followed in Study 2: the effect of the programme on participant well‐being over time was not significant. Sixteen programme participants and eight programme clinicians were interviewed (Study 3). Experiences of nurses and midwives engaging with the programme were highly positive and strong attributes of the programme included (1) shared professional experience of clinicians and participants which supported a common language and facilitated understanding, and (2) effective programme leadership, and autonomy and flexibility in the clinicians' role which enabled and supported a positive working experience. Thirty‐nine broader stakeholders participated in a cross‐sectional survey (Study 4). All stakeholders reported high satisfaction with the programme. Participants considered the programme being 'by nurses and midwives, for nurses and midwives' critical to the programme's success and value. Conclusions: The community‐based psychological health and well‐being programme developed, led and delivered by nurses and midwives, for nurses and midwives, was a highly valued resource. Impact: Levels of stress and burnout in the health workforce are high.A community‐based psychological health and well‐being programme for nurses and midwives was found to be an important and highly valued resource for nurses and midwives.A programme delivered by nurses and midwives, for nurses and midwives, was considered critical to programme success.Programme leadership, and autonomy and flexibility in the programme clinicians' roles, facilitated and supported a positive working experience for programme clinicians. Implications for the Profession and Patient Care: Quality and safety in patient care is directly impacted by the well‐being of nurse and midwives. A community‐based psychological health and well‐being programme for nurses and midwives was found to be an important and highly valued resource for nurses and midwives. Reporting Method: Survey findings were reported according to STROBE (von Elm et al. in Lancet, 370:1453–1457, 2007) and qualitative findings according to COREQ (Tong et al. in International Journal for Quality in Health Care, 19(6):349–357, 2007). Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

People affected by breast cancer experience a multitude of toxicities and unmet needs across physical, cognitive, psychosocial, and economic domains that adversely impact their quality of life. High-quality and diverse supportive care is required to improve outcomes and rehabilitation for people affected by breast cancer. However, the availability and access to high-quality supportive care services is limited due to factors including cost and demand. As such, many people affected by breast cancer do not receive optimal supportive care. The Think Pink Foundation facilitates free-of-charge supportive care services to breast cancer survivors, their families, and caregivers through ‘The Living Centre’. Think Pink seeks to provide a high-quality survivorship care model that overcomes barriers associated with the economic burden of cancer. Within its suite of services, The Living Centre offers ongoing exercise classes, creative therapy, support groups, specialist breast cancer nurse consultations, wellness services, and education support through face-to-face and online service provision. This paper outlines the development, model of care, service provision, and planning for future outcomes and economic evaluation of The Living Centre as a supportive care model for others to consider establishing in their local context. This paper may therefore directly inform the development of cancer survivorship care services globally to increase equitable access to optimal supportive care. [ABSTRACT FROM AUTHOR]

ABSTRACT Aims Design Methods Results Conclusion Impact Patient or Public Contribution To explore the alignment of nursing and healthcare practice illustrated in the Fundamentals of Care framework with Māori (Indigenous person of Aotearoa, New Zealand) worldviews using Indigenous methods.Discursive report.In October 2023, around 50 healthcare professionals and Māori leaders from across Aotearoa, New Zealand, attended a wānanga, an Indigenous Māori approach for sharing knowledge and engaging in in‐depth discussion and deliberation.Attendees understood the origins of the Fundamentals of Care framework and how it translates to practice. The depth and breadth of meaning when referring to Māori values and practices adds a layer of complexity when attempting to align Māori worldviews with the Fundamentals of Care framework. A key outcome of the day was a call for tāngata Tiriti (people of the Treaty—non‐Māori) to continue to work in partnership with tāngata whenua (people of the land—Māori) to explore how the Fundamentals of Care framework could be used with a mode of practice that emphasises Māori values and practices such as whakawhanaungatanga (establishing relationships) and manaakitanga (showing respect, generosity and care for others).Applying Indigenous methods to explore problems and co‐create solutions offers the potential to advance health equity agendas. Wānanga, as a forum for engaging in the process of sharing, reflecting, discussing and learning, provides a mana‐enhancing (strengths‐based) space for tāngata whenua (people of the land—Māori) and tāngata Tiriti (people of the Treaty—non‐Māori), to relate and collaborate. Additional wānanga are required to co‐create a mode of practice that can be applied by all health professionals and that meets the needs of Māori.This report addresses how the Fundamentals of Care framework can be scrutinised for its usefulness or adaptability to encompass Indigenous populations' culture and care needs. Critical points of difference between the Fundamentals of Care framework and Indigenous Māori worldviews exist and need further exploration. This report impacts the delivery of healthcare for Indigenous Māori and the provision of healthcare by all nurses.No patient or public contribution. [ABSTRACT FROM AUTHOR]

This article describes the development of a Model of Care (MoC) resource to support youth involved with the justice system where a neurodevelopmental disability such as Fetal Alcohol Spectrum Disorder (FASD) is suspected. Service staff within the Youth Justice sector were engaged in an iterative process of resource development over a 9-month period. A reference group was established for feedback at each stage, expert advice was sought from the Australian and New Zealand FASD Clinical Network. Five phases of iterative resource development occurred; the first three covered function, form and content of the resource while iterations 4 and 5 mainly pertained to usability. Referral pathway schematics, poster style resources and a user manual were developed and distributed to Youth Justice affiliated organizations. The aim is for the resource to assist in early and appropriate intervention and support for youth with suspected neurodevelopmental disabilities involved in the justice system. [ABSTRACT FROM AUTHOR]

Introduction: The BetterBack model of care (MoC), a best practice physiotherapy MoC for low back pain (LBP), was implemented in Swedish primary care to improve management of patients with LBP and provide patients with support tools to better self-manage episodes of LBP. Purpose: The objective was to describe how physiotherapists in primary care experienced the implementation of the BetterBack MoC for LBP. Methods: Focus group interviews were conducted with physiotherapists in 2018–2019, 14–18 months after the introduction of the BetterBack MoC. Data were analyzed using qualitative content analysis. Results: Five focus group interviews with 23 (15 female and 8 male) physiotherapists, age range 24–61 years were analyzed. A supportive organization and adaptation to the local culture, combined with health care professionals' attitudes and collaboration between physiotherapists emerged as important factors for a successful implementation and for long-term sustainability of the MoC. Physiotherapists had differing opinions if the implementation led to change in clinical practice. Improved confidence in how to manage patients with LBP was expressed by physiotherapists. Conclusions: Several barriers and facilitators influence the implementation of a best practice physiotherapy MoC for LBP in primary care, which need to be considered in future implementation and sustainability processes. [ABSTRACT FROM AUTHOR]

For aging‐related research, there is a pressing need to attend to the dissemination and implementation of evidence‐based interventions. Some aging‐related interventions with established effectiveness may be poorly disseminated and implemented due to behavioral, organizational, payment, or other constraints. To provide insight into the beginning to end process of translation and implementation, we present a case history of the three‐decade progression of Hospital at Home (HaH) now nearing national dissemination. We summarize research at various phases with particular attention to implementation considerations. Reviewing over three decades of HaH‐related research dating from initial discovery to translation and implementation, we found that the content and importance of different constructs (e.g., inner practice vs. outer environmental setting) and the choice of implementation strategies differed depending on implementation context (testing of effectiveness, scaling, or sustainability). Early effectiveness studies mostly examined implementation issues related to the intervention, the practice setting, and the individuals involved. However, explicit and early consideration of scale and sustainment was not the primary focus. For example, HaH program intake is primarily through hospital emergency departments (ED). Initial efforts would have benefited from incorporating strategies (e.g., incorporating ED leadership into program leadership) to address night and weekend admissions. Many regulatory barriers did not surface during initial considerations. Considering implementation issues late may contribute to delay in bringing discoveries to population impact. The experience with HaH suggests that scale and sustainability bear earlier consideration because barriers and facilitators to implementation are likely to be different in content and importance at different phases of implementation. [ABSTRACT FROM AUTHOR]

