An Examination Of The Causes Of Mortality Following Imprisonment In New South Wales Using Data-linkage.
Funder
National Health and Medical Research Council
Funding Amount
$205,500.00
Summary
Prisoner populations are characterised by poor health status including infectious diseases, injury, risk taking behaviours (eg. smoking and self-harm), mental illness, and substance abuse. Serosurveys of blood borne viruses such as hepatitis C and hepatitis B conducted in Australian and overseas prison settings have found that over one third of inmates have been exposed to these viruses with higher rates detected in injecting drug users and female inmates. Few attempts have been made to examine ....Prisoner populations are characterised by poor health status including infectious diseases, injury, risk taking behaviours (eg. smoking and self-harm), mental illness, and substance abuse. Serosurveys of blood borne viruses such as hepatitis C and hepatitis B conducted in Australian and overseas prison settings have found that over one third of inmates have been exposed to these viruses with higher rates detected in injecting drug users and female inmates. Few attempts have been made to examine the causes of mortality among prisoners following release from detention. Most interest has focused on overdoses in the period immediately following release; the aim of this study will examine all causes of death among individuals exposed to the correctional environment and compare these to death rates for NSW. Correctional centres house a largely male (94% in NSW) population with backgrounds of disadvantage in all areas, including Indigenous Australians, people of lower socio-economic status, those with a mental illness, and the intellectually disabled. There are currently over 21,000 (June 2001) prisoners detained in Australian correctional centres with approximately 39% housed in NSW. Fifteen percent of the NSW prisoners are Indigenous but comprise only 2% of the general population. The aims of this project will be to: (1) Identify all causes of death among ex-prisoners in NSW for the period 1985 to 2001; (2). Compare death rates in the study group with those in the NSW community; (3) Correlate pre-release health information contained in medical records with specific causes of death; (4) Compare causes of mortality among various sub-groups eg. injecting drug users, the mentally ill, violent offenders, and the intellectually disabled; (5) Examine causes of mortality between Indigenous and non-Indigenous inmates; and (6) use this information to develop pre-release programmes aimed at reducing excess mortality among this group.Read moreRead less
INVESTIGATING MORTALITY AMONG EX-PRISONERS IN QUEENSLAND: A DATA LINKAGE STUDY
Funder
National Health and Medical Research Council
Funding Amount
$716,801.00
Summary
NOTE: At the time of submitting the NOI for this project we had not yet received feedback from a submission to a parallel NHMRC funding round concerned with social disadvantage. We have since received very positive reviews for the trial foreshadowed in our NOI, and consistent with the recommendations of one reviewer, we have modified our application to complement the proposed trial by conducting a record linkage study. The content area and ethical issues associated with the proposed project rema ....NOTE: At the time of submitting the NOI for this project we had not yet received feedback from a submission to a parallel NHMRC funding round concerned with social disadvantage. We have since received very positive reviews for the trial foreshadowed in our NOI, and consistent with the recommendations of one reviewer, we have modified our application to complement the proposed trial by conducting a record linkage study. The content area and ethical issues associated with the proposed project remain largely unchanged. Studies in Australia and elsewhere have identified a heightened risk of death among ex-prisoners, with drug overdose, suicide and 'accidents' three major causes. Many deaths occur soon after release. Although the high incidence of 'overdose' among ex-prisoners is often attributed to reduced tolerance,most fatal drug overdoses are due to the combined effects of multiple drugs. A detailed understanding of deaths among ex-prisoners is a prerequisite for evidence-based preventive strategies. The proposed study will: (a) Link the identities of prisoners released from custody in QLD between 1994 and 2006, with the National Death Index (NDI). The linked database will permit exploration of the incidence, timing, causes and risk factors for death among ex-prisoners. (b) Compare correctional records of deceased ex-prisoners and a random sample of ex-prisoners known to be alive, focussing on suspected risk factors including criminal history, behaviour in custody, health status, psychosocial adjustment, socio-economic status, and history and treatment for drug use. This will allow more detailed analysis of risk factors for death post-release. (c) Conduct in-depth analysis of causes of death among ex-prisoners, using the National Coroners Information System (NCIS). Information regarding cause and context of death will be coded by a research assistant and analysed to identify group differences (e.g., between ATSI and non-ATSI ex-prisoners).Read moreRead less
Investigating Best Practice Primary Care For Older Australians With Diabetes Using Data Linkage
Funder
National Health and Medical Research Council
Funding Amount
$522,278.00
Summary
This study will use data linkage to examine questions about health service use by older Australians to manage chronic conditions such as diabetes. It will lead to a better understanding of the uptake of community based care initiatives and incentives through general practice, the factors that assist or impede uptake, and the impact of these on patient outcomes such as hospitalisation. The research findings will address important questions of interest to practitioners and policy advisors.
