Medicare Locals and the performance regime in Primary Health Care: a review of the policy context

Historically, the Australian Government’s driver of performance in primary health care was dominated by the use of levers to effect change in General Practice. Accordingly, performance measurement directed at achieving population health outcomes has not received much traction and in its place, ad hoc strategies have been attempted. However, with the general trend to greater transparency and accountability and in an effort to address the challenges of chronic disease, Australia has more recently taken an alternative approach to performance management. This strategy has involved the establishment of Medicare Locals (MLs), a primary health organisation, targeted at the delivery of population health outcomes. A core responsibility of MLs is to provide data for a national system of public reporting on primary health care. The initiative marks a significant shift in thinking about performance measurement in Australia’s health system. This paper examines the policy contexts that have underpinned this move from the use of levers to the use of outcomes as a means to improve the quality of primary health care. It ends with a reflection on the possible challenges, tensions and contradictions that may be encountered with the implementation of MLs

Models of governance in long-term disability care and support: A framework for assessing and reforming social policy

Abstract Over the last three decades, the financing and provision of care and support services for disabled adults has undergone profound and ongoing change in advanced welfare states. Despite national variations in contemporary care and support systems, common characteristics of the ‘mixed economy of care’ are its complexity, diversity and inequality of outcomes. Different policy and service delivery models for the delivery of care and support services have been developed, implemented and promoted as ways in which to enhance the governance of these services. In helping to advance research and evaluation into these varied policy and service delivery models, this paper outlines four distinct ideal type models of governance of care and support: uncoordinated; case manager coordinated; dwelling coordinated and user coordinated. In presenting each governance model, their relative strengths and weaknesses are articulated. Each governance model is further illustrated by empirical case studies drawn from research conducted in Australia with adults with an acquired disability. Such models provide a conceptual, analytical and methodological tool for critically thinking about and engaging with policy debate and research into this domain

Unmet health and rehabilitation needs of people with long-term neurological conditions in Queensland, Australia

The survival and life expectancy rates of people with traumatic and degenerative neurological conditions are increasing, sometimes up to several decades. Yet compared to the general population, people with a disability continue to experience poorer health and are at greater risk of developing secondary health problems and facing barriers to services they require. These trends have significant implications for provision of health and rehabilitation services. In this study, the adequacy of health and rehabilitation services provided to people with long-term neurological conditions and their unmet needs were explored from the perspectives of individual users, their nominated family members and key service providers. A qualitative research design with maximum variation sampling was used. Data were collected from semi-structured interviews with 65 participants comprising 25 long-term care service users, nominated family members or friends (n = 22) and care service providers (n = 18) in Queensland, Australia. All service users needed assistance with usual daily activities, and 22 were wheelchair dependent. The hours of funded personal care ranged from 2 to 201 hours per week. Data were analysed using framework analysis. Participants generally perceived that specialist medical and hospital services were adequate and satisfactory. They valued supportive health and rehabilitation professionals and receiving client-centred physical rehabilitation. However, the majority of participants (n = 17) had perceived unmet needs for physical rehabilitation (n = 14), other health or rehabilitation services (n = 10) or counselling (n = 6). Community-based physical maintenance rehabilitation was often perceived as inadequate, costly or inconveniently located. Participants highlighted the importance of personal and family counselling and information provision at time points such as diagnosis. The findings contribute to the limited international evidence on the gaps in health and rehabilitation services for people with neurological conditions receiving lifetime care services in the community. A continuum of integrated rehabilitation services to minimise avoidable impairments, optimise independence and functioning, and sustain quality of life is warranted

Understanding choice in assistive technology service provision: considerations for research methodology

The adoption of choice as a policy principle in disability services reforms warrants research into the practical implications for assistive technology provision. This paper outlines methodological considerations for the investigation of how choice is constructed and experienced in assistive technology provision. It argues for an interpretive approach that considers the interactions between stakeholders and the influence of contextual factors on choices over time. Understanding stakeholders’ interpretations and contextual factors that affect their choice behaviors in AT acquisition will assist the interpretation of AT outcomes. It may also assist in efforts to increase the usability of AT services, develop improved service delivery models, and target policy initiatives to support AT provision practices

Flight Test Results of an Angle of Attack and Angle of Sideslip Calibration Method Using Output-Error Optimization

As part of a joint partnership between the NASA Aviation Safety Program (AvSP) and the University of Tennessee Space Institute (UTSI), research on advanced air data calibration methods has been in progress. This research was initiated to expand a novel pitot-static calibration method that was developed to allow rapid in-flight calibration for the NASA Airborne Subscale Transport Aircraft Research (AirSTAR) facility. This approach uses Global Positioning System (GPS) technology coupled with modern system identification methods that rapidly computes optimal pressure error models over a range of airspeed with defined confidence bounds. Subscale flight tests demonstrated small 2- error bounds with significant reduction in test time compared to other methods. Recent UTSI full scale flight tests have shown airspeed calibrations with the same accuracy or better as the Federal Aviation Administration (FAA) accepted GPS 'four-leg' method in a smaller test area and in less time. The current research was motivated by the desire to extend this method for inflight calibration of angle of attack (AOA) and angle of sideslip (AOS) flow vanes. An instrumented Piper Saratoga research aircraft from the UTSI was used to collect the flight test data and evaluate flight test maneuvers. Results showed that the output-error approach produces good results for flow vane calibration. In addition, maneuvers for pitot-static and flow vane calibration can be integrated to enable simultaneous and efficient testing of each system

Factors associated with the occurrence of sentinel events during transition from hospital to home for individuals with traumatic brain injury

Objective: To describe the timing and factors associated with the occurrence of sentinel events (financial strain, difficulty accessing therapy, return to work, accommodation change and independent transport use) during transition to the community for individuals with traumatic brain injury. Design: Longitudinal cohort design with data collected pre discharge and at 1, 3 and 6-month follow-ups. Subjects: Individuals with moderate to severe traumatic brain injury (n = 127), discharged home from acute care and inpatient rehabilitation. Methods: Data were collected using self-report questionnaires (sentinel events questionnaire, Mayo Portland Adaptability Inventory-4, Sydney Psychosocial Reintegration Scale, Depression Anxiety Stress Scale). Logistic regression was used to identify factors associated with sentinel events. Results: The most commonly reported events were independent transport use and return to work, reported on 104 and 90 occasions, respectively. A longer hospital stay and poorer community integration were related to negative events (e.g. reduced therapy). The inverse relationship was seen for positive events. Links existed between sentinel events (e.g. previous financial strain increased the likelihood of this event in transition). Conclusion: This paper highlights the interplay between personal and environmental factors and life events in shaping transition experiences. Individualised service planning and monitoring of sentinel events is important to promote successful community transition

Investing in big ideas: utilisation and cost of Medicare Allied Health services in Australia under the Chronic Disease Management initiative in primary care

To critically examine utilisation of the 13 allied health services provided through Medicare Chronic Disease Management program and related general practitioner (GP) care planning initiatives

Estimating the Costs of Preventive Interventions

The goal of this article is to improve the practice and reporting of cost estimates of prevention programs. It reviews the steps in estimating the costs of an intervention and the principles that should guide estimation. We then review prior efforts to estimate intervention costs using a sample of well-known but diverse studies. Finally, we illustrate the principles with an example, the Family Bereavement Program. We conclude that example by discussing whether and how the costs of the intervention might differ when implemented in a real-world setting