Background: Spinal cord injuries (SCI) are devastating conditions which often cause multiple permanent physical impairments and psychosocial complications. Discharge from hospital is often delayed and precious health resources are consumed. In Hong Kong SAR, China, the government welfare system and the public hospital system have worked together to address these problems through partnership with non-governmental organizations. An SCI transitional care facility (the Jockey Club New Page Inn, JCNPI) run by a non-governmental organization (SAHK), was inaugurated in 2008. Objectives: Review the local experience of the implementation of SCI transitional care in Hong Kong SAR, China. Methods: A narrative review of the service model, facilitators and barriers, and future development. Service output and outcomes were evaluated with quantitative and qualitative means. Results: The SCI transitional care in Hong Kong provides person-centred transitional care and support, including a time-limited residential rehabilitation, a post-discharge community day rehabilitation programme, and a residential respite care. The current intervention strategy is based on the WHO's International Classification of Functioning, Disability, and Health (ICF). In the past 16 years, a total of 226 clients were discharged from the residential rehabilitation service. A total of 223 (98.6%) clients have successfully returned to community living. Positive feedback was received from the service users. Conclusions: The SCI transitional care has transformed care for SCI patients from the previous biomedical-oriented, hospital-based rehabilitation into a journey with an empowering and participatory approach addressing their biopsychosocial needs. The model has proven to be a key player in the continuum of care and sustainable community reintegration of individuals with SCI. [ABSTRACT FROM AUTHOR]

Abstract Background We set out to assess the appropriateness of current placement of mentally disordered offenders allocated by the courts in Italy to REMS or to forensic community residences. We hypothesised that as in other countries, the match between a standardised assessment and the decision of the court would be imperfect. Methods The DUNDRUM Toolkit was translated into Italian. The translation had good psychometric properties. In order to compare the current level of therapeutic security with a calculated safest current placement, we compared the DUNDRUM-1 triage security assessment of need for therapeutic security prior to treatment, with evidence for progress made in treatment (DUNDRUM-3) and forensic recovery (DUNDRUM-4). The more conservative of these two would be taken as the safe current level of need for therapeutic security. Results The Italian translation of the DUNDRUM Toolkit had good internal consistency and mean scores had a Reliable Change Index less than one unit. 3.7% of those in REMS (medium security) were assessed as needing high security and 38% were ready to move to a less secure place. In low secure places, 56% were assessed as needing a higher level of therapeutic security and 6% could have moved to open non-secure places. Conclusions The Italian translation of the DUNDRUM Toolkit allows an assessment of the current working of the model of care for forensic psychiatry following the reforms of 2015. Most patients are safely placed. A small but important proportion needed high secure places that are not currently available. (3.7% of 604 nationally, 95% Confidence Interval 1.2% to 8.4%, 7 to 50). A greater use of such measures would enable better health gains and safer outcomes. Trial registration ClinicalTrials.gov ID: NCT06018298 Unique Protocol ID: ITAL-EE-REMS.

Eduardo N Naranjo,1 Indershini Pillay,1 Sandra J Squire,2 Agnes T Black,1 Manu Gill3 1Providence Health Care, University of British Columbia, Vancouver, British Columbia, Canada; 2Vancouver General Hospital and UBC Hospital, Vancouver, British Columbia, Canada; 3Providence Health Care, Vancouver, British Columbia, CanadaCorrespondence: Eduardo N Naranjo, Providence Health Care, Room 432, Comox Building 4th Floor, St. Paul’s Hospital, 1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada, Email enaranjo@providencehealth.bc.caPurpose: The Independence Model (TIM) is a new rehabilitative model of care implemented in an acute care hospital to address patients’ functional decline and a high vacancy rate for rehabilitation therapists.Methods: TIM was developed by a team with expertise in evidence, scope of practice and roles, population care needs, and current state related to rehabilitation. TIM utilizes rehabilitation assistants, supervised by physical therapists, occupational therapists or speech-language pathologists, to assist patients in functional areas such as ambulation, activities of daily living (ADLs), cognition and communication. The planning team ensured patient engagement, utilized change management principles, and evaluated the effectiveness of care.Results: Preliminary evaluation of TIM was positive, with staff reporting improved caseload quality and patients feeling more prepared for discharge.Conclusion: This study suggests innovative models of care, such as TIM, can help address the functional needs of patients while navigating the global health human resource crisis.Keywords: multidisciplinary, optimization, health human resource crisis, model of care, function, hospital

Abstract Background Osteoporotic fractures signal severely compromised bone strength and are associated with a greatly increased risk of refracture. Despite the availability of effective and safe medications that reduce fracture risk, 70–80% of patients are inadequately investigated or treated for osteoporosis following an initial fracture, constituting a significant ‘osteoporosis care gap’. Optimal methods of bridging this gap with primary care at the forefront of secondary fracture prevention remain undetermined. This protocol describes a cluster randomised controlled trial to evaluate the effectiveness of a novel integrated model of secondary fracture prevention and management in primary care. Methods The cluster randomised controlled trial involves multiple branches of a community-based radiology provider (CRP), a hospital-based secondary fracture prevention program (SFPP) and numerous primary care practices in metropolitan Sydney that refer to either the CRP or SFPP. Using natural language processing tools, patients diagnosed with a potential osteoporotic fracture will be identified by automatically screening radiology reports generated at the CRP or SFPP. The primary care practices that these patients attend will be randomised (1:1) to either the intervention or usual care. The intervention consists of (i) electronic and fax alerts informing the practice/primary care physician that their patient has been diagnosed with a potential osteoporotic fracture; (ii) provision of osteoporosis management guidelines and (iii) follow-up surveys at 4 weeks and 6 months. Practices in the usual care (control) group will receive no alerts and provide usual care. The primary outcome is the proportion of patients undergoing a bone density scan and/or filling a prescription for osteo-protective pharmacotherapy within 3 months of the initial diagnostic imaging report. Secondary outcomes are the proportion of patients: (i) undergoing an osteoporosis-related blood test within 3 months of the initial diagnostic imaging report; (ii) initiated on a chronic disease management plan within 3 months of the diagnostic report, and (iii) filling a second prescription for osteo-protective pharmacotherapy within 9 months post initial diagnostic imaging report. Outcomes will be obtained through de-identified linked data from Medical Benefits Schedule and Pharmaceutical Benefits Scheme held by the Australian Institute of Health and Welfare. Discussion This is the first randomised trial to integrate case-detection of potential osteoporotic fractures in a hospital and community setting with direct alerts to the patient’s primary care provider. This study will determine whether such an intervention is effective in improving investigation and/or treatment rates of osteoporosis in patients with a potential osteoporotic fracture. Trial registration This study is registered with the Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12623000658617p.

ABSTRACT Aim Design Data Sources Review Methods Results Conclusions Implications for the Profession Impact Reporting Method Patient or Public Contribution This systematic review aims to describe and compare the characteristics of Hospital in the Home (HITH) models of care within Australia.A systematic review of peer‐reviewed Australian literature.Seven databases were searched in January 2024, followed by citation searching. Articles were included if they were described the HITH model of care and were published between 1994 and 2024.Covidence was used to facilitate the removal of duplicates, independent total and abstract screening and full text review. The Critical Appraisal Skills Program (CASP) was used to assess the quality of evidence, and title and abstract screening and full text review were completed by multiple authors. This ensured that all articles met the inclusion criteria and were then assessed, and the final articles were assessed using matrix analysis, and results were presented using narrative synthesis.Ten articles met the inclusion criteria, highlighting three models care; the medical model, the nursing model and the brokerage model.There is limited research available that includes the model of care and patient outcomes. Future research needs to consider the differences between HITH programs, such as the model of care, admission pathway, utilisation of telehealth and geography of the population.This review may assist Australian HITH health professionals to improve the efficacy of the HITH model of care delivered within their health service and increase translatability of future HITH research.This study highlighted for the first time the models of HITH care utilised within Australia. Three models of care are currently utilised within Australia, this knowledge may assist health services seeking to enhance their HITH model of care and policy writers.This review adhered to the EQUATOR guidelines, Preferred Reporting Items for Systematic Reviews and Meta‐Analysis.No patient or public contribution.Trial Registration: Registered with the international prospective register for protocols of systematic reviews in health social care CRD42024500950 [ABSTRACT FROM AUTHOR]

