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Issue 44, February 2016
The Hospital Alliance for Research Collaboration
In the news
Focus on falls and fractures
Intervention impact
Spotlight on obstetrics

Measuring up on outcomes

Measuring patient outcomes is the focus for HARC Scholar Sigrid Patterson

Measuring healthcare outcomes and value for patients rather than measuring the volume of healthcare that is delivered, is the focus of research by HARC Scholar Sigrid Patterson.

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What works ‒ and what doesn't

In this month’s HARC e-Bulletin, we look at new research on interventions that are having a positive impact on health outcomes, and some that aren't proving quite as successful.

In our focus on falls and fractures, we report on a study revealing the heavy cost burden of osteoporosis-related falls on on one state health system, while another study shows falls prevention strategies are falling short of their intended impact.

Among the interventions that are proving succesful are a Hospital in the Home service for aged care facility residents with pneumonia in Victoria, and the SEPSIS KILLS program implemented by the Clinical Excellence Commission (CEC) in NSW hospitals.

In our profile, we meet 2015 HARC scholar Sigrid Patterson, from the Agency for Clinical Innovation (ACI), who is committed to working across disciplines to achieve outcomes that really matter for patients.

Please forward this edition of the Bulletin to colleagues who may be interested in joining the HARC Network. We’d love to hear your feedback or suggestions at

Megan Howe
Editor, HARC e-Bulletin

Upcoming symposium will explore the Patient Centred Medical Home

Reforms to the US primary health care system to introduce a concept known as the Patient Centred Medical Home (PCMH) could have an impact on the way healthcare is delivered in NSW, a symposium co-hosted by HARC will hear this month.

The patient centred medical home model emphasises patients having an ongoing relationship with a particular doctor, and primary care that is comprehensive co-ordinated and accessible.

The symposium, being held in Sydney on 17 March, is co-hosted by HARC and the Centre for Primary Health Care and Equity (CPHCE) at the University of NSW.

Two distinguished US speakers will give their insights into the US experience of the PCMH model. They are Professor Kevin Grumbach from the University of California, San Francisco, and Associate Professor Jennifer DeVoe, a principal investigator on five research studies funded by the US Patient-Centred Outcomes Research Institute, the Agency for Healthcare Research and Quality, the National Cancer Institute and the National Heart, Lung and Blood Institute.

Local experts will lead a panel discussion to explore the implications and opportunities for NSW to develop similar models.

Find out more and register to attend the free symposium. Places are limited.

Shooting prompts new security plan for NSW hospitals

Emergency department staff in NSW hospitals will receive intensive training in managing aggressive patients and a security audit will be conducted on 20 hospital EDs as part of a 12-point security action plan endorsed by NSW Health Minister Jillian Skinner.

The plan comes in the wake of a violent incident last month at Nepean Hospital in Sydney’s west, in which a police officer and a security guard were both shot by a patient who allegedly took a doctor hostage before grabbing a police officer’s gun during a struggle in the ED.

The incident led to a roundtable of health stakeholders and union representatives, where the action plan was agreed.

Under the plan, ED staff including nursing, security and medical staff will receive training in managing disturbed and aggressive behaviour and NSW Health will partner with TAFE to establish new courses to train existing and new security staff specifically for the health environment.

The audit of EDs at 20 hospitals around the state will recommend if any security policies or procedures need to be strengthened, in particular regarding how they respond to patients who are affected by alcohol or drugs including psychostimulants like ice.

The plan also commits to immediately examining the availability of mental health and drug and alcohol resources in EDs to deal with patients under the influence of drugs like ice, including the use of telehealth options for rural and regional areas.

Read the full 12-point plan.

HARC scholar's work reaches broad audience

Research conducted by the CEC’s Cathy Vinters as part of her HARC scholarship is continuing to have an impact, after being published recently in the New Zealand Medical Journal.

Ms Vinters, program leader ‒ Clinical Practice Improvement Training at the Clinical Excellence Commission (CEC), was awarded a HARC scholarship in 2014 to examine factors that are needed to achieve both the spread and sustainability of quality improvement programs.

Her research, including a literature review and interviews with clinicians, quality improvement specialists and other individuals in the UK, outlined factors that need to be in place to enable programs to be sustainable - such as strong leadership - and for programs to be expanded, such as staff stability.

Last year, she presented the findings at the APAC Forum on quality improvement in Auckland, New Zealand, after which she was selected to have her abstract published in the December issue of the New Zealand Medical Journal.

