Caseload Midwifery For Women At Low Risk Of Medical Complications: A Randomised Controlled Trial
Funder
National Health and Medical Research Council
Funding Amount
$604,527.00
Summary
In June 2004, the Victorian Department of Human Services released a policy document Future directions for Victoria's maternity services. The document endorsed the expansion of public models of maternity care that offer 'one on one' midwifery care (caseload). This model has had limited evaluation with safety and efficacy largely unknown. Research conducted in the UK and in Australia has largely measured the effect of teams of care providers (commonly 6-12 midwives) with only two in the UK testing ....In June 2004, the Victorian Department of Human Services released a policy document Future directions for Victoria's maternity services. The document endorsed the expansion of public models of maternity care that offer 'one on one' midwifery care (caseload). This model has had limited evaluation with safety and efficacy largely unknown. Research conducted in the UK and in Australia has largely measured the effect of teams of care providers (commonly 6-12 midwives) with only two in the UK testing caseload care. Studies of continuity of midwifery teams have reported reduced caesareans and other interventions in labour. They have also found increased satisfaction, with no statistically significant differences in health outcomes for babies. Women who are identified at low medical risk will be recruited from the antenatal clinic of a large, tertiary, public maternity hospital. Women will be randomly allocated to caseload midwifery or standard low risk care. Those allocated to caseload will receive pregnancy, birth and postnatal care from a primary midwife with one or two pregnancy visits to be conducted by a 'back-up' midwife. The midwife will collaborate with obstetricians and other health professionals as necessary. This will be the first RCT of caseload midwifery care in Australia and only the third one conducted anywhere. It is a unique opportunity to provide a rigorous evaluation of a model that is beginning to be implemented widely in Australia. The trial will provide much needed information regarding the outcomes of caseload midwifery including interventions in childbirth, safety, costs, women's satisfaction with care and impact on the midwifery workforce. The study will provide data that will inform clinical practice and guide service providers involved in the organisation of maternity services.Read moreRead less
The Impact Of Insurance On Use Of Dental Services And Oral Health
Funder
National Health and Medical Research Council
Funding Amount
$203,616.00
Summary
Dental problems are very common in the Australian population, and health expenditure on dental services is large. This project addresses the impact of dental insurance on use of dental services and oral health outcomes to investigate the effect of insurance on dental visit patterns and mix of dental services provided, and examine how the cost of dental care is related to outcomes such as tooth loss and quality of life.
This study proposes to examine the quality of procedural medical care provided by rural doctors who are not specialists. The disciplines of Anaesthetics, Surgery and Obstetrics will be included. Most of these services in rural Australia are not provided by specialist medical practitioners, but rather by rural general practitioners who have obtained additional training, albeit shorter than that undertaken by specialist trainees, and who are supported by skilled nurses and other health professiona ....This study proposes to examine the quality of procedural medical care provided by rural doctors who are not specialists. The disciplines of Anaesthetics, Surgery and Obstetrics will be included. Most of these services in rural Australia are not provided by specialist medical practitioners, but rather by rural general practitioners who have obtained additional training, albeit shorter than that undertaken by specialist trainees, and who are supported by skilled nurses and other health professionals in relatively small rural hospitals. Patients and rural doctors often have little choice but to manage urgent cases locally and in some cases experienced and skilled local teams are able to offer a wider range of services, including a limited number of elective procedures. Despite underlying assumptions that the quality of the services cannot match that of specialist care in larger hospitals, there is no agreement on what constitutes quality of rural procedural care and little evidence that the quality is different. This issue is important as substantial government funds are spent on recruiting, training and retaining a qualified rural medical workforce, and yet fewer rural doctors are providing these services and fewer rural hospitals have the facilities to support those rural doctors still providing the services. Further, measuring the quality of care is a complex issue on which different stakeholders may have different views. This study proposes a multi-perspective approach to assessing the quality of care through a number of case studies provided by rural doctors.Read moreRead less
Health Services Research: A Randomised Controlled Trial To Evaluate A Model Of Comprehensive Stroke Care
Funder
National Health and Medical Research Council
Funding Amount
$519,150.00
Summary
This study compares the length of stay and patient outcomes between two stroke care models - co-located acute-rehabilitation and dislocated acute-rehabilitation stroke care. In participating hospitals, acute stroke patients admitted to the emergency department will be randomly allocated to either model of care. Length of hospital stay and clinical outcomes will be examined 90 days post-stroke. Study results will provide high level of evidence for future stroke care model development.
Development Of Quality Indicators For The Frail Elderly In Acute Care
Funder
National Health and Medical Research Council
Funding Amount
$372,311.00
Summary
Frail older people are particularly vulnerable to a range of mishaps while in hospital. Good care can reduce the frequency and extent of these problems. Quality indicators (QIs) assist hospitals, and clinical service units within them, to appraise their performance, and to compare it to other hospitals. QIs for the measurement of outcomes for the frail aged in the acute care setting do not exist in Australia or overseas. We aim to develop these indicators during this study.
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.
Patterns Of Care And Quality Of Life In Patients With Pancreatic Cancer.
Funder
National Health and Medical Research Council
Funding Amount
$680,010.00
Summary
Available evidence suggests that care of patients with pancreatic cancer is variable and dependent on a variety of factors such as geographic location, socioeconomic status and hospital volume. Variability in care may influence survival and quality of life of patients. We propose to conduct a comprehensive study of the management of patients with pancreatic cancer in NSW and, in a substudy in QLD, to determine how variation in management affects patient quality of life.