The impact of electronic health records on risk management of information systems in Australian residential aged care homes

To obtain indications of the influence of electronic health records (EHR) in managing risks and meeting information system accreditation standard in Australian residential aged care (RAC) homes. The hypothesis to be tested is that the RAC homes using EHR have better performance in meeting information system standards in aged care accreditation than their counterparts only using paper records for information management. Content analysis of aged care accreditation reports from the Aged Care Standards and Accreditation Agency produced between April 2011 and December 2013. Items identified included types of information systems, compliance with accreditation standards, and indicators of failure to meet an expected outcome for information systems. The Chi-square test was used to identify difference between the RAC homes that used EHR systems and those that used paper records in not meeting aged care accreditation standards. 1,031 (37.4%) of 2,754 RAC homes had adopted EHR systems. Although the proportion of homes that met all accreditation standards was significantly higher for those with EHR than for homes with paper records, only 13 RAC homes did not meet one or more expected outcomes. 12 used paper records and nine of these failed the expected outcome for information systems. The overall contribution of EHR to meeting aged care accreditation standard in Australia was very small. Risk indicators for not meeting information system standard were no access to accurate and appropriate information, failure in monitoring mechanisms, not reporting clinical incidents, insufficient recording of residents\u27 clinical changes, not providing accurate care plans, and communication processes failure. The study has provided indications that use of EHR provides small, yet significant advantages for RAC homes in Australia in managing risks for information management and in meeting accreditation requirements. The implication of the study for introducing technology innovation in RAC in Australia is discussed

Co-designing a dashboard of predictive analytics and decision support to drive care quality and client outcomes in aged care: a mixed-method study protocol

IntroductionThere is a clear need for improved care quality and quality monitoring in aged care. Aged care providers collect an abundance of data, yet rarely are these data integrated and transformed in real-time into actionable information to support evidence-based care, nor are they shared with older people and informal caregivers. This protocol describes the co-design and testing of a dashboard in residential aged care facilities (nursing or care homes) and community-based aged care settings (formal care provided at home or in the community). The dashboard will comprise integrated data to provide an 'at-a-glance' overview of aged care clients, indicators to identify clients at risk of fall-related hospitalisations and poor quality of life, and evidence-based decision support to minimise these risks. Longer term plans for dashboard implementation and evaluation are also outlined.MethodsThis mixed-method study will involve (1) co-designing dashboard features with aged care staff, clients, informal caregivers and general practitioners (GPs), (2) integrating aged care data silos and developing risk models, and (3) testing dashboard prototypes with users. The dashboard features will be informed by direct observations of routine work, interviews, focus groups and co-design groups with users, and a community forum. Multivariable discrete time survival models will be used to develop risk indicators, using predictors from linked historical aged care and hospital data. Dashboard prototype testing will comprise interviews, focus groups and walk-through scenarios using a think-aloud approach with staff members, clients and informal caregivers, and a GP workshop.Ethics and disseminationThis study has received ethical approval from the New South Wales (NSW) Population & Health Services Research Ethics Committee and Macquarie University's Human Research Ethics Committee. The research findings will be presented to the aged care provider who will share results with staff members, clients, residents and informal caregivers. Findings will be disseminated as peer-reviewed journal articles, policy briefs and conference presentations

International Profiles of Health Care Systems, 2011

This publication presents overviews of the health care systems of Australia, Canada, Denmark, England, France, Germany, Japan, Italy, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United States. Each overview covers health insurance, public and private financing, health system organization, quality of care, health disparities, efficiency and integration, use of health information technology, use of evidence-based practice, cost containment, and recent reforms and innovations. In addition, summary tables provide data on a number of key health system characteristics and performance indicators, including overall health care spending, hospital spending and utilization, health care access, patient safety, care coordination, chronic care management, disease prevention, capacity for quality improvement, and public views

Designated auditing agency handbook: Ministry of Health auditor handbook (revised 2015)

Introduction: This handbook outlines the Ministry of Health\u27s requirements of designated auditing agencies for auditing and audit reporting for the certification of health care services under the Health and Disability Services (Safety) Act 2001. The handbook also gives providers of health care services a guide to specific requirements for various types of audits.     &nbsp