Ms Vinters said she used her findings on program sustainability and spread on a day-to-day basis in her role teaching NSW Health staff who were undertaking CEC clinical practice improvement training, as well in teaching she conducted with advanced trainees with the Royal Australasian College of Physicians.

“The HARC scholarship is a fantastic opportunity to network with experts doing absolutely brilliant things in other places, and also to be able to reflect on the work you’re doing and the way it all fits in the international environment,” she said, adding that she still liaises with the network of contacts she made during her scholarship research.

The 2016 HARC Scholarship Program is now calling for applications. The program is open to employees of the HARC partners: the Clinical Excellence Commission, the Bureau of Health Information, the NSW Agency for Clinical Innovation, Cancer Institute NSW, the NSW Office of Kids and Families and the Sax Institute.

Under the guidance of a nominated local mentor, the successful scholars will investigate an issue of interest, based on a challenge facing their agency. The Scholarship, including funding up to a maximum of $10,000, will include a visit to a nominated national or international agency with expertise in the chosen field.

Applications close Monday 14 March 2016.  For enquiries about the scholarship program contact Jo Khoo via: or 02 9188 9559.

Push for hospitals to make organ donation rates public

Making individual hospital organ donation rates public would help foster “friendly competitive rivalry”, according to the Federal Minister formerly responsible for organ donation, Fiona Nash.

Ms Nash released an independent review conducted by Ernst and Young, which recommended changes in the governance, transparency and accountability of the organ and tissue donation sector.

The recommendations include a call for organ and tissue donation data to be made public on a hospital-by-hospital and state-by-state basis, and for monitoring of the proportion of ICU specialists, staff and trainees in each hospital who have been trained in having donation conversations with families.

“Hospitals need to see organ donation as a key priority,” Ms Nash said. “I look forward to fostering a friendly competitive rivalry between the states and territories and individual hospitals as to who has the better organ donation rate through publicising their results.”

The review comes as figures from the NSW Organ and Tissue Donation Service show there was a record 127 deceased organ donors in NSW last year, exceeding the 2015 target of 116 donors.


Fractures costly to state hospital system

Low-trauma fractures in patients with osteoporosis has cost Western Australian hospitals more than $100 million over a decade.

The findings point to a vital need for programs to prevent recurrent fractures, according to the researchers.

The index admissions over the study period cost a total of $57 million, while readmissions cost almost $48 million  
Re-fractures common

The researchers studied data on osteoporotic fractures in 5326 patients aged 50 and older admitted to WA hospitals between 2002 and 2011. They found that 38% of those patients had a re-fracture requiring admission. A total of 23% of all patients with an initial fracture had one re-fracture episode, 8.5% had two and 6.8% had three or more re-factures episodes requiring readmission.

The study found the cumulative probability of readmission within six months of the index admission was 20% for males, and 17% for females.

The index admissions over the study period cost a total of $57 million, while readmissions cost almost $48 million, according to findings in the Australian and New Zealand Journal of Public Health.

And the average cost per readmission rose linearly over the decade, due to patients needing progressively longer stays in hospital.

The authors said it was critical to initiate preventive interventions after a patient’s first fracture, given both the trajectory of increasing costs for the state health system and the benefits to patients’ health.

“These data highlight the need for system reform initiatives to stem the flow of recurrent factures among people with osteoporosis,” they wrote.

Briggs AM, Sun W, Miller LJ, Geelhoed E, Huska A, et al. Hospitalisations, admission costs and re-fracture risk related to osteoporosis in WA are substantial: a 10-year review. Australian and New Zealand Journal of Public Health. 2015;39:447‒62


Hip fracture discharge and death discrepancies

Patients with hip fracture face an increased risk of early mortality after discharge if they have a long hospital stay rather than being sent home early, a US study shows.

The study analysed mortality rates at 30 days after hospital discharge among 188,208 patients aged 50 and over admitted to hospital for hip fracture in New York State from 2000 to 2011.

Hospital stays of 11‒14 days were associated with a 32% increased odds of death 30 days after discharge, compared with hospital stays lasting one to five days, the study found.

The odds increased to 103% for hospital stays longer than 14 days, according to findings in the BMJ.

The authors said the findings contrasted with a recent Swedish study that found a shortened hospital stay was associated with increased rates of early mortality among patients with hip fracture.

