Coronary artery bypass grafts and diagnosis related groups: patient classification and hospital reimbursement in 10 European countries

The prospective reimbursement of hospitals through the grouping of patients into a finite number of categories (Diagnosis Related Groups, DRGs), is common to many European countries. However, the specific categories used vary greatly across countries, using different characteristics to define group boundaries and thus those characteristics which result in different payments for treatment. In order to assist in the construction and modification of national DRG systems, this study analyses the DRG systems of 10 European countries

Why do patients having coronary artery bypass grafts have different costs or length of stay? : An analysis across ten European countries

We analyse variations in costs or lengths of stay (LoS) for 66,587 patients from ten European countries receiving a coronary artery bypass graft (CABG) procedure. In five of these countries, variations in cost are analysed using log-linear models. In the other five countries, negative binomial regression models are used to explore variations in LoS. We compare how well each country’s Diagnosis Related Group (DRG) system and a set of patient-level characteristics explain these variations. The most important explanatory factors are the total number of diagnoses and procedures, although no clear effects are evident for our CABG-specific diagnostic and procedural variables. Wound infections significantly increase length of stay and costs in all countries. There is no evidence that countries using larger numbers of DRGs to group CABG patients were better at explaining variations in cost or LoS. However, refinements to the construction of DRGs to group CABG patients might recognise first and subsequent CABGs or other specific surgical procedures, such as multiple valve repair

Regression tree construction by bootstrap: Model search for DRG-systems applied to Austrian health-data

Background. DRG-systems are used to allocate resources fairly to hospitals based on their performance. Statistically, this allocation is based on simple rules that can be modeled with regression trees. However, the resulting models often have to be adjusted manually to be medically reasonable and ethical. Methods. Despite the possibility of manual, performance degenerating adaptations of the original model, alternative trees are systematically searched. The bootstrap-based method bumping is used to build diverse and accurate regression tree models for DRG-systems. A two-step model selection approach is proposed. First, a reasonable model complexity is chosen, based on statistical, medical and economical considerations. Second, a medically meaningful and accurate model is selected. An analysis of 8 data-sets from Austrian DRG-data is conducted and evaluated based on the possibility to produce diverse and accurate models for predefined tree complexities. Results. The best bootstrap-based trees offer increased predictive accuracy compared to the trees built by the CART algorithm. The analysis demonstrates that even for very small tree sizes, diverse models can be constructed being equally or even more accurate than the single model built by the standard CART algorithm. Conclusions. Bumping is a powerful tool to construct diverse and accurate regression trees, to be used as candidate models for DRG-systems. Furthermore, Bumping and the proposed model selection approach are also applicable to other medical decision and prognosis tasks. 2010 Grubinger et al; licensee BioMed Central Ltd

Structural and individual costs of residential aged care services in Australia. The Resource Utilisation and Classification Study: Report 3

The Australian Health Services Research Institute (AHSRI), University of Wollongong, was commissioned by the Commonwealth Department of Health (the Department) in August 2017 to undertake the ‘Resource Utilisation and Classification Study’ (RUCS). The RUCS is an important national study commissioned by the Department to inform the development of future funding models for residential aged care in Australia. The purpose of the analysis covered in this report is to identify the drivers of care related costs that are fixed for residential aged care facilities. These are costs that relate to the characteristics of facilities rather than the care needs of individual residents. This study was the second of four separate but interrelated and overlapping studies undertaken to inform the design and implementation strategies for future funding reforms in the Australian residential aged care sector

Structural and individual costs of residential aged care services in Australia. The Resource Utilisation and Classification Study: Report 3

The Australian Health Services Research Institute (AHSRI), University of Wollongong, was commissioned by the Commonwealth Department of Health (the Department) in August 2017 to undertake the ‘Resource Utilisation and Classification Study’ (RUCS). The RUCS is an important national study commissioned by the Department to inform the development of future funding models for residential aged care in Australia. The purpose of the analysis covered in this report is to identify the drivers of care related costs that are fixed for residential aged care facilities. These are costs that relate to the characteristics of facilities rather than the care needs of individual residents. This study was the second of four separate but interrelated and overlapping studies undertaken to inform the design and implementation strategies for future funding reforms in the Australian residential aged care sector

What Does It Take to Get Somebody Back to Work after Severe Acquired Brain Injury?:Service Actions within the Vocational Intervention Program (VIP 2.0)

