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In virtually every major industry, quality improvement has been based on measuring and monitoring performance. There is good evidence to show that when processes and outcome data is measured and compared, improvements are made. Healthcare has been slow to introduce systematic measurement across the sector, however internationally this is rapidly changing. In Australia, we have data available to measure quality and safety; however it is not collected systematically or consistently between states ....In virtually every major industry, quality improvement has been based on measuring and monitoring performance. There is good evidence to show that when processes and outcome data is measured and compared, improvements are made. Healthcare has been slow to introduce systematic measurement across the sector, however internationally this is rapidly changing. In Australia, we have data available to measure quality and safety; however it is not collected systematically or consistently between states and territories. Our aim is to develop a national set of high quality, credible indicators using existing data sources to measure healthcare performance in regard to safety and quality in clinical practice. We propose a “probes in the pudding” approach, where each probe measures the performance of one aspect of the healthcare system. Coded administrative hospital data collected mainly for financial reasons has potential to be used as quality indicators. However, to provide an accurate picture, indicators must take into account people’s risk factors over which the doctor has no control but which can influence outcome. For example, a hospital in an area surrounded by a principally elderly population would be more likely to have a higher death rate than a hospital admitting younger patients. In effect, indicators must compare apples with apples. We will further test ways in which clinical patient information databases can be linked to develop quality indicators. For example, by linking pharmacy data with hospital data we can monitor whether patients are receiving appropriate medication. The most reliable data for use in measuring quality exists in registries, which have been established for a number of procedures and conditions in Australia. We will investigate ways in which registries can be better standardised at a national level. We will compare registry data with administrative hospital data to investigate how quality indicators can be developed which provide an accurate picture of the health system. This program will succeed because it can be implemented at a low cost using data readily available in most Australian health settings. The group doing the research consists of consumer advocates and people with knowledge in the use of administrative data and registries, health policy, law, research design and statistics.Read moreRead less
Which Heart Failure Intervention Is Most Cost-effective And Consumer Friendly In Reducing Hospital Care: The Which
Funder
National Health and Medical Research Council
Funding Amount
$921,640.00
Summary
Chronic heart failure (CHF) is a costly, debilitating and deadly condition that has reached near epidemic proportions in Australia. In the absence of a permanent cure for CHF, the number of people affected by CHF has risen beyond 350,000 and is expected to increase by 20-30% in the next 20 years. We recently reviewed the benefits of applying nurse-led, CHF management programs (CHF-MPs) to typically old and fragile patients, in whom recurrent hospital admissions and a premature death are common. ....Chronic heart failure (CHF) is a costly, debilitating and deadly condition that has reached near epidemic proportions in Australia. In the absence of a permanent cure for CHF, the number of people affected by CHF has risen beyond 350,000 and is expected to increase by 20-30% in the next 20 years. We recently reviewed the benefits of applying nurse-led, CHF management programs (CHF-MPs) to typically old and fragile patients, in whom recurrent hospital admissions and a premature death are common. We confirmed the results of pioneering Australian research that CHF-MPs dramatically improve health outcomes in CHF. CHF-MPs now form part of the recommended gold-standard management of CHF. However, we also have evidence that only a small proportion of patients are exposed to a CHF-MP in Australia. Residual issues such as consumer preference and the cost of applying these programs are hindering their wide-spread application. The WHICH? Study addresses this _road block� to implementing a potentially valuable health care service by tackling a number of critical issues: which form of CHF-MP (home or specialist clinic-based follow-up), will produce the best health outcomes, save the most money and meet the needs of consumers at the same time? To answer this question, we will undertake a randomised, head-to-head study of a home versus clinic-based CHF-MP, in 1000 recently hospitalised CHF patients recruited from SA, VIC, NSW and QLD. Patterns and of health care and consumer preferences and quality of life will then be compared for these two different forms of CHF-MP from a combined health economic, health policy and consumer perspective to determine the best form of CHF-MP to be applied. A _consensus� vision for applying an Australia-wide service will then be developed. The potential impact of the results of the study will then be modelled on the status of Australian CHF-MPs in the year 2010 and a blue-print for action devised.Read moreRead less
Enhancing Mental Health In Aboriginal People: Reducing Violence And Developing Resilience
Funder
National Health and Medical Research Council
Funding Amount
$1,771,151.00
Summary
