Sadia Hossain

SAFety, Effectiveness of care and Resource use among Australian Hospitals (SAFER Hospitals): a protocol for a population-wide cohort study of outcomes of hospital care

Publisher: BMJ

Date: 08-2020

DOI: 10.1136/BMJOPEN-2019-035446

Abstract: Despite global concerns about the safety and quality of health care, population-wide studies of hospital outcomes are uncommon. The SAFety, Effectiveness of care and Resource use among Australian Hospitals (SAFER Hospitals) study seeks to estimate the incidence of serious adverse events, mortality, unplanned rehospitalisations and direct costs following hospital encounters using nationwide data, and to assess the variation and trends in these outcomes. SAFER Hospitals is a cohort study with retrospective and prospective components. The retrospective component uses data from 2012 to 2018 on all hospitalised patients age ≥18 years included in each State and Territories’ Admitted Patient Collections. These routinely collected datasets record every hospital encounter from all public and most private hospitals using a standardised set of variables including patient demographics, primary and secondary diagnoses, procedures and patient status at discharge. The study outcomes are deaths, adverse events, readmissions and emergency care visits. Hospitalisation data will be linked to subsequent hospitalisations and each region’s Emergency Department Data Collections and Death Registries to assess readmissions, emergency care encounters and deaths after discharge. Direct hospital costs associated with adverse outcomes will be estimated using data from the National Cost Data Collection. Variation in these outcomes among hospitals will be assessed adjusting for differences in hospitals’ case-mix. The prospective component of the study will evaluate the temporal change in outcomes every 4 years from 2019 until 2030. Human Research Ethics Committees of the respective Australian states and territories provided ethical approval to conduct this study. A waiver of informed consent was granted for the use of de-identified patient data. Study findings will be disseminated via presentations at conferences and publications in peer-reviewed journals.

Long term survival after acute myocardial infarction in Australia and New Zealand, 2009‒2015: a population cohort study

Publisher: AMPCo

Date: 16-05-2021

DOI: 10.5694/MJA2.51085

Sex Differences in Acute Complications of Cardiac Implantable Electronic Devices: Implications for Patient Safety

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 22-01-2019

DOI: 10.1161/JAHA.118.010869

Abstract: To date, limited population‐level studies have examined the impact of sex on the acute complications of cardiac implantable electronic devices ( CIED) , including permanent pacemakers, implantable cardioverter defibrillators, and cardiac resynchronization therapy devices. We studied all patients aged years from 2010 to 2015 who were a resident of Australia or New Zealand, undergoing a new permanent pacemaker, implantable cardioverter defibrillator , or cardiac resynchronization therapy implant. Standardized variables were collected including patient demographic characteristics, primary and secondary diagnoses, procedures performed and discharge status. Diagnoses and procedures were coded as per the International Classification of Diseases, Tenth Revision ( ICD‐10 ) and the Australian Classification of Health Interventions. The primary end point was the incidence of major CIED ‐related complications in‐hospital or within 90 days of discharge, with the effect of sex evaluated using multiple logistic regression. A total of 81 304 new CIED (61 658 permanent pacemakers, 12 097 implantable cardioverter defibrillators, 7574 cardiac resynchronization therapy) implants were included (38% women). Overall, 8.5% of women and 8.0% of men experienced a CIED complication ( P =0.008). Differences between women and men remained significant after adjustment for age, procedural acuity, and comorbidities (odds ratio 1.10, 95% CI: 1.04–1.16, P .001). Differences in CIED complication rates were primarily driven by excess rate of in‐hospital pleural drainage (1.2% women versus 0.6% men, P .001 adjusted odds ratio 1.86, 95% CI: 1.59–2.17, P .001) and pericardial drainage (0.3% women versus 0.1% men, P .001 adjusted odds ratio 2.17, 95% CI: 1.48–3.18, P .001). Women are at higher risk of acute CIED complications. Improvements in implant technique and technologies are required to minimize the risk of implant‐related complications in women.

