Australian health review : a publication of the Australian Hospital Association最新文献

Establishing an evidence-based framework to monitor and evaluate quality and safety of care for older people is critical. Despite progress in health system performance monitoring in Australia, slower progress has occurred for the older population accessing aged care services. With an aging population and increasing demands on aged care and healthcare systems, there is growing recognition of the need for more coordinated and integrated care across settings. It is not uncommon for older people accessing aged care to require a range of services administered by different organisations simultaneously (e.g. primary care, home care) and sequentially (e.g. hospitals, residential care). Aged care also represents an increasingly regulated sector, with significant investment in and growing recognition of the value of quality measurement. Accountability for care quality and safety is often shared among providers, with consequent challenges in attributing responsibility. Therefore, the development of a pragmatic national framework to support high-quality, person-centred care for the older population accessing aged care services across care settings is one opportunity for shared responsibility, care monitoring, and quality improvement activities that could lead to better outcomes for this population. The strategy for framework development proposed in this perspective has implications for aged care and healthcare providers, consumers, policy makers, regulators, and academics. Once implemented, this framework has the potential to drive consistent high-quality care to improve health outcomes and wellbeing among older people accessing aged care services.

Objective The Australian Medicare Benefits Schedule (MBS) telehealth items were expanded in March 2020 and consolidated in January 2022. We aim to describe the trend of the ratio of MBS psychiatric video items for once-off assessments to follow-up sessions and examine the effect of telehealth consolidation. Methods Psychiatric once-off item to follow-up item ratios in face-to-face (F2F) and video modes were computed from state and territory-level monthly Medicare data (January 2016-December 2023). We performed a multilevel interrupted times series analysis (ITSA) of once-off video consultations with telehealth consolidation as the intervention, followed by subgroup analyses by age groups. Finally, in the young adult group (25-44years), we performed a multiple-group ITSA comparing video once-off to follow-up ratios between genders. Results The once-off to follow-up ratio for video items after telehealth consolidation greatly increased compared with F2F items, with rapid growth in once-off assessments. Sustained high video once-off assessment usage occurred in the youth (15-24years) and young adult (25-44years) groups, while other age groups showed declines following the initial rise. The male group showed a greater initial increase in the video once-off to follow-up ratio among young adults but the ratio continued to rise only in the female group. Conclusions The evolving trends of reimbursed telepsychiatry consultations require further examination given their potential implications concerning service quality, health equity, health attitudes and behaviours, and healthcare costs.

Objective The aim of this study was to develop a concise, accessible definition of value-based health care (VBHC) and identify its main characteristics through a comprehensive analysis of existing literature. Methods A scoping review methodology was employed to map definitions and characteristics of VBHC from nine databases, including JBI EBP Database, Cochrane Reviews, Embase, Ovid MEDLINE(R), APA PsycINFO, and others, from inception until November 2023. The scoping review aimed to clarify existing concepts and identify gaps in VBHC definitions and frameworks across various geographical contexts. Additionally, qualitative data on VBHC were analysed from the included studies using a word cloud generated via an online tool and a word frequency table generated from Excel. This dual analysis informed the creation of a simplified, data-driven definition of VBHC along with its key characteristics. Results The word frequency analysis highlighted common themes, including 'care,' 'outcomes,' 'quality,' 'efficiency,' and 'cost.' Based on these frequently mentioned terms, a simplified definition of VBHC was formulated, focusing on patient-centred care that aims to improve health outcomes relative to costs. Comparisons with existing literature revealed that while the derived definition is more accessible and concise, it lacks the depth of the academic definitions, which emphasise strategic implementation, interdisciplinary collaboration, and nuanced measurement of outcomes. Conclusion This study provides a simplified, data-driven definition of VBHC that can facilitate understanding and implementation among practitioners and stakeholders. Integrating this accessible definition can bridge the gap between theory and practice, ultimately supporting better health outcomes and system sustainability.

Sudden cardiac arrest (SCA) represents a major cause of premature mortality globally, with an enormous effect on victims, families, and communities. Cardiac arrest prevention should be considered a health priority in Australia. A multi-faceted strategy will include community awareness, improved fundamental mechanistic understanding, preventive strategies, implementation of best-practice resuscitation strategies, secondary risk assessment of family members, and development of (near) real-time registries to inform areas of need and assess the effectiveness of interventions. Challenges of patient access to specialised care and equity within the Australian and New Zealand healthcare system should also be recognised.

