Smitten Hips: costs, complexities and consequences of hip fracture for 2552 Australian patients hospitalised in 2008–09. Analyses of linked Department of Veterans’ Affairs databases

This work describes hospital management and its aftermaths for a sample of 2552 elderly Australians with hip fracture. Administrative databases for hospital, residential aged care and community services were obtained from the Department of Veterans’ Affairs (DVA). Patient-level linkages within and between databases were enabled using unique code numbers assigned by DVA. An historical and epidemiological overview of Australian and international reports, with particular reference to declining age-related incidence includes a caseload projection for Australia to 2051 using national data in the public domain. Five specific research studies describe the total hospital stay for initial management, hospital-related cost (in 2009), the proportions of hospital stay due to acute care, rehabilitation and other reasons, and factors associated with greater use of resources. Mortality for this elderly population is shown at final hospital discharge, and at follow-up to 4 years, with determinant factors for these outcomes. The six Australian states used widely different hospital resources initial management but achieved very similar 12-month outcomes. Patients referred to rehabilitation incurred much higher total hospital costs, but likelihood of subsequent independent living was not improved. The Thesis demonstrates the necessity of data linkage for adequate analysis of services and outcomes for patients with complex condition

Smitten Hips: costs, complexities and consequences of hip fracture for 2552 Australian patients hospitalised in 2008–09. Analyses of linked Department of Veterans’ Affairs databases

This work describes hospital management and its aftermaths for a sample of 2552 elderly Australians with hip fracture. Administrative databases for hospital, residential aged care and community services were obtained from the Department of Veterans’ Affairs (DVA). Patient-level linkages within and between databases were enabled using unique code numbers assigned by DVA. An historical and epidemiological overview of Australian and international reports, with particular reference to declining age-related incidence includes a caseload projection for Australia to 2051 using national data in the public domain. Five specific research studies describe the total hospital stay for initial management, hospital-related cost (in 2009), the proportions of hospital stay due to acute care, rehabilitation and other reasons, and factors associated with greater use of resources. Mortality for this elderly population is shown at final hospital discharge, and at follow-up to 4 years, with determinant factors for these outcomes. The six Australian states used widely different hospital resources initial management but achieved very similar 12-month outcomes. Patients referred to rehabilitation incurred much higher total hospital costs, but likelihood of subsequent independent living was not improved. The Thesis demonstrates the necessity of data linkage for adequate analysis of services and outcomes for patients with complex condition

Indigenous Health – Australia, Canada, New Zealand and the United States - Laying Claim to a Future that Embraces Health for Us All.

Improving the health of all peoples has been a call across the globe for many decades and unfortunately remains relevant today, particularly given the large disparities in health status of peoples found around the world. Rather than differences in health, or health inequalities, we use a different term, health inequities. This is so as mere differences in health (or inequalities ) can be common in societies and do not necessarily reflect unfair social policies or practices. For example, natural ageing implies older people are more prone to illness. Yet, when differences are systematic, socially produced and unfair, these are considered health inequities. Certainly making judgments on what is systematic, socially produced and unfair, reflects value judgments and merit open debate. We are making explicit in this paper what our judgments are, and the basis for these judgment

Assessing preventable hospitalisation indicators (APHID): protocol for a data-linkage study using cohort study and administrative data

Introduction Potentially preventable hospitalisation (PPH) has been adopted widely by international health systems as an indicator of the accessibility and overall effectiveness of primary care. The Assessing Preventable Hospitalisation InDicators (APHID) study will validate PPH as a measure of health system performance in Australia and Scotland. APHID will be the first large-scale study internationally to explore longitudinal relationships between primary care and PPH using detailed person-level information about health risk factors, health status and health service use. Methods and analysis APHID will create a new longitudinal data resource by linking together data from a large-scale cohort study (the 45 and Up Study) and prospective administrative data relating to use of general practitioner (GP) services, dispensing of pharmaceuticals, emergency department presentations, hospital admissions and deaths. We will use these linked person-level data to explore relationships between frequency, volume, nature and costs of primary care services, hospital admissions for PPH diagnoses, and health outcomes, and factors that confound and mediate these relationships. Using multilevel modelling techniques, we will quantify the contributions of person-level, geographic-level and service-level factors to variation in PPH rates, including socioeconomic status, country of birth, geographic remoteness, physical and mental health status, availability of GP and other services, and hospital characteristics. Ethics and dissemination Participants have consented to use of their questionnaire data and to data linkage. Ethical approval has been obtained for the study. Dissemination mechanisms include engagement of policy stakeholders through a reference group and policy forum, and production of summary reports for policy audiences in parallel with the scientific papers from the study.</p

