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

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.

Objective In Australia, Tasmania has the second highest rate of incident lung cancer cases at 44.0 per 100,000 population, with an overall 5year relative survival rate of 20%. The aim of this retrospective study was to map and compare patient transit timelines from referral, diagnosis and treatment, to national care quality indicators (NCQI) and optimal care pathway (OCP) benchmarks. Methods Data were extracted from the weekly lung cancer multidisciplinary team meeting minutes, digital medical records and the ARIA Oncology-Information System for newly diagnosed small cell and non-small cell lung cancer cases between 2019 and 2022, at a regional, university-affiliated tertiary hospital in Tasmania. Sociodemographic data and key dates were extracted, including first general practitioner (GP) referral, specialist appointments (respiratory, medical oncology, radiation oncology and cardiothoracic), investigations, diagnosis, staging and treatment of any intent. Timelines were benchmarked against NCQI and the OCP. Results A total of 165 cases were included; mean patient age was 72years, and 57% were male. A total of 153 patients (93%) were diagnosed with non-small cell cancer and 12 (7%) with small cell lung cancer. Results for all years showed that 93% of patients were seen by the respiratory service within 14days of their GP referral and 71% diagnosed within 28days of their referral, in accordance with current standards. The time taken between GP referrals and diagnosis to any treatment was greater than the required standards, with on average 7% of patients meeting the quality standards (range, 0-16%) for all treatment intents. Conclusion Current national benchmarks have proven challenging to achieve, with prolonged time to treatment of any intent. Challenges both at a patient and systemic level will need to be assessed to improve clinical indicator outcomes.

Objective Statutory checking requirements for nursing students vary across Australian states and territories. In Australia, predictions of a shortfall of 123,000 full-time equivalent nurses will occur by 2030, emphasising the necessity for standardised policies that enhance processes and address inconsistencies to ensure a qualified and accessible nursing workforce. The objective of this study was to understand the requirements for nursing students' statutory checking across Australian jurisdictions. Methods The study investigated compliance requirements through in-depth pragmatic case study analysis utilising publicly available data from official government sources. Results The study found that nursing students in Australia are mandated by the federal government to undergo statutory checks that are regulated by state and territory laws. All have similarities while varying in cost, processes, and timeframes. Costs varied widely between A$19.90 and A$254 over the course of a 3-year degree. Conclusion This study highlights the inconsistencies regarding nursing students' statutory checking requirements in different jurisdictions in Australia. Various financial and logistical challenges negatively impact nursing students as they prepare for clinical placements. Further examination and potential reforms in healthcare policy to facilitate a smoother transition for nurses entering health care are required.

Objective This paper aims to identify and describe legislative and administrative barriers to hospital participation and national data linkage for the National Australian Congenital Heart Disease (CHD) Registry. Methods A narrative review based on the National Australian CHD Registry experience of establishing participating hospital sites and national linkages associated with each jurisdiction. Results There were numerous identified barriers that could be overcome with additional resources/time, and barriers that could not be overcome, reported by jurisdiction. Conclusions There is a pressing need for greater harmonisation of state-based legislation governing research and harmonisation of administration to reduce duplication. Substantial state-based differences hinder the establishment of a truly national registry.

Facing unprecedented levels of junior medical officer (JMO) vacancies, absenteeism, and burnout, the Sir Charles Gairdner Osborne Park Health Care Group (SCGOPHCG) collaborated with JMOs to create and implement the JMO Manifesto in January of 2023. With the aim of improving the organisation's attraction, recruitment, and retention of JMOs, this initiative consisted of five strategic imperatives that addressed key workplace issues affecting JMOs: (1) part-time work opportunities, (2) access to leave and (3) overtime pay, (4) limited support for workplace issues (particularly after-hours), and (5) poor workplace culture and bullying. Led by the Clinical Services team, the JMO Manifesto was an investment in building JMO wellbeing, trust, and engagement with simple but innovative strategies. The effectiveness of these strategies was evaluated by comparing pre- and post-JMO Manifesto results from routinely collected organisational data (e.g. vacancy rates) and JMO feedback through the annual Hospital Health Check survey by the Australian Medical Association. Within 6months, the SCGOPHCG was fully recruited, had created 35 new part-time positions and new processes for managing leave, overtime claims, and support for JMOs. Eighteenmonths in, we remain the top-ranking public health service provider for access to leave, claiming of un-rostered overtime, workplace culture and morale, and wellbeing support for JMOs in Western Australia. The JMO Manifesto highlights the importance of healthcare organisations investing in the engagement and wellbeing of their junior doctors to achieve a sustainable medical workforce.

