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
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
Determining Critical Points In The Potential Palliative Care Pathway In The Last Year Of Life
Funder
National Health and Medical Research Council
Funding Amount
$356,461.00
Summary
People with serious illnesses who are approaching the end of their lives undergo a journey where, along the way, they experience several critical points. Although we know these critical points are crucial to how they might access the best kind of care, we are unsure exactly when these points may occur and how they may vary for different kinds of people. We need to know when is the best time to start withdrawing invasive and purely curative treatments, when are discussions about approaching death ....People with serious illnesses who are approaching the end of their lives undergo a journey where, along the way, they experience several critical points. Although we know these critical points are crucial to how they might access the best kind of care, we are unsure exactly when these points may occur and how they may vary for different kinds of people. We need to know when is the best time to start withdrawing invasive and purely curative treatments, when are discussions about approaching death best introduced and how we can care for people from a diverse range of backgrounds and beliefs within our current health care system. We also need to identify and promote the best possible ways of supporting patients at the end of life and their families as they negotiate the often complex path towards a good death. With this kind of information, health care practitioners, particularly those involved in palliative care, can design better services that put in place pathways where assessment of patient and family needs, referral to the most appropriate services and coordination of all the aspects of care are easy to understand and access for all people. This kind of care can be expensive so we need to use the money allocated to palliative care wisely. This can be achieved with thoughtful research that identifies those most in need, at the time of most need and investigates the best approaches to alleviating pain in suffering in the weeks and months before death. A fair and equitable health care system is not just about keeping people healthy, but also about dealing humanely with the inevitability of deathRead moreRead less
Development And Implementation Of An Educational Program To Guide Palliative Care For People With Motor Neurone Disease
Funder
National Health and Medical Research Council
Funding Amount
$258,525.00
Summary
The project aims to improve the quality of care for people with MND and their family carers through the development, testing and implementation of an educational program for health professionals and other service providers focused on the palliative care needs of this population. The project is taking place in three sites: Western Australia, Victoria and South Australia, in collaboration with the MND associations in the three states. The effectiveness of the flexible model of care provided to peo ....The project aims to improve the quality of care for people with MND and their family carers through the development, testing and implementation of an educational program for health professionals and other service providers focused on the palliative care needs of this population. The project is taking place in three sites: Western Australia, Victoria and South Australia, in collaboration with the MND associations in the three states. The effectiveness of the flexible model of care provided to people with MND and their carers as a result of the implementation of the MND Education Program will be assessed and a national implementation plan will be developed.Read moreRead less
Better Targeting Of Preventive Services Using Epidemiological Modelling
Funder
National Health and Medical Research Council
Funding Amount
$1,951,463.00
Summary
The purpose of this program of research is to improve the effectiveness of chronic disease prevention in Australia. The focus is to develop epidemiological models that can assist policy-makers to make more informed choices of which preventive programs to fund, improve the ability of clinicians to provide accurate preventive advice and to increase the ability of consumers to make decisions about preventive activities (that may relate to themselves or their communities). Australian population tren ....The purpose of this program of research is to improve the effectiveness of chronic disease prevention in Australia. The focus is to develop epidemiological models that can assist policy-makers to make more informed choices of which preventive programs to fund, improve the ability of clinicians to provide accurate preventive advice and to increase the ability of consumers to make decisions about preventive activities (that may relate to themselves or their communities). Australian population trends over coming years will be dominated by increasing numbers of elderly and a continuing increase in average lifespan. A priority for preventive healthcare is to maintain the elderly in a healthy active state, free of chronic disease, for as long as possible. Options to achieve this are increasing but vary in terms of likely effectiveness and cost-effectiveness. Since many of the costs and benefits of preventive programs occur beyond the time-scale of major intervention trials, the prediction of long-term benefits requires the integration of information from multiple sources including trials, epidemiological studies, risk-factor surveys and demography through a process referred to as epidemiological modelling. This project has major relevance to consumers, allied health professionals and Aboriginal and Torres Strait Islander people. One outcome of the project will be to allow consumers to make informed decisions about their preventive health care and will assist allied health professionals providing preventive advice to patients. These include occupational health nurses, health promotion officers, Aboriginal health workers and nurse practitioners.Read moreRead less
Palliative Care Constituency, Utilisation & Impact On Health Care: A Western Australia Based Epidemiology & Sociological
Funder
National Health and Medical Research Council
Funding Amount
$150,000.00
Summary
Using the Western Australian linked database and in consultation with palliative care service providers, the study will: 1. Study patterns of palliative care delivery during the last 12 months of life, comparing utilisation between different socio-demographic groups and cause of death. 2. Study the relationships between the services provided and the terminally ill. 3. Develop a definition of those who utilise designated palliative care programs and apply it to ....Using the Western Australian linked database and in consultation with palliative care service providers, the study will: 1. Study patterns of palliative care delivery during the last 12 months of life, comparing utilisation between different socio-demographic groups and cause of death. 2. Study the relationships between the services provided and the terminally ill. 3. Develop a definition of those who utilise designated palliative care programs and apply it to the population of Western Australia in 1994-1999. 4. Develop a forecasting model to optimise the planning and delivery of palliative care service in Australia.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
Dementia Literacy In Greek, Italian And Chinese Australians
Funder
National Health and Medical Research Council
Funding Amount
$228,473.00
Summary
The dementia knowledge and beliefs of persons from Italian, Greek and Chinese backgrounds will be compared to third generation Australians. Five hundred persons from each group will be randomly selected from around Australia to be surveyed by telephone. Questions will assess whether dementia symptoms are recognised, what these persons think causes dementia, where they would go for help, how likely they are to use aged care services and stigma towards persons with dementia. Focus groups will be c ....The dementia knowledge and beliefs of persons from Italian, Greek and Chinese backgrounds will be compared to third generation Australians. Five hundred persons from each group will be randomly selected from around Australia to be surveyed by telephone. Questions will assess whether dementia symptoms are recognised, what these persons think causes dementia, where they would go for help, how likely they are to use aged care services and stigma towards persons with dementia. Focus groups will be conducted to identify barriers to service use and identify methods to improve dementia knowledge in Italian, Greek and Chinese groups. This information will be used to improve community education and service delivery for persons with dementia from culturally and linguistically diverse backgrounds. The Primary Dementia Collaborative Research Centre at the University of NSW, NSW Multicultural Health Communication Service and Alzheimer’s Australia are partners in this research.Read moreRead less