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Issue 40 September 2015
The Hospital Alliance for Research Collaboration
In the news
Hospital transfers: What works and what doesn't
Measuring hospital performance
Cancer care and data

The complexity of evaluating integrated care

Professor Nicholas Mays

The challenge of evaluating integrated care starts with the fact that there are at least 170 definitions of the term “integrated care” in the literature, visiting expert Professor Nicholas Mays told a HARC Forum this month.

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Challenges of evaluation and measurement

In this month’s e-Bulletin, we look at the challenging areas of evaluation and measurement. Speaking at a recent HARC Forum, visiting expert Professor Nicholas Mays offered valuable insights into the evaluation of integrated care strategies. See our story below.

Our research section features new findings about the measurement of hospital performance and we shine a light on hospital transfers, with an Australian study finding that lateral patient transfers to optimise bed capacity can decrease congestion without jeopardising patient outcomes.

Please forward this edition of the Bulletin to colleagues who might be interested in joining the HARC network and get in touch with your feedback, or suggestions at:

Megan Howe
Editor, HARC e-Bulletin

The challenge of evaluating integrated care initiatives

Healthcare systems globally are forging ahead with integrated care initiatives, but the complex programs pose a host of challenges for the researchers who evaluate them, visiting expert Professor Nicholas Mays told a HARC Forum this month.

Professor Mays, Director of the Policy Innovation Research Unit (PIRU) working out of the London School of Hygiene and Tropical Medicine, outlined the many challenges facing evaluators, starting with the fact that there are at least 170 definitions of “integrated care” in the literature.

“It is an intrinsically difficult area,” he told the packed Forum, which was chaired by Mr Chris Shipway, Acting Chief Executive at the NSW Agency for Clinical Innovation.

Multi-level, multi-faceted and multi-site

Most integrated care programs covered a wide range of different service changes and were specific to their local environment, meaning research on such programs wasn’t easily transferable. The programs were also typically multi-level, multi-faceted and multi-site, so evaluating the impact of specific elements wasn’t easy.

“It is difficult to accumulate knowledge,” Professor Mays said.

He said there were often high expectations on evaluators to assess the cost-effectiveness of programs, despite the fact that many programs were set up in a way that made such assessments problematic. For example, it was often difficult to find comparison groups, or to establish exactly when the integrated care initiative “switched on”.

“There is a mismatch between evaluation imperative and the reality of the programs.”

He said evaluation of integrated care initiatives so far suggested they were unlikely to reduce costs, and may in fact increase the demand for health and social services by uncovering unmet patient needs.

He added that it took three to five years for the impact of many integrated care programs to become evident, over which time priorities could change, meaning evaluations needed to be flexible.

Does it work?

Rather than tackling the question of “does it work”, Professor Mays suggested it was better for evaluators to ask questions such as:

• What works for whom in what circumstances, in what respects, how and why?
• How can the program be adapted to help it work better? and
• How should the context be modified to help?

Evaluation in practice

While the evaluation of complex systems wasn’t easy, it could be done successfully, as demonstrated by a 2014 multi-method evaluation of changes in stroke care in the UK, he said. The study highlighted the importance of using mixed methods of research (quantitative and qualitative) and several different strands of data collection and analysis.

Professor Mays also outlined how his team at PIRU was tackling the challenge of evaluating NHS England’s  Integrated Care Pioneers Programme , which involves 25 different regions introducing new, patient-centred approaches to integrating health and social care.

The evaluation had three strands, he said, including whole system analysis; assessing the impact at the initiative-level; and working with the Pioneers, partners, patients and national policy makers to disseminate learnings.

The HARC Forum also heard from Dr George Argyrous, senior lecturer with the Australian and New Zealand School of Government who was an advisor for the development of the NSW Whole Of Government Evaluation Framework, Dr Jean-Frederic Levesque, Chief Executive of the Bureau of Health Information and Dr Anne-Marie Feyer, advisor to the NSW Ministry of Health’s Integrated Care Monitoring and Evaluation Work Stream.