Objective This scoping review explored the unique value or impacts of clinician scientists (CSs) to the health services in which they work and metrics used to identify and measure this value. Methods Five databases, grey literature, and the internet were searched in April 2024 to identify articles that described and measured the value or impact of CSs within clinical health services. CSs were defined as having dual clinical and research qualifications and work duties. Articles were screened at title, abstract, and full text level against inclusion and exclusion criteria, before extracting data and analysing the included articles. Results The search identified 5368 articles, with six eligible for inclusion. Articles were qualitative in nature (structured interviews or multiple case study reports) and had relatively few participants. The reported value or impacts included educating colleagues on research skills and processes, promoting evidence-based practice, fostering inter-institutional collaboration, and conducting clinically relevant research. No articles recommended a detailed suite of metrics as to how this value or impact could be measured. Conclusions There is limited literature describing the unique value or impact of CSs to the health services in which they work. While some articles described aspects of CS value, no articles provided metrics for how specific CS value could be measured.

Rheumatic heart disease remains a major health problem for Aboriginal and Torres Strait Islander peoples. In this Reflection, potential solutions to this lamentable situation are reviewed.

The importance of authentic consumer engagement to shape decisions in health care is now well recognised. Both the National Health and Medical Research Council and Cancer Council conceptualise consumer involvement as a process that requires consumer capability and organisational capacity and emphasise that organisations should commit to acting on outcomes that have involved consumers. In this perspective piece, we share our experience of working with consumers to develop strategies that aimed to optimise referrals to an evidence-based and cost-effective intervention; a pulmonary rehabilitation program. Although we were successful at implementing some of the co-design strategies and were able to demonstrate an increase in referrals, we were surprised that many of the strategies, which were seemingly simple, could not be implemented due to bureaucratic barriers. Based on our experience, given their ability to navigate bureaucratic barriers within the system, future health researchers should consider actively recruiting senior hospital staff to be part of the co-design process from project inception.

Objective Breast cancer is the most common cancer in Australian women, with rising prevalence and costs. Inefficient care leads to poorer outcomes and strains healthcare systems. This review explores the association between breast cancer management strategies and efficiency in delivering care. Methods An exploratory single database review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA-P) guidelines was conducted by searching MEDLINE for studies on patient-centred care, efficiency, and breast cancer published 2014-present. Data extraction and synthesis followed PRISMA extension for Scoping Reviews (PRISMA-ScR) Checklist. Results Eleven studies were included (one systematic review, one randomised control trial (RCT), four comparative studies, three observational studies, one budget analysis, and one protocol). Seven studies found a positive association between patient-centred care and efficiency; six showed statistical significance. These included reduced diagnostic delays (n =3), improved shared decision-making with decision aids (n =3), need to address ethnic/socioeconomic status disparities (n =2), and survivorship interventions/experience (n =3). Conclusion This is the first review analysing multiple strategies to improve delivery of care, demonstrating improved efficiency throughout the treatment journey in breast cancer by using patient-centred care. Further implementation studies are needed to understand how to optimise outcomes and healthcare sustainability.

Digitally delivered health care, such as telehealth, mobile apps and remote monitoring via apps or devices, can result in improved outcomes for chronic conditions. However, Australia is struggling to maximise the potential of digital health for chronic conditions, due in part to funding arrangements that lack incentives for providers and end users. The aim of this article is to examine the current landscape of digital health funding for chronic conditions and considers potential funding arrangements for the future. Current funding arrangements for digital health in Australia lack sufficient incentives for both providers and end users, limiting the reach and effectiveness of digital health for managing chronic conditions. Alternative funding approaches, such as value-based models, are used internationally which include funding avenues for mobile apps and remote patient monitoring via apps or devices as well as for those operating digital health services. The development of sustainable value-based funding mechanisms that support stakeholder involvement and national adoption are recommended. For Australia to fully leverage the benefits of digital health in managing chronic conditions, funding reforms are one critical area to assist with the implementation of patient-centred and outcome-driven funding models. Effective and sustainable funding structures are essential to ensure long-term benefits of digital health for chronic disease management. Further research will be essential to identify effective funding avenues for digital health services, including mobile apps and remote patient monitoring.