Kathy Eagar

Functional Assessment to Predict Capacity for Work in a Population of School-leavers with Disabilities

K. Eagar et al. — Sun, 09 Dec 2012 19:21:52 PST

This study reports on an assessment system for school-leavers with disabilities to identify their capacity for work and the type of transition-to-work programme best suited to each person. Participants were 1,556 high school students in four cohorts who left school between 1999 and 2002. Each school-leaver was assessed by rehabilitation counsellors for functional ability and capacity for work. In a supplementary study, the 2002 cohort was assessed by special transition teachers using a short screening tool. The results demonstrate that there is a predictable hierarchy of functional acquisition among school-leavers with disabilities and that the single best predictor of future capacity for work and need for transition-to-work programmes among this group of young people is the capacity to manage activities of daily living. The results also demonstrate that a short screen used by teachers, together with a behavioural assessment, is sufficient to stream school-leavers with a disability into a range of transition-to-work programmes.

Evaluation of a midwifery model of care

Kathryn E. Williams et al. — Sun, 09 Dec 2012 19:21:51 PST

Primary Care: Where and Why

Kathleen M. Eagar et al. — Sun, 09 Dec 2012 19:21:49 PST

Lessons from the National Mental Health Integration Program

Jane Pirkis et al. — Sun, 09 Dec 2012 19:21:48 PST

Evaluation of the Asthma Management Program: mid-term review report: Volume 1

Karen Quinsey et al. — Sun, 09 Dec 2012 19:21:46 PST

The Clinical Services Redesign Program in New South Wales : perceptions of senior health managers

Malcolm R. Masso et al. — Sun, 09 Dec 2012 19:21:45 PST

OBJECTIVE: This study explores the views of senior managers regarding their experience of participating in the Clinical Services Redesign Program (CSRP) in New South Wales and the impact of that Program. METHODS: Semi-structured interviews were conducted in 2007 with 42 senior managers working in the NSW health system. RESULTS: Managers reported being increasingly oriented towards efficiency, achieving results and using data to support decision-making. The increased focus on managing performance was accompanied by concerns about the narrowness of the indicators being used to manage performance and how these are applied. The value placed by interviewees on the use of 'competition' as a lever for improving services varied. Leadership was repeatedly identified as important for long-term success and sustainability. No one was confident that the CSRP had yet been sufficiently embedded in day to day practice in order for it to keep going on its own. CONCLUSION: Our findings are generally consistent with the extensive literature on change management, performance management and leadership. Some cultural change has taken place in terms of observed patterns of behaviour but it is unrealistic to think that CSRP can on its own deliver the desired deeper cultural changes in the values and assumptions underpinning the NSW Health system. There is some evidence of dysfunctional aspects of performance management but no call for the focus on performance or redesign to be abandoned.

The NSW Post School Programs eligibility assessment: a guide to functional assessments in 2012

Kathleen M. Eagar et al. — Sun, 09 Dec 2012 19:21:43 PST

Performance of routine outcome measures in adult mental health care

Thomas Trauer et al. — Sun, 09 Dec 2012 19:21:42 PST

Overlaps between initial intake assessments and ACAT assessment and suggested modifications

Janet E. Sansoni et al. — Sun, 09 Dec 2012 19:21:41 PST

Triggers, algorithms and priority settings in the initial intake tools

Peter Samsa et al. — Sun, 09 Dec 2012 19:21:39 PST

The Clinical Services Redesign Program in New South Wales: perceptions of senior health managers

Malcolm R. Masso et al. — Sun, 09 Dec 2012 19:21:38 PST

Counting acute inpatient care. ABF Information Series No. 5

Kathleen M. Eagar — Sun, 09 Dec 2012 19:21:36 PST

As outlined in ABF Information Paper Number 1, a critical element of Activity Based Funding (ABF) is the need to define, classify, count, cost and pay for each health care activity in a consistent manner. For acute patients who stay in hospital for more than a day, this is not an issue. These patients are classified as acute ‘overnight admitted patients’ and are counted by Diagnosis Related Group (DRG).

Is It Feasible and Desirable to Collect Voluntarily Quality and Outcome Data Nationally in Palliative Oncology Care?

David L. Fildes et al. — Sun, 09 Dec 2012 19:21:34 PST

Hospice/palliative care is a critical component of cancer care. In Australia, more than 85% of people referred to specialized hospice/palliative care services (SHPCS) have a primary diagnosis of cancer, and 60% of people who die from cancer will be referred to SHPCS. The Palliative Care Outcomes Collaboration (PCOC) is an Australian initiative that allows SHPCS to collect nationally agreed-upon measures to better understand quality, safety, and outcomes of care. This article describes data (October 2006 through September 2007) from the first 22 SHPCS, with more than 100 inpatient admissions annually. Data include phase of illness, place of discharge, and, at each transition in place of care, the person's functional status, dependency, and symptom scores. Data are available for 5,395 people for 6,379 admissions. After categorizing by phase of illness and dependency, there remain at the end of each admission 12-fold differences (mean, 26%; range, 4% to 52%) in the percentage of patients who became stable after an unstable phase; seven-fold differences (mean, 22%; range, 6% to 41%) in the percentage of patients with improved symptom scores, five-fold differences (mean, 25%; range, 12% to 64%) in discharge back to the community, four-fold differences (mean, 10%; range, 4% to 16%) in improved function, and three-fold differences in the length of stay (mean, 14 days; range, 6 to 19 days). PCOC shows it is feasible to collect quality national palliative care outcome data voluntarily. Variations in outcomes justify continued enrollment of services. Benchmarking should include all patients whose cancer will cause death and explore observed variations.