Dr Levesque said there were three elements to the new paradigm for evaluation of integrated care programs: being agile, using mixed methods of research, and depth of research.

Sax Institute honours researchers for work that delivers real-world results

Four NSW researchers whose work has changed the way healthcare is designed and delivered were honoured in the Sax Institute’s inaugural Research Action Awards this month.

The winning researchers’ work has impacted on areas as diverse as being pivotal in having commercial sunbeds banned to changing the way health workers communicate about vaccination with hesitant parents.

The Institute established the annual awards to recognise research that supports policy decisions that make a real-world difference to people’s health and wellbeing.

“The winning applications are outstanding examples of research that is making a critical contribution to health and health systems,” said Sax Institute CEO Professor Sally Redman.

“Our award winners have not only undertaken research about issues of immediate relevance to those who make health decisions, they have also found elegant ways to have their findings acted upon.”

The awards were presented at a cocktail reception attended by senior health leaders and members of the public health and health services research community including Professor Nicholas Mays (see story above), NSW Chief Scientist Professor Mary O’Kane and Secretary of NSW Health Dr Mary Foley.

The award winners are:

Dr Anne Cust, University of Sydney, who led the first Australian population-based study to establish a link between sunbed use and melanoma. Her research, including modelling showing that banning commercial sunbeds would reduce the number of melanoma cases in NSW alone by 120 per year, was pivotal in the NSW Government introducing a total ban on commercial sunbeds in late 2014. Bans have now been rolled out in other Australian states and overseas. 

Associate Professor Julie Leask, University of Sydney, has been researching the area of vaccine refusal and acceptance for nearly two decades, and has found that strategies to improve vaccination rates should target fence-sitting parents rather than those whose opposition to vaccines is entrenched. Her work has led to an international collaboration to develop a Vaccine Communication Framework and is being further developed and evaluated by the Federal Government and National Centre for Research and Surveillance in a three-year project called SARAH – Strategies and Resources to Assist Hesitant parents with vaccination.

Associate Professor Farah Magrabi, Macquarie University, has sought to shed more light on the poorly understood area of patient safety risks posed by e-health systems. From her world-first analysis of IT safety incidents, she developed a new classification system for e-health risks, which has become the de facto international standard for analysing IT safety incidents. Her work is shaping policy to govern e-health safety in the US, and she has developed a new IT incident monitoring system that has been tested in general practices across Australia.

Dr Santosh Khanal, NSW Ministry of Health, took an evidence-based approach to the policy question faced by the Ministry’s Office of Prevention: how to remove barriers to families attending the State Government obesity treatment program Go4Fun. He led a randomised controlled trial to determine the impact of restructuring the 10-week program, finding that it could be delivered weekly rather than twice a week without compromising health outcomes or attendance. As a result, the program is more accessible to families, and there have been substantial cost efficiencies.

The successful applicants, who each received $3000 towards their professional development, were selected by a panel of national and international experts.

• Watch videos of the Award winners discussing their work 

• View the photo gallery from the Award night


Seven national priorities for Indigenous cancer care

Federal Health Minister Sussan Ley has outlined seven new national priorities aimed at addressing the Indigenous cancer gap and rising cancer mortality rates in Aboriginal and Torres Strait Islander people.

Since 1998, cancer mortality increased by 16% among Indigenous Australians, while it fell by 10% in non-Indigenous Australians, Ms Ley said, adding that Aboriginal and Torres Strait Islander people were 30% more likely to die from cancer than non-Indigenous Australians.

She said the Government had joined with Indigenous communities, health professionals, service providers, cancer control organisations and researchers to establish an agreed, nationally-coordinated approach to tackling Indigenous cancer.

