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

Objective: Unplanned readmissions are key indicators of hospital care quality, yet research on potentially avoidable unplanned readmissions (PAURs) remains limited. This study aimed to assess the prevalence, causes, and predictors of PAURs in an Australian tertiary hospital.

Methods: This retrospective cohort study included all unplanned readmissions to a general medicine unit between 1 July and 30 September 2022, in South Australia. Patients aged ≥18 years readmitted within 30 days of discharge were included. A panel of senior clinicians assessed the preventability of each readmission using predefined criteria. Data on demographics, comorbidities, frailty, inflammatory markers, and discharge factors were collected. Predictors of PAURs were examined using multivariable logistic regression and LASSO (least absolute shrinkage and selection operator) regression for sensitivity analysis.

Results: Among 381 readmissions, 80 (21%) were classified as potentially avoidable. The mean age was 68.7 years (s.d. 18.2), and 58.3% were female. The most common cause of PAURs was relapse of the condition treated during the index admission (43%), followed by treatment-related complications (22.8%). Contributing factors included suboptimal care during the index admission (43.8%) and inadequate post-discharge follow-up (30%). Compared to non-avoidable readmissions, PAUR patients were older, more frequently readmitted within 7 days, and had higher rates of coronary artery disease and congestive heart failure (CHF). They also had higher neutrophil-to-lymphocyte ratios (NLR) on admission. Multivariable analysis identified CHF (aOR 2.46, 95% CI 1.28-4.71) and elevated NLR (aOR 1.05, 95% CI 1.02-1.08) as independent predictors.

Conclusions: Over one in five readmissions were potentially avoidable, and only a few patient characteristics can predict avoidable readmissions.

Objective: This study aimed to highlight trends in the utilisation of selected endometriosis treatments before and after the launch of the National Action Plan for Endometriosis and observe the impact of the action plan on the utilisation of these interventions.

Methods: Monthly Medicare and Pharmaceutical Benefits Scheme claims were used to represent the utilisation of laparoscopic resection and nafarelin for endometriosis. Time series analysis using autoregressive integrated moving average models was used to establish the trend in the utilisation of these treatments. An interruption was then applied at the launch of the plan, and a counterfactual prediction was modelled based on the claims made before the interruption. Factual values and counterfactual predictions were compared to evaluate the impact of the plan.

Results: The action plan was associated with an immediate increase of 3.94 Medicare Benefits Schedule claims per month (95% CI -44.61 to 52.50) and an estimated change in slope of 1.30 claims per month (95% confidence interval (CI) -3.80 to 6.30) for laparoscopic resection. Nafarelin dispensing after the launch of the action plan had an immediate increase of 68.30 dispensing claims per month (95% CI -4.34 to 141.03), with a slope change of -2.84 claims per month (95% CI -10.975 to 5.293).

Conclusions: The results suggest that although the action plan was linked with a marked immediate spike in the utilisation of nafarelin, it did not make any difference in the long term. However, it may have contributed to a small but steady increase in the utilisation of laparoscopic resection, used in severe cases of the condition.

Online short summary What is known about the topic? Value-based health care (VBHC) is now enmeshed within Australian healthcare conversations as well as implementation strategies. What does this paper add? This paper explores the barriers and opportunities for VBHC and compares the differing paradigms of VBHC and health economics. What are the implications for practitioners? o harmonise the two, and realise VBHCs potential, we must bridge existing misalignments, experiment with hybrid models that integrate VBHC's focus on outcomes with health economic principles to ensure care is not just high value at the bedside, but also fair and efficient at the population level.

Objective Intravenous medications are frequently used within hospital settings. To safely administer these medications to patients, further instructions are required on preparation and administration details. We describe a novel working group of hospital pharmacists (the Intravenous Medications Guidelines Working Group) formed with the aim to produce and maintain consistently high-quality, site-specific intravenous medication guidelines across a multi-site hospital group with complex needs. Methods The Intravenous Medications Guidelines Working Group consists of clinical pharmacists from multiple specialties and specialist pharmacists (medicines information, medication safety). The Intravenous Medications Guidelines Working Group meets monthly, and discusses feedback from end-users, improvements to consistency and readability of guidelines, as well as maintaining a robust review process. Results Since its inception nearly 10years ago, the Intravenous Medications Guidelines Working Group has reviewed 714 intravenous medication guidelines, maintaining a compliance review date for 98.4% of the 190 guidelines owned by the hospital group. Incident reports relating to high-risk intravenous medication preparation and administration are low (<1%). Informal feedback suggests the guidelines are also accessed from outside the hospital group via the state-based health intranet. Challenges remain in upskilling new pharmacy staff and further improving the usefulness of guidelines for end-user nursing staff. Conclusions A pharmacy team-based approach has consistently produced high-quality guidelines for hospital staff over a prolonged period with low clinical incident numbers. Ongoing staff investment, standardised processes and user feedback are key to maintaining a high standard.