The longer length of hospital stay found in the US study may be a result of patients’ medical comorbidities or complications occurring in the hospital that delayed a safe, early discharge, they suggested.

“This critical difference suggests prolonging admission to hospital would not improve mortality outcomes in a New York state population,” they wrote, adding that the findings may not apply to different health systems.

Nikkel LE, Kates SL, Schreck M, Maceroli M, Mahmood B, et al. Length of hospital stay after hip fracture and risk of early mortality after discharge in New York State: retrospective cohort study. BMJ 2015;351 [Internet] Doi:


Falls prevention strategies falling short

Australian researchers have suggested new solutions are needed to reduce patient falls while in hospital, after a program of nurse-led interventions failed to have any impact on patients’ risk of falling.

The “6-PACK program” included a fall risk tool and individualised use of one or more of six interventions: “falls alert” sign; supervision of patients in the bathroom; ensuring patients’ walking aids are within reach; a toileting regimen; use of a low bed, or use of a bed/chair alarm.

Participating wards in six Australian hospitals, involving a total of 46,245 patient admissions, were randomly assigned to receive either the program, or usual care, over a 12-month period. During the study period, 1831 falls and 613 fall injuries were recorded, according to findings in BMJ Open.

However, the intervention was found to have no effect on falls or fall injuries. The fall rate on intervention wards was 7.46 per 1000 occupied bed days, compared with 7.03 per 1000 occupied bed days in control wards, and the rate of all injuries was 2.33 and 2.53 per 1000 occupied bed days respectively.

“Although the substantial harm and negative consequences of inpatient falls are unquestionable, high-quality evidence showing the effectiveness of preventive interventions for falls in acute wards is lacking,” the authors wrote.

Meanwhile, another study across medical and surgical wards in nine acute care hospitals in Australia found that clinical audit and feedback was an effective way of improving falls prevention practices ‒ but it failed to impact fall rates.

In the study, a clinical leader assessed falls prevention practices, identified barriers to compliance with best practice – such as insufficient falls education for staff --and implemented falls prevention strategies, including multidisciplinary staff education sessions.

There was 50.4% compliance with falls prevention audit criteria initially, which increased to 74.5% at follow up about four months later, and was sustained at a second follow up another five-six months later, findings in the International Journal for Quality in Health Care show.

Despite the sustained practice improvement, the study found the reported fall rates remained unchanged ‒ a finding the authors suggested might be explained by the intervention leading to improved reporting of falls.

Barker A, Morello R, Wolfe R, Brand CA, Haines TP, et al. 6-PACK programme to decrease fall injuries in acute hospitals: cluster randomised controlled trial. BMJ Open 2016;352:h6781 [Internet] doi: 10.1136/bmj.h6781

Stephenson M, McArthur A, Giles K, Lockwood C, Aromataris E, et al. Prevention of falls in acute hospital settings: a multi-site audit and best practice implementation project. International Journal for Quality in Health Care 2015 [Internet] doi: 10.1093/intqhc/mzv113.


An alternative to hospital for elderly pneumonia patients

Hospital in The Home services may be a safe and effective alternative to hospital treatment for aged care facility residents with pneumonia, an Australian study suggests.

In the study, 60 patients with nursing home acquired pneumonia were treated within their aged care facilities under the Victorian Hospital in the Home (HITH) program, while 54 controls were treated in hospital.

The state’s HITH program provides seven-day, 24-hour service, can administer oxygen and intravenous antibiotics and fluids, and includes pathology and mobile radiology services. Medical staff can visit patients each day, and one or two daily nursing visits are made.

There were no differences in the median length of stay between the HITH patients and those treated in hospital, according to findings in the MJA,  and similar proportions of patients in the two groups were given intravenous fluids and supplemental oxygen.

There were no significant differences in overall mortality at 30 days for the two groups after adjusting for baseline differences. However, in-patient mortality was lower for HITH patients (while they were an inpatient of the HITH service), but the unadjusted post-discharge 30-day mortality was higher.

The authors suggested this may be due to factors such as HITH continuing intravenous antibiotic treatment for longer than hospitals, or to HITH patients being discharged to their usual care providers after active treatment was stopped and palliation had begun, whereas patients in hospital may be given palliation there.

The study authors said the proportion of the hospital workload associated with treating aged care home patients was set to increase, and suggested HITH could be a “targeted and effective” way of delivering care equivalent to that provided in hospital.

