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Berkovic D, Vallance P, Harris IA, Naylor JM, Lewis PL, de Steiger R, Buchbinder R, Ademi Z, Soh SE, Ackerman IN. A systematic review and meta-analysis of short-stay programmes for total hip and knee replacement, focusing on safety and optimal patient selection. BMC Med 2023; 21:511. [PMID: 38129857 PMCID: PMC10740291 DOI: 10.1186/s12916-023-03219-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 12/06/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Short-stay joint replacement programmes are used in many countries but there has been little scrutiny of safety outcomes in the literature. We aimed to systematically review evidence on the safety of short-stay programmes versus usual care for total hip (THR) and knee replacement (KR), and optimal patient selection. METHODS A systematic review and meta-analysis. Randomised controlled trials (RCTs) and quasi-experimental studies including a comparator group reporting on 14 safety outcomes (hospital readmissions, reoperations, blood loss, emergency department visits, infection, mortality, neurovascular injury, other complications, periprosthetic fractures, postoperative falls, venous thromboembolism, wound complications, dislocation, stiffness) within 90 days postoperatively in adults ≥ 18 years undergoing primary THR or KR were included. Secondary outcomes were associations between patient demographics or clinical characteristics and patient outcomes. Four databases were searched between January 2000 and May 2023. Risk of bias and certainty of the evidence were assessed. RESULTS Forty-nine studies were included. Based upon low certainty RCT evidence, short-stay programmes may not reduce readmission (OR 0.95, 95% CI 0.12-7.43); blood transfusion requirements (OR 1.75, 95% CI 0.27-11.36); neurovascular injury (OR 0.31, 95% CI 0.01-7.92); other complications (OR 0.63, 95% CI 0.26-1.53); or stiffness (OR 1.04, 95% CI 0.53-2.05). For registry studies, there was no difference in readmission, infection, neurovascular injury, other complications, venous thromboembolism, or wound complications but there were reductions in mortality and dislocations. For interrupted time series studies, there was no difference in readmissions, reoperations, blood loss volume, emergency department visits, infection, mortality, or neurovascular injury; reduced odds of blood transfusion and other complications, but increased odds of periprosthetic fracture. For other observational studies, there was an increased risk of readmission, no difference in blood loss volume, infection, other complications, or wound complications, reduced odds of requiring blood transfusion, reduced mortality, and reduced venous thromboembolism. One study examined an outcome relevant to optimal patient selection; it reported comparable blood loss for short-stay male and female participants (p = 0.814). CONCLUSIONS There is low certainty evidence that short-stay programmes for THR and KR may have non-inferior 90-day safety outcomes. There is little evidence on factors informing optimal patient selection; this remains an important knowledge gap.
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Affiliation(s)
- Danielle Berkovic
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Patrick Vallance
- Department of Physiotherapy, School of Primary and Allied Health Care, Monash University, Melbourne, Australia
| | - Ian A Harris
- School of Clinical Medicine, UNSW Medicine and Health, UNSW Sydney, Kensington, Australia
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
| | - Justine M Naylor
- School of Clinical Medicine, UNSW Medicine and Health, UNSW Sydney, Kensington, Australia
- Liverpool Hospital, Liverpool, NSW, Australia
| | - Peter L Lewis
- Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, Australia and Faculty of Medicine, University of Adelaide, Adelaide, Australia
| | - Richard de Steiger
- Department of Surgery, Epworth HealthCare, University of Melbourne, Melbourne, Australia
| | - Rachelle Buchbinder
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Zanfina Ademi
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
- Health Economics and Policy Evaluation Research (HEPER), Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia
| | - Sze-Ee Soh
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
- Department of Physiotherapy, School of Primary and Allied Health Care, Monash University, Melbourne, Australia
| | - Ilana N Ackerman
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.