A reflection of the effectiveness of national health funding reforms to improve system efficiency and improve patient outcomes. Despite the complexities, policy levers exist that can promote value. However, a pressing question remains will those levers be used when activity is required to balance the budgets of our economies' largest employers.

Value-based healthcare incorporates patient experience into the delivery of cost-effective and efficient health care delivery, but this does not occur seamlessly or in an ethical vacuum. The incorporation of effective complaints resolution processes, as a restorative justice mechanism, and robust integration of ethical principles into all aspects of clinical practice will create more patient-centred and compassionate healthcare.

Health systems widely talk about value, but too rarely acknowledge meaning - the human cost of unmet need, eroded trust, and invisible exclusion. This commentary makes the case that meaning must be treated as foundational, arguing that equitable value-based care depends on consumer voice genuinely shaping decisions.

Objective This study aims to outline the bureaucratic process of obtaining ethical and governance approval to undertake a research project on severe acute maternal morbidity (SAMM), highlighting the effect this had on performing research in a timely way. Methods A retrospective, descriptive case study evaluation, from the researcher's perspective, of the research ethics and governance process required, during 2022-2023, to conduct a retrospective audit of 20years of one SAMM event (peripartum hysterectomy) in five public maternity care facilities (two Hospital and Health Services (HHSs)) within a single state of Australia. Outcome measures included: the number of documents/forms completed, emails sent, phone calls/meetings held, number of people involved in approval, the number of submissions/re-submissions required and the time to obtain ethics/governance approval (working days). Results Ten data custodian approvals from within the same organisation were required to obtain peripartum hysterectomy data from five statewide databases and from local records in two HHSs. Overall, it took 268 working days from submission of the first ethics application to obtaining approval for the final governance application. Conclusions Cumbersome research approval processes consume a lot of research time. Our study exemplifies the continuing overregulation of low- and negligible-risk research that continues to limit investigation and prevention of serious obstetric conditions.

Objective This study aimed to investigate the relationship between emergency department (ED) patient volume at time of presentation and risk of departing before commencing treatment in the ED (did not wait; DNW). Methods A retrospective analysis of linked data was conducted using the New South Wales Emergency Department Data Collection for level 5 and level 6 hospitals, between April 2022 and March 2023. ED patient volume was measured at the time of each patient's presentation and categorised into quintiles by hospital level. Patients who DNW were compared to those who waited, using multivariable logistic regression to identify independent predictors of DNW, such as rising ED patient volumes, age, triage category, and time of presentation. Results Out of 1,673,247 ED presentations, 155,425 (9.29%) patients were recorded as DNW. ED patient volume was a significant predictor of increased likelihood of DNW, with those presenting when the ED was at the highest patient volume quintile being 3.5 times more likely not to wait compared to the lowest quintile of patient volume after adjusting for relevant characteristics such as age, triage category, and time of presentation. Conclusion ED patient volume was a significant predictor of DNW with a direct dose-response relationship observed further emphasising the effect of ED overcrowding on the quality of care in EDs.

Objective This study aims to understand workforce retention and attrition of chiropractors in Australia. Methods An online survey of chiropractors in 2024 and a retrospective analysis of 10years of Australian Health Practitioner Regulation Agency (Ahpra) registration data were undertaken. Results Of 1513 surveyed chiropractors, 80.0% intended to continue in the profession, 6.6% intended to leave (excluding retirement), 6.7% were unsure, and the remainder were retired. Seventy percent of those intending to leave planned to do so within 1year. Top reasons included unsatisfactory remuneration (35.4%), lack of recognition/feeling undervalued (31.3%), work no longer professionally satisfying (31.3%), work no longer fulfilling/meaningful (29.2%), and retirement (29.2%). Those with limited registration status, working outside 20 to 49h per week, and on casual or temporary contracts are also more likely to not renew or be unsure. Australian Health Practitioner Regulation Agency (Ahpra) data (2014-2023) showed a 12.2% increase in registered chiropractors per 100,000 of the Australian population and a 15.8% rise in replacement rate (with fluctuations). Conclusions The overall number of chiropractors has increased from 2014 to 2023, and the replacement rate increased from 2015 to 2023. This highlights growth in the profession despite some issues in workforce stability, particularly among those with limited registration, non-standard work hours per week, and casual/temporary contract status. Addressing intrinsic and workplace factors such as remuneration, workplace recognition, and job satisfaction may improve retention.