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

Developing an implementation research logic model : Using a multiple case study design to establish a worked exemplar

Background Implementation science frameworks explore, interpret, and evaluate different components of the implementation process. By using a program logic approach, implementation frameworks with different purposes can be combined to detail complex interactions. The Implementation Research Logic Model (IRLM) facilitates the development of causal pathways and mechanisms that enable implementation. Critical elements of the IRLM vary across different study designs, and its applicability to synthesizing findings across settings is also under-explored. The dual purpose of this study is to develop an IRLM from an implementation research study that used case study methodology and to demonstrate the utility of the IRLM to synthesize findings across case sites. Method The method used in the exemplar project and the alignment of the IRLM to case study methodology are described. Cases were purposely selected using replication logic and represent organizations that have embedded exercise in routine care for people with cancer or mental illness. Four data sources were selected: semi-structured interviews with purposely selected staff, organizational document review, observations, and a survey using the Program Sustainability Assessment Tool (PSAT). Framework analysis was used, and an IRLM was produced at each case site. Similar elements within the individual IRLM were identified, extracted, and re-produced to synthesize findings across sites and represent the generalized, cross-case findings. Results The IRLM was embedded within multiple stages of the study, including data collection, analysis, and reporting transparency. Between 33-44 determinants and 36-44 implementation strategies were identified at sites that informed individual IRLMs. An example of generalized findings describing “intervention adaptability” demonstrated similarities in determinant detail and mechanisms of implementation strategies across sites. However, different strategies were applied to address similar determinants. Dependent and bi-directional relationships operated along the causal pathway that influenced implementation outcomes. Conclusions Case study methods help address implementation research priorities, including developing causal pathways and mechanisms. Embedding the IRLM within the case study approach provided structure and added to the transparency and replicability of the study. Identifying the similar elements across sites helped synthesize findings and give a general explanation of the implementation process. Detailing the methods provides an example for replication that can build generalizable knowledge in implementation research

Developing a clinical pathway for the identification and management of anxiety and depression in adult cancer patients: an online Delphi consensus process

Purpose: People with cancer and their families experience high levels of psychological morbidity. However many cancer services do not routinely screen patients for anxiety and depression and there are no standardized clinical referral pathways. This study aimed to establish consensus on elements of a draft clinical pathway tailored to the Australian context. Methods: A two-round Delphi study was conducted to gain consensus among Australian oncology and psycho-oncology clinicians about the validity of 39 items that form the basis of a clinical pathway that includes screening, assessment, referral and stepped-care management of anxiety and depression in the context of cancer. The expert panel comprised 87 multidisciplinary clinician members of the Australian Psycho-oncology Cooperative Research Group (PoCoG). Respondents rated their level of agreement with each statement on a 5-point likert scale. Consensus was defined as >80% of respondents scoring within 2 points on the likert scale. Results: Consensus was reached for 21 of 39 items, and a further 15 items approached consensus except for specific contextual factors, after 2 Delphi rounds. Formal screening for anxiety and depression, a stepped care model of management and recommendations for inclusion of length of treatment and time to review were endorsed. Consensus was not reached on items related to roles and responsibilities, particularly those not applicable across cancer settings. Conclusions: This study identified a core set of evidence- and consensus-based principles considered essential to a stepped care model of care incorporating identification, referral and management of anxiety and depression in adult cancer patients.This study was funded by Sydney Catalyst Translational Cancer Research Centr

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

Clinical pathway for the screening, assessment and management of anxiety and depression in adult cancer patients: Australian guidelines.

Purpose A clinical pathway for anxiety and depression in adult cancer patients was developed to guide best practice in Australia. Methods The pathway was based on a rapid review of existing guidelines, systematic reviews and meta-analyses, stakeholder interviews, a Delphi process with 87 multi-disciplinary stakeholders and input from a multidisciplinary advisory panel. Results The pathway recommends formalised routine screening for anxiety and depression in patients with cancer at key points in the patient’s journey. The Edmonton Symptom Assessment System (ESAS) or Distress Thermometer (DT) with problem checklist are recommended as brief screening tools, combined with a more detailed tool, such as the Hospital Anxiety and Depression Scale (HADS), to identify possible cases. A structured clinical interview will be required to confirm diagnosis. When anxiety or depression is identified it is recommended one person in a treating team takes responsibility for co-ordinating appropriate assessment, referral and follow-up (not necessarily carrying these out themselves). A stepped care model of intervention is proposed, beginning with the least intensive available that is still likely to provide significant health gain. The exact intervention, treatment length and follow up timelines as well as professionals involved, are provided as a guide only. Each service should identify their own referral network based on local resources and current service structure, as well as patient preference. Discussion This clinical pathway will assist cancer services to design their own systems to detect and manage anxiety and depression in their patients, to improve the quality of care

Implementation of physical activity interventions in a community-based youth mental healthcare service : A case study of context, strategies, and outcomes

Aims Physical activity interventions are recommended for community-based youth mental health services to prevent physical health disparities. Implementation is challenging, and studies focusing on the methods to achieve change are needed. This study aims to identify the context, implementation strategies, and implementation outcomes that illustrate how physical activity interventions were implemented within an early intervention service in Australia. Methods A theoretically informed case study was undertaken. Data from a community-based youth mental health service that delivers an early psychosis programme were collected between July and November 2020. Three data sources were accessed (1) interviews with service managers, mental health clinicians and exercise physiologists; (2) document review of organizational policies and procedures; and (3) survey using the Program Sustainability Assessment Tool. The implementation outcomes investigated were acceptability, fidelity, penetration, and sustainability. Framework analysis was used, and a logic model developed guided by an established template, to interpret findings. Results Forty-three contextual factors and 43 implementation strategies were identified. The data suggests that creating a new clinical team and auditing and feedback are critical for implementation. High levels of acceptability and sustainability were described, while fidelity of implementation was difficult to establish, and penetration was low. Conclusions The relationship between constructs suggests several mechanisms underpinned implementation. These include changing professional beliefs, establishing new organizational norms, augmenting existing work processes, and aligning physical activity with priorities of the mental healthcare system and existing work tasks. This case study provides direction for future health service planning of physical activity interventions in community-based youth mental health service

Modelling the impact of the AN-ACC in Australia.The Resource Utilisation and Classification Study: Report 4

A national study to develop a new methodology for determining appropriate funding for places in residential aged care homes, the ‘Resource Utilisation and Classification Study’ (RUCS), was commissioned by the Commonwealth Department of Health (the Department) in August 2017 and undertaken by the Australian Health Services Research Institute (AHSRI) at the University of Wollongong. This report is the fourth in a series, written to present the results of this important national study. Each report deals with a different aspect of the project, as described in Appendix 1. In this report, Report 4, the findings from Study Three of the RUCS are presented. The purpose of the casemix profiling study covered in this report was to develop a national casemix profile of residents in residential aged care facilities in Australia, to identify any differences in resident casemix by facility type (i.e. by location, ownership type and size), and to model and test the likely financial impact of implementing the blended payment model nationally. To do so, a nationally representative sample was used to model patterns of resident need and to investigate the funding implications of a new payment model based on resident casemix