Trajectories of hospital service use in the last 12months of life by people with chronic kidney disease: a retrospective cohort study.

ObjectiveThis study aimed to examine group-based trajectories of hospital service use by people with chronic kidney disease (CKD) in the last 12months of life.MethodsA retrospective cohort study was conducted using hospital admission and mortality data in New South Wales, Australia. Individuals aged ≥18years who were hospitalised during 2014-2021 and who died during 2015-2021 were included.

Association between self-reported pain experiences in hospital and ratings of care, readmission and emergency department visits: a population-based study from New South Wales, Australia.

Introduction: Evidence on patient experiences with pain in hospitals and its impact on post-discharge outcomes is limited. This study investigated the prevalence of pain in hospitals, patient characteristics associated with pain management adequacy, and the link between pain experiences, care ratings, readmission and emergency department visits after discharge.

Methods: We conducted a retrospective cross-sectional analysis of the 2019 Adult Admitted Patient Survey, focusing on self-reported pain experiences, including presence, severity and management adequacy.

The association between patient self-reported experiences with medication discharge counselling and hospital readmissions: A cross-sectional analysis of a population-based survey.

Objective: To investigate the association between patient-reported experiences with new medication discharge counselling and readmission to hospital or emergency department (ED) visits within 30 days of discharge.

Methods: A retrospective cross-sectional study of patient-reported experiences from 8715 patients who reported being prescribed a new medication at discharge from a public hospital. Completeness of medication counselling was assessed based on (i) explanation of medication purpose, (ii) explanation of medication side effects, (iii) patient involvement in decision to use medication, (iv) provision of contradictory information.

The association between patient-reported experiences with hospital food services and recovery outcomes - A population survey of patients from 75 public hospitals.

Background: The quality of food service is vital to patients' experiences in care and recovery in hospitals. This study aimed to identify opportunities for improving hospital food services to enhance overall patient experiences and outcomes.

Methods: This retrospective cross-sectional study uses the Adult Admitted Patient Survey in 2019.

Factors affecting 12-month unplanned readmissions for chronic obstructive pulmonary disease patients: the effect of mental disorders in an Australian cohort.

Background: Many individuals with chronic obstructive pulmonary disease (COPD) experience frequent hospitalization and readmissions, which is burdensome on the health system. This study aims to investigate factors associated with unplanned readmissions and mortality following a COPD-related hospitalization over a 12-month period in Australia, focusing on mental disorders and accounting for the acute phase of the COVID-19 pandemic.

Methods: A retrospective cohort study using linked hospitalization and mortality records identified individuals aged ≥40 years who had at least one hospital admission with a principal diagnosis of COPD between 2014 and 2020 in New South Wales, Australia.

Implementation of large, multi-site hospital interventions: a realist evaluation of strategies for developing capability.

Background: This study presents guidelines for implementation distilled from the findings of a realist evaluation. The setting was local health districts in New South Wales, Australia that implemented three clinical improvement initiatives as part of a state-wide program. We focussed on implementation strategies designed to develop health professionals' capability to deliver value-based care initiatives for multisite programs.

Impact of mental disorders on unplanned readmissions for congestive heart failure patients: a population-level study.

Aims: Reducing preventable hospitalization for congestive heart failure (CHF) patients is a challenge for health systems worldwide. CHF patients who also have a recent or ongoing mental disorder may have worse health outcomes compared with CHF patients with no mental disorders. This study examined the impact of mental disorders on 28 day unplanned readmissions of CHF patients.

Four System Enablers of Large-System Transformation in Health Care: A Mixed Methods Realist Evaluation.

Unlabelled: Policy Points The implementation of large-scale health care interventions relies on a shared vision, commitment to change, coordination across sites, and a spanning of siloed knowledge. Enablers of the system should include building an authorizing environment; providing relevant, meaningful, transparent, and timely data; designating and distributing leadership and decision making; and fostering the emergence of a learning culture. Attention to these four enablers can set up a positive feedback loop to foster positive change that can protect against the loss of key staff, the presence of lone disruptors, and the enervating effects of uncertainty.

Audit and feedback to reduce unwarranted clinical variation at scale: a realist study of implementation strategy mechanisms.

Background: Unwarranted clinical variation in hospital care includes the underuse, overuse, or misuse of services. Audit and feedback is a common strategy to reduce unwarranted variation, but its effectiveness varies widely across contexts. We aimed to identify implementation strategies, mechanisms, and contextual circumstances contributing to the impact of audit and feedback on unwarranted clinical variation.

The role of frailty risk for fracture-related hospital readmission and mortality after a hip fracture.

Background: Frailty risk estimated using hospital administrative data may provide a useful clinical tool to identify older hip fracture patients at-risk of fracture-related readmissions and mortality. This study examined hip fracture hospitalisation temporal trends and explore the role of frailty risk in fracture-related readmission and mortality.

Methods: This retrospective cohort study was conducted using linked hospital admission and mortality data in New South Wales, Australia.

Patient-reported experiences and outcomes following hospital care are associated with risk of readmission among adults with chronic health conditions.

This study quantifies the association between patient reported measures (PRMs) and readmission to inform efforts to improve hospital care. A retrospective, cross-sectional study was conducted with adults who had chronic obstructive pulmonary disease (COPD) or congestive heart failure (CHF) and were admitted for acute care in a public hospital in New South Wales, Australia for any reason (n = 2394 COPD and 2476 CHF patients in 2018-2020). Patient- level survey data were linked with inpatient data for one year prior to risk-adjust outcomes and after discharge to detect all cause unplanned readmission to a public or private hospital.