The Lived Experience Advisor Program (LEAP), introduced at Western Health in January 2023, is an innovative approach to consumer engagement in mainstream health care, integrating lived experience perspectives into organisational decision-making, research, and quality improvement. As health care has increasingly embraced consumer involvement at both direct care and governance levels, the LEAP was implemented to expand the role of health consumers beyond traditional volunteer positions, recognising lived experience as a valuable form of expertise. Through employment of Lived Experience Advisors (LEAs) across a range of clinical and operational projects, this program has enhanced service planning and health literacy for diverse communities. This case study details the development, implementation, and outcomes of the LEAP, focusing on how LEAs have contributed to areas such as youth health services, carer support, emergency care, and consumer engagement strategies. With support from a Community of Practice, LEAs receive ongoing mentorship and training, fostering skill development and promoting sustainable career pathways. The program has also driven shifts in staff perspectives, supporting a patient-centred culture where consumer voices are prioritised. Challenges in program funding, role clarity, and matching lived experience to project needs, underscore the need for thoughtful recruitment, executive sponsorship, and adaptable role design. The impact of the LEAP has extended beyond individual projects, influencing organisational culture, and enhancing staff capabilities in consumer partnership. The case study offers practical insights for other healthcare organisations aiming to integrate lived experience roles, emphasising the potential for consumer-led initiatives to drive transformative change in healthcare delivery and policy.

Objectives We aimed to compare the prevalence and clarity of paramedic to general practitioner (GP) referral pathways among clinical practice guidelines (CPGs) of Australian jurisdictional ambulance services (JASs). Methods We completed a document analysis on all publicly available Australian JAS CPGs that were accessed online during 2024. We appraised CPGs according to the AGREE II Domain 4: Clarity of Presentation criteria. Results We located 711 CPGs across the eight Australian JASs, of which 109 (15%) referenced a pathway to GP referral. Overall, 5.5% (n =6/109) of CPGs met all the AGREE II Domain 4 criteria and considerations. The items most frequently satisfied across CPGs were (i) 'specific recommendations are appropriately selected and reflect the key messages of the guideline' and (ii) 'specific recommendations are grouped together in one section', both of which were met in 96% (105/109) of CPGs. The item least often satisfied was 'uncertainty in the interpretation and discussion of the evidence is reflected in the recommendations and explicitly stated', with only 17% (18/109) of CPGs including a discussion of evidence supporting or cautioning referral to GP pathways. Inclusion of a 'specific and unambiguous statement of the recommended action' was also consistently lacking from CPGs, with only 23% (25/109) of CPGs with referral pathways giving a specific timeframe within which the patient should be seen by a GP. Conclusion A minority of Australian JAS CPGs include a referral to GP pathway, however, these recommendations are generally non-specific and ambiguous, limiting usability for paramedics.

This article addresses organisational governance, including perceived reputational concerns, by health data custodians as the principal barrier to timely and transparent research. Although existing literature primarily addresses ethics reviews and site-specific research approvals, our experience with a Local Hospital Network uncovered additional active barriers within this complex health system. We position these experiences in relation to literature that has documented inefficiencies in health research governance processes that lead to lost knowledge capital and opportunities for significant advancements in health systems research.