Overcoming silos in health care systems through meso-level organisations - a case study of health reforms in New South Wales, Australia.

Fragmented care delivery is a barrier to improving health system performance worldwide. Investment in meso-level organisations is a potential strategy to improve health system integration, however, its effectiveness remains unclear. In this paper, we provide an overview of key international and Australian integrated care policies.

Lumos: a statewide linkage programme in Australia integrating general practice data to guide system redesign.

Objective: With ageing of the Australian population, more people are living longer and experiencing chronic or complex health conditions. The challenge is to have information that supports the integration of services across the continuum of settings and providers, to deliver person-centred, seamless, efficient and effective healthcare. However, in Australia, data are typically siloed within health settings, precluding a comprehensive view of patient journeys.

The impact of integrated care for people with chronic conditions on hospital and emergency department utilization: a rapid review.

Aim: Integrated care commonly involves provision of comprehensive community-based care for people with chronic conditions. It is anticipated that implementation of integrated care, with a proactive approach to management of chronic conditions, will reduce reliance on hospital and emergency department (ED) services. The aim of this rapid review was to summarize the best available evidence on the impact of integrated care for patients with chronic conditions on hospital and ED utilization and investigate trends in outcomes over time.

Impact Evaluation of a System-Wide Chronic Disease Management Program on Health Service Utilisation: A Propensity-Matched Cohort Study.

Background: The New South Wales Health (NSW Health) Chronic Disease Management Program (CDMP) delivers interventions to adults at risk of hospitalisation for five target chronic conditions that respond well to ambulatory care: diabetes, hypertension, chronic obstructive pulmonary disease, congestive heart failure, and coronary artery disease. The intervention consists of two main components: (1) care coordination across sectors (acute, ambulatory, and community care from both public and private sectors) and clinical specialties, facilitated by program care coordinators, and (2) health coaching including management of lifestyle risk factors and medications and self-management. These components were broadly prescribed by the head office of NSW Health, which funded the program, and were implemented by regional health services (local health districts) in ways that best suited their own history, environment, workforce, and patient need.

Course of recovery for whiplash associated disorders in a compensation setting.

Context: The detailed course of recovery following compensable whiplash associated disorders (WAD) is not well understood. Some people recover within months and others report symptoms for extended periods. Recent research identified distinct recovery pathways.

Associations with duration of compensation following whiplash sustained in a motor vehicle crash.

Context: Continued exposure to compensation systems has been reported as deleterious to the health of participants. Understanding the associations with time to claim closure could allow for targeted interventions aimed at minimising the time participants are exposed to the compensation system.

Study Objective: To identify the associations of extended time receiving compensation benefits with the aim of developing a prognostic model that predicts time to claim closure.

Associations with legal representation in a compensation setting 12 months after injury.

Context: Many people with Whiplash Associated Disorder (WAD) seek treatment though a compensation system where factors such as legal involvement have been reported as having a negative impact on recovery outcomes.

Objective: To compare those with and without legal involvement in their compensation claim, and identify associations with legal involvement at 12 months post injury; and longer term disability.

Study Design: Inception cohort study.

Identifying predictors of early non-recovery in a compensation setting: The Whiplash Outcome Study.

Context: People with Whiplash Associated Disorder (WAD) often experience pain and disability for extended periods of time. A large proportion of these people will seek treatment through a compensation process. Rarely is data related to people's health collected within the compensation process making it difficult to identify those that are at risk of delayed recovery and appropriately direct interventions.

Surveillance of working conditions and the work environment: development of a national hazard surveillance tool in New Zealand.

Objectives: Changes to work and the impact of these changes on worker health and safety have been significant. A core surveillance data set is needed to understand the impact of working conditions and work environments. Yet, there is little harmony amongst international surveys and a critical lack of guidance identifying the best directions for surveillance efforts.

Legislative change is associated with improved health status in people with whiplash.

Study Design: Interrupted time series.

Objective: To assess whether a change in legislation improved health status and quality of life for people with whiplash.

Summary Of Background Data: Whiplash was the most prevalent injury in a compulsory, fault based, third party motor vehicle insurance scheme in New South Wales, Australia.

Implementing chronic disease self-management in community settings: lessons from Australian demonstration projects.

The evaluation of the Sharing Health Care Initiative addressed the translation of different models of chronic disease self-management into health and community service contexts in Australia. Across seven projects, four intervention models were adopted: (1) the Stanford Chronic Disease Self Management course; (2) generic disease management planning, training and support; (3) tailored disease management planning, training and support, and; (4) telephone coaching. Targeted recruitment through support groups and patient lists was most successful for reaching high-needs clients.

Work-related bystander deaths in New Zealand: a significant hidden problem.

Objectives: To estimate the extent of bystander work-related traffic fatal injury for New Zealand as well as the contribution of all bystander events to the total burden of work-related fatal traffic injury and work-related fatal injury in general.

Methods: Potential cases were identified from national administrative databases. The circumstances of the deaths in each incident were reviewed directly from coronial files to determine work-relatedness.

Obtaining health information from farmers: interviews versus postal questionnaires in a New Zealand case study.

Purpose: To compare the effectiveness of interviewer-led and postal surveys in gathering adequate health data for occupational health programmes among farmers.

Methods: Two cross-sectional studies of farmers from southern New Zealand were conducted. Farms were randomly selected from the public land valuation roll and all farmers and farm workers invited to participate in the farmers' health study.

Work-related fatal traffic crashes in New Zealand: 1985-1998.

Aim: To identify and describe all work-related traffic fatalities in New Zealand between 1985 and 1998 inclusive.

Methods: Potential cases were identified from databases held by three national agencies. The circumstances of the deaths in each fatal incident were reviewed directly from coronial files to determine work-relatedness.

A survey of forest workers in New Zealand. Do hours of work, rest, and recovery play a role in accidents and injury?

Problem: A number of structural and organizational changes have occurred recently within the New Zealand Forestry Industry, with concerns being raised about the impact of these changes on the forestry worker in terms of fatigue, sleepiness, and compromised safety. This study explored the relationship of fatigue, and some of its key determinants, with accidents and injuries in a group of forestry industry workers in New Zealand.

Method: A total of 367 forestry workers responded to a self-administered questionnaire.