To explore clients' and clinicians' perspectives about the acceptability and perceived outcomes of the Sustaining New South Wales (NSW) Families (SNF) program shifted to a hybrid service delivery model during the COVID‐19 pandemic. Mixed methods design comprising cross‐sectional online surveys and a focus group. Eighty clients who accessed the SNF service and 12 SNF clinicians. Anonymous client survey comprising questions about perceived benefits and impacts of the hybrid SNF program model, and suggestions for change. Clinician focus group discussion about perceived benefits and challenges of the hybrid SNF model. The hybrid SNF program is a child and family health nursing home visitation program for families with moderate level psychosocial risks. It comprises a mix of face‐to‐face and virtual telehealth/telephone appointments, delivered during pregnancy and up to 2 years postpartum. Clients reported high levels of satisfaction with the program, and improvements in confidence and decision‐making. Clinicians spoke of increased efficiency and flexibility, and capacity for ongoing service provision during the COVID‐19 period. Technology access issues were identified as a barrier. Overall, however, both clients and clinicians expressed a preference for face‐to‐face SNF service provision. While further studies are required to test clinical outcomes, the hybrid SNF model is acceptable to clients and clinicians. [ABSTRACT FROM AUTHOR]

Background: Female genital mutilation (FGM) is a global public health concern. However, reconstructive surgery remains unavailable in many countries. Objectives: This scoping review, guided by Joanna Briggs Institute (JBI) principles, explores indications, referral routes, eligibility, care pathways and clinical outcomes of reconstructive surgery for FGM. Search strategy: Medical Subject Headings (MeSH) terms and subject headings were searched in EMBASE, MEDLINE, SCOPUS, Web of Science and publicly available trial registers. Selection criteria: Any primary experimental and quasi‐experimental study addressing reconstructive surgery for FGM, and its impact on women, published before June 2023. Data collection and analysis: After removing duplicates from the search results, titles and abstracts were screened and data were extracted. Disagreements were resolved through panel discussion. The Preferred Reporting Items for Systematic reviews and Meta‐Analyses (PRISMA) flow diagram depicts the search results and inclusion process. Main results: A total of 40 studies were included. Multidisciplinary teams were involved in 40% (16/40) of the studies, and psychosexual counselling was offered in 37.5% (15/40) of studies. Clitoral reconstruction using Foldes' technique was predominant (95%, 38/40). A total of 7274 women underwent some form of reconstruction. Post‐surgery improvement was reported in 94% of the cases (6858/7274). The complication rate was 3% (207/7722 women with reconstruction). Conclusions: Further research and clinical trials are needed. Although the outcomes suggest improved sexual function and quality of life post‐surgery, the evidence remains limited. Advocating surgical reconstruction for survivors of FGM is vital for addressing health disparities and potential cost‐effectiveness. [ABSTRACT FROM AUTHOR]

Background: We set out to assess the appropriateness of current placement of mentally disordered offenders allocated by the courts in Italy to REMS or to forensic community residences. We hypothesised that as in other countries, the match between a standardised assessment and the decision of the court would be imperfect. Methods: The DUNDRUM Toolkit was translated into Italian. The translation had good psychometric properties. In order to compare the current level of therapeutic security with a calculated safest current placement, we compared the DUNDRUM-1 triage security assessment of need for therapeutic security prior to treatment, with evidence for progress made in treatment (DUNDRUM-3) and forensic recovery (DUNDRUM-4). The more conservative of these two would be taken as the safe current level of need for therapeutic security. Results: The Italian translation of the DUNDRUM Toolkit had good internal consistency and mean scores had a Reliable Change Index less than one unit. 3.7% of those in REMS (medium security) were assessed as needing high security and 38% were ready to move to a less secure place. In low secure places, 56% were assessed as needing a higher level of therapeutic security and 6% could have moved to open non-secure places. Conclusions: The Italian translation of the DUNDRUM Toolkit allows an assessment of the current working of the model of care for forensic psychiatry following the reforms of 2015. Most patients are safely placed. A small but important proportion needed high secure places that are not currently available. (3.7% of 604 nationally, 95% Confidence Interval 1.2% to 8.4%, 7 to 50). A greater use of such measures would enable better health gains and safer outcomes. Trial registration ClinicalTrials.gov ID: NCT06018298 Unique Protocol ID: ITAL-EE-REMS. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Methods Discussion Major knowledge and practice gaps exist in aged care home services to support independence of older people with dementia. This research evaluates an adaptation of a community‐based rehabilitation model for care homes, namely Interdisciplinary Care Home‐bAsed Reablement Program (I‐CHARP), by examining whether (and, if so, how) I‐CHARP produces its intended effects and how this programme can be practicably implemented, sustained and scaled up across care homes in Australia.I‐CHARP is a 4‐month bio‐behavioural‐environmental rehabilitation model of care, integrated in care home services, supported through the deployment of an implementation strategy, the Research Enabled Aged Care Homes (REACH) network. It consists of (1) 8–12 full individual sessions and additional eight brief follow‐ups per resident, tailored to the resident's needs, delivered primarily by a team of an occupational therapist, registered nurse and other allied health staff; (2) environmental modifications/assistive devices up to the value of $400 per resident; and (3) engagement of intervention care home staff, managers and regular visitors. An overarching evaluation approach is participatory action research using a cluster quasi‐experimental design and mixed methods. It involves testing of the implementation strategy (REACH network and other approaches) while observing/gathering information on the intervention (I‐CHARP) and related outcomes in three cycles. Participants include residents (aged ≥ 60 years with early stages of dementia) and care staff from 16 care homes. Care quality indicators, health care costs, field notes and semi‐structured interviews/focus groups with intervention site staff, regular visitors and managers will provide further insights into I‐CHARP processes and implementation issues.In the final phase of the project, an Agile Implementation Playbook will be developed for the delivery of reablement care that can be used in routine practice across care homes in Australia. The study findings will also inform future policy development and strategic directions for dementia care in care homes.Trial Registration: Australian New Zealand Clinical Trial Registry, ACTRN12623000885695 Registered 16 August 2023, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=386088.Protocol version: 1.0 dated 20 July 2023 [ABSTRACT FROM AUTHOR]

Backgrounds Methods Results Conclusion There is growing evidence on the benefits of integrated models of care between surgeons and physicians in non‐orthopaedic surgery. We implemented a new General Surgery/General Medicine care model, for all emergency General Surgery patients aged 75 years and older. We compared rates of goals of care (GOC) documentation, hospital‐acquired complications (HAC), mortality, and hospital length of stay (LOS).This is a non‐randomized trial, with data collected prospectively in phase 1 (2021–2022), where patients received the traditional standard of care (case‐by‐case referral to a General Physician), and in phase 2 (2022–2023) where patients received integrated care. Variables were compared between phase 1 and phase 2 using Generalized Linear Models (GLMs).Five hundred and forty‐nine patients, 188 in phase 1 and 361 in phase 2, participated in the study. On univariate analysis, there was a significant increase in patients treated non‐surgically in phase 2 (58.5% vs. 69.0%). Patients treated non‐surgically had significantly shorter LOS, experienced less HACs (P < 0.001). Other variables did not significantly differ after implementation of the service. The multivariate GLM revealed a significant reduction in admissions with undocumented GOC in phase 2 (P = 0.037).This study showed that an integrated care model resulted in a greater proportion of patients being treated non‐surgically with a comparable rate of HAC and mortality, as well as better documentation of patients' GOC. As the number of older surgical patients will continue to rise, the call for such service to become standard of care in non‐orthopaedic surgery is pressing. [ABSTRACT FROM AUTHOR]