“This requires well resourced, intensive, medically based HITH, supported by hospital level technologies, such as intravenous therapies, expert staff and mobile x-ray facilities, as well as the willingness to meet the challenge of switching care models for the high level of disease severity with which these patients inevitably present,” they wrote.

Montalto M, Chu MY, Ratnam I, Spelman T, Thursky K. The treatment of nursing home-acquired pneumonia using a medically intensive Hospital in the Home service. MJA 2015;203(11):441-42


SEPSIS KILLS program leads to early intervention

A program aimed at better managing the increasing incidence of sepsis within NSW hospital emergency departments (EDs) has led to earlier diagnosis and more urgent treatment of patients suspected to have the potentially fatal condition, new findings show.

The data demonstrating that patients with sepsis were being managed earlier and more urgently showed the program had been a success  
Program expanded following success

The Clinical Excellence Commission (CEC) implemented the SEPSIS KILLS program in 2011, to promote the skills and knowledge needed for recognising and managing patients with sepsis in the NSW EDs. The program focuses on the principle of “Recognise, Resuscitate, Refer”.

Data from 97 EDs, which submitted more than 13,000 records on patients with a provisional diagnosis of sepsis between 2011 and 2013, showed that the proportion of patients receiving intravenous antibiotics within 60 minutes of triage increased from 29.3% in 2009‒2011, to 52.2% in 2013, according to findings in the MJA.

The percentage of patients for whom a second litre of intravenous fluid was started within 60 minutes increased from 10.6% to 27.5%, while the proportion of patients triaged as needing to be seen either immediately or within 10 minutes also rose following the introduction of the program.

The authors said the data demonstrating that patients with sepsis were being managed earlier and more urgently showed the program had been a success.

There was a decrease in overall mortality from 19.3% in 2009‒2011 to 14.1% in 2013. While the mortality rate for patients with severe sepsis admitted to either intensive care or a ward did not change significantly over time, the study found that the proportion of patients with uncomplicated sepsis transferred to a ward increased and the mortality rate after transfer increased from 3.2% in 2009‒2011 to 6.2% in 2013.

The high proportion of patients with sepsis being treated on wards may be the result of under-appreciation of the potential mortality of sepsis, together with the practical problem of intensive care unit bed availability, the authors said. They called for a shift in research focus to managing sepsis on the ward.

The SEPSIS KILLS program was extended to hospital wards in 2014 and a 48-hour management plan has also been implemented.

Meanwhile, a US study showed that a multidisciplinary sepsis quality improvement program that focused on the earlier identification of sepsis, early administration of antibiotics and a mandatory education program throughout all hospital units and services, resulted in a 4.6% drop in sepsis mortality in one hospital.

Septic patients had shorter ICU stays, shorter overall hospital stays and reduced hospital costs as a result or the program, according to the findings in the American Journal of Medical Quality.

Burrell AR, McLaws M-L, Fullick M, Sullivan RB, Sindhusake, D. SEPSIS KILLS: Early intervention saves lives. MJA 2016;204(2):73.

Armen SB, Freer CV, Showalter JW, Crook T, Whitener CJ, West C, et al. Improving outcomes in patients with sepsis. American Journal of Medical Quality. 2016;31(1)56‒63.


Discharge information sheet boosts communication

Giving patients a bedside “leaving hospital information sheet” can improve communication between patients, their families and their treating team, an Australian study finds.

The study authors said communication was a common barrier to discharge, particularly in regard to a patient’s discharge date or destination.

They trialled the use of a laminated information sheet placed behind the patient’s bed in a stroke-neurological rehabilitation ward at a Victorian hospital, which included the name of the patient’s key clinician, the estimated date of discharge and the likely discharge destination.

The information sheets resulted in significant improvement in patients’ knowledge of their key clinician for team-patient communication (31% prior to introduction of the sheet compared with 75% after), in correctly identifying who that key clinician was (47% vs 79%), and in correctly reporting their anticipated discharge date (54% vs 86%), according to findings in Internal Medicine Journal.

There was also significant improvement in the family’s knowledge of the anticipated discharge date. While the researchers said the implementation of the sheet was suboptimal, with 18% of staff not utilising it, those staff who did use it reported that it assisted with communication about discharge details.

“We believe the ‘Leaving Hospital Information Sheet’ has the potential to be used across many other hospital settings, especially rehabilitation and aged-care hospitals where patients can have long admissions and uncertain discharge destinations,” the authors wrote, adding that it would also be used to improve communication in acute hospital wards.