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Ackerman IN, Berkovic D, Soh SE, Naylor J, Lewis P, de Steiger R, Buchbinder R, Ademi Z, Vallance P, Harris IA. Stakeholder perspectives on short-stay joint replacement programs: results from a national cross-sectional study. BMC Health Serv Res 2023; 23:1436. [PMID: 38110962 PMCID: PMC10729344 DOI: 10.1186/s12913-023-10427-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 12/04/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND The capacity to meet anticipated growth in joint replacement demand requires safe, efficient models of care. While short-stay joint replacement programs are being used internationally, they have not been widely implemented in many countries. Importantly, the critical challenges that need to be addressed ahead of large-scale program implementation remain unclear. This study aimed to investigate stakeholder perspectives on short-stay joint replacement programs, including perceived barriers and enablers to implementation and sustainability, and understand current practices in Australia. METHODS Four key stakeholder groups were invited to participate in this national study: (1) health professionals who provide joint replacement care; (2) hospital administrators involved in joint replacement provision; (3) patients with recent joint replacement; and (4) carers of people with recent joint replacement. Data on perceived feasibility (0 (not at all feasible) - 10 (highly feasible), appeal (0 (not at all appealing) - 10 (highly appealing), current practices, and barriers and enablers were collected using visual analogue scales, multiple response option and open-ended questions, via an online platform. Descriptive analysis and free-text content analysis was undertaken. RESULTS Data were available from 1,445 participants including 360 health professionals, 20 hospital administrators, 1,034 patients, and 31 carers. Short-stay program implementation was considered moderately feasible by health professionals (median 6, interquartile range (IQR) 3-8) and hospital administrators (median 5, IQR 5-6). Short-stay programs were moderately appealing to patients (median 7, IQR 2-9) but of little appeal to carers (median 3, IQR 1-7). Prominent implementation barriers included perceived limited appropriateness of short-stay programs, inadequate home supports, and issues around reimbursement models or program funding. Not having daily physiotherapy access and concerns about pain and mobility at home were common barriers for patients. Concern about patients' ability to manage daily activities was the most common barrier for carers. Access to post-discharge services, better funding models, improved staffing, and consistent protocols and national care standards were prominent enablers. CONCLUSIONS This national study has uniquely captured multiple stakeholder perspectives on short-stay joint replacement programs. The findings can guide future quality improvement and implementation initiatives and the development of resources to best support patients, carers, clinicians, and hospitals.
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Affiliation(s)
- Ilana N Ackerman
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
| | - Danielle Berkovic
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Sze-Ee Soh
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- School of Primary and Allied Health Care, Monash University, Melbourne, Australia
| | - Justine Naylor
- Liverpool Hospital, Liverpool, Australia
- School of Clinical Medicine, UNSW Medicine and Health, UNSW Sydney, Sydney, Australia
| | - Peter Lewis
- Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, Australia
- Faculty of Medicine, University of Adelaide, Adelaide, Australia
| | - Richard de Steiger
- Department of Surgery, Epworth HealthCare, University of Melbourne, Melbourne, Australia
| | - Rachelle Buchbinder
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Zanfina Ademi
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Health Economics and Policy Evaluation Research (HEPER) Group, Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia
| | - Patrick Vallance
- School of Primary and Allied Health Care, Monash University, Melbourne, Australia
| | - Ian A Harris
- School of Clinical Medicine, UNSW Medicine and Health, UNSW Sydney, Sydney, Australia
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Sydney, Australia