Little is known about service actions delivered in the complex intervention of vocational rehabilitation (VR) for people with severe acquired brain injury (ABI). Scale-up of the Vocational Intervention Program (VIP) across the 12 Community teams of the NSW Brain Injury Rehabilitation Program provided an opportunity to analyse the intensity and profile of actions delivered in providing VR programs. Seventy-two participants with severe TBI were supported in returning to either pre-injury employment (FastTrack, FT, n = 27) or new employment (NewTrack, NT, n = 50), delivered by two types of VR providers (Disability Employment Service DES; private providers). VR providers documented their service actions in hours and minutes, using the Case Management Taxonomy, adapted to VR. The NT pathway required significantly higher levels of intervention in comparison to FT (25 h, five minutes vs. 35 h, 30 min, p = 0.048, W = 446). Case coordination was the most frequent service action overall (41.7% of total time for FT, 42.3% for NT). DES providers recorded significantly greater amounts of time undertaking engagement, assessment and planning, and emotional/motivational support actions compared to private providers. Overall duration of the programs were a median of 46 weeks (NT) and 36 weeks (FT), respectively. This study helps illuminate the profile of VR interventions for people with severe TBI

Development of Version 1 of the Australian National Aged Care Classification (AN-ACC) funding model for community transport

This report details the development of a prototype classification and funding model for community transport providers in NSW. The research was conducted by the Centre for Health Service Development, within the Australian Health Services Research Institute at the University of Wollongong, in partnershipwith and funded by Community Transport Organisation (CTO), the peak body for community transport providers in NSW. The project was commissioned by CTO in March 2022 in response to concerns from the sector around future funding stability under the payment in arrears model that has been proposed by the Australian Government in the ‘Support at Home Program’

Comparison of real-time elastography and multiparametric MRI for prostate cancer detection: A whole-mount step-section analysis

OBJECTIVE. The purpose of this study was to compare prostate cancer detection rate of real-time elastography (RTE) with that of multiparametric MRI to evaluate the advantages and disadvantages of the two methods. SUBJECTS AND METHODS. Thirty-nine patients with biopsy-proven prostate cancer underwent both RTE and multiparametric MRI to localize prostate cancer before radical prostatectomy. RTE was performed to assess prostate tissue elasticity, and hard lesions were considered suspicious for prostate cancer. Multiparametric MRI included T2-weighted MRI, diffusion-weighted MRI (DWI), and contrast-enhanced MRI (CE-MRI) with an endorectal coil at 1.5 T. After radical prostatectomy, whole-mount step sections of the prostate were generated, and the prostate cancer detection rates with both modalities were analyzed for cancer lesions measuring 0.2 cm 3 or larger. RESULTS. Histopathologic examination revealed 61 cancer lesions. RTE depicted 39 of 50 cancer lesions (78.0%) in the peripheral zone and 2 of 11 (18.2%) in the transitional zone. Multiparametric MRI depicted 45 of 50 cancer lesions (90.0%) in the peripheral zone and 8 of 11 (72.7%) in the transitional zone. Significant differences between the two modalities were found for the transitional zone and anterior part in prostates with volumes greater than 40 cm3 (p \u3c 0.05). Detection rates for high-risk prostate cancer (Gleason score ≥ 4 and 3) and cancer lesions with volumes greater than 0.5 cm3 were high for both methods (93.8% and 80.5% for RTE, 87.5% and 92.7% for multiparametric MRI). Volumetric measurements of prostate cancer were more reliable with T2-weighted MRI than with RTE (Spearman rank correlation, 0.72 and 0.46). CONCLUSION. RTE and multiparametric MRI depicted high-risk prostate cancer with high sensitivity. However, multiparametric MRI seems to have advantages in tumor volume assessment and for the detection of prostate cancer in the transitional zone and anterior part within prostates larger than 40 cm3. American Roentgen Ray Society

A psychometric analysis of the Caring Assessment Tool version V

Aim The aim of this study was to examine the factor structure and construct validity of the Caring Assessment Tool version V (CAT‐V) for patients in Australian hospitals. Design Secondary analysis of CAT‐V surveys from the Australian Nursing Outcomes Collaborative (AUSNOC) data set was used. The CAT was originally developed in the United States of America. Methods The 27‐item CAT‐V was administered to patients prior to discharge from eight wards in three Australian hospitals in 2016. The psychometric properties of the CAT were evaluated using item analysis and exploratory factor analyses. Results Item analysis of surveys from 476 participants showed high levels of perceived caring behaviours and actions. Exploratory factor analysis revealed a two‐factor structure consisting of: Nurse-patient communication; and Feeling cared for. The CAT‐V is a reliable and valid instrument for measuring patients\u27 perceptions of the attitudes and actions of nurses in Australia

A funding model for the residential aged care sector. The Resource Utilisation and Classification Study: Report 5

This is one of a series of reports that presents the results of an important national study commissioned by the Department of Health (the Department) to inform the development of a new funding model for residential aged care in Australia. The purpose of this report is to provide an outline of the key design features of the proposed new funding model. Also discussed are the anticipated impacts of the model for both government and the aged care sector, and a recommended approach to implementation