Costs of acute admitted patients in public hospitals from 2011–12 to 2013–14

Every day, decisions are made in hospitals, or by governments, that influence how efficiently hospitals run. In 2013–14, the running costs of public hospitals ($44 billion) continued to represent the largest proportion of the$154.6 billion that was spent on health by all governments, insurers and consumers. This report examines Australia’s largest public hospitals and the amount of money each of those hospitals spent in 2013–14 to provide a notional ‘average’ hospital service to their acute admitted patients – the group that accounts for the largest proportion of hospital costs nationally. This group includes patients who are admitted for the management of childbirth, surgery, or other diagnostic and therapeutic procedures. These results were calculated by comparing a hospital’s running costs to a measure of output known as a National Weighted Activity Unit (NWAU). The report finds: In 2013–14, the cost of providing an average service could be almost twice as high at one major metropolitan hospital ($6,100) compared to another ($3,100) From 2011–12 to 2013–14, eight major metropolitan public hospitals decreased their cost for providing a notional ‘average’ service by at least 5%, indicating improved efficiency. Both Western Hospital in Footscray in Vic and Westmead Hospital in NSW decreased their cost by 9% over this period Six major metropolitan public hospitals increased their costs per notional ‘average’ service by at least 10%, indicating decreased efficiency. Hornsby Ku-ring-gai Hospital in NSW had the largest increase at 17%, followed by John Hunter Hospital at 15%

Healthy communities: frequent GP attenders and their use of health services in 2012–13

More than one-third of Australians (35.3%) went to a GP six or more times in 2012–13, and those who went most often tended to be older and less wealthy, were more likely to have several long-term health conditions and were more likely to see several different GPs. Summary Many Australians are fortunate to experience very good or excellent health and have few or no long-term health conditions. They might visit a GP once or twice a year or they may go the whole year without any visits. Overall, Australians see GPs 5.6 times per year on average.* However, many other Australians need to see a GP more often than this.   Those patients who see a doctor much more than the average, as well as those who see many different doctors, are of considerable interest to health system managers and clinicians because in many cases these patients have the greatest need for effective and well-coordinated health care. Improvements targeted at these patients therefore have the potential to bring significant benefits in terms of patient outcomes and system efficiencies. However, until now there has been limited publicly available information about these types of patients, such as their age, geographic distribution and other characteristics.   The National Health Performance Authority (the Authority) aims to fill some of these gaps in knowledge by providing in this report the most detailed picture to date of who are these ‘frequent GP attenders’ and which local areas have greater or lesser percentages of them. It breaks down the Australian population into groups according to how often they went to a GP in 2012–13, and how many different GPs and specialists they saw.   The results show how the two highest GP user groups compare to other attendance groups in terms of their age, socioeconomic and insurance status, the extent to which they have chronic or other health problems, and how many times they went to an emergency department or were admitted to hospital. The results also show how much money was contributed through Medicare towards GP, medical specialist and pathology and diagnostic imaging services for the two highest GP user groups in each local area.   Through the use of tables and maps, the report also shows which local areas have the highest and lowest percentages of very high and frequent ‘GP attenders’

Hospital performance: costs of acute admitted patients in public hospitals in 2011–12

Some public hospitals spend nearly twice as much money as others to provide similar services to similar groups of patients. Overview Hospitals account for a large share of the funds Australia spends on the health sector each year. In 2011–12, about 30% of the estimated $140.2 billion that Australia spent on health was spent on running costs for public hospitals (excluding property, plant and equipment costs). Having effective measures to help assess the efficiency of hospitals is therefore important, because the size of the hospital sector means efforts to improve efficiency, if well targeted, have a large potential to yield significant benefits. One way to assess hospital efficiency is to see how much money each hospital uses in comparison to its peers to provide specific treatments or procedures. Conducting such comparisons is however very difficult, because sicker or more complex patients cost more to treat, and because there are a variety of reasons why some cost variations are unavoidable or why some hospitals use more resources than others. It is important to adjust for unavoidable cost variations and to adjust for these other differences before comparisons can be considered meaningful. This report is the result of innovative development work by the National Health Performance Authority (the Authority) that for the first time allows these meaningful comparisons of the relative efficiency of more than 80 of Australia’s largest public hospitals. To achieve this, the Authority includes two headline measures in the report, Cost per National Weighted Activity Unit (NWAU) and Comparable Cost of Care, both of which adjust as much as possible for the factors that can push hospital costs up unavoidably or in ways that mean they cannot fairly be compared to others. The main difference between the two measures is that Comparable Cost of Care includes emergency department (ED) costs for patients admitted through EDs. The first part of the report compares the overall performance of Australian public hospitals using Cost per NWAU and Comparable Cost of Care for acute admitted patients. Both measures report costs for activity units, which allow different treatments and operations to be compared fairly. The second part of the report breaks this down further into costs across major hospitals for 16 selected medical conditions or surgical procedures