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Orchard JJ, Giskes K, Orchard JW, La Gerche A, Neubeck L, Hespe C, Lowres N, Freedman B. In a large primary care data set, the CHA2DS2-VASc score leads to an almost universal recommendation for anticoagulation treatment in those aged ≥65 years with atrial fibrillation. Eur J Cardiovasc Nurs 2023; 22:769-772. [PMID: 36594969 DOI: 10.1093/eurjcn/zvad002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 12/23/2022] [Accepted: 12/31/2022] [Indexed: 01/04/2023]
Affiliation(s)
- Jessica J Orchard
- Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, The University of Sydney, Sydney, NSW, Australia
- School of Public Health, Faculty of Medicine & Health, The University of Sydney, Sydney, NSW 2006Australia
| | - Katrina Giskes
- Heart Research Institute, Charles Perkins Centre (D17), The University of Sydney, Sydney, NSW 2006, Australia
- School of Medicine, University of Notre Dame Australia, 160 Oxford St Darlinghurst, Sydney, NSW 2010Australia
| | - John W Orchard
- School of Public Health, Faculty of Medicine & Health, The University of Sydney, Sydney, NSW 2006Australia
| | - Andre La Gerche
- Baker Heart and Diabetes Institute, 75 Commercial Rd, Melbourne, VIC 3004Australia
| | - Lis Neubeck
- School of Health and Social Care, Edinburgh Napier University, Sighthill Campus, Sighthill Court, Sighthill, Edinburgh, EH11 4BN, UK
| | - Charlotte Hespe
- School of Medicine, University of Notre Dame Australia, 160 Oxford St Darlinghurst, Sydney, NSW 2010Australia
| | - Nicole Lowres
- Heart Research Institute, Charles Perkins Centre (D17), The University of Sydney, Sydney, NSW 2006, Australia
| | - Ben Freedman
- Heart Research Institute, Charles Perkins Centre (D17), The University of Sydney, Sydney, NSW 2006, Australia
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Mills JMZ, Luscombe GM, Hugh TJ. The ANZ hernia repair practices study: improving informed consent and surgeon-patient communication. ANZ J Surg 2023; 93:2792-2795. [PMID: 37583354 DOI: 10.1111/ans.18646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 07/21/2023] [Indexed: 08/17/2023]
Affiliation(s)
- Joanna M Z Mills
- Northern Clinical School, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Georgina M Luscombe
- The University of Sydney School of Rural Health, Sydney Medical School, Sydney, New South Wales, Australia
| | - Thomas J Hugh
- Northern Clinical School, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
- Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital, Sydney, New South Wales, Australia
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Doumit M, Strachan R, Lazarus R, Middleton P, Dentice R, Marouvo J, Jeffrey L, Selvadurai H, Sivam S, Pacey V, Jaffe A, Gray K. Screening for Cystic Fibrosis Related Complications in the Context of a Pandemic and Altered Models of Care. Health Serv Insights 2023; 16:11786329231205145. [PMID: 37854074 PMCID: PMC10580724 DOI: 10.1177/11786329231205145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 09/15/2023] [Indexed: 10/20/2023] Open
Abstract
Background Standard of care recommend that patients with cystic fibrosis (CF) require screening investigations to assess for complications. Changing models of care due to the COVID19 pandemic may have impacted completion of recommended screening. Objective To compare the frequency of screening investigations completed in people with CF before and after the onset of the COVID19 pandemic. Methods Medical records were reviewed at 4 CF-specialist centers to identify screening investigations completed in the 12-months before and after pandemic onset. Results Records of 625 patients were reviewed. Prior to pandemic onset, there was between center variability in completion of screening investigations. There was greatest baseline variation between centers in performing oral glucose tolerance test (OGTT); range 38%-69%, exercise tests; 3%-51% and sputum screening for non-tuberculous mycobacteria; 53%-81%. Following pandemic onset, blood tests, and sputum cultures were maintained at the highest rates. Exercise testing, CXR and OGTT exhibited the greatest declines, with reductions at individual centers ranging between 10%-24%, 22%-43%, and 20%-26%, respectively. Return to in-person visits following pandemic onset was variable, ranging from 16% to 74% between centers. Conclusion Completion of screening investigations varies between CF centers and changes in models of care, such as increased virtual care in response to COVID19 pandemic was associated with reduction in completion of investigations. Centers would benefit from auditing their adherence to standards of care, particularly considering recent changes in care delivery.