Institutional Variation in Quality of Cardiovascular Implantable Electronic Device Implantation

Publisher: American College of Physicians

Date: 30-07-2019

DOI: 10.7326/M18-2810

Institutional Variation in Quality of Cardiovascular Implantable Electronic Device Implantation

Publisher: American College of Physicians

Date: 21-01-2020

DOI: 10.7326/L19-0709

Outcome comparison of very preterm infants cared for in the neonatal intensive care units in Australia and New Zealand and in Canada

Publisher: Wiley

Date: 25-03-2015

DOI: 10.1111/JPC.12863

Abstract: To compare risk-adjusted neonatal intensive care unit outcomes between regions of similar population demography and health-care systems in Australia-New Zealand and Canada to generate meaningful hypothesis for outcome improvements. Retrospective study of data from preterm infants (<32 weeks gestational age) cared for in 29 ANZNN (Australian and New Zealand Neonatal Network) and 26 Canadian Neonatal Network (CNN) intensive care unit admitted between 2005 and 2007. Moribund infants or those with major congenital malformation were excluded. The 9995 ANZNN infants had a higher gestational age (29 vs. 28 weeks, P < 0.0001), lower rate of outborn status (13.2% vs. 19.1%, P < 0.0001) and Apgar score <7 at 5 min (14.8% vs. 21.6%, P < 0.0001) than their 7141 CNN counterparts. After adjustment, ANZNN and CNN infants had a similar likelihood of survival (adjusted odds ratio (AOR) 1.01 (0.88, 1.16)), but ANZNN infants were at lower risk of severe retinopathy (AOR 0.71 (0.61, 0.83)), severe ultrasound neurological injury (AOR 0.68 (0.59, 0.78)), necrotising enterocolitis (AOR 0.65 (0.56, 0.76)), chronic lung disease (AOR 0.67 (0.62, 0.73)) and late-onset sepsis (AOR 0.83 (0.76, 0.91)). ANZNN infants were at a higher risk of pulmonary air leak (AOR 1.20 (1.01, 1.42)), early-onset sepsis (AOR 1.33 (1.02, 1.74)). More ANZNN infants received any respiratory support (AOR 1.27 (1.14, 1.41)) and continuous positive airway pressure as sole respiratory support (AOR 2.50 (2.27, 2.70)). Despite similarities in settings, ANZNN infants fared better in most measures. Outcome disparities may be related to differences in tertiary service provision, referral and clinical practices.

Frequency, trends and institutional variation in 30‐day all‐cause mortality and unplanned readmissions following hospitalisation for heart failure in Australia and New Zealand

Publisher: Wiley

Date: 09-11-2021

DOI: 10.1002/EJHF.2030

Outborns or Inborns: Where Are the Differences? A Comparison Study of Very Preterm Neonatal Intensive Care Unit Infants Cared for in Australia and New Zealand and in Canada

Publisher: S. Karger AG

Date: 20-11-2015

DOI: 10.1159/000441272

Abstract: b i Background: /i /b Very preterm infants born outside tertiary centers are at higher risks of adverse outcomes than inborn infants. Regionalization of perinatal care has been introduced worldwide to improve outcomes. b i Objective: /i /b To compare the risk-adjusted outcomes of both inborn and outborn infants cared for in tertiary neonatal intensive care units in Australia and New Zealand and in Canada. b i Methods: /i /b Deidentified data of infants weeks' gestational age from the 29 Australian and New Zealand Neonatal Network units (ANZNN n = 9,893) and 26 Canadian Neonatal Network units (CNN n = 7,133) between 2005 and 2007 were analyzed for predischarge adverse outcomes. b i Results: /i /b ANZNN had lower rates of outborns compared to CNN (13 vs. 19%), particularly of late admissions ( days of age 5.8 vs. 22.2% of outborns) who had high morbidity rates. After adjusting for confounding variables including gestation, ANZNN inborn infants had lower odds of chronic lung disease [CLD 17.0 vs. 23.3% adjusted odds ratio (AOR) = 0.70, 95% CI: 0.64-0.77], severe neurological injuries on ultrasound (SNI 4.1 vs. 6.7% AOR = 0.62, 95% CI: 0.53-0.73), severe retinopathy (5.6 vs. 7% AOR = 0.71, 95% CI: 0.59-0.84) and necrotizing enterocolitis (3.5 vs. 5.4% AOR = 0.67, 95% CI: 0.56-0.79), but no difference in mortality odds. After excluding the late outborn admissions, ANZNN outborns had lower odds of SNI (AOR = 0.43, 95% CI: 0.32-0.58) and CLD (AOR = 0.63, 95% CI: 0.49-0.81) than CNN. b i Conclusions: /i /b ANZNN inborn and early admitted outborn infants had lower odds of neonatal morbidities than their CNN counterparts. However, compared to ANZNN, the higher CNN rates of outborns and their late admissions are likely related to the differences in regionalization and referral practices, and may explain differences in outcomes.