Adapting the community sector for climate extremes

Abstract People experiencing poverty and inequality will be affected first and worst by the impacts of climate change to infrastructure and human settlements, including those caused by increasingly frequent and intense extreme weather events and natural disasters. They have the least capacity to cope, to adapt, to move and to recover. Community service organisations (CSOs) play a critical role in supporting individuals, families and communities experiencing poverty and inequality to build resilience and respond to adverse changes in circumstances. As such, the services they provide comprise a critical component of social infrastructure in human settlements. However, very little is understood about CSOs own vulnerability to – or their role in managing and mitigating risks to their clients and the community from – climate change impacts to physical infrastructure. The Extreme Weather, Climate Change and the Community Sector – Risks and Adaptations project examined the relationship between physical and social infrastructure (in the form of CSO service provision). Specifically, the ways in which the climate-driven failure of CSO service delivery worsens risks to the individuals and communities they serve and, on the other hand, how preparedness may reduce vulnerability to climate change and extreme weather impacts to human settlements and infrastructure.The research comprised a comprehensive and critical scoping, examination and review of existing research findings and an audit, examination and judgment-based evaluation of the current vulnerabilities and capacities of CSOs under projected climate change scenarios. It employed three key methods of consultation and data collection. A literature review examined research conducted to date in Australia and comparative countries internationally on the vulnerability and climate change adaptation needs of CSOs. A program of 10 Community Sector Professional Climate Workshops consulted over 150 CSO representatives to develop a qualitative record of extreme event and climate change risks and corresponding adaptation strategies specific to CSOs. A national survey of CSOs, which resulted in the participation of approximately 500 organisations, produced a quantitative data set about the nature of CSO vulnerability to climate change and extreme weather impacts to infrastructure, whether and how CSOs are approaching the adaptation task and key barriers to adaptation.While the methods employed and the absence of empirical data sets quantifying CSO vulnerability to climate change impacts create limitations to the evidence-base produced, findings from the research suggest that CSOs are highly vulnerable and not well prepared to respond to climate change and extreme weather impacts to physical infrastructure and that this underlying organisational vulnerability worsens the vulnerability of people experiencing poverty and inequality to climate change. However, the project results indicate that if well adapted, CSOs have the willingness, specialist skills, assets and capacity to make a major contribution to the resilience and adaptive capacity of their clients and the community more broadly (sections of which will be plunged into adversity by extreme events). Despite this willingness, the evidence presented shows that few CSOs have undertaken significant action to prepare for climate change and worsening extreme weather events. Key barriers to adaptation identified through the research are inadequate financial resources, lack of institutionalised knowledge and skills for adaptation and the belief that climate change adaptation is beyond the scope of CSOs core business. On the other hand, key indicators of organisational resilience to climate change and extreme weather impacts include: level of knowledge about extreme weather risks, past experience of an extreme weather event and organisational size.Given its size, scope and the critical role the Australian community sector plays in building client and community resilience and in assisting communities to respond to and recover from the devastating impacts of extreme weather events and natural disasters, the research identifies serious gaps in both the policy frameworks and the research base required to ensure the sector’s resilience and adaptive capacity – gaps which appear to have already had serious consequences. To address these gaps, a series of recommendations has been prepared to enable the development and implementation of a comprehensive, sector-specific adaptation and preparedness program, which includes mechanisms to institutionalise knowledge and skills, streamlined tools appropriate to the needs and capacity of a diverse range of organisations and a benchmarking system to allow progress towards resilience and preparedness to be monitored. Future research priorities for adaptation in this sector have also been identified

Healthcare in continuum for an ageing population: national self monitoring or remote offshore monitoring for Australia?

Australia is a country, similar to other developed nations, confronting an ageing population with complex demographics. Ensuring continued healthcare for the ageing, while providing sufficient support for the already aged population requiring assistance, is at the forefront of the national agenda. Varied initiatives are with foci to leverage the advantages of lCTs leading to e-Health provisioning and assisted technologies. While these initiatives increasingly put budgetary constraints on local and federal governments, there is also a case for offshore resourcing of non-critical health services, to support, streamline and enhance the continuum of care, as the nation faces acute shortages of medical practitioners and nurses. However, privacy and confidentiality concerns in this context are a significant issue in Australia. In this paper, we take the position that if the National and state electronic health records system initiatives, are fully implemented, offshore resourcing can be a feasible complementary option resulting in a win-win situation of cutting costs and enabling the continuum of healthcare.<br /

The use of predictive fall models for older adults receiving aged care, using routinely collected electronic health record data : a systematic review

Background: Falls in older adults remain a pressing health concern. With advancements in data analytics and increasing uptake of electronic health records, developing comprehensive predictive models for fall risk is now possible. We aimed to systematically identify studies involving the development and implementation of predictive falls models which used routinely collected electronic health record data in home-based, community and residential aged care settings. Methods: A systematic search of entries in Cochrane Library, CINAHL, MEDLINE, Scopus, and Web of Science was conducted in July 2020 using search terms relevant to aged care, prediction, and falls. Selection criteria included English-language studies, published in peer-reviewed journals, had an outcome of falls, and involved fall risk modelling using routinely collected electronic health record data. Screening, data extraction and quality appraisal using the Critical Appraisal Skills Program for Clinical Prediction Rule Studies were conducted. Study content was synthesised and reported narratively. Results: From 7,329 unique entries, four relevant studies were identified. All predictive models were built using different statistical techniques. Predictors across seven categories were used: demographics, assessments of care, fall history, medication use, health conditions, physical abilities, and environmental factors. Only one of the four studies had been validated externally. Three studies reported on the performance of the models. Conclusions: Adopting predictive modelling in aged care services for adverse events, such as falls, is in its infancy. The increased availability of electronic health record data and the potential of predictive modelling to document fall risk and inform appropriate interventions is making use of such models achievable. Having a dynamic prediction model that reflects the changing status of an aged care client is key to this moving forward for fall prevention interventions

Strengthening Primary and Chronic Care: State Innovations to Transform and Link Small Practices

Presents case studies of state policies for reorganizing and improving primary and chronic care delivery among small practices, including leadership and convening, payment incentives, infrastructure support, feedback and monitoring, and certification