Atlas of the Global Burden of Stroke (1990-2013): The GBD 2013 Study

Background—World mapping is an important tool to visualize stroke burden and its trends in various regions and countries. Objectives—To show geographic patterns of incidence, prevalence, mortality, disability-adjusted life-years (DALYs) and years lived with disability (YLDs), and their trends for ischemic stroke (IS) and hemorrhagic stroke (HS) in the world for 1990 to 2013. Methodology—Stroke incidence, prevalence, mortality, DALYs and YLDs were estimated following the general approach of the Global Burden of Disease (GBD) 2010 with several important improvements in methods. Data were updated for mortality (through April 2014) and stroke incidence, prevalence, case fatality, and severity through 2013. Death was estimated using an ensemble modelling approach. A new software package, DisMod-MR 2.0 was used as part of a custom modelling process to estimate YLDS. All rates were age-standardized to new GBD estimates of global population. All estimates have been computed with 95% uncertainty intervals (UI). Results—Age-standardized incidence, mortality, prevalence and DALYs/YLDs declined over the period from 1990 to 2013. However, the absolute number of people affected by stroke has substantially increased across all countries in the world over the same time period, suggesting that the global stroke burden continues to increase. There were significant geographical (country and regional) differences in stroke burden in the world, with the majority of the burden borne by low- and middle-income countries. Conclusions—Global burden of stroke has continued to increase in spite of dramatic declines in age-standardized incidence, prevalence, mortality rates, and disability. Population growth and ageing have played an important role in the observed increase in stroke burden

Projecting the Fiscal Impact of Population Ageing on the Hospital System: A Distributional Analysis

This study examines the socioeconomic status of NSW hospital patients in 1999-00 and projects likely hospital costs to 2009-10. It draws upon unique patient based datasets from NSW public and private hospitals that include hospital admissions, as well as the associated treatment costs in each of the four years to 1999-00. Using a novel method, we impute socioeconomic status to each patient, accounting for age, sex, family income, family size and the geographic area of the patient’s residence at the Census Collector District level. First, we use the 1999-00 dataset to examine whether patients of similar age had similar per patient hospital costs by socioeconomic status. Second, we study whether patients requiring similar treatment had similar per patient hospital costs, regardless of the patient’s socioeconomic status. To examine this issue we analyse the patient subgroup with coronary heart disease. Third, we examine the impact that population ageing and changes in treatment propensities are likely to have on hospital usage and costs by 2009-10, assuming that no changes occur in per unit treatment costs. Finally, we estimated the combined impact on hospital usage and costs of: population ageing; changes in treatment propensities; and a continuation of per unit hospital costs increases in line with past trends

Encouraging Best Practice in Residential Aged Care program: final evaluation report

The EBPRAC program represents the most compre hensive, coordinated, approach to implementing evidence-based practice in reside ntial aged care unde rtaken in Australia, involving 13 projects working with facilities in 108 locati ons across six states. Previous work has been limited, generally undertaken on a small scale a nd within short timeframes

The \u27Inverse Care Law\u27, Population Ageing and the Hospital System: A distributional analysis

This s t u 4 examines the socioeconomic status of NSW hospital patients in 1999-2000 and projects likely hospital costs to 2009-2010. It draws upon unique patient based datasets from NSW public and private hospitals that include hospital separations, as well as the associated treatment costs in each of the four years to 1999-2000. First, we examine whether patients of similar age had similar per patient hospital costs by socioeconomic status. Second, we examine whether patients requiring similar treatment had similar per patient hospital costs by considering patients treated for coronary heart disease. Third, we consider the impact that population ageing and changes in treatment propensities are likely to have on hospital usage and costs by 2009-2010, assuming that no changes occur in per unit treatment costs. Finally, we have estimated the additional impact of rising medical costs on these projections

Estimating and projecting subacute care demand: findings from a review of international methods

A review of projection methodologies used to project sub-acute inpatient activity in various international health care jurisdictions was undertaken as part of a project to develop subacute inpatient activity projections for the state with the largest population in Australia. The literature search identified nearly 200 articles and found three main groups of projection methodologies: projections with a focus on subacute care; projections with a focus on acute care, but which often included subacute activity in the overall projections; and projections of specific diseases/conditions influencing the demand for subacute care.In terms of the examples in the literature specifically regarding subacute care, the most common method of estimating current or future need was the use of normative benchmark ratios of beds to population. This was mainly to provide a policy basis to encourage development of subacute services, but also because of convenience.In the literature regarding acute activity projection methodologies, many incorporated subacute activity in the overall activity measures of the acute hospital unit. The most common method of acute care activity projection was use of current or trended utilisation rates applied to population projections. It appears that a significant amount of planning and demand projection being undertaken internationally on subacute care takes place within acute care methodologies.In regard to the potential use of specific diseases/conditions that drive demand for subacute care, such as stroke or cancer, it is suggested that the best use of these disease-specific projections is in reality testing the results of other modelling.A number of conclusions are made and issues highlighted regarding projections of subacute inpatient activity