Challenges and Opportunities for Disinvestment in Australia: A need to evaluate the implementation and impact of Choosing Wisely in Australia

Purpose – Worldwide, there is significant growth in the cost of (and demand for) healthcare, which often clashes with a requirement to contain expenditure. This duality leads to an increasing need for a systematic approach to disinvestment in health technologies. The purpose of this paper is to consider the challenges and opportunities for disinvestment policy decisions in Australia. It discusses the implementation of the Choosing Wisely campaign and the need for rigorous evaluation of such campaigns in the Australian healthcare system. Design/methodology/approach – The authors highlight characteristics of disinvestment: what it is and what it is not and discuss international examples of identifying low value care, including the recent Choosing Wisely initiative. The authors discuss the barriers to implementing initiatives such as Choosing Wisely and the complexities in evaluating their effectiveness. Findings – While the primary purpose of the Choosing Wisely campaign is improved decision making through clinical engagement, it is expected that implementation could lead to resource savings alongside improvements in patient safety and service quality. While there is research looking to understand the barriers and facilitators to the implementation of initiatives such as Choosing Wisely, little is known about broader patient impacts, and more attention on the quantification of their effect on both patient outcomes and resource use is needed. Originality/value – This work highlights the limited knowledge around implementation of disinvestment strategies and the paucity of research around the impact of strategies such as Choosing Wisely in the Australian public hospital system. This is important as future research in this area will give greater certainty about the benefits and consequences of Choosing Wisely leading to improved opportunities for resource savings and patient safety and quality

Prophylactic dressing to minimize sacral pressure injuries in high-risk hospitalized patients: A pilot study

Aim: In this paper, we describe a trial protocol used to assess feasibility related to: study administration (recruitment, randomization, retention, compliance, eligibility criteria, suitability of protocol instructions and data collection questionnaires); resource and data management (suitability of site, time and budget allocation, management of personnel and data); intervention fidelity (treatment dose, violations); and effect size. Background: Pressure injury can lead to increases in hospital length of stay and cost. The sacrum is identified as one of the most common anatomical pressure injury sites for hospitalized patients. Silicone foam border dressings have been proposed as one strategy to reduce pressure injury incidence; however, rigorous testing of benefit in a general medical-surgical population is required. Design: Randomized controlled trial. Methods: Eighty patients will be recruited after assessment of high risk of pressure injury in a large tertiary hospital in south-east Queensland, Australia. Eligible, consenting participants will be randomly allocated to either a control group (routine care) or an intervention group (routine care and a sacral prophylactic dressing). The primary outcomes comprise feasibility criteria as identified above. The secondary measure is the presence and severity of sacral pressure injury via blind assessment of digital photographs. Research ethics approval was received in October 2013. Discussion: Prophylactic dressings applied to the sacrum may be an effective method for reducing pressure injury in high-risk general medical-surgical patients. However, more rigorous studies to confirm benefit are required. This pilot study will determine the feasibility and effect size to inform a larger randomized controlled trial

Transition to Specialty Practice Program characteristics and professional development outcomes

publisher: Elsevier articletitle: Transition to Specialty Practice Program characteristics and professional development outcomes journaltitle: Nurse Education Today articlelink: http://dx.doi.org/10.1016/j.nedt.2016.05.017 content_type: article copyright: © 2016 The Author(s). Published by Elsevier Ltd

Community hospitals and their services in the NHS: identifying transferable learning from international developments - scoping review, systematic review, country reports and case studies