This project aims to determine the best ways to improve the Social Emotional Well Being (SEWB) of the Aboriginal people of Broken Hill, Menindee and Wilcannia. This project will develop a culturally appropriate and evidenced based intervention to break the cycle of ongoing grief, mental illness, alcohol and other drugs and violence. The project will proceed in a number of interrelated phases including extensive community consultations and a baseline survey. The project will then implement and ev ....This project aims to determine the best ways to improve the Social Emotional Well Being (SEWB) of the Aboriginal people of Broken Hill, Menindee and Wilcannia. This project will develop a culturally appropriate and evidenced based intervention to break the cycle of ongoing grief, mental illness, alcohol and other drugs and violence. The project will proceed in a number of interrelated phases including extensive community consultations and a baseline survey. The project will then implement and evaluate an intervention program that provides a community and individual program that adopts evidence-based approaches and modifies them to be acceptable within Aboriginal communities. These interventions aim to break the cycle of violence and mental health problems by teaching adaptive skills to reduce violent behaviours and by providing mental health interventions that reduce disorders that contribute to violence.Read moreRead less
1+1- A Healthy Start To Life:Targeting The Year Before And The Year After Birth In Aboriginal Children In Remote Areas
Funder
National Health and Medical Research Council
Funding Amount
$587,272.00
Summary
Indigenous Australians in remote communities are less healthy and more socially disadvantaged than other Australians. This influences the quality of the intrauterine environment. Babies often suffer malnutrition and recurring infections during infancy which are exacerbated by their less than optimal birth status and contribute to chronic conditions (diabetes, cardiovascular disease, renal failure) in adulthood. Existing health services are costly to Government and do not achieve their potential ....Indigenous Australians in remote communities are less healthy and more socially disadvantaged than other Australians. This influences the quality of the intrauterine environment. Babies often suffer malnutrition and recurring infections during infancy which are exacerbated by their less than optimal birth status and contribute to chronic conditions (diabetes, cardiovascular disease, renal failure) in adulthood. Existing health services are costly to Government and do not achieve their potential for promoting health and providing quality care. Evidence suggests redesigned models based on continuity of care, focused, proactive family support and workload reform will improve maternal and infant outcomes. New models need to be developed, costed, implemented and evaluated providing governments with the evidence base to initiate service improvement. Such models will have applicability elsewhere in Australia. Professor Lesley Barclay and her team of researchers from Charles Darwin University will conduct research into developing such a model. The project aims to improve the quality of care for remote dwelling Aboriginal women and infants in the year before, during and the year after birth by providing evidence for, and facilitating changes to, service delivery. This will enhance the potential for the development of resilience and well-being of their children. It will also test if service improvements can improve the health of women and reduce childhood disease and therefore reduce the impact of health conditions occurring in adulthood which have their origins in the early stages of life.Read moreRead less
A Computer Model Of Service Delivery For Behavioural And Psychological Symptoms Of Dementia: A Tool For Policy Makers An
Funder
National Health and Medical Research Council
Funding Amount
$400,108.00
Summary
Behavioural and psychological symptoms of dementia (BPSD) affect approximate 90% of persons with dementia. BPSD include depression, aggression and psychosis and have negative effects on persons with dementia and carers. Management of BPSD is costly. This project will update and enhance our theoretical model of service delivery for BPSD by turning it into a computer-based model to assist health managers and policy makers. This model will incorporate the projected increase in prevalence of dementi ....Behavioural and psychological symptoms of dementia (BPSD) affect approximate 90% of persons with dementia. BPSD include depression, aggression and psychosis and have negative effects on persons with dementia and carers. Management of BPSD is costly. This project will update and enhance our theoretical model of service delivery for BPSD by turning it into a computer-based model to assist health managers and policy makers. This model will incorporate the projected increase in prevalence of dementia and project associated costs of care into the future. It will also incorporate information about interventions for BPSD, and how they may affect prevalence and cost in the future.Read moreRead less
Models Of Care To Address Unmet Of Older Indigenous With Dementia Their Families And Communites Living In Remote WA
Funder
National Health and Medical Research Council
Funding Amount
$1,081,060.00
Summary
