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

Objective With the digital transformation of hospitals having unfolded globally, it is important to understand the impacts of eHealth on hospital practice. This study aims to update two previous narrative reviews of systematic reviews and assess: (1) what is the current state of eHealth impacts in hospitals? and (2) how have these impacts changed over time? Methods A narrative review of systematic reviews investigating the impact of eHealth (i.e. Electronic Medical Records (EMR), Clinical Decision Support System (CDSS), ePrescribing, and Computerised Provider Order Entry (CPOE)) published between 2 August 2017 and 31 December 2021 was conducted using PubMed and Medline. A meta-review was conducted to qualitatively compare the results of this review with two previous reviews, spanning from 2010 to 2021. Results Fourteen studies were included in the narrative review and 42 studies informed the meta-review. eHealth technologies were associated with a diverse array of outcomes with varying degrees of sentiment (positive, negative, neutral, mixed) reported between 2017 and 2021. In contrast to EMR, CDSS, and ePrescribing, the outcomes of CPOE were reported less frequently and less favourably although improvements to resource utilisation were evident. The meta-review identified mixed findings for the outcomes of CPOE, EMR, and ePrescribing and largely positive findings for CDSS. Conclusions The mixed impacts reported for EMR, CPOE, and ePrescribing and the largely positive impacts for CDSS should provide confidence to healthcare stakeholders of the potential of eHealth for hospitals. However, the presence of mixed and negative impacts demonstrate that realising the potential of eHealth is not guaranteed and dedicated efforts are needed to improve its outcomes. Future research should seek to identify the mechanisms that can be used to improve the impacts of eHealth.

Patients continue to self-present to ophthalmology with advanced diabetic retinopathy. An audit of people living with diabetes attending our regional diabetes clinic revealed a significant number had undetected vision-threatening diabetic retinopathy despite regular community optometry review. Further work is required to determine why and whether this is a more widespread issue.

Objective Fertility treatments offer the only pathway to parenthood for many people, including those with infertility, single people and those in same-sex relationships. We aimed to explore how current Medicare policy affects Australians' fertility treatment decision-making. Methods Twenty-five people (22 females, 2 males, 1 agender/gender non-conforming) aged 26-54 who had used medically assisted reproduction treatments participated in semi-structured interviews. Data were analysed using reflexive thematic analysis. Results We developed three themes. Theme 1: For those eligible, Medicare enhances accessibility - describes how Medicare influences affordability and, in turn, increases accessibility. Theme 2: Medicare alters treatment plans - demonstrates how Medicare influences who undertakes treatment, what treatment, when and how often. Theme 3: Medicare enables more treatment for some people - discusses how Medicare enables people to undertake more treatment than they could otherwise afford. Conclusions For eligible people, the current Medicare policy enhanced treatment accessibility and allowed them to undertake more treatment than they could have without financial assistance. However, Medicare policy also contributed to people altering their treatment plans, including who received treatment, the type, timing, frequency and amount of treatment. Given Medicare's influence on fertility treatment decisions, our findings support calls for changes to Medicare eligibility to enable equitable access to fertility treatment and a pathway to parenthood for all Australians.

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.

Background: People living in regional Queensland, Australia, have less access to health care than their metropolitan neighbours; a gap that is wider if they are also of Aboriginal and Torres Strait Islander ethnicity. The Bariatric Surgery Initiative (BSI) aims to provide metabolic bariatric surgery as a public service accessible to all Queenslanders for patients with morbid obesity according to need, regardless of location or ethnicity.

Methods: We investigated the BSI's progress in closing the metro-regional gap by comparing the distribution of referrals for surgery with the geographic and ethnic spread of obesity across Queensland in 2017-2019.

Results: Regional Queensland is home to 59.8% of Queensland's individuals with obesity, whereas 40.2% live in metropolitan Brisbane. In contrast, 47.8% of referrals were from regional areas, with 52.2% received from Brisbane. We found that more patients from metropolitan than regional areas underwent metabolic bariatric surgery, probably due to a paucity of referrals from regional locations. Aboriginal and Torres Strait Islander peoples were able to access the service and all patients realised significant health benefits after surgery.

Conclusions: The BSI improved access to this service, and inequities in metro-regional access may depend on patient choice and healthcare provider awareness of the BSI.

Trial registration: This initiative was a quality improvement study focused on providing access to care rather than a clinical trial; as such it was not registered as a clinical trial.