The National Aboriginal and Torres Strait Islander Cancer Framework  lists seven evidence-based priority areas which Ms Ley said would have the greatest impact in addressing cancer disparities:

• Improving knowledge and attitudes about cancer
• Focusing on prevention activities
• Increasing participation in screening and immunisation
• Ensuring early diagnosis
• Delivering optimal and culturally appropriate treatment and care
• Involving, informing and supporting families and carers
• Strengthening the capacity of cancer-related services to meet the needs of Indigenous people

The Minister also announced $350,000 towards a program aimed at raising awareness and reducing rates of lung cancer in Indigenous communities.

New resources aim to cut CT scan risk in children

New resources aimed at reducing the number of unnecessary CT scans performed on children and young people have been released by the Australian Commission on Safety and Quality in Health Care.

More than 80,000 CT scans were performed on children and young people in Australia each year, despite international evidence showing that exposure to ionising radiation potentially increases cancer risk, the Commission said.

The resources include brochures for parents about the benefits and risks of CT scans as well as an updated fact sheet for clinicians that outlines information on the key questions to consider when deciding whether or not to refer a child for a CT scan.

Commission chair Professor Villis Marshall said the resources were designed to provide guidance for all involved in the pathway of care − from parents, to referring doctors and dentists who request CT scans, to the imaging professionals who perform them.

Professor Susan Moloney, Staff Specialist and Director of Paediatrics at the Gold Coast University Hospital said: “It is important to remember that a CT scan which is warranted will almost always result in more benefit than harm to most patients.

However, these resources will help ensure that CT imaging is only performed when clinically necessary with radiation doses that are as low as possible.”

Report reveals how NSW health system stacks up globally

The NSW health system performs well in areas such as providing preventive health services and follow-up care on discharge, but it has a higher rate of some post-surgical complications than many other comparator countries, a new report shows.

The Bureau of Health Information (BHI) report, Healthcare in Focus 2014: How does NSW compare?, looked at how the NSW health system compared with Australia and 10 other countries, including the UK, US and France.

It found nine out of 10 NSW people who were hospitalised overnight said the hospital made arrangements for their follow-up care upon discharge, which was better than seven comparator countries.

More than half of adults aged 55 and over (54%) said the healthcare system worked well and only minor changes were needed, a rate that was higher than that in countries including the US, Canada, France, Sweden and Germany.

The findings also showed that people aged 55 and older with chronic conditions were more likely to say that a health professional had given them a written management plan and made contact between appointments to check on their condition than in eight other countries surveyed.

However, the rates of some post-surgical complications including deep vein thrombosis and sepsis in NSW were the highest of all countries surveyed, and only 70% of hip fracture surgeries were performed within the recommended timeframe of two days, which was a poorer result than all but one country.

A second BHI report, Insights: Healthcare performance across the life span, focused on how people aged 55 and older use and experience the NSW health service.

People aged 55‒64 years were less positive about their experiences in NSW emergency departments than older patients. Those aged 65‒74 years were more positive about care they received in hospital than other age groups, and those aged 75 and over were more positive about interactions with their GPs.

In each age group, almost two in 10 people said they experienced a complication or negative effect during or shortly after their hospital stay; and a similar proportion said their discharge from hospital was delayed, the report showed.


Unplanned transfers highlight need for better systems

Better systems are needed for recognising and responding to deteriorating patients in subacute care settings, according to an Australian study that shows one-third of unplanned transfers from subacute to acute care occur within 24 hours of patients being admitted to subacute care.

Patients in subacute care require regular physiological assessment and early escalation of care if there are physiological abnormalities  
Transfers within 24 hours

The researchers analysed data on 431 patients within four Victorian health services who were transferred from subacute to acute care by ambulance due to clinical deterioration or an acute adverse events, such as a fall. The median age of patients was 81 years.

They found the median length of stay in subacute care was 43 hours, with 29% of patients transferred to acute care within 24 hours, and 83.5% transferred within 72 hours of subacute care admission.

Patients transferred within 24 hours of subacute care admission were older, had more comorbidities and a longer acute care length of stay following readmission than those transferred later.

Findings in Australian Health Review showed that patients who experienced unplanned transfer had high hospital admission and in-hospital mortality rates.