Background Aim Methods Results Conclusions Multidisciplinary endocarditis team (MDET) management is supported by current evidence and recommended in international society guidelines. The extent to which this recommendation has been implemented in Australian centres and the attitudes, barriers and facilitators of this model are unclear.To describe current infective endocarditis (IE) models of care in Australian specialist referral centres and evaluate facilitators, barriers and attitudes towards MDET implementation.Aims were addressed using two online surveys. Survey 1 audited IE models of care and was distributed to infectious disease physicians at specialist referral centres. Survey 2 assessed barriers, facilitators and attitudes towards MDETs and was distributed via societal email listings.From 56 identified cardiac surgery centres, survey 1 received 47 responses (84%). A total of 28% (13/47) of participating institutions had an existing MDET. A total of 85% (11/13) of MDETs were in public hospitals and 85% (11/13) were in high IE volume centres. Survey 2 had 109 respondents from seven specialties. Attitudes towards MDET implementation were generally favourable. Identified barriers to MDET implementation included a lack of funding, resources, expertise, time and collaboration. Facilitators included strong leadership, engagement from key stakeholders and tangible benefits.Even though it is recommended in international guidelines, the MDET model is used by less than one‐third of Australian specialist referral centres. Stakeholders in IE care have generally favourable attitudes towards MDET implementation but cite a lack of resources, funding, collaboration and time as barriers to this. Dedication of financial and administrative support and leadership from key stakeholders are required to increase MDET utilisation. [ABSTRACT FROM AUTHOR]

Background: Almost half the world's population lives in rural areas. How best to provide palliative care to rural populations is unclear. Privileging rural patient and family voices about their experiences of receiving care delivered via rural palliative care models is necessary. Aim: To identify the key palliative care elements that rural patients with palliative care needs and their families perceive to be critical to receiving the care and support they need to live well. Design and Data Sources: A systematic review and meta-synthesis registered with Prospero (CRD42020154273). Three databases were searched in June 2024. Raw qualitative data were extracted and analysed using Thomas and Harden's three-stage thematic synthesis methodology. Findings reported according to the PRISMA statement. Results: Of the 10,834 identified papers, 11 met the inclusion criteria. Meta-synthesis of extracted, raw quotes (n = 209) revealed three major themes: (1) Honouring the patient's existing relationship with their General Practitioner (GP); (2) strategically timed access to specialist services, clinicians and equipment is critical; and (3) a need to feel safe, prepared and supported. Conclusion: The strategic inclusion of specialists alongside primary care providers is integral to optimising rural palliative care models. General Practioners are central to these models, through being embedded in their communities and as the conduit to specialist palliative care services. Rural palliative care patients and families value responsive care, trajectory signposting, effective communication, 24/7 support and recognise the value of virtual health. Globally, positive public policy and funding is critical to ensuring access to GP-led, specialist-supported, rural palliative care models. [ABSTRACT FROM AUTHOR]

Background: Osteoporotic fractures signal severely compromised bone strength and are associated with a greatly increased risk of refracture. Despite the availability of effective and safe medications that reduce fracture risk, 70–80% of patients are inadequately investigated or treated for osteoporosis following an initial fracture, constituting a significant 'osteoporosis care gap'. Optimal methods of bridging this gap with primary care at the forefront of secondary fracture prevention remain undetermined. This protocol describes a cluster randomised controlled trial to evaluate the effectiveness of a novel integrated model of secondary fracture prevention and management in primary care. Methods: The cluster randomised controlled trial involves multiple branches of a community-based radiology provider (CRP), a hospital-based secondary fracture prevention program (SFPP) and numerous primary care practices in metropolitan Sydney that refer to either the CRP or SFPP. Using natural language processing tools, patients diagnosed with a potential osteoporotic fracture will be identified by automatically screening radiology reports generated at the CRP or SFPP. The primary care practices that these patients attend will be randomised (1:1) to either the intervention or usual care. The intervention consists of (i) electronic and fax alerts informing the practice/primary care physician that their patient has been diagnosed with a potential osteoporotic fracture; (ii) provision of osteoporosis management guidelines and (iii) follow-up surveys at 4 weeks and 6 months. Practices in the usual care (control) group will receive no alerts and provide usual care. The primary outcome is the proportion of patients undergoing a bone density scan and/or filling a prescription for osteo-protective pharmacotherapy within 3 months of the initial diagnostic imaging report. Secondary outcomes are the proportion of patients: (i) undergoing an osteoporosis-related blood test within 3 months of the initial diagnostic imaging report; (ii) initiated on a chronic disease management plan within 3 months of the diagnostic report, and (iii) filling a second prescription for osteo-protective pharmacotherapy within 9 months post initial diagnostic imaging report. Outcomes will be obtained through de-identified linked data from Medical Benefits Schedule and Pharmaceutical Benefits Scheme held by the Australian Institute of Health and Welfare. Discussion: This is the first randomised trial to integrate case-detection of potential osteoporotic fractures in a hospital and community setting with direct alerts to the patient's primary care provider. This study will determine whether such an intervention is effective in improving investigation and/or treatment rates of osteoporosis in patients with a potential osteoporotic fracture. Trial registration: This study is registered with the Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12623000658617p. [ABSTRACT FROM AUTHOR]

Introduction: Many older people who cannot live independently live in aged residential care facilities to obtain support with social and healthcare needs. Despite old age being a precious time for people to live well, many facility residents have limited access to activities that promote their well‐being and connectedness. In New Zealand, one provider of aged residential care developed a village inspired by de Hogeweyk in the Netherlands, where resident engagement in valued activities supports continuing lifelong identities. Methods: The study aimed to explain the transition from a traditional Aged Residential Care facility to a clustered domestic model of care. A critical realist theoretical perspective underpinned case study research. Data comprised transcripts of interviews with key informants, facility staff, residents and their families, records of observation of residents' daily lives, organisational documents, photographs and the first author's study journal. Results: The intersection of philosophical workplace change to support delivery of person‐centred care and a change in the physical environment enabled realisation of the organisational vision of residents living normal lives. Conclusion: Policy makers and practitioners must be aware that while a domestic‐scale environment provides cues to normal living, staff who know residents and what is important to them enable participation in community and valued activities. Implications for Practice: Innovative living arrangements are a synthesis of philosophical aspirations, architectural and design vision, dedicated leadership and committed teamwork. [ABSTRACT FROM AUTHOR]

Abstract Background and aim The evidence about the acceptability and effectiveness of innovative paediatric models of care for Type 1 diabetes is limited. To address this gap, we synthesised literature on implemented models of care, model components, outcomes, and determinants of implementation and sustainability. Methods A systematic review was conducted and reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Database searches of Medline, CINAHL, EMBASE and Scopus were conducted. Empirical studies focused on Type 1 diabetes paediatric models of care, published from 2010 to 2022 in English were included. Results Nineteen extant studies reported on models and their associations with health and psychosocial outcomes, patient engagement with healthcare, and healthcare costs. Thirteen studies described multidisciplinary teamwork, education and capacity building that supported self-care. Four studies involved shared decision making between providers and patients, and two discussed outreach support where technology was an enabler. Fourteen studies reported improvements in health outcomes (e.g. glycaemic control), mostly for models that included multidisciplinary teams, education, and capacity building (11 studies), outreach support or shared care (3 studies). Four studies reported improvements in quality of life, three reported increased satisfaction for patients and carers and, and one reported improved communication. Four of five studies describing shared care and decision-making reported improvements in quality of life, support and motivation. Outreach models reported no negative outcomes, however, accessing some models was limited by technological and cost barriers. Eight studies reported on model sustainability, but only half reported implementation determinants; none reported applying a theoretical framework to guide their research. Conclusion Some health and psychosocial benefits were associated with newer models. To address knowledge gaps about implementation determinants and model sustainability, longitudinal studies are needed to inform future adoption of innovative models of care for children with Type 1 diabetes.