Why patients attend emergency departments for conditions potentially appropriate for primary care: Reasons given by patients and clinicians differ

Malcolm R. Masso et al. — Sun, 09 Dec 2012 19:21:33 PST

Objectives: To compare reasons identified by clinical staff for potential primary care attendances to the ED with those previously identified by patients. Methods: Survey of staff and primary care patients in five ED in New South Wales, Australia using questionnaire based on reasons identified in published studies. Results: Clinicians in the survey identify a broader spectrum of reasons for potential primary care cases presenting to the ED than the patients themselves report. Doctors reported on average 4.1 very important reasons and nurses 4.8 compared with patients 2.4 very important reasons. The main reasons identified by both doctors and nurses were similar and quite different to those identified by patients. Clinicians were more likely to emphasize cost and access issues rather than acuity and complexity issues. There was no difference within the clinician group between doctors and nurses nor by varying levels of experience. Furthermore doctors with significant experience in both primary care and emergency medicine did not differ from the overall clinicians' pattern. Conclusions: These data confirm that clinician perspectives on reasons for potential primary care patients' use of ED differ quite markedly from the perspectives of patients themselves. Those differences do not necessarily represent a punitive or blaming philosophy but will stem from the very different paradigms from which the two protagonists approach the interactions, reflecting the standard tension in a provider - consumer relationship. If policy is to be developed to improve system use and access, it must take both perspectives into account with respect to redesign, expectations and education.

Caring Communities Palliative Care Program: Second Evaluation Progress Report

Kathleen M. Eagar et al. — Sun, 09 Dec 2012 19:21:31 PST

Primary care patients' views on why they present to Emergency Departments - inappropriate attendances or inappropriate policy?

Peter M. Siminski et al. — Sun, 09 Dec 2012 19:21:30 PST

This study investigates why some patients with apparently less urgent conditions present to emergency departments (EDs). We report on a survey of "potential primary-care" ED patients, who were asked about their reasons for choosing the ED over GPs. The sample consisted of 397 patients (with a response rate of 99% = 397/400), recruited in the former Illawarra Health Area. The three main reasons selected were: self-assessed urgency; being able to see the doctor and having tests or X-rays done in the same place; and self-assessed seriousness or complexity. The results do not appear to be sensitive to two potential sources of bias (fixed question ordering and non-random sampling). The results suggest a number of potential policy levers for encouraging some people to present to GPs rather than EDs. However, the main conclusion is that the majority of "potential primary-care" patients appear to be presenting for appropriate reasons. Thus "inappropriate attendances" do not seem to be the cause of EDs being under stress. We also argue that the results are useful for drawing inferences more broadly than just in relation to the Illawarra.

Determining level of care appropriateness in the patient journey from acute care to rehabilitation

Christopher J. Poulos et al. — Sun, 09 Dec 2012 19:21:28 PST

"Background: The selection of patients for rehabilitation, and the timing of transfer from acute care, are important clinical decisions that impact on care quality and patient flow. This paper reports utilization review data on inpatients in acute care with stroke, hip fracture or elective joint replacement, and other inpatients referred for rehabilitation. It examines reasons why acute level of care criteria are not met and explores differences in decision making between acute care and rehabilitation teams around patient appropriateness and readiness for transfer. Methods: Cohort study of patients in a large acute referral hospital in Australia followed with the InterQual utilization review tool, modified to also include reasons why utilization criteria are not met. Additional data on team decision making about appropriateness for rehabilitation, and readiness for transfer, were collected on a subset of patients. Results: There were 696 episodes of care (7189 bed days). Days meeting acute level of care criteria were 56% (stroke, hip fracture and joint replacement patients) and 33% (other patients, from the time of referral). Most inappropriate days in acute care were due to delays in processes/scheduling (45%) or being more appropriate for rehabilitation or lower level of care (30%). On the subset of patients, the acute care team and the utilization review tool deemed patients ready for rehabilitation transfer earlier than the rehabilitation team (means of 1.4, 1.3 and 4.0 days from the date of referral, respectively). From when deemed medically stable for transfer by the acute care team, 28% of patients became unstable. From when deemed stable by the rehabilitation team or utilization review, 9% and 11%, respectively, became unstable. Conclusions: A high proportion of patient days did not meet acute level of care criteria, due predominantly to inefficiencies in care processes, or to patients being more appropriate for an alternative level of care, including rehabilitation. The rehabilitation team was the most accurate in determining ongoing medical stability, but at the cost of a longer acute stay. To avoid inpatients remaining in acute care in a state of 'terra nullius', clinical models which provide rehabilitation within acute care, and more efficient movement to a rehabilitation setting, is required. Utilization review could have a decision support role in the determination of medical stability."

Primary Care Patients in the Emergency Department ? who are they? A review of the definition of the ?primary care patient? in the Emergency Department

Andrew J. Bezzina et al. — Sun, 09 Dec 2012 19:21:27 PST

Lessons from interdisciplinary research

Kathleen M. Eagar — Sun, 09 Dec 2012 19:21:26 PST

The effects of model of care/demand management strategies on projected public sector acute and community based health services in the ACT

Cristina J. Thompson et al. — Sun, 09 Dec 2012 19:21:24 PST