Physiological assessment in the 24 hours preceding transfer was infrequent and incomplete in most patients, the study showed. Just one in 10 patients had all six elements of physiological observations that are recommended by the Australian Council on Quality and Safety of Health Care documented, despite deterioration significant enough to warrant ambulance transfer to an acute care facility.

“Patients in subacute care require regular physiological assessment and early escalation of care if there are physiological abnormalities,” the authors wrote. “Risk of clinical deterioration should be a factor in the decision to admit patients to subacute care after an acute illness or injury.”

Considine J, Street M, Botti M, O’Connell B, Kent B, et al. Multisite analysis of the timing and outcomes of unplanned transfers from subacute to acute care. Australian Health Review 2015;39:387-94.


Study supports transfers to optimise bed capacity

Transferring acutely unwell general medical patients from one hospital to another to optimise regional bed capacity does not adversely affect patient outcomes, an Australian study shows.

Researchers analysed “lateral” patient transfers between two tertiary-referral urban hospitals within a single area healthcare network, which were arranged to optimise bed capacity. The patients presented to one of the hospitals, which had an ED. Some patients were then transferred to the other hospital which had no ED, but greater bed capacity to accommodate acutely unwell admissions.

“None of our patients was transferred for their individual benefit, but to coordinate better the flow of patients with the bed availability in our region,” the authors wrote.

The study, in Australian Health Review, showed that transferred patients were likely to be older and suffer from less comorbidity than those kept at the initial hospital where they had presented.

Appropriate patients for transfer could be selected within 24 hours of arrival at an index hospital, they found.

Patients who were transferred spent a shorter time in hospital, were less likely to readmitted within seven days and had lower mortality than patients who were not transferred.

“This study may have wider implications for hospital managers at a time when tertiary referral centres are suffering bed block and community hospitals are threatened with closure,” the study authors wrote.

“Lateral transfer would reduce congestion and decrease elective surgery waiting time.”

Russell P, Hakendorf P, Thompson C. Inter-hospital lateral transfer does not increase length of stay. Australian Health Review. 2015;39:400-3.


Patient groups that benefit from the "four-hour rule"

The push to improve compliance with National Emergency Access Targets (NEAT) ‒ or the “four-hour rule” ‒ has led to reduced mortality among some groups of patients presenting to emergency, including older patients with complex medical conditions, new research shows.

Patients presenting to ED after hours or on weekends, or those with time-sensitive acute cardiorespiratory conditions also benefited from hospitals’ improved compliance with the NEAT targets ‒ under which hospitals aim to either discharge, admit or transfer ED patients within four hours of presentation.

The researchers analysed data from a major tertiary hospital that reported a near halving in mortality in association with a doubling in NEAT compliance over a two-year period from 2012‒2014.

Findings in Australian Health Review show that the inpatient mortality rate for emergency admissions decreased from 1.9% in 2011 to 1.2% in 2013, although there was no change in the percentage of deaths in the ED.

The mortality rate of older patients admitted to medical wards decreased significantly from 3.5% to 1.7%. over that time. In 2011, there was a higher mortality rate seen among patients presenting to ED triage between midnight and 12 noon and among patients presenting on weekends versus weekdays. However, those differences had disappeared by 2013.

“The present study provides the first preliminary evidence that low-cost targeted clinical redesign of the ED-inpatient interface leading to enhanced NEAT compliance is associated with improved mortality for particular subgroups of emergency patients admitted to inpatient wards,” the authors wrote.

Sullivan C, Staib A, Eley R, Griffin B, Cattell R, et al. Who is less likely to die in association with improved National Emergency Access Target (NEAT) compliance for emergency admissions in a tertiary referral hospital? Australian Health Review [Online 17 August 2015]


SMR “misleading” as a measure of hospital quality

New research has raised questions about the use of the Standardised Mortality Ratio (SMR) as an indicator of hospital performance, after finding that the measure is a “misleading” measure of quality and is not associated with a hospital’s avoidable death rate.