Further studies were needed to determine whether the sheet could prevent unnecessary delays in discharge, they said.

New PW, McDougall KE, Scroggie CPR. Improving discharge planning communications between hospitals and patients. Internal Medicine Journal. 2016 [Internet] DOI: 10.1111/imj.12919​​​


Study shows poor compliance with NSW caesarean policy

More than one-third of prelabour, repeat caesarean sections among low-risk women occur before 39 weeks gestation, despite a clear policy to the contrary, a new study shows.

The researchers called for strategies to improve compliance with a NSW Ministry of Health policy directive that requires low-risk elective or pre-labour caesarean sections do not occur before 39 completed weeks’ gestation.

Of 15,163 prelabour repeat caesareans in low-risk women that occurred in NSW public hospitals between 2008 and 2011, 34.7% occurred before 39 weeks’ gestation, according to findings in Public Health Research & Practice.

Rates of early repeat caesareans varied greatly between hospitals, with adjusted rates ranging from 16.3% to 67.5%, the study found.

Adjusted rates of compliance with the policy ranged from 32.5% to 83.7%, and the authors said the findings suggested that the timing of low-risk prelabour caesareans was influenced by nonmedical factors.

“Patient preferences and physicians’ decision making vary, and may explain the remaining variation,” they wrote, adding that challenges in scheduling may also play a part.

Reducing the number of elective caesareans before 39 weeks gestation had been associated with a reduction in neonatal mortality, they said.

Internationally, strategies such as enforcing prohibition of elective caesareans before 39 weeks ‒ known as the “hard stop” approach ‒ had achieved some success.

“Further strategies, such as those implemented internationally, are required to improve adherence to this evidence based policy,” they wrote.

Schemann K, Patterson JA, Nippita TA, Ford J , Mathad, D, Roberts CL. Variation in and factors associated with timing of low risk, pre-labour repeat caesarean sections in NSW, 2008-2011. Public Health Res Pract. 2016:26(1):e2611608. Doi: http://


New gestational diabetes criteria ups cases by 20%

The introduction of a lower threshold for diagnosing gestational diabetes could increase diagnoses by 20%, but the health benefits for both mothers and infants may justify the increased burden on health services, an Australian study suggests.

The researchers assessed perinatal outcomes for women with gestational diabetes mellitis (GDM), as classified by the 1988 Australasian Diabetes in Pregnancy Society (ADIPS) criteria, compared with those diagnosed under the proposed International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria, which has been endorsed by some, but not all, Australian diabetes and obstetric bodies.

Concerns have been raised that the newer criteria, which include dropping the fasting blood glucose diagnostic cut-off from 5.5mmol/L to 5.1mmol/L and making a diagnosis if one-hour glucose is 10mmol/L or greater, and a two-hour glucose is 8.5mmol/L or greater, would see an increase in the incidence of GDM in Australia from around 9.6% of pregnancies to 13% of pregnancies, leading to a rise in costs and interventions.

The study showed that among 3571 pregnant women treated at King Edward Memorial Hospital in Perth, 466 (13%) met the criteria for the 1988 ADIPS criteria for GDM, while 16% would be diagnosed using the newer IADPSG criteria ‒ a 20% increase.

Findings in The Australian and New Zealand Journal of Obstetrics and Gynaecology showed that the group of women with potentially undiagnosed GDM were more obese, had increased gestational weight gain compared with women treated for GDM based on the 1988 criteria, and were at a 2.2-fold increased risk of delivering a macrosomic (large) baby ‒ a possible risk factor for later life obesity and type 2 diabetes in the offspring.

“The increase in diagnoses of GDM brought about by the introduction of the new diagnostic criteria would increase clinical workload, primarily for diabetes educators and dieticians,” the authors wrote. “However, the potential benefits in terms of dietary education, reduced gestational weight gain a well as the decreased incidence of macrosomia should translate into short- and long-term health benefits.”

They concluded that the increased costs of treating more women with gestational diabetes based on the lower diagnostic threshold may be offset by the health benefits gained.

Laafira A, White, SW, Griffin CJ, Graham D. Impact of the new IADPSG gestational diabetes diagnostic criteria on pregnancy outcomes in Western Australia. Australian and New Zealand Journal of Obstetrics and Gynaecology 2016;56:36‒41


What’s the optimal caesarean delivery rate?

Caesarean delivery rates of approximately 19% are associated with optimal levels of maternal and neonatal mortality, according to a study of data across 194 WHO member states. 