Complications of cardiac implantable electronic device placement in public and private hospitals

Publisher: Wiley

Date: 10-2020

DOI: 10.1111/IMJ.14704

Abstract: Few safety data exist comparing clinical outcomes in Australian public and private hospitals. We hypothesised that differences could exist between public and private hospitals due to differences in acuity and patient-level co-morbidities. To report comparative complications of cardiac implantable electronic device (CIED) placement in public and private hospitals. We conducted an observational cohort study of outcomes of patients aged >18 years from 2010 to 2015 undergoing a new permanent pacemaker (PPM), implantable cardioverter defibrillator (ICD) or cardiac resynchronisation therapy pacemaker or defibrillator (CRT-D/P) implant in NSW and Queensland public and private hospitals. The primary endpoint was major CIED-related complications occurring in-hospital or within 90 days of discharge. The independent effect of hospital sector was determined using multiple logistic regression, adjusting for covariates, including age, sex, co-morbidities and procedural acuity. A total of 32 364 new CIED implants (PPM 23 845, ICD 5361 and CRT-D/P 3158) were included (49% in private hospitals). Overall, 8.0% of private hospital procedures and 9.6% public hospital procedures experienced at least one complication. After adjustment, the overall risk of CIED complications was similar in private and public hospitals (OR: 0.92, 95% CI: 0.84-1.00, P = 0.06). In analysis of in idual complications, adjusted all-cause in-hospital mortality was higher in private hospitals, (OR: 1.49, 95% CI: 1.03-2.16, P = 0.036) primarily driven by an excess mortality in acute cases. The adjusted risk of in-hospital generator operation (OR: 0.53, 95% CI: 0.30-0.94, P = 0.03) and post-discharge infection (OR: 0.61, 95% CI: 0.46-0.81, P < 0.001) was lower in private hospitals. These data identify important similarities and differences in safety outcomes of CIED implantation between Australian public and private hospitals.

Long‐term survival and life expectancy following an acute heart failure hospitalization in Australia and New Zealand

Publisher: Wiley

Date: 02-08-2022

DOI: 10.1002/EJHF.2595

Abstract: Contemporary long‐term survival following a heart failure (HF) hospitalization is uncertain. We evaluated survival up to 10 years after a HF hospitalization using national data from Australia and New Zealand, identified predictors of survival, and estimated the attributable loss in life expectancy. Patients hospitalized with a primary diagnosis of HF from 2008–2017 were identified and all‐cause mortality assessed by linking with Death Registries. Flexible parametric survival models were used to estimate survival, predictors of survival and loss in life expectancy. A total of 283 048 patients with HF were included (mean age 78.2 ± 12.3 years, 50.8% male). Of these, 48.3% (48.1–48.5) were surviving by 3 years, 34.1% (33.9–34.3) by 5 years and 17.1% (16.8–17.4) by 10 years (median survival 2.8 years). Survival declined with age with 53.4% of patients aged 18–54 years and 6.2% aged ≥85 years alive by 10 years (adjusted hazard ratio [aHR] for mortality 4.84, 95% confidence interval [CI] 4.65–5.04 for ≥85 years vs. 18–54 years) and was worse in male patients (aHR 1.14, 95% CI 1.13–1.15). Prior HF (aHR 1.20, 95% CI 1.18–1.22), valvular and rheumatic heart disease (aHR 1.11, 95% CI 1.10–1.13) and vascular disease (aHR 1.07, 95% CI 1.04–1.09) were cardiovascular comorbidities most strongly associated with long‐term death. Non‐cardiovascular comorbidities and geriatric syndromes were common and associated with higher mortality. Compared with the general population, HF was associated with a loss of 7.3 years in life expectancy (or 56.6% of the expected life expectancy) and reached 20.5 years for those aged 18–54 years. Less than one in five patients hospitalized for HF were surviving by 10 years with patients experiencing almost 60% loss in life expectancy compared with the general population, highlighting the considerable persisting societal burden of HF. Concerted multidisciplinary efforts are needed to improve post‐hospitalization outcomes of HF.

Flinders University

Location: Australia

View Organisation

University Of Adelaide

Location: Australia

View Organisation

University Of New South Wales Faculty Of Medicine

Location: Australia

View Organisation

Western Sydney University - Campbelltown Campus

Location: Australia

View Organisation