For two decades, the overall SMR for all deaths in a hospital had been advocated as an indicator of the quality of the hospital, despite little evidence to support its use in that way, the UK researchers said.

They reviewed case records of 100 randomly selected hospital deaths from each of 34 English acute hospital trusts to determine the proportion of avoidable deaths and to determine the association with the trust’s hospital-wide SMR.

Findings in the BMJ showed that the proportion of avoidable deaths was 3.6%, but there was no statistically significant association between this measure and the hospital-wide SMRs.

The authors said the low rate of avoidable deaths, combined with the absence of any association with the SMR, suggested neither measure was a helpful or informative indicator of the quality of a hospital trust.

“Both hospital-wide SMRs and avoidable death proportions based on the judgment of only one or two reviewers have methodological shortcomings making them unsuitable indicators to compare the quality of hospitals,” the authors wrote.

They warned that it was “potentially misleading to the public, clinicians, managers and commissioners to praise or condemn” a health service or hospital on the basis of either the SMR, or the avoidable death proportions.

They added that neither of the two measures should be used as a screening test or “smoke alarm” to identify poorly performing hospital trusts until its validity for that purpose had been rigorously evaluated and demonstrated.

Hogan H, Zipfel R, Neuburger J, Hutchings A, Darzi A et al. Avoidability of hospital death and association with hospital-wide mortality ratios: retrospective case record review and regression analysis. BMJ  2015;351;h3239.


Inpatient deaths an efficient indicator of adverse events

Reviewing records of inpatient deaths is a more efficient way of identifying preventable adverse events than reviewing the records of those discharged alive, a new study finds. The researchers, from the Netherlands, said retrospective review of patient records was a commonly used method for estimating adverse event rates, but reviewing the records of discharged patients was time-consuming and costly.

The authors said sampling inpatient deaths was an efficient method of reviewing adverse events, as fewer records needed to be studied to identify where safety improvements were possible  
An efficient choice

They studied a sample of nearly 12,000 admissions, half of which were inpatient deaths and half for patients who had been discharged alive, to look at whether records of inpatient deaths were a valid indicator of preventable adverse events. 

Trained external nurses and physicians reviewed the nursing, medical and inpatient records to determine adverse events, which were defined as unintended injury resulting in prolongation of hospital stay, temporary or permanent disability or death that was caused by healthcare management rather than the patient’s disease.

They found patients who died in hospital were on average older, had a longer length of stay and were more often urgently admitted.

Twice as many adverse events and preventable adverse events were found among inpatient deaths, compared with in patients discharged alive

No specific type of preventable adverse event that was found in the patients discharged alive was absent in deceased patients, according to findings in BMJ Open.

The authors said sampling inpatient deaths was an efficient method of reviewing adverse events, as fewer records needed to be studied to identify where safety improvements were possible.

“To acquire information on as many improvement possibilities as possible, this would seem to be an efficient choice,” they wrote, although they added it was important to be aware that studying inpatient deaths may result in some problems remaining underexposed or overexposed.

Baines R, Langelaan M, de Bruijne MC, Wagner C. Is researching adverse events in hospital deaths a good way to describe patient safety in hospitals: a retrospective patient record review study. BMJ Open 2015;5:e007380 doi:10.1136/bmjopen-2014-007380.


Administrative database of little value to identify adverse events

A hospital’s clinical administrative database is of very limited value in detecting post-operative adverse events, a Spanish study has found, after showing it fails to identify almost half of such incidents.

Using a sample of 1602 patients undergoing surgery in a Spanish hospital, the researchers compared information originating from clinical and administrative database (CADB) with the data extracted from the patients’ complete clinical record, which is seen as the “gold standard”.

The study found that the rate of adverse events within 30 days of surgery was 12.5% when using the CADB, compared with 24% when using the patients’ clinical records.

The clinical administrative database failed to identify 48% of the adverse events, for two main reasons: the high rate of adverse events occurring after discharge from the hospital, and that most adverse events were identified in different patients, depending on the records used.