The health and unmet needs of older Indigenous people, particularly in remote and rural areas is generally under researched. It is well known that the life expectancy of indigenous people is approximately 20 years younger than non-Indigenous counterparts. Many illnesses generally experienced by non Indigenous people in older ages (e.g. 75 years) are seen at a much younger age in Indigenous populations. These conditions include dementia, falls, incontinence, premature heart disease and strokes. O ....The health and unmet needs of older Indigenous people, particularly in remote and rural areas is generally under researched. It is well known that the life expectancy of indigenous people is approximately 20 years younger than non-Indigenous counterparts. Many illnesses generally experienced by non Indigenous people in older ages (e.g. 75 years) are seen at a much younger age in Indigenous populations. These conditions include dementia, falls, incontinence, premature heart disease and strokes. Over the last 4 years the applicants of this project have started to address some of the health related problems faced by older Indigenous people, particularly the challenging area of dementia. The authors have developed a culturally appropriate assessment tool to help determine if an older Indigenous person has dementia. This has been very successful and is now frequently used by health professionals in remote and rural areas of Australia. A survey is in the final stages of completion to determine the estimated number of people in remote areas of the Kimberley who manifest signs and symptoms of dementia and associated old age diseases. Preliminary data sadly indicate that the frequency of dementia is higher than expected for people of this age group. The next phase of this project is to determine the unmet needs of this vulnerable group, by interviewing those with dementia and their families, communities and service providers in remote areas of Kimberley and Pilbara. This will determine culturally appropriate and practical ways to provide care to assist those with this condition and their families and communities.Read moreRead less
Optimising Prevention And The Management Of Care For Australians With Or At Risk Of Serious And Continuing Chronic Illne
Funder
National Health and Medical Research Council
Funding Amount
$3,760,301.00
Summary
The project aims to study three prototype conditions - cardiovascular disease, diabetes and chronic obstructive pulmonary disease - in people aged 45 to 85 in the Sydney West Area Health Service and the Australian Capital Territory with a view to implementing and evaluating new models of care and developing policies that observe accurately the current state of the art technologies, discern the gaps in knowledge, locate the barriers to optimality and engage policy makers in practical proposals ab ....The project aims to study three prototype conditions - cardiovascular disease, diabetes and chronic obstructive pulmonary disease - in people aged 45 to 85 in the Sydney West Area Health Service and the Australian Capital Territory with a view to implementing and evaluating new models of care and developing policies that observe accurately the current state of the art technologies, discern the gaps in knowledge, locate the barriers to optimality and engage policy makers in practical proposals about how best to use the currently available resources to achieve better health outcomes.Read moreRead less
Avian Influenza - National Perception Of Risks To Paramedics And Innovative Ambulance Service Population-based Models Of
Funder
National Health and Medical Research Council
Funding Amount
$297,909.00
Summary
This research addresses the important public health role of prehospital Emergency Medical Services (EMS) in containing and managing contagion should an influenza pandemic evolve in Australia. Paramedics are front line health staff and in the event of a pandemic will be among the first members of the community to face exposure to infection. This research will explore the attitudes and perceptions of paramedics and their families to working in epidemic conditions, provide prediction of behavioural ....This research addresses the important public health role of prehospital Emergency Medical Services (EMS) in containing and managing contagion should an influenza pandemic evolve in Australia. Paramedics are front line health staff and in the event of a pandemic will be among the first members of the community to face exposure to infection. This research will explore the attitudes and perceptions of paramedics and their families to working in epidemic conditions, provide prediction of behavioural responses to highly infectious environments, and a clear understanding of attitudes to infection control and use of Personal Protective Equipment (PPE). Knowledge of how to manage and support the responses of frontline health workers to an infectious disease outbreak is critical to the emergency system response. This project aims to mitigate the effects of perceived risk of infection on attitudes and behaviour of paramedics, by informing health promotion and infection-prevention messages to paramedics and their families. This research will also explore the emerging role of ambulance services as a key component of a public health surveillance system to provide an early warning of pandemic disease outbreaks and facilitate implementation of effective disease control strategies. Current triage systems, used for allocation of patients to appropriate treatment and-or quarantine, are not designed for epidemic environments, and may inadvertently facilitate disease spread and delay identification of victims requiring immediate care and-or quarantine. This project will explore the utility of a population-based triage tool to control an infectious disease outbreak by reducing patient-to-patient disease transmission. The project will facilitate expansion of current public health disease surveillance strategies and triage mechanisms for use during an epidemic, to effectively manage increased workloads within a highly infectious environment, whilst maintaining usual emergency medical services.Read moreRead less
PASSPORTS TO ADVANTAGE: Health And Capacity Building As A Basis For Social Integration
Funder
National Health and Medical Research Council
Funding Amount
$1,894,012.00
Summary
This project will conduct a randomised controlled trial of a post-release intervention for adult prisoners in Queensland. The findings of the study will inform the development of an evidence-based post-release intervention for prisoners in Australia and elsewhere, as well as providing an unprecedented insight into the post-release experiences of prisoners in Queensland.