Clinical indicators for common paediatric conditions: processes, provenance and products of the CareTrack Kids study

BACKGROUND:In order to determine the extent to which care delivered to children is appropriate (in line with evidence-based care and/or clinical practice guidelines (CPGs)) in Australia, we developed a set of clinical indicators for 21 common paediatric medical conditions for use across a range of primary, secondary and tertiary healthcare practice facilities. METHODS:Clinical indicators were extracted from recommendations found through systematic searches of national and international guidelines, and formatted with explicit criteria for inclusion, exclusion, time frame and setting. Experts reviewed the indicators using a multi-round modified Delphi process and collaborative online wiki to develop consensus on what constituted appropriate care. RESULTS:From 121 clinical practice guidelines, 1098 recommendations were used to draft 451 proposed appropriateness indicators. In total, 61 experts (n = 24 internal reviewers, n = 37 external reviewers) reviewed these indicators over 40 weeks. A final set of 234 indicators resulted, from which 597 indicator items were derived suitable for medical record audit. Most indicator items were geared towards capturing information about under-use in healthcare (n = 551, 92%) across emergency department (n = 457, 77%), hospital (n = 450, 75%) and general practice (n = 434, 73%) healthcare facilities, and based on consensus level recommendations (n = 451, 76%). The main reason for rejecting indicators was 'feasibility' (likely to be able to be used for determining compliance with 'appropriate care' from medical record audit). CONCLUSION:A set of indicators was developed for the appropriateness of care for 21 paediatric conditions. We describe the processes (methods), provenance (origins and evolution of indicators) and products (indicator characteristics) of creating clinical indicators within the context of Australian healthcare settings. Developing consensus on clinical appropriateness indicators using a Delphi approach and collaborative online wiki has methodological utility. The final indicator set can be used by clinicians and organisations to measure and reflect on their own practice.Louise K. Wiles, Tamara D. Hooper, Peter D. Hibbert, Charlotte Molloy, Les White ... Helena Williams ... et al

Die Entwicklung der Arbeit aus der Perspektive ihrer Informatisierung

Die Entwicklung der Arbeit aus der Perspektive ihrer Informatisierung Im Mittelpunkt des Beitrags stehen die Erzeugung und Nutzung von Informationen und In-formationssystemen im Arbeitsprozess und die damit verbundenen Veränderungen der Arbeit. Die historische Entwicklung der Informatisierung der Arbeit wird -ausgehend von dem ersten Auftreten des Handelskapitals und der Buchführung im 13. und 14. Jahrhundert bis zur Durchsetzung eines global verfügbaren "Informationsraums", welcher als neuartiger sozialer Handlungsraum die aktuelle Entwicklung bestimmt - kurz skizziert. Dieser "Informationsraum" bildet das "Rückgrat" moderner Unternehmenskonzepte. Er ist charakteristisch für die modernen, in globalisierten Märkten agierenden horizontalen oder Netzwerkunternehmen. In solchen netzwerkförmigen Organisationsstrukturen erbrachte Teil-arbeiten werden zu in sich konsistenten und zugleich veränderungsoffenen Leistungserstel-lungsprozessen zusammengefügt. Statt in starr vorprogrammierten Funktionsketten findet sich das Subjekt nun in offenen Verweisstrukturen, die durch reflexiven Umgang mit den Infor-mationsobjekten chrakterisiert sind. Hier ist das Funktionieren des Informationssystems von kommunikativ vermittelten Ausdeutungs- und Gestaltungsleistungen des Subjekts abhängig. Dieses ist in Zukunft nicht mehr ausschließlich an den Rand und in die Nischen geschlossener Informationssysteme gedrängt, sondern es muß sich in seinem Denken und Handeln in die Informationssysteme hineinbegeben, um den Anforderungen flexibler Produktionsprozesse gerecht zu werden. Damit entsteht eine neuartige Dichotomie von Chancen und Risiken

Best Care, First Time: Optimising Youth Mental Health Services Using Digital Technologies

The Youth Mental Health and Technology team at the Brain and Mind Centre aims to change the way in which clinical care is delivered to young people with emerging mental health disorders. To do this, we are utilising sophisticated digital technology and systems modelling to shift the way that services deliver care, to modernise and connect the previously disconnected mental health system in Australia, allowing young people to seamlessly move through the system and receive the best care as required. This work is made possible by the Bupa Health Foundation, one of Australia’s leading charitable organisations committed to addressing the health needs of the Australian community to help people live longer, healthier, happier lives. The investment provided by the Bupa Health Foundation, and their ongoing support of and collaboration with the research team, speaks to the value, and progressive nature of this work. This report provides on overview of the current research project (‘Can digitally-supported care pathways deliver better care for young people with emerging mood or psychotic disorders?’), and importantly, aims to promote the potential of this work to the broader mental health community, including policy-makers, funders, service managers, and clinicians. By publicly advocating for the adoption of digital technologies, and the application of systems modelling approaches, it is possible to bring the exponential benefits of these under-utilised methods to the forefront of mental health care, and mental health care research, in Australia. This highly translational work is not limited to sitting within a circle of academic papers, but can affect change in real-world mental health care settings almost immediately – through the adoption of digital technologies, which can enable a more accessible, effective and connected mental health system, directly benefiting the young people who need to use it