Of 19 types of adverse events studies, only two had moderate validity using the CADB: cardiac arrest requiring cardiopulmonary resuscitation and accidental puncture or laceration, according to findings in the International Journal for Quality in Health Care.

“Despite its limitation, we did not have a better source of information than a complete medical record,” the authors wrote.

They said despite the fact that the use of the clinical administrative database was appealing, it was of “very limited value” and could not collect information on the many adverse events that happened after discharge.

Rodrigo-Rincon I, Martin-Vizcaino MP, Tirapu-Leon B, Zabalza-Lopez P, Abad-Vicente FJ et al. Validity of the clinical and administrative databases in detecting post-operative adverse events. Int J Quality in Health Care. 2015: [Internet] doi:


One in 10 cancer patients experience errors in care

About 10% of cancer patients report that there were errors in in the diagnosis of their illness and one in four say they experienced errors during their hospital treatment, a Danish study shows. The survey of 4346 adults with cancer found that 10% of the respondents said they experienced error at their GP during their diagnosis, 11% at the specialist practitioner and 15% at the hospital.

The findings suggested that practices related to informed consent, diagnostic reasoning as well as handling of test results, referrals and the medical chart, should be further improved  
Surgical errors most common

During hospital treatment, 25% reported experiencing errors, with 61% of those saying the error had consequences such as an increased length of hospital stay, physical and psychological consequences.

The most frequent type of errors identified in the study were unexpected surgical errors and complications (27%), delay due to doctors’ assessment errors (24%) and test results being unavailable when expected after being mislaid or delayed (21%), according to findings in the Patient Experience Journal.

The authors said it was likely the prevalence of errors was high compared to international health professional estimates because patients and healthcare professionals had different perspectives on errors.

The findings suggested that practices related to informed consent, diagnostic reasoning as well as handling of test results, referrals and the medical chart, should be further improved, they said.

They added that greater attention to patient-provider communication was needed, with a particular focus on information about surgical complications.

“The fact that patients identify errors that are not necessarily recognised by the health care system sets the stage for the involvement of patients as an extra safety barrier,” they wrote.

Dorflinger LH, Enevoldsen C, Vinter MM, Knudsen JL. Cancer patients’ experiences of error and consequences during diagnosis and treatment. Patient Experience Journal. 2015;2(1)102‒110.


The evolving role of cancer registries

The role of cancer registries has evolved since they were first established in Australia more than four decades ago, a new paper suggests, with data linkage enabling registers to play an increasing part in contributing to health systems management.

The perspective piece in Australian Health Review states that cancer incidence monitoring began in NSW in 1972, with other jurisdictions soon following.

Traditionally, the role of cancer registers included monitoring incidence mortality and survival by cancer type, in order to demonstrate the changing burden of cancers and how they affected different subgroups of the population.

Registers had also been useful to show decreases in cancer incidence following interventions and had been used for workforce and other infrastructure planning, the paper stated.

However, more recently, the role of registers had expanded to include using survival data to assess health service performance, and clinical quality surveillance and improvement.

“Increasingly, population-based registry data in Australia are linked with administrative data on service delivery to assess system performance,” the authors said.

The addition of tumour stage and other prognostic indicators was important for those analyses, they said. Structured reporting of pathology, surgery and radiology data was increasing the opportunities for registers to automatically collect data on stage, grade, biomarkers and other prognostic indicators, they added.

“Registry data linkage with administrate data enable assessments of patterns of care and other performance indicators for health-system monitoring,” they wrote.

The paper was published as the federal government moved ahead with plans to introduce a new National Cancer Screening Register. As announced in this year’s budget, the new register will cover both the national bowel and cervical screening programs and will provide a template for any future national population screening tests.

This month, the federal Department of Health issued a request for a tender for a new ICT (information communication technology) system to build the register, Pulse +It magazine reported.