Background: The notion of a community hospital in England is evolving from the traditional model of a local hospital staffed by general practitioners and nurses and serving mainly rural populations. Along with the diversification of models, there is a renewed policy interest in community hospitals and their potential to deliver integrated care. However, there is a need to better understand the role of different models of community hospitals within the wider health economy and an opportunity to learn from experiences of other countries to inform this potential. Objectives This study sought to (1) define the nature and scope of service provision models that fit under the umbrella term ‘community hospital’ in the UK and other high-income countries, (2) analyse evidence of their effectiveness and efficiency, (3) explore the wider role and impact of community engagement in community hospitals, (4) understand how models in other countries operate and asses their role within the wider health-care system, and (5) identify the potential for community hospitals to perform an integrative role in the delivery of health and social care. Methods A multimethod study including a scoping review of community hospital models, a linked systematic review of their effectiveness and efficiency, an analysis of experiences in Australia, Finland, Italy, Norway and Scotland, and case studies of four community hospitals in Finland, Italy and Scotland. Results The evidence reviews found that community hospitals provide a diverse range of services, spanning primary, secondary and long-term care in geographical and health system contexts. They can offer an effective and efficient alternative to acute hospitals. Patient experience was frequently reported to be better at community hospitals, and the cost-effectiveness of some models was found to be similar to that of general hospitals, although evidence was limited. Evidence from other countries showed that community hospitals provide a wide spectrum of health services that lie on a continuum between serving a ‘geographic purpose’ and having a specific population focus, mainly older people. Structures continue to evolve as countries embark on major reforms to integrate health and social care. Case studies highlighted that it is important to consider local and national contexts when looking at how to transfer models across settings, how to overcome barriers to integration beyond location and how the community should be best represented. Limitations The use of a restricted definition may have excluded some relevant community hospital models, and the small number of countries and case studies included for comparison may limit the transferability of findings for England. Although this research provides detailed insights into community hospitals in five countries, it was not in its scope to include the perspective of patients in any depth. Conclusions At a time when emphasis is being placed on integrated and community-based care, community hospitals have the potential to assume a more strategic role in health-care delivery locally, providing care closer to people’s homes. There is a need for more research into the effectiveness and cost-effectiveness of community hospitals, the role of the community and optimal staff profile(s). Funding: The National Institute for Health Research Health Services and Delivery Research programme

Healthy communities: immunisation rates for children in 2014–15

Although the percentage of children fully immunised in Australia is high, rates are not uniform across the country and there are significant variations at the local level. Overview: The third report on child immunisation rates from the National Health Performance Authority finds that while coverage has improved in some local areas, there are a number of areas where rates remain potentially too low to prevent the spread of diseases. The report shows the percentages of children who were fully immunised at 1 year, 2 years and 5 years, as well as the numbers of children who are not fully immunised, in each of the 31 Primary Health Network (PHN) areas. Where possible the results are broken down into smaller geographic areas – including more than 300 statistical areas and across Australian postcodes. The report focuses on variation in immunisation rates for 1 year olds at different levels of geography including changes in immunisation rates over time. In late 2014, the Australian Chief Medical Officer and all state and territory chief health officers agreed to an aspirational target for 95% of children to be fully immunised in line with the National Immunisation Program Schedule. The report shows that for 1-year-old children, rates are below 95% in all PHN areas, although this fact does not reflect on the performance of PHNs as they were set up after the period to which the data relate. The report finds: 90.9% of all children aged 1, 2 and 5 years were fully immunised and 9.1% (84,571) were not fully immunised, though rates vary across local areas 89.2% of Aboriginal and Torres Strait Islander children aged 1, 2 and 5 years were fully immunised and 10.8% (4,922) were not fully immunised, though rates vary across local areas Immunisation rates for all 1 year olds ranged across PHN areas from 93.6% to 87.7% with a total of 26,671 children not fully immunised nationally. None of the 31 PHNs had immunisation rates of 95% or higher for this age group Immunisation rates for 2 year olds ranged across PHN areas from 92.3% to 86.7% with a total of 33,681 children not fully immunised nationally. None of the 31 PHNs had immunisation rates of 95% or above for this age group, although rates for 2 year olds may have been lower due to a recent change in the number of vaccines counted in the definition for ‘fully immunised’ 2 year olds Immunisation rates for 5 year olds ranged across PHN areas from 95.6% to 89.2% with a total of 24,219 children not fully immunised nationally. Only two of the 31 PHN areas had immunisation rates of 95% or higher for this age group Across smaller local areas (SA3s), among all 1-year-old children, 39 out of 324 local areas (SA3s) recorded a significant increase in immunisation rates, while only one area showed a significant decrease. Among 5 year olds, 16 SA3s showed an increase and six a decrease Immunisation rates for 1-year-old Indigenous children significantly increased in seven out of 49 geographic areas (SA4s) where data were available, and decreased in none. &nbsp