The findings challenge the long-established WHO recommendation that caesarean delivery rates should not exceed 10 to 15 per 100 live births, the study suggested.

The findings suggested that while some countries would benefit from strategies to boost surgical capacity and caesarean rates, others might see mortality benefits from reducing caesarean rates  
Australian births by caesarean nearly one in three

The researchers gathered data from 194 WHO member states to examine the relationship between the population-level caesarean delivery rate and the resultant maternal and neonatal mortality rates.

They found that 45 countries had a caesarean delivery rate of 7.2 or lower per 100 live births, 48 had a rate between 7.2 and 19.1; 48 countries had a rate between 19.1 and 27.3  and 53 countries had rate greater than 27.3, according to findings in JAMA.

Australia’s caesarean rate, as at 2010, was 32.2 per 100 live births, similar to the US, while rates were as high as 50% in some South American countries like Brazil.

The authors said the findings suggested that while some countries would benefit from strategies to boost surgical capacity and caesarean rates, others might see mortality benefits from reducing caesarean rates.

Meanwhile, a study following up babies born in Scotland between 1993 and 2007 found that those born by planned caesarean (but not unscheduled caesarean delivery) compared with vaginal delivery had a small absolute increased risk of asthma requiring hospital admission, salbutamol inhaler prescription at age five years, and all-cause death by age 21.

There were no significant differences in risk of obesity at age five, inflammatory bowel disease, type 1 diabetes and cancer.

The researchers suggested exposure to maternal bowel flora may affect development of T-cell-mediated asthma, but said further research was needed to understand whether the associations they observed were causal.

Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, et al. Relationship between Cesarean Delivery rate and maternal and Neonatal Mortality. JAMA 2015;314(21):2265‒70

Black M, Bhattacharya S, Philip S, Norman JE, McLernon DJ. Planned Cesarean Delivery at term and Adverse Outcomes in Childhood Health. JAMA 2015;314(21):2271‒9


Insight into older Australians’ wellbeing

The first report mapping how older people are faring nationally across five domains, including education, health, resources and wealth (including housing), shows that housing affordability is the single most important factor determine older people’s wellbeing.

The Index of Wellbeing for Older Australians, released by the Benevolent Society, also shows that there are large concentrations of over 65s experiencing low wellbeing on the fringes of major cities compared to inner-city areas.

Download report

Technologies that will transform health

This report by the UK Kings Fund, The digital revolution: Eight technologies that will change health and care, examines the technologies that are most likely to change health and care over the next few years.  

From the smart phone to smart pills to digital therapeutics, genome sequencing and blockchains, it looks at some technologies that are already in our pockets, surgeries and hospitals, and some that on the horizon, but none of which are as yet systematically deployed in our health and care system. Each could represent an opportunity to achieve better outcomes or more efficient care, the report suggests.

Download report

Cancer screening data breakdown

The Australian Institute of Health and Welfare has released a dynamic data display giving an at-a-glance view of cancer screening by Primary Health Network. The display gives a breakdown of data on participation the National Bowel Cancer Screening Program, BreastScreen and National Cervical Screening Program across the 31 PHNs, as well as incidence of the three cancers in each Network.

Download report

AMA hospital report card warns of funding crisis

The AMA’s Public Hospital Report Card 2016 finds that the performance of public hospitals against key measures is declining in some areas and stagnant in others. Bed numbers are deteriorating, waiting times are largely static with only very minor improvement, ED times are worsening and elective surgery waiting times and treatment targets are largely unchanged, it states.

The report warns the states and territories will face a public hospital funding crisis in 2017, when the Commonwealth is set to limit its contribution to public hospital costs.

Download report

Measuring the impact of the US patient-centred medical home

The US Patient-Centered Primary Care Collaborative had released a report examining the effectiveness of the patient-centred medical home (PCMH) concept in the US. The report analyses the findings of studies of 30 primary care PCMH initiatives published in 2014–15 that measured cost and utilisation of service.

The 30 initiatives point to a clear trend showing that the medical home drives reductions in health care costs and/or unnecessary utilisation, such as emergency department visits, inpatient hospitalisations and hospital readmissions, it finds.

Download report

Report looks at rules of patient engagement

The Canadian independent health policy think tank, The Change Foundation, has released a report called Rules of Engagement: Lessons from Panorama after convening a panel of patients and family caregivers to share their experiences and insights on issues related to improving people’s healthcare experience.