Roder D, Creighton N, Baker D, Walton R, Aranda S, Currow D. Changing roles of population-based cancer registries in Australia. Australian Health Review 2015;39;425‒8.


Demand on NSW hospitals increases

The Bureau of Health Information’s latest Hospital Quarterly report covering April to June 2015 showed that the number of people presenting to emergency departments was 2% higher than for the same quarter last year, with 11,926 more emergency department presentations. There had been a 25% increase in emergency presentations over the past five years and hospital admissions were 1% higher than for the same quarter last year, while 97% of patients received their surgery within recommended timeframes.

Download report

Hospitals vary widely in antimicrobial use

The use of antimicrobials varies widely across Australian hospitals, from a low of 330 defined daily doses per 1000 occupied bed days to a high of 2040, according to the 2014 Report of the National Antimicrobial Utilisation Surveillance Program (NAUSP). However, the report, released by the Australian Commission on Safety and Quality in Health Care, showed that the total rate of antibiotics prescribed in Australia decreased by 2.2% from 2013 to 2014, and fell by 6.2% from Australia’s peak usage in 2010.

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Call for crackdown on inappropriate care in hospitals

Australia urgently needs a system to identify “outlier” hospitals in which far too many patients are being given treatments that have been shown to be unnecessary or ineffective, according to the Questionable Care: Avoiding ineffective treatment report released by the Grattan Institute. The report authors called for the Australian Commission on Safety and Quality in Health Care to publish a list of “do-not-do” treatments and to identify hospitals that provide such treatments more than usual, then to take definitive steps to address the problem.

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15 things that should never happen in a hospital

A Canadian report has listed 15 things that should never happen in a hospital, from an infant being abducted to surgery performed on the wrong side of the body. Never Events for Hospital Care in Canada, released by Health Quality Ontario and the Canadian Patient Safety Institute, lists the 15 medical errors or in-hospital incidents that should never occur in the country’s healthcare institutions and guidance on how they can be prevented.

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Unpaid care valued at $60.3 billion per year

A report launched by Carers Australia has revealed that the replacement value of the care provided by the nation’s unpaid carers has increased to $60.3 billion per year, or more than $1 billion every week. The Deloitte Access Economics Report, The Economic Value of Informal Care in Australia 2015, details how the demand for carers is at an all-time high and predicts that by 2025, only 42% of those with a severe disability aged over 65 and not living in residential care will have access to an unpaid carer.

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Older people’s attitudes to cancer

Older people are no more likely to refuse cancer treatment than younger people, according to a survey of more than 1500 people commissioned by the UK cancer charity Macmillan Cancer Support and carried out by Ipsos MORI. The report, Exploring the attitudes and behaviours of older people living with cancer, challenges a view that older people may be more likely to turn down treatment. It also found that a series of misconceptions among older people about the risk of cancer and eligibility for screening may impact upon early diagnosis efforts and should be addressed.

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Kate Callaghan  

Kate Callaghan

HARC Scholar

Clinical Excellence Commission

Exploring novel antimicrobial interventions

With a background in clinical pharmacy, Kate Callaghan has always had a keen interest in the quality use of medicines, infectious diseases and antibiotic prescribing behaviours.

So it was a natural fit for her to take on the role of Project Officer, Antimicrobial Stewardship (AMS) at the Clinical Excellence Commission (CEC), where she has been involved in the Quality Use of Antimicrobials in Healthcare project that aims to facilitate and support AMS initiatives in NSW public health facilities.

Miss Callaghan has now gone a step further and, after being awarded a HARC scholarship, has embarked on a research project to explore innovative antimicrobial stewardship interventions and the science behind their success.

A global health threat

In April 2014, the World Health Organization, in its first global report on antibiotic resistance, warned that the issue was a serious, worldwide threat to public health.

With attention turning to the issue worldwide, Ms Callaghan said she wanted to look at what international, evidence-based interventions were helping to change healthcare workers’ behaviour, and to explore whether they could be applied to antimicrobial stewardship, and translated into practice in Australian hospitals.