HealthConnect and the duty of care: a dilemma for medical practitioners

This article asks whether medical practitioners\u27 duty of care to their patients will encompass participation in the HealthConnect shared electronic records initiative. Medico-legal aspects of the HeathConnect scheme relating to the nature of shared electronic health record summaries (SEHRS) are examined, focusing on their function as an element of patient care and their ultimate purpose. The analysis is based on the premise that an incomplete and hence inaccurate shared electronic health record summary is clinically and legally more perilous than no record at all

Linkage of health and aged care service events: comparing linkage and event selection methods

<p>Abstract</p> <p>Background</p> <p>Data linkage is a technique that has long been used to connect information across several disparate data sources – most commonly for medical and population health research. Often the purpose is to connect data for individuals over extended time periods or across different service settings, and so person-based linkage using detailed personal information is preferred. Linkage which aims to link connected events, on the other hand, requires information about the time and place of the event as well as the person or persons involved in that event in order to make high quality linkages.</p> <p>This paper describes the detailed process of event linkage and compares directly an event-based linkage method for identifying transition events between two care sectors in Australia with a well-established high quality longitudinal person-based linkage which facilitates identification of event data for individuals.</p> <p>Methods</p> <p>Direct comparisons are made between transition events identified using an event-based linkage and an existing person-based linkage for people moving from hospital into aged care in Western Australia. Several aspects of event-based linkage are examined: refinement of the strategy to reduce false positives, causes of false positives and false negatives, quality of the linked event dataset, and utility of the linked event dataset for transition analysis.</p> <p>Results</p> <p>Over 97% of the event-based links were among those selected using the person-based linkage and over 90% of the latter were identified by the event-based method, with the remainder missed mostly due to differences in reported event date or residential region. Consequently the two linked datasets were sufficiently similar to give very similar results for analyses, but the actual volume of movement from hospital to RAC was underestimated by about 10% by the event-based method.</p> <p>Conclusion</p> <p>This project has allowed a 'preferred event' event-based linkage strategy to be selected and deployed across Australia to study movements from hospital to residential aged care facilities using databases in which only limited personal information is available, but event dates and details can be readily accessed. The utility of this approach in other transition situations depends on the volume of movement and the accuracy of recording information in each setting.</p

Event-based record linkage in health and aged care services data: a methodological innovation

<p>Abstract</p> <p>Background</p> <p>The interface between acute hospital care and residential aged care has long been recognised as an important issue in aged care services research in Australia. However, existing national data provide very poor information on the movements of clients between the two sectors. Nevertheless, there are national data sets which separately contain data on individuals' hospital episodes and stays in residential aged care, so that linking the two data sets–if feasible–would provide a valuable resource for examining relationships between the two sectors. As neither name nor common person identifiers are available on the data sets, other information needs to be used to link events relating to inter-sector movement.</p> <p>Methods</p> <p>Event-based matching using limited demographic data in conjunction with event dates to match events in two data sets provides a possible method for linking related events. The authors develop a statistical model for examining the likely prevalence of false matches, and consequently the number of true matches, among achieved matches when using anonymous event-based record linkage to identify transition events.</p> <p>Results</p> <p>Theoretical analysis shows that for event-based matching the prevalence of false matches among achieved matches (a) declines as the events of interest become rarer, (b) declines as the number of matches increases, and (c) increases with the size of the population within which matching is taking place. The method also facilitates the examination of the trade-off between false matches and missed matches when relaxing or tightening linkage criteria.</p> <p>Conclusion</p> <p>Event-based record linkage is a method for linking related transition events using event dates and basic demographic variables (other than name or person identifier). The likely extent of false links among achieved links depends on the two event rates, the match rate and population size. Knowing these, it is possible to gauge whether, for a particular study, event-based linkage could provide a useful tool for examining movements. Analysis shows that there is a range of circumstances in which event-based record linkage could be applied to two event-level databases to generate a linked database useful for transition analysis.</p

Record Linkage Techniques: Exploring and developing data matching methods to create national record linkage infrastructure to support population level research

In a world where the growth in digital information and systems continues to expand, researchers have access to unprecedented amounts of data. These large and complex data reservoirs require creative, innovative and scalable tools to unlock the potential of this ‘big data’. Record linkage is a powerful tool in the ‘big data’ arsenal. This thesis demonstrates the value of national record linkage infrastructure and how this has been achieved for the Australian research community