The resource, aimed at health providers and professionals, gives tips for better patient engagement and outlines key moments in the engagement process that require extra thought and preparation.

Download report

Sigrid Patterson  

Sigrid Patterson

HARC Scholar

Evaluation Manager, Health Economics and Evaluation Team, Agency for Clinical Innovation 

Measuring up on outcomes

She may have taken a “winding road” to her current role as an evaluation manager with the Agency for Clinical Innovation (ACI), but Sigrid Patterson has always been focused on working across disciplines to achieve outcomes that really matter.

Sigrid, who is based at ACI’s Health Economics and Evaluation Team in Lismore, NSW, now works to ensure programs are designed with the end-users’ ideas and perspectives in mind, and in a way that can be effectively evaluated.

She says her career has taken a circuitous route, beginning with working in adolescent mental health with homeless youth.

“I felt very much that we were addressing the issues there but not looking at the structure and system that could prevent it [homelessness],” she says. “I was increasingly interested in policy.”

She moved to a role with NSW Health as a manager on the NGO Grants Program and from there, worked in a health planning position at Queensland Health. That led her into a four-year stint leading a whole-of-government policy team in NSW, focusing on the issues of population and ageing across 18 different government departments and NGOs.

Mastering evaluation

Sigrid began working with ACI in 2012, at the same time as studying for her Masters of Program Evaluation – her third Masters, following on from a Master of Public Health and an Executive Master in Public Administration.

Her HARC scholarship research is focused on the concept of value-based healthcare. She says such an approach advocates a move away from measuring and funding the volume of healthcare that is delivered, and towards a system that measures outcomes and value for patients.

“We need a way for people to be engaged with outcomes, we need to look at what matters to the end-user, not just those sitting in offices and developing programs,” she says.

She began her scholarship research in Chicago, where she attended a 5000-delegate international evaluation conference, which included presentations on outcome-impact evaluation and met with several key evaluators to discuss how to measure value-based healthcare – an approach that she says is now starting to be implemented in Europe and some parts of the USA.

That was followed by a visit to ICHOM, the International Consortium for Health Outcomes Measurement, in Boston, and then to Sweden where one of the highlights of her trip was a fascinating week spent visiting many projects working in value-based health care while based in the value-based healthcare unit in Sahldrenska University Hospital in Gottenberg.

There, Sigrid says she gained an overview of the Swedish health system and learned about the way health services are using both bottom-up and top-down approaches to design and implement programs that can be evaluated and benchmarked.

Designing patient-centred care

She finished her trip in the Netherlands, where her visits included a trip to a new hospital in Rotterdam that is designed around person-centred care.

“It is such a good system. They have single rooms set up in a way that the multidisciplinary care comes to the person rather than the person being located in a treatment specific ward,” she says. 

While it would be challenging to set up a similar system in Australia, especially in rural areas where there is much lower throughput of patients, Sigrid believes many of her learnings could be transferred to the Australian experience. For example, she says Sweden makes good use of large surveys to gauge what patients perceive as the most important aspects of their care and outcomes.

“ACI is already starting to do that and I hope what I learned on this trip contributes to that work in a value-based healthcare approach and patient-reported outcomes and measures.”

The trip also allowed her to begin sharing ideas with an international group of PhD students studying evaluation in value-based health care, setting in train her next challenge – a PhD in value-based approach to evaluation.

“It’s an area I’m passionate about and when you are passionate about it, it doesn’t feel so much like work,” she says.

Rural Innovations Changing Healthcare 2016

This state-wide forum being held by the NSW Agency for Clinical Innovation will link 18 satellite hubs via videoconference to showcase innovative rural models of care that have potential for broader implementation, to share lessons learned and to increase collaboration across rural health sectors.

15 March, Videoconference
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Patient Centred Medical Home Symposium
17 March, Sydney
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This free symposium being run jointly by HARC and the Centre for Primary Health Care and Equity (CPHCE) at the University of New South Wales features two leading US experts who will outline developments in the Patient Centred Medical Home (PCMH) concept in the US, as well as exploring what the implications and opportunities may be in NSW for a move towards the PCMH.

Primary Health Care Research Conference

The Primary Health Care (PHC) Research Conference is the national knowledge exchange opportunity for people working across primary healthcare frontline. This year’s conference is themed “Reform and innovation in PHC policy and practice”. The call for abstracts is now open.

8‒9 June, Canberra
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