In June and July she travelled to Geneva, Switzerland, where she attended the 3rd International Conference for Prevention and Infection Control, and to Scotland, to attend and present at a meeting of the Scottish Antimicrobial Prescribing Group, which is seen as a global pioneer in the area of AMS. Miss Callaghan said the CEC had been collaborating with the Scottish group in developing its 5x5 Antimicrobial Audit tool.

After visiting major hospitals in Glasgow and Edinburgh, she then travelled to London to meet with researchers from Imperial College who are working on incorporating behavioural science and social marketing principles into AMS interventions. It was in London that Miss Callaghan also met with the Pharmacist Lead for Antimicrobial Resistance and Stewardship at Public Health England, as well as an advisor from the Behavioural Insights Team, who work in partnership with the UK government’s Cabinet Office.

Harnessing technology

One of her key learnings was the need to embrace the potential value of mobile technology in influencing clinicians’ behaviour, she said.

“While I was overseas I gained insight into the various ways app technology can be used to educate prescribers.”

For example, gamification was being used in apps to help clinicians learn in a more engaging way.

“The use of technology can make information like guidelines on antimicrobial prescribing accessible at the bedside,” Miss Callaghan said. ”If you can make more guidance available at the point of prescribing you can support clinicians to make more prudent antibiotic prescribing decisions.”

She would now explore how such strategies could be applied in CEC programs to support front-line health workers and reduce the inappropriate use of antibiotics, she said

Innovations in Cancer Treatment and Care Conference

Value-based care is the theme of this conference hosted by the Cancer Institute, NSW. The conference will provide health professionals with an opportunity to hear, collaborate and share the latest innovations in quality cancer treatment and care. The keynote address will be delivered by Professor Thomas Feeley, an esteemed US academic and doctor of medicine whose areas of interest include healthcare quality, value creation and cancer care innovation.

15 October, Sydney
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4th Annual NHMRC Symposium on Research Translation jointly with CIPHER
27‒28 October, Sydney
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This year’s NHMRC Research Translation Faculty Symposium will be held in collaboration with CIPHER – the Centre for Informing Policy in Health with Evidence from Research. The goal of the Symposium is to create more effective working relationships between health policy makers and researchers.

Youth Health Forum ‒ Locked up but not locked out: Working with young people not young offenders

This forum focuses on key issues for young offenders. With presentations from senior clinicians in the Justice Health and Forensic Mental Health Network and NSW Police Force, the forum examines issues around the health needs of young people in custody, supporting young people to return to the community, saying no to domestic violence, and a case study based in Western Sydney. Video conferences are available in 15 sites across NSW.

28 October, Sydney
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45 and Up Study Collaborators’ Meeting
12 November, Sydney
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The 45 and Up Study’s 12th Annual Collaborators’ Meeting is themed: Opportunities and challenges in a big data environment. Professor Karen Canfell, Director, Cancer Research Division at Cancer Council NSW, will provide the keynote address on big data’s potential for predictive modelling in health. Plenary presentations will be on population-based data linkage, patients’ experiences of adverse events, visualisation of linked health data, community pathology, and genome sequencing.

NSW Respiratory Clinical Innovations Forum

This forum, hosted by the Agency for Clinical Innovation, will target multidisciplinary clinicians and managers involved in the delivery of care to adults or children with respiratory disease across acute, subacute, community and primary care settings. NSW clinicians, managers and researchers will showcase their work across the themes of delivering evidence-based care, integrated care and effective partnerships, patient-centred outcomes and solutions to address local needs.

27 November, Melbourne
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9th Health Services and Policy Research Conference
7‒9 December, Melbourne
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The Health Services Research Association of Australia and New Zealand (HSRAANZ) biennial conference at the Melbourne Convention and Exhibition Centre has the theme: “From data to delivery: Connecting research, policy and practice for better health outcomes” and will focus on the interface between research, practice and policy, with the ultimate aim of using research to improve health outcomes for society.
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