Association between number of replacements and readmissions following total knee and total hip replacements in New South Wales' public hospitals.

Background: Total knee and total hip replacement are common and resource-intensive procedures. Complications are associated with worse outcomes and can add to the health care costs, particularly if associated with readmission. The aims of this study were to inform quality improvement by reporting on the extent of variation in readmissions across public hospitals and investigating the association between hospital volume and readmissions.

Implementing large-system, value-based healthcare initiatives: a realist study protocol for seven natural experiments.

Introduction: Value-based healthcare delivery models have emerged to address the unprecedented pressure on long-term health system performance and sustainability and to respond to the changing needs and expectations of patients. Implementing and scaling the benefits from these care delivery models to achieve large-system transformation are challenging and require consideration of complexity and context. Realist studies enable researchers to explore factors beyond 'what works' towards more nuanced understanding of 'what tends to work for whom under which circumstances'.

Avoiding unnecessary hospitalisation for patients with chronic conditions: a systematic review of implementation determinants for hospital avoidance programmes.

Background: Studies of clinical effectiveness have demonstrated the many benefits of programmes that avoid unnecessary hospitalisations. Therefore, it is imperative to examine the factors influencing implementation of these programmes to ensure these benefits are realised across different healthcare contexts and settings. Numerous factors may act as determinants of implementation success or failure (facilitators and barriers), by either obstructing or enabling changes in healthcare delivery.

Disparities in experiences of emergency department care for people with a mental health condition.

Background: The aim of this study was to explore differences in experiences of care in Emergency Departments (EDs) for people with and without mental health conditions.

Methods: Secondary analyses of a survey of 15,995 patients from 82 EDs in New South Wales, Australia was conducted focusing on the most positive responses for 53 questions across nine dimensions of experiences. Logistic regression was used to compare experiences between people with and without a self-reported mental health condition, regardless of the reason for presentation.

Variation in the recording of common health conditions in routine hospital data: study using linked survey and administrative data in New South Wales, Australia.

Objectives: To investigate the nature and potential implications of under-reporting of morbidity information in administrative hospital data.

Setting And Participants: Retrospective analysis of linked self-report and administrative hospital data for 32,832 participants in the large-scale cohort study (45 and Up Study), who joined the study from 2006 to 2009 and who were admitted to 313 hospitals in New South Wales, Australia, for at least an overnight stay, up to a year prior to study entry.

Outcome Measures: Agreement between self-report and recording of six morbidities in administrative hospital data, and between-hospital variation and predictors of positive agreement between the two data sources.

Can a book of charts catalyze improvements in quality? Views of a healthcare alchemist.

This commentary reviews international evidence about the impact of public reporting on better care and outcomes, outlines conditions under which publicly available performance information can become a potent catalyst to precipitate improvements in quality and the optimal conditions in healthcare systems to ensure that such a catalyst results in a desirable reaction.

Musings on collaborative health policy - 15 years on.

Strategies to facilitate an understanding of successful collaborations between researchers and policy makers in the article "Twisting the Lion's Tail: Collaborative Health Policy Making in British Columbia" have relatively good face validity and fairly good construct validity. It's been my experience, however, that strategies that work for one project don't necessarily work for others and strategies that work for parts of one project don't always work for other parts of the same project. What seems important is that health policy collaborators establish clarity on roles, responsibilities and rules of engagement for specific projects, knowing prospectively that these will vary across time and depending on the nature of a project.

Public perspectives on health human resources in primary healthcare: context, choices and change.

The purpose of this study was to examine factors identified by patients as relevant to health human resources (HHR) planning for primary healthcare (PHC). Eleven focus groups were conducted in British Columbia and a thematic analysis was undertaken, informed by a needs-based HHR planning framework. Three themes emerged: (a) the importance of geographic context, (b) change management at the practice level and (c) the need for choices and changes in delivery of PHC.

For discussion: a roadmap for population-based information systems to enhance primary healthcare in Canada.

The purpose of this paper is to promote expansion of population-based information systems to enhance primary healthcare renewal (PHC) across Canada. The vision is to ensure that healthcare policy makers, managers and clinical leaders receive relevant, valid and timely information that is useful to them in exercising their responsibilities in accountability and performance improvement. The paper sketches a roadmap of options for new information systems and describes the opportunities and limitations associated with each.

Supply and distribution of primary healthcare registered nurses in british columbia.

WHAT DID WE DO?: This study uses an existing data source to (a) describe the population and geographic distribution of registered nurses (RNs) working in primary healthcare (PHC) in British Columbia, (b) compare this workforce to PHC physicians and (c) assess the distribution of PHC-RNs relative to population health status. WHAT DID WE LEARN?: Of the 27,570 practising RNs in British Columbia in 2000, there were 3,179 (12%) in the PHC workforce. This translates into 147 people per practising RN and 1,277 people per PHC-RN.

Methods to develop and maintain a valid physician registry in evolving information environments.

Unlabelled: WHAT DID WE DO?: As the amount of alternative funding for physician services grows in Canada, the usefulness of fee-for-services (FFS) payment data as a source of population-based information declines. This paper describes methods used to develop and validate an anonymous registry of the physician workforce to support policy-relevant analyses in environments where doctors are increasingly funded through diverse arrangements. WHAT DID WE LEARN?: Among the 8,558 physicians in clinical practice in British Columbia in 2004, 97% could be identified via FFS payment data.