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Affiliation(s)
- Michael Doumit
- Department of Health Sciences, Macquarie University, Sydney, NSW, Australia
- School of Women’s and Children’s Health, University of New South Wales, Sydney, NSW, Australia
- Respiratory Medicine Department, Sydney Children’s Hospital, Sydney, NSW, Australia
| | - Roxanne Strachan
- Respiratory Medicine Department, Sydney Children’s Hospital, Sydney, NSW, Australia
| | - Raynuka Lazarus
- Respiratory Medicine Department, Westmead Hospital, Sydney, NSW, Australia
| | - Peter Middleton
- Respiratory Medicine Department, Westmead Hospital, Sydney, NSW, Australia
- Westmead Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Ruth Dentice
- The Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Jessica Marouvo
- The Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Laura Jeffrey
- Department of Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - Hiran Selvadurai
- Respiratory Medicine Department, The Children’s Hospital at Westmead, Sydney, NSW, Australia
- Discipline of Adolescent and Child Health, University of Sydney, Sydney, NSW, Australia
| | - Sheila Sivam
- The Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Verity Pacey
- Department of Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - Adam Jaffe
- School of Women’s and Children’s Health, University of New South Wales, Sydney, NSW, Australia
- Respiratory Medicine Department, Sydney Children’s Hospital, Sydney, NSW, Australia
| | - Kelly Gray
- Department of Health Sciences, Macquarie University, Sydney, NSW, Australia
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Mills K, Bowden JL, Boland R, Pardey M, Descallar J, Naylor JM. Taking the first step: protocol for a cluster randomised implementation trial comparing strategies on access to exercise programmes for people with knee osteoarthritis. BMJ Open 2023; 13:e071045. [PMID: 37567743 PMCID: PMC10423770 DOI: 10.1136/bmjopen-2022-071045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 06/29/2023] [Indexed: 08/13/2023] Open
Abstract
INTRODUCTION This cluster randomised implementation trial will assess the effect of two behavioural change interventions on the proportion of people with structural knee osteoarthritis (OA) referred and attending exercise-based professionals (physiotherapists and exercise physiologists). The interventions are designed to increase awareness of guidelines, benefits and access pathways for exercise therapy. We hypothesise either strategy will result in more people with knee OA being referred and attending physiotherapy/exercise physiology than current standard of care. METHODS AND ANALYSIS We will recruit 30 radiology clinics. 10 clinics will be randomly assigned to each trial arm with 1020 people with knee OA consecutively recruited (102 people per practice) into each arm. Intervention arm 1 is an educational reminder message targeted at primary care practitioners with a hyperlink to national guidelines regarding knee OA clinical management. It will be included in the reporting template of a plain knee X-ray. Intervention arm 2 is the reminder message and a patient-facing infographic explaining the benefits and access pathways for exercise. Both interventions will be delivered once, by the radiology clinics, when a person undergoes plain X-ray for non-traumatic knee pain/dysfunction. The primary outcome is referral to physiotherapist/exercise physiology. The secondary outcome is attendance to that appointment. Both outcomes are self-reported via an online survey administered 4 weeks after the X-ray. Additional survey questions explore facilitators and barriers to appointment attendance and acceptability of the interventions. A subsample of the intervention groups will be recruited for semistructured telephone-based interviews to further explore these latter outcomes. ETHICS AND DISSEMINATION The study protocol was approved by Macquarie University Human Research Ethics Committee (#520221190343842) and prospectively registered with the Australian New Zealand Clinical Trials Registry. The findings of the trial will be disseminated through peer-reviewed scientific journals and conferences. We will engage with Australian physician colleges and main-stream media to distribute findings. TRIAL REGISTRATION NUMBER ACTRN12622001414707p.
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Affiliation(s)
- Kathryn Mills
- Department of Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Jocelyn L Bowden
- Institute of Bone and Joint Research, The University of Sydney, St Leonards, New South Wales, Australia
| | - Robert Boland
- Discipline of Physiotherapy, The University of Sydney, Camperdown, New South Wales, Australia
| | - Margery Pardey
- Department of Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Joseph Descallar
- South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Justine M Naylor
- South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
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Mills JMZ, Luscombe GM, Hugh TJ. The ANZ hernia repair practices study: low consensus on inguinal and small ventral hernia management and infrequent long-term follow-up. ANZ J Surg 2023; 93:1758-1762. [PMID: 36876856 DOI: 10.1111/ans.18339] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 02/04/2023] [Indexed: 03/07/2023]
Affiliation(s)
- Joanna M Z Mills
- Northern Clinical School, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Georgina M Luscombe
- The University of Sydney School of Rural Health, Sydney Medical School, Sydney, New South Wales, Australia