Use And Adequacy Of Diabetic Retinopathy Screening: A Whole Population Linked Data Study
Funder
National Health and Medical Research Council
Funding Amount
$219,382.00
Summary
Diabetes and its health complications are major public health issues presently facing Australia. Currently, around 7% of Australians have diabetes and it is estimated that 300 million people will be diabetic within 20-years. One major complication of diabetes is diabetic retinopathy, which is the most common cause of blindness in working-age adults. Although early treatment can prevent vision loss from diabetic retinopathy, often there are no visual symptoms until the condition is more advanced ....Diabetes and its health complications are major public health issues presently facing Australia. Currently, around 7% of Australians have diabetes and it is estimated that 300 million people will be diabetic within 20-years. One major complication of diabetes is diabetic retinopathy, which is the most common cause of blindness in working-age adults. Although early treatment can prevent vision loss from diabetic retinopathy, often there are no visual symptoms until the condition is more advanced and less treatable. Consequently, it is vital that people with diabetes have their eyes examined regularly. We aim to investigate the use of eye services by people with diabetes. The WA Data Linkage System provides the unique opportunity to efficiently examine the benefits of specialist eye care in diabetics within WA over a 17-year period. The study period encompasses the introduction of NHMRC guidelines for diabetic retinopathy screening in 1997. This will enable us to examine the effectiveness of these guidelines in increasing ophthalmic services use by people with diabetes. Evaluating these trends will provide important data on the effectiveness of policy and NHMRC guidelines in improving diabetic eye care, which has never been comprehensively investigated. Early intervention can prevent and delay vision loss from diabetic retinopathy, substantially reducing the personal and community burden from diabetes. The identification of poorly screened groups will enable more targeted programs to improve the use of ophthalmic series, which in turn may reduce the risk of: i) eye surgery related to diabetes, ii) injury resulting from diabetes-related vision disorder or iii) blindness. The feasibility of using linked health data to evaluate eye screening in diabetics will enable future work addressing processes of care in the prevention of other diabetic complications to be undertaken quickly and cost-effectively.Read moreRead less
Population Based Estimates Of MBS, PBS And Hospital Utilisation Rates Using Prevalent Chronic Disease Denominators
Funder
National Health and Medical Research Council
Funding Amount
$246,000.00
Summary
This project will use hospital morbidity and mortality data from the WA Data Linkage System, linked to the Medicare Benefits Scheme and Pharmaceutical Benefits Scheme databases to produce measures of disease occurrence and health service utilisation within the Western Australian population according to indices of social and geographical disadvantage. The first objective will involve establishing teams of clinicians and researchers who will work together to develop and validate lists of MBS and P ....This project will use hospital morbidity and mortality data from the WA Data Linkage System, linked to the Medicare Benefits Scheme and Pharmaceutical Benefits Scheme databases to produce measures of disease occurrence and health service utilisation within the Western Australian population according to indices of social and geographical disadvantage. The first objective will involve establishing teams of clinicians and researchers who will work together to develop and validate lists of MBS and PBS item numbers that are indicative of specified chronic diseases. This information will then be used to identify patients with these conditions from the MBS and PBS databases during the period 1990-2003 and this method of case ascertainment will be compared with the use of the Hospital morbidity data system alone. Once groups of patients have been identified, their utilisation rates of MBS, PBS and hospital services will be calculated. The effect of social and geographical indices on the occurrence of disease and the utilisation of services will also be studied. Trends over time in health status and health service utilisation are vital to the evidence-based planning and evaluation of health services and to the provision of an equitable and accessible health service which is based on the needs of the community. The work will represent the first time that the utilisation of Australian MBS and PBS itemised services is measured in diagnostically defined groups of patients with chronic diseases.Read moreRead less
Are Cardiac Conditions In Older Women Managed Appropriately?