Abstract Background Most countries are off-track to achieve global maternal and newborn health goals. Global stakeholders agree that investment in midwifery is an important element of the solution. During a global shortage of health workers, strategic decisions must be made about how to configure services to achieve the best possible outcomes with the available resources. This paper aims to assess the relationship between the strength of low- and middle-income countries’ (LMICs’) midwifery profession and key maternal and newborn health outcomes, and thus to prompt policy dialogue about service configuration. Methods Using the most recent available data from publicly available global databases for the period 2000–2020, we conducted an ecological study to examine the association between the number of midwives per 10,000 population and: (i) maternal mortality, (ii) neonatal mortality, and (iii) caesarean birth rate in LMICs. We developed a composite measure of the strength of the midwifery profession, and examined its relationship with maternal mortality. Results In LMICs (especially low-income countries), higher availability of midwives is associated with lower maternal and neonatal mortality. In upper-middle-income countries, higher availability of midwives is associated with caesarean birth rates close to 10–15%. However, some countries achieved good outcomes without increasing midwife availability, and some have increased midwife availability and not achieved good outcomes. Similarly, while stronger midwifery service structures are associated with greater reductions in maternal mortality, this is not true in every country. Conclusions A complex web of health system factors and social determinants contribute to maternal and newborn health outcomes, but there is enough evidence from this and other studies to indicate that midwives can be a highly cost-effective element of national strategies to improve these outcomes.

Abstract Background Frailty reduction and reversal have been addressed successfully among older populations within community settings. However, these findings may not be applicable to residential care settings, largely due to the complex and multidimensional nature of the condition. Relatively, few attempts at frailty prevention exist in residential settings. This review aims to identify and describe best practice models of care for addressing frailty among older populations in residential care settings. This research also sets out to explore the impact of multidisciplinary health service delivery models on health outcomes such as mortality, hospitalisations, quality of life, falls and frailty. Methods A scoping review of the literature was conducted to address the project objectives. Reference lists of included studies, bibliographic databases and the grey literature were systematically searched for literature reporting multidisciplinary, multidimensional models of care for frailty. Results The scoping review found no interventions that met the inclusion criteria. Of the 704 articles screened, 664 were excluded as not relevant. Forty articles were fully assessed, and while no eligible studies were found, relevant data were extracted from 10 near-eligible studies that reported single disciplines or single dimensions rather than a model of care. The physical, nutritional, medicinal, social and cognitive aspects of the near eligible studies have been discussed as playing a key role in frailty reduction or prevention care models. Conclusion This review has identified a paucity of interventions for addressing and reducing frailty in residential care settings. High-quality studies investigating novel models of care for addressing frailty in residential care facilities are required to address this knowledge gap. Similarly, there is a need to develop and validate appropriate screening and assessment tools for frailty in residential care populations. Health service providers and policy-makers should also increase their awareness of frailty as a dynamic and reversible condition. While age is a non-modifiable predictor of frailty, addressing modifiable factors through comprehensive care models may help manage and prevent the physical, social and financial impacts of frailty in the ageing population.

AbstractPurposeMethodsResultsConclusions\nIMPLICATIONS FOR REHABILITATIONObtain the perspectives of people with Parkinson’s disease (PwPD) and their care partners (CPs) about their lived experiences with Parkinson’s Disease (PD) to characterize a new model of care that meets their biopsychosocial and healthcare needs.This phenomenological study included semi-structured focus groups exploring PD diagnosis/care experiences and conceptualizations of an ideal model of care among PwPD and CPs. Data were analyzed via thematic analysis.Twenty-five individuals (PwPD, n = 18; CPs, n = 7) participated across four focus groups. Researchers developed four themes to describe participants’ lived experience with, barriers to, and needs for PD care. These themes characterize key hopes for care as: 1) person-centered, 2) coordinated, 3) provides access to education and information, and 4) builds on the benefits of community.Participants emphasized that, beyond clinical interactions and diagnosis-centered conversations, they wished for holistic healthcare that acknowledged the larger picture of their life with PD. An ideal model of care for PwPD should aim to be person centered, maximize collaboration and coordination across multiple disciplines, provide access to a wide range of information and resources, refer to community centers and support groups, and be designed with ease of navigation in mind.Health professionals need to inquire about an individual’s lived experience and employ strategies that center the person and personalizes their care while also integrating a coordinated interdisciplinary approach.An ideal model of care needs to integrate healthcare professionals as part of a larger care team that includes the person with Parkinson’s disease, and facilitates communication and planning with those team membersAn ideal model of care needs to integrate the larger community and seek to refer and build relationships with health professionals, organizations, and non-medical providers that will facilitate holistic care and advocate for people with Parkinson’s disease.Health professionals need to inquire about an individual’s lived experience and employ strategies that center the person and personalizes their care while also integrating a coordinated interdisciplinary approach.An ideal model of care needs to integrate healthcare professionals as part of a larger care team that includes the person with Parkinson’s disease, and facilitates communication and planning with those team membersAn ideal model of care needs to integrate the larger community and seek to refer and build relationships with health professionals, organizations, and non-medical providers that will facilitate holistic care and advocate for people with Parkinson’s disease. [ABSTRACT FROM AUTHOR]

Early studies of oncology visits performed via telehealth demonstrate patient and provider satisfaction; however, understanding of the impact of telehealth on clinic workflows is limited. The incorporation of telehealth visits into an interprofessional model of oncology care was evaluated to assess for changes in care delivery and patient engagement. New patients with a gastrointestinal cancer diagnosis who were actively undergoing treatment and followed for at least three months were divided into two cohorts based on telehealth utilization. Individual patient charts were reviewed by touchpoint, consisting of in-person visits, telehealth visits, phone calls, and patient portal messages. A total of 28 patient charts were analyzed, 11 pre-telehealth conventional care patients, and 17 telehealth patients. Telehealth cohort patients demonstrated an increased average number of total touchpoints when compared to the pre-telehealth cohort (p -value = 0.008) and had an increased number of patient portal and phone call touchpoints (p -value = 0.00 and 0.002). Telehealth provided more interactions between patients and providers demonstrating increased connectivity between a patient and their care team throughout their complex cancer journey. Clinic workflows may need to adjust to account for the increased demand of unscheduled patient interactions. [ABSTRACT FROM AUTHOR]

Background and aim: The evidence about the acceptability and effectiveness of innovative paediatric models of care for Type 1 diabetes is limited. To address this gap, we synthesised literature on implemented models of care, model components, outcomes, and determinants of implementation and sustainability. Methods: A systematic review was conducted and reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Database searches of Medline, CINAHL, EMBASE and Scopus were conducted. Empirical studies focused on Type 1 diabetes paediatric models of care, published from 2010 to 2022 in English were included. Results: Nineteen extant studies reported on models and their associations with health and psychosocial outcomes, patient engagement with healthcare, and healthcare costs. Thirteen studies described multidisciplinary teamwork, education and capacity building that supported self-care. Four studies involved shared decision making between providers and patients, and two discussed outreach support where technology was an enabler. Fourteen studies reported improvements in health outcomes (e.g. glycaemic control), mostly for models that included multidisciplinary teams, education, and capacity building (11 studies), outreach support or shared care (3 studies). Four studies reported improvements in quality of life, three reported increased satisfaction for patients and carers and, and one reported improved communication. Four of five studies describing shared care and decision-making reported improvements in quality of life, support and motivation. Outreach models reported no negative outcomes, however, accessing some models was limited by technological and cost barriers. Eight studies reported on model sustainability, but only half reported implementation determinants; none reported applying a theoretical framework to guide their research. Conclusion: Some health and psychosocial benefits were associated with newer models. To address knowledge gaps about implementation determinants and model sustainability, longitudinal studies are needed to inform future adoption of innovative models of care for children with Type 1 diabetes. [ABSTRACT FROM AUTHOR]

