A qualitative insight into rural casemix education, CHERE Project Report No 10

NSW, while often regarded as the non- Casemix state, has been using Casemix information to assist planning and funding of hospitals. However, the use of this tool and the necessary education and knowledge about Casemix has not been evenly spread throughout the state, with health service staff in metropolitan areas relatively more familiar with its use then their colleagues in rural NSW. In 1998, both NSW Health and the NSW Casemix Clinical Committee (NCCC) proposed that an effort be made to increase the knowledge and participation of rural clinical and health service staff in Casemix activities. This research was proposed as a means of establishing the current situation regarding Casemix, knowledge in rural areas, providing advice regarding the best methods of implementing Casemix education for rural staff and, if possible, evaluating the success of the education. Casemix is a broad term referring to the tools and information system used to assist in such activities as planning, benchmarking, managing and funding health care services. Casemix is underpinned by classification systems that allow meaningful comparisons of workload or throughput between facilities. In this study, qualitative research methods were used to examine the issues faced by rural health service staff in gaining knowledge of and using Casemix. This information was supplemented by a survey, which assessed the level of knowledge and understanding of Casemix in two rural areas.Casemix, hospital funding

Cost impact of hospital acquired diagnoses and impacts for funding based on quality signals

Background Internationally, there have been efforts to adjust hospital funding based on the quality of care provided by the hospital. A variety of approaches has been used by different countries and payers. Incorporating quality signals into activity-based funding is also a possibility for Australia. This study set out to explore the cost impact of potentially poor quality care in Australian hospitals, and to understand the implications from a funding perspective

Using a theoretical framework to inform implementation of the patient-centred medical home (PCMH) model in primary care: protocol for a mixed-methods systematic review

Background The patient-centred medical home (PCMH) was conceived to address problems that primary care practices around the world are facing, particularly in managing the increasing numbers of patients with multiple chronic diseases. The problems include fragmentation, lack of access and poor coordination. The PCMH is a complex intervention combining high-quality primary care with evidence-based disease management. Becoming a PCMH takes time and resources, and there is a lack of empirically informed guidance for practices. Previous reviews of PCMH implementation have identified barriers and enablers but failed to analyse the complex relationships between factors involved in implementation. Using a theoretical framework can help with this, giving a better understanding of how and why interventions work or do not work. This review will aim to refine an existing theoretical framework for implementing organisational change — the Consolidated Framework for Implementation Research (CFIR) — to apply to the implementation of the PCMH in primary care. Methods We will use the ‘best-fit’ framework approach to synthesise evidence for implementing the PCMH in primary care. We will analyse evidence from empirical studies against CFIR constructs. Where studies have identified barriers and enablers to implementing the PCMH not represented in the CFIR constructs, we will use thematic analysis to develop additional constructs to refine the CFIR. Searches will be undertaken in MEDLINE (Ovid), Embase (Ovid), Web of Science Core Collection (including Science Citation Index and Social Science Citation Index) and CINAHL. Gaps arising from the database search will be addressed through snowballing, citation tracking and review of reference lists of systematic reviews of the PCMH. We will accept qualitative, quantitative and mixed methods primary research studies published in peer-reviewed publications. A stakeholder group will provide input to the review. Discussion The review will result in a refined theoretical framework that can be used by primary care practices to guide implementation of the PCMH. Narrative accompanying the refined framework will explain how the constructs (existing and added) work together to successfully implement the PCMH in primary care. The unpopulated CFIR constructs will be used to identify where further primary research may be needed