Funder
National Health and Medical Research Council
Funding Amount
$289,492.00
Summary
Cardiac conditions, including heart attach, heart failure, angina and high blood pressure are very common among older Australians. They account for large proportions of deaths, morbidity and health care costs. For most of these conditions there are highly effective treatments, however there is evidence that these are not as well used as they should be. Also, for women, diagnosis may be delayed due to perceptions that heart disease is a problem mainly among men. The project is based on the Austra ....Cardiac conditions, including heart attach, heart failure, angina and high blood pressure are very common among older Australians. They account for large proportions of deaths, morbidity and health care costs. For most of these conditions there are highly effective treatments, however there is evidence that these are not as well used as they should be. Also, for women, diagnosis may be delayed due to perceptions that heart disease is a problem mainly among men. The project is based on the Australian Longitudinal Study on Women's Health which includes more than 10,000 women, over half living in rural and remote areas. Women with cardiac conditions will be surveyed about their medical care. This information, together with data they have provided over the last 6 years (and Medicare data if the women have given their consent), will be compared with best practice guidelines established by NHMRC and the Heart Foundation. In this way the project will examine the adequacy of medical care among older women in sufficient detail to make actionable recommendations to health authorities for where improvements are needed.Read moreRead less
The Physiology Of Health Systems: Port Lincoln As A Case Study
Funder
National Health and Medical Research Council
Funding Amount
$2,228,073.00
Summary
No health system in Australia has a complete, population-wide view of how they are used, by whom, and with what effect on health. Our plan is to capture and describe comprehensively all health system activity relating to a sizeable and carefully-defined Australian population and to complement this with a population-wide census of health status. Such 'intelligence' is fundamental to evaluating the current performance of health systems and to planning changes to them.
The WA Safety And Quality Of Surgical Care Project: Improving The Safety, Quality And Provision Of Surgical Care.
Funder
National Health and Medical Research Council
Funding Amount
$583,500.00
Summary
The basis of this application is a three-year project which aims to improve the safety, quality and the provision of surgical care. This application constitutes the core of the WA Safety and Quality of Surgical Care Project (SQSCP), which was established in 1996 to evaluate the clinical epidemiology, health care utilisation, patient safety and health outcomes following admission to hospital for specific surgical and medical procedures in Western Australia (WA). The study will use data from the W ....The basis of this application is a three-year project which aims to improve the safety, quality and the provision of surgical care. This application constitutes the core of the WA Safety and Quality of Surgical Care Project (SQSCP), which was established in 1996 to evaluate the clinical epidemiology, health care utilisation, patient safety and health outcomes following admission to hospital for specific surgical and medical procedures in Western Australia (WA). The study will use data from the WA Data Linkage System, which brings together 15 million records from hospital morbidity, death, cancer, midwives notification and mental health databases. Surgical procedures have been selected for review based on national priorities and after consultation with the WA Branch of the Royal Australasian College of Surgeons (RACS) and other clinical Colleges. This application proposes to continue the core research activities of the SQSCP. A special focus will be on the use of minimally invasive surgical techniques including laparoscopic, endoscopic and endoluminal procedures, which have increased dramatically during the last decade. The study will also evaluate differences in the outcomes of surgical care in rural and metropolitan settings. The findings of the SQSCP will be comprehensively disseminated to surgeons, the RACS, hospital managers, health policy makers and consumers. The rationale of this project is that by providing high quality data on the epidemiology, utilisation and outcomes of surgical care, we will be able to increase the knowledge-base that will contribute to improvements in the safety, quality and provision of surgical care in Australia and internationally. The aims of the SQSCP are consistent with national health priorities and the recommendations of the Taskforce on Quality of Australian Health Care Study, the Australian Council for Safety and Quality in Health Care and the National Institute of Clinical Studies.Read moreRead less
A Population Based Linked Data Analysis Of The Prognostic Determinants Of Out Of Hospital Cardiac Arrest
Funder
National Health and Medical Research Council
Funding Amount
$174,000.00
Summary
Heart disease, resulting in a cardiac arrest, is the largest single cause of death for men and women in Australia, accounting alone for almost a quarter of all deaths. Despite the scope of the problem, there is a paucity of objective data about the factors that determine outcomes in the short-term and long-term. This study will capitalise on the unique research potential of the WA Data Linkage Project to combine the WA Cardiac Arrest Register with existing health service data and death records, ....Heart disease, resulting in a cardiac arrest, is the largest single cause of death for men and women in Australia, accounting alone for almost a quarter of all deaths. Despite the scope of the problem, there is a paucity of objective data about the factors that determine outcomes in the short-term and long-term. This study will capitalise on the unique research potential of the WA Data Linkage Project to combine the WA Cardiac Arrest Register with existing health service data and death records, to describe the outcomes of out-of-hospital cardiac arrest in Perth WA. Both morbidity and mortality will be described and compared to patients with similar health conditions, but who do not experience a cardiac arrest. More specifically this study will address questions such as 'what is the effect of age, gender, pre-existing illness and socio-economic status on survival from out-of-hospital cardiac arrest?' and What is the long-term survival and health status for initial survivors of out-of-hospital cardiac arrest?' This project will both identify those factors associated with best outcome as well as identify a profile of persons who are 'at risk' of experiencing a further cardiac arrest. Such information is important for the evaluation of current resuscitative practices as well as providing the basis for future planning initiatives.Read moreRead less