Background: Most countries are off-track to achieve global maternal and newborn health goals. Global stakeholders agree that investment in midwifery is an important element of the solution. During a global shortage of health workers, strategic decisions must be made about how to configure services to achieve the best possible outcomes with the available resources. This paper aims to assess the relationship between the strength of low- and middle-income countries' (LMICs') midwifery profession and key maternal and newborn health outcomes, and thus to prompt policy dialogue about service configuration. Methods: Using the most recent available data from publicly available global databases for the period 2000–2020, we conducted an ecological study to examine the association between the number of midwives per 10,000 population and: (i) maternal mortality, (ii) neonatal mortality, and (iii) caesarean birth rate in LMICs. We developed a composite measure of the strength of the midwifery profession, and examined its relationship with maternal mortality. Results: In LMICs (especially low-income countries), higher availability of midwives is associated with lower maternal and neonatal mortality. In upper-middle-income countries, higher availability of midwives is associated with caesarean birth rates close to 10–15%. However, some countries achieved good outcomes without increasing midwife availability, and some have increased midwife availability and not achieved good outcomes. Similarly, while stronger midwifery service structures are associated with greater reductions in maternal mortality, this is not true in every country. Conclusions: A complex web of health system factors and social determinants contribute to maternal and newborn health outcomes, but there is enough evidence from this and other studies to indicate that midwives can be a highly cost-effective element of national strategies to improve these outcomes. [ABSTRACT FROM AUTHOR]

Aim Design Methods Results Conclusion Impact Reporting method Patient or public contribution To conduct a child and family health nursing service redesign to improve pathways of access, response and outcomes for all families with children aged 0–5 years.The study was conducted as an iterative, mixed‐method study of the process and impact of the service redesign, informed by a participatory action research paradigm and the NSW Agency for Clinical Innovation process for developing a model of care.Diagnostic, solution design, implementation and sustainability phases were undertaken. Quantitative analyses were undertaken of administrative data, and child and family health nurse and client surveys. Qualitative analyses were undertaken of design workshops.The administrative data demonstrated that prior to the redesign service provision was the same for all clients regardless of levels of risk. The design solution, developed through a series of diagnostic and visioning workshops, included multiple new client response pathways. Implementation included development of tools and training. Sustainability of the redistribution of resources to the new pathways was assessed though an evaluation demonstrating a positive impact for families with adversity, with no deleterious effects for families receiving a universal response, and improvements in the emotional labour undertaken by nurses. Despite this, nurse burnout increased post‐redesign.The shift from equal services (everyone receives the same) to equitable proportionate universal provision in response to need can be achieved and has positive impacts for nurses and families.This study shows the value of undertaking a systematic and participatory approach to service redesign. A proportionate universalism approach can ensure that early childhood nursing services are available to all in relation to needs.The Revised Standards for Quality Improvement Reporting Excellence (SQUIRE 2.0) check‐list was used to guide reporting.No patient or public contribution. [ABSTRACT FROM AUTHOR]

Background: Little Haven is a rural, community-based specialist palliative care service in Gympie, Australia. Its goals are to provide highest quality of care, support and education for those experiencing or anticipating serious illness and loss. Families and communities work alongside clinical services, with community engagement influencing compassionate care and support of dying people, their families and communities. Public Health Palliative Care promotes community engagement by community-based palliative care services and is grounded in equal partnerships between civic life, community members, patients and carers, and service providers. This takes many forms, including what we have termed the 'citizen organization'. Objectives: This paper reports on an evaluation of Little Haven's model of care and explores the organization's place as a 'citizen' of the community it services. Design: A co-designed evaluation approach utilizing mixed-method design is used. Methods: Multiple data sources obtained a broad perspective of the model of care including primary qualitative data from current patients, current carers, staff, volunteers and organizational stakeholders (interviews and focus groups); and secondary quantitative survey data from bereaved carers. Thematic analysis and descriptive statistics were generated. Results: This model of care demonstrates common service elements including early access to holistic, patient/family-centred, specialized palliative care at little or no cost to users, with strong community engagement. These elements enable high-quality care for patients and carers who describe the support as 'over and above', enabling good quality of life and care at home. Staff and volunteers perceive the built-in flexibility of the model as critical to its outcomes; the interface between the service and the community is similarly stressed as a key service element. Organizational stakeholders observed the model as a product of local activism and accountability to the community. Conclusion: All participant groups agree the service model enables the delivery of excellent care. The construction of a community palliative care service as a citizen organization emerged as a new concept. Plain language summary: 'Citizen organization': an Australian community-based palliative care service model Little Haven is a rural, community-based specialist palliative care service in Gympie, Australia. It aims to provide highest quality of care, support and education for those experiencing or anticipating serious illness and loss. Families and communities work alongside clinical services, with community engagement influencing compassionate care and support of dying people, their families and communities. Public Health Palliative Care promotes community engagement by community-based palliative care services in equal partnerships between civic organizations, community members, patients and carers, and service providers. We undertook an evaluation of Little Haven's model of care by speaking with current patients, current and past carers, staff, volunteers and stakeholders about their experiences of Little Haven. We found that Little Haven's model contains the essential elements of a palliative care service and provides early access to holistic, patient/family-centred, specialized palliative care at little or no cost to users. They have strong community engagement with a strong background in community activism. We identified that Little Haven's 'being in the community' goes beyond service provision or even sentiment. We observed a symbiotic relationship between the organization and the community it supports in what we have termed the 'citizen organization'. The distinctive characteristic of the citizen organization is its inseparability from the community in which it dwells. [ABSTRACT FROM AUTHOR]

Issue Addressed Methods Results Conclusions So What? In 2021, the Australian government implemented a population wide COVID‐19 vaccination program. People experiencing homelessness faced challenges accessing vaccines and many were not being reached. By reorienting vaccination services to include assertive outreach strategies, a Brisbane‐based non‐profit health care team successfully administered 2065 COVID‐19 vaccinations to homeless and precariously housed people. This study examines insights from stakeholders delivering the service and perspectives of clients who received a vaccine.Semi‐structured interviews with five stakeholders and a survey of 63 clients involved in the Micah Projects COVID‐19 vaccination program are reported. Client survey questions covered demographic characteristics, and motivations and hesitancies around vaccination. Stakeholder interviews were inductively analysed and quantitative survey data were exported into SPSS (IBM V27) and analysed using descriptive statistics.The Micah Projects team initiated 220 pop‐up vaccination clinics and worked closely with Aboriginal and Torres Strait Islander communities. Downsizing and mobilising the service engaged greater numbers of people sleeping rough and Aboriginal and Torres Strait Islander people. Clients' decisions to vaccinate were often spontaneous, driven by immediate availability and motivated by a desire to stay healthy and protect the community.Tailoring vaccination programs to include assertive outreach strategies effectively reduces barriers for people experiencing homelessness. Community embeddedness, trust, flexibility and cultural safety are critical elements for success.People experiencing homelessness are motivated to vaccinate. Reorientating health services to remove structural barriers and build the supportive environments needed to work through vaccine hesitancies are critical elements to ensure equitable access and promote health. [ABSTRACT FROM AUTHOR]

Background: Frailty reduction and reversal have been addressed successfully among older populations within community settings. However, these findings may not be applicable to residential care settings, largely due to the complex and multidimensional nature of the condition. Relatively, few attempts at frailty prevention exist in residential settings. This review aims to identify and describe best practice models of care for addressing frailty among older populations in residential care settings. This research also sets out to explore the impact of multidisciplinary health service delivery models on health outcomes such as mortality, hospitalisations, quality of life, falls and frailty. Methods: A scoping review of the literature was conducted to address the project objectives. Reference lists of included studies, bibliographic databases and the grey literature were systematically searched for literature reporting multidisciplinary, multidimensional models of care for frailty. Results: The scoping review found no interventions that met the inclusion criteria. Of the 704 articles screened, 664 were excluded as not relevant. Forty articles were fully assessed, and while no eligible studies were found, relevant data were extracted from 10 near-eligible studies that reported single disciplines or single dimensions rather than a model of care. The physical, nutritional, medicinal, social and cognitive aspects of the near eligible studies have been discussed as playing a key role in frailty reduction or prevention care models. Conclusion: This review has identified a paucity of interventions for addressing and reducing frailty in residential care settings. High-quality studies investigating novel models of care for addressing frailty in residential care facilities are required to address this knowledge gap. Similarly, there is a need to develop and validate appropriate screening and assessment tools for frailty in residential care populations. Health service providers and policy-makers should also increase their awareness of frailty as a dynamic and reversible condition. While age is a non-modifiable predictor of frailty, addressing modifiable factors through comprehensive care models may help manage and prevent the physical, social and financial impacts of frailty in the ageing population. [ABSTRACT FROM AUTHOR]

Fetal Alcohol Spectrum Disorders affect up to 5% of the population, with additional children affected by prenatal drug exposures. The majority of these children display symptoms of ADHD and poor emotional dysregulation, a common reason for seeking psychiatric care. However, high prevalence of comorbid look-alike symptoms and limited availability of evidence-based treatments complicates psychiatric decision making in this population. The goal of the current study is to report on the effectiveness of psychotropic medications in a case series of 16 individuals with prenatal alcohol/drug exposure and propose a model for psychiatric care for this population. In addition to traditional subjective reports, an objective continuous performance test (T.O.V.A.®) was used to aid with guiding treatment. We found that T.O.V.A.®-scores improved on average from − 6.5 to − 2.9 with our psychiatric approach (p = 0.03). T.O.V.A.®-measurements were helpful in differentiating ADHD symptoms from comorbid symptoms and to guide decision-making on starting and changing medications. [ABSTRACT FROM AUTHOR]

Background: Outpatient waiting list figures have substantially increased over the last 3 years due to the effects of a global pandemic and cyber-hacking crisis. Multidisciplinary initiatives are essential to try to reduce the burden on overwhelmed medical and surgical specialties. Objective: The purpose of the study is as follows: (1) to demonstrate the potential for a problem-specific clinic to help ease the burden on an overwhelmed specialty and identify high-risk patients who may benefit from earlier surgical intervention and (2) to provide supervised clinical training to our clinical nurse specialist. Methods: A retrospective audit of outpatient referrals awaiting an appointment was conducted, and a new outpatient clinic was formed for patients referred with tonsil issues with or without additional complaints. Results: Two hundred ninety-five patients with an average waiting time of 14.4 months were offered an outpatient appointment over 5 months. Sixty-four percent (n = 189) attended their appointments, and 59.3% (n = 112) of these were listed for surgery. One hundred fifty-eight patients were able to be discharged back to the care of their general practitioners. Discussion/conclusion: This outpatient clinic identified a large number of patients waiting significant periods of time for an outpatient appointment and allowed a definitive clinical decision to be made with most patients being either discharged or listed for surgery. Initiatives such as this offer the possibility of reducing the burden of long waiting times on individual institutions. [ABSTRACT FROM AUTHOR]

Background and Aims: The number of perinatally HIV‐infected adolescents (PHIVA) is increasing however many health care systems are not prepared for this population and their health challenges, specifically a model of care (MoC) is lacking. Thus the objective of this study was to develop and propose a MoC for PHIVA. Methods: Through a qualitative study design, a MoC was developed and ratified with two focus groups, consisting of PHIVA and healthcare professionals. Results: Seven participants were included in each focus group and the following themes were developed: relatable attributes; missing components; implementation and suggestions. Changes were made to the drafts of the MoC in response to the focus group results, leading to the finalisation of a MoC for PHIVA. The MoC focused on the importance of interprofessional health care and addressed the physical sequelae that PHIVA are likely to encounter. A schematic of the MoC was created for the use in general public education. Conclusion: It is important that healthcare facilities are equipped to handle the specific needs of PHIVA. The interprofessional MoC developed in this study helps to address the requirements of this population. [ABSTRACT FROM AUTHOR]

The provision of timely and comprehensive healthcare is a fundamental aspect of resettlement for refugees, who often experience critical unmet health needs. In Canada, this includes connecting refugees with primary care providers to treat acute health conditions, as well as to provide longitudinal and preventative care. However, refugee access to healthcare is often complicated by numerous barriers, such as difficulty navigating health services, financial constraints, language barriers, discrimination, and limited access to physicians. Due to these unmet health needs and barriers to access, there has been a need for dedicated primary healthcare models for refugees that provide integrated and culturally safe care. In response, a refugee community health center, the New Canadians Health Centre (NCHC), was established in Edmonton, Alberta, Canada in 2021. The NCHC operates through an innovative, principles-based model that delivers interdisciplinary primary healthcare services to refugees that are culturally safe, include clients as partners in their care, and are grounded in principles of social justice, equity, and inclusion. Early and effective healthcare services are needed to address the health of refugees; however, there is a lack of research on the development and implementation of dedicated refugee health service models. This paper addresses this gap by providing an in-depth account of the opening of the NCHC as a principles-based community health center for refugees, including the process by which it was established in response to local needs and the development of its principles-based model for supporting refugee health. This community case description will support the development and implementation of other dedicated models for refugee health, and comes at a critical time in which there are rapidly growing refugee populations in Canada and internationally.

Children with otitis media who are referred to paediatric otorhinolaryngology (ORL) departments often experience significant delays in treatment. Alternate models of care utilising audiologists with extended scopes of practice can potentially improve outcomes in services experiencing difficulties with high demand and insufficient ORL capacity. An Advanced Audiology Practitioner (AAP) service was implemented in Counties Manukau to combat known long wait times for children with otitis media. This study aimed to retrospectively evaluate the clinical and service outcomes of the 165 children referred to the AAP service during the initial 3 month period of operation. Engagement with the AAP service was high, with a 96% attendance rate at the first appointment. The proportion of children waiting longer than recommended (>120 days) for paediatric ORL appointments was reduced by 33%, and the average wait time for children seen in the AAP service was reduced from 196 to 14 days. The AAP model provided an efficient and effective clinical service, with 55% of children seen in a single visit and 91% of waitlisted children having middle ear effusion on myringotomy. In conclusion, the AAP model improves access to ORL treatment, particularly for children at risk for otitis media and associated hearing loss. [ABSTRACT FROM AUTHOR]

Aim: To evaluate a nurse‐led model of supportive care in a COPD outpatient service from patient and caregiver perspectives. Design: Case study methodology. Methods: Data were collected from semi‐structured interviews with patients (n = 12) and caregivers (n = 7) conducted between April 2020 and September 2022. A purposive sampling strategy was used. Interviews were transcribed verbatim and analysed using content analysis with an inductive approach. COREQ guidelines informed reporting of this study. Results: Eight categories were identified from the data evaluating of the model of care relating to the most helpful aspects of COPD supportive care and suggested improvements to the model of care. The categories were: guidance with managing symptoms; participating in advance care planning; home visiting; expert advice; continuity and trust; caring; caregiver support and improvements to the model of care. Conclusion: In a nurse‐led model of COPD supportive care, what patients and caregivers valued most was expert advice and guidance with symptom management, flexible home visiting, participation in advance care planning, caring and continuity within an ongoing trusted therapeutic relationship. Understanding what patients and caregivers value most is essential in designing and delivering models of care that meet the needs of patients living with chronic, life‐limiting illness. Implications for the profession and/or patient care: Nurses can lead effective models of supportive care that offer valuable support to patients living with COPD and their caregivers. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to externally validate a reported model for identifying patients requiring extended stay following lower limb arthroplasty in a new setting. Design: External validation of a previously reported prognostic model, using retrospective data. Setting: Medium-sized hospital orthopaedic department, Australia. Participants: Electronic medical records were accessed for data collection between Sep-2019 and Feb-2020 and retrospective data extracted from 200 randomly selected total hip or knee arthroplasty patients. Intervention: Participants received total hip or knee replacement between 2-Feb-16 and 4-Apr-19. This study was a non-interventional retrospective study. Main measures: Model validation was assessed with discrimination, calibration on both original and adjusted forms of the candidate model. Decision curve analysis was conducted on the outputs of the adjusted model to determine net benefit at a predetermined decision threshold (0.5). Results: The original model performed poorly, grossly overestimating length of stay with mean calibration of −3.6 (95% confidence interval −3.9 to −3.2) and calibration slope of 0.52. Performance improved following adjustment of the model intercept and model coefficients (mean calibration 0.48, 95% confidence interval 0.16 to 0.80 and slope of 1.0), but remained poorly calibrated at low and medium risk threshold and net benefit was modest (three additional patients per hundred identified as at-risk) at the a-priori risk threshold. Conclusions: External validation demonstrated poor performance when applied to a new patient population and would provide limited benefit for our institution. Implementation of predictive models for arthroplasty should include practical assessment of discrimination, calibration and net benefit at a clinically acceptable threshold. [ABSTRACT FROM AUTHOR]

Introduction: Elimination of hepatitis C virus stands as an unresolved World Health Organization target, and is associated with complications including cirrhosis and hepatocellular carcinoma. Hepatitis C virus management has been revolutionised following the widespread availability of direct-acting antiviral agents in Australia since 2016; however, large proportions of the population remain untreated. Telehealth-based service delivery is an accessible and effective alternative, and we aimed to assess qualitative and clinical outcomes in a clinical nurse consultant-led regional telehealth model. Methods: A prospective cohort analysis of all patients referred to a Victorian regional hospital's hepatitis C virus telehealth clinic between 1 April 2017 and 10 June 2020 was conducted. Data were collated from outpatient and electronic medical records. Results: Fifty-five out of 71 referred patients were booked, with 44 patients (80%) attending at least one appointment. A history of alcohol use disorder and psychiatric comorbidity was seen in 25 (54%) and 24 (52%) patients, respectively. Twenty-one out of 24 (88%) eligible patients had direct-acting antiviral agent treatment and 14 out of 21 (67%) successfully completed the treatment. An average of 46.5 km, 54.6 min and $AUD30.70 was saved per patient for each visit. Observed benefits included: increased medical engagement, adherence to and completion of HCV treatment and cirrhosis monitoring. Telehealth-driven hepatocellular carcinoma surveillance was successful in the cirrhotic subgroup. Conclusion: Clinical nurse consultant-led hepatitis C virus management via telehealth allows access to marginalised regional populations. Clinical outcomes were comparable to other cohorts with additional cost-benefit, efficiency gains and carbon footprint reduction amongst a previously unreported regional Victorian hepatitis C virus population. [ABSTRACT FROM AUTHOR]

Introduction: Rapid translation of research findings into clinical practice through innovation is critical to improve health systems and patient outcomes. Access to efficient systems of learning underpinned with real-time data are the future of healthcare. This type of health system will decrease unwarranted clinical variation, accelerate rapid evidence translation, and improve overall healthcare quality. Methods: This paper aims to describe The HARMONY model (acHieving dAta-dRiven quality iMprovement to enhance frailty Outcomes using a learNing health sYstem), a new frailty learning health system model of implementation science and practice improvement. The HARMONY model provides a prototype for clinical quality registry infrastructure and partnership within health care. Results: The HARMONY model was applied to the Western Sydney Clinical Frailty Registry as the prototype exemplar. The model networks longitudinal frailty data into an accessible and useable format for learning. Creating local capability that networks current data infrastructures to translate and improve quality of care in real-time. Conclusion: This prototype provides a model of registry data feedback and quality improvement processes in an inpatient aged care and rehabilitation hospital setting to help reduce clinical variation, enhance research translation capacity, and improve care quality. [ABSTRACT FROM AUTHOR]

Aims: The aim of this study is to evaluate the relative merits of various heart failure models of care with regard to a variety of outcomes. Design: Systematic review. Data Sources: Five databases including PubMed, Web of Science, Medline, Embase and Science Direct were searched from the inception date of databases to August 20, 2022. Review Methods: This review used the Cochrane Collaboration's 'Risk of Bias' tool to assess quality. Only randomised controlled trails were included in this review that assessed all care models in the management of adults with heart failure. A categorical summary of the pattern of the papers was found, followed by extraction of outcome indicators. Results: Twenty articles (19 studies) were included. Seven examined nurse‐led care, two examined multidisciplinary specialist care, nine (10 articles) examined patient self‐management, and one examined nurse and physiotherapist co‐led care. Regarding outcomes, this review examined how well the four models performed with regard to quality of life, health services use, HF self‐care, and anxiety and depression for heart failure patients. The model of patient self‐management showed more beneficial results than nurse‐led care, multidisciplinary specialist care, and nurse and physiotherapist co‐led care in reducing hospital days, improving symptoms, promoting self‐care behaviours of HF patients, enhancing the quality of life, and strengthening self‐care ability. Conclusions: This systematic review synthesises the different care models and their relative effectiveness. Four different models of care were summarised. Of these models, the self‐management model demonstrated better outcomes. Impact: The self‐management model is more effective in increasing self‐management behaviours and self‐management abilities, lowering the risk of hospitalisation and death, improving quality of life, and relieving anxiety and depression than other models. No Patient or Public Contribution: There was no funding to remunerate a patient/member of the public for this review. [ABSTRACT FROM AUTHOR]

Background We aimed to evaluate the efficacy of opportunistic treatment of hepatitis C virus (HCV) infection among hospitalized people who inject drugs (PWID). Methods We performed a pragmatic, stepped wedge cluster randomized trial recruiting HCV RNA positive individuals admitted for inpatient care in departments of internal medicine, addiction medicine, and psychiatry at three hospitals in Oslo, Norway. Seven departments were sequentially randomized to change from control conditions (standard of care referral to outpatient care) to intervention conditions (immediate treatment initiation). The primary outcome was treatment completion, defined as dispensing the final package of the prescribed treatment within six months after enrolment. Results A total of 200 HCV RNA positive individuals were enrolled between 1 October 2019 and 31 December 2021 (mean age 47.4 years, 72.5% male, 60.5% injected past 3 months, 20.4% cirrhosis). Treatment completion was accomplished by 67 of 98 (68.4% [95% confidence interval {CI}: 58.2–77.4]) during intervention conditions and by 36 of 102 (35.3% [95% CI: 26.1–45.4]) during control conditions (risk difference 33.1% [95% CI: 20.0–46.2]; risk ratio 1.9 [95% CI: 1.4–2.6]). The intervention was superior in terms of treatment completion (adjusted odds ratio [aOR] 4.8 [95% CI: 1.8–12.8]; P =.002) and time to treatment initiation (adjusted hazard ratio [aHR] 4.0 [95% CI: 2.5–6.3]; P <.001). Sustained virologic response was documented in 60 of 98 (61.2% [95% CI: 50.8–70.9]) during intervention and in 66 of 102 (64.7% [95% CI: 54.6–73.9]) during control conditions. Conclusions An opportunistic test-and-treat approach to HCV infection was superior to standard of care among hospitalized PWID. The model of care should be considered for broader implementation. Clinical Trials Registration. NCT04220645 [ABSTRACT FROM AUTHOR]

Community Paramedicine is a model of care which is effective and accepted by health professionals and the community. Community paramedicine delivers low acuity primary care to disadvantaged communities and addresses service gaps. We aimed to identify successful implementation of community paramedicine models and signalled opportunities and challenges. A narrative review was conducted. We identified 14 literature reviews from four databases EMBASE, CINAHL, PubMed, Cochrane. The results from the thematic analysis were structured along the quadruple aim for healthcare redesign framework. The reviews supported acceptability of the model. Patients are satisfied and there is evidence of cost reduction. Long term evidence of the positive effects of community paramedicine on patient, community health and the health system are lacking. Equally, there is unfamiliarity about the role and how it is part of an integrated health model. Community paramedicine could alleviate current stresses in the healthcare system and uses an available workforce of registered paramedics. To facilitate integration, we need more evidence on long-term effects for patients and the system. In addition, the unfamiliarity with the model needs to be addressed to enhance the uptake of the model. [ABSTRACT FROM AUTHOR]