| | - Thomas J Hugh
- Northern Clinical School, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
- Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital, Sydney, New South Wales, Australia
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Zhou Y, Weeden C, Patten L, Dowsey M, Bunzli S, Choong P, Schilling C. Evaluating willingness for surgery using the SMART Choice (Knee) patient prognostic tool for total knee arthroplasty: study protocol for a pragmatic randomised controlled trial. BMC Musculoskelet Disord 2022; 23:179. [PMID: 35209877 PMCID: PMC8876449 DOI: 10.1186/s12891-022-05123-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 02/16/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Approximately 1 in 5 patients feel unsatisfied after total knee arthroplasty (TKA). Prognostic tools may aid in the patient selection process and reduce the proportion of patients who experience unsatisfactory surgery. This study uses the prognostic tool SMART Choice (Patient Prognostic Tool for Total Knee Arthroplasty) to predict patient improvement after TKA. The tool aims to be used by the patient without clinician input and does not require clinical data such as X-ray findings or blood results. The objective of this study is to evaluate the SMART Choice tool on patient decision making, particularly willingness for surgery. We hypothesise that the use of the SMART Choice tool will influence willingness to undergo surgery, especially when used earlier in the patient TKA journey. METHODS This is a multicentred, pragmatic, randomised controlled trial conducted in Melbourne, Australia. Participants will be recruited from the St. Vincent's Hospital, Melbourne (SVHM) Orthopaedic Clinic, and the client base of HCF, Australia (private health insurance company). Patients over 45 years of age who have been diagnosed with knee osteoarthritis and considering TKA are eligible for participation. Participants will be randomised to either use the SMART Choice tool or treatment as usual. The SMART Choice tool provides users with a prediction for improvement or deterioration / no change after surgery based on utility score change calculated from the Veterans-RAND 12 (VR-12) survey. The primary outcome of the study is patient willingness for TKA surgery. The secondary outcomes include evaluating the optimal timing for tool use and using decision quality questionnaires to understand the patient experience when using the tool. Participants will be followed up for 6 months from the time of recruitment. DISCUSSION The SMART Choice tool has the potential to improve patient decision making for TKA. Although many prognostic tools have been developed for other areas of surgery, most are confined within academic bodies of work. This study will be one of the first to evaluate the impact of a prognostic tool on patient decision making using a prospective clinical trial, an important step in transitioning the tool for use in clinical practice. TRIAL REGISTRATION Australia and New Zealand Clinical Trials Registry (ANZCTR) - ACTRN12622000072718 . Prospectively registered - 21 January 2022.
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Affiliation(s)
- Yuxuan Zhou
- Department of Surgery, The University of Melbourne, Melbourne, Australia.
| | - Claire Weeden
- Department of Surgery, The University of Melbourne, Melbourne, Australia
| | - Lauren Patten
- Department of Surgery, The University of Melbourne, Melbourne, Australia
| | - Michelle Dowsey
- Department of Surgery, The University of Melbourne, Melbourne, Australia
| | - Samantha Bunzli
- Department of Surgery, The University of Melbourne, Melbourne, Australia
| | - Peter Choong
- Department of Surgery, The University of Melbourne, Melbourne, Australia
| | - Chris Schilling
- Department of Surgery, The University of Melbourne, Melbourne, Australia
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Badge HM, Churches T, Naylor JM, Xuan W, Armstrong E, Gray L, Fletcher J, Gosbell I, Lin C, Harris IA. Non-compliance with clinical guidelines increases the risk of complications after primary total hip and knee joint replacement surgery. PLoS One 2021; 16:e0260146. [PMID: 34793555 PMCID: PMC8601457 DOI: 10.1371/journal.pone.0260146] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 11/03/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Total hip and total knee replacement (THR/TKR) are common and effective surgeries to reduce the pain and disability associated with arthritis but are associated with small but significant risks of preventable complications such as surgical site infection (SSI) and venous-thrombo-embolism (VTE). This study aims to determine the degree to which hospital care was compliant with clinical guidelines for the prevention of SSI and VTE after THR/TKR; and whether non-compliant prophylaxis is associated with increased risk of complications. METHODS AND FINDINGS A prospective multi-centre cohort study was undertaken in consenting adults with osteoarthritis undergoing elective primary TKR/THR at one of 19 high-volume Australian public or private hospitals. Data were collected prior to surgery and for one-year post-surgery. Four adjusted logistic regression analyses were undertaken to explore associations between binary non-compliance and the risk of surgical complications: (1) composite (simultaneous) non-compliance with both (VTE and antibiotic) guidelines and composite complications [all-cause mortality, VTE, readmission/reoperation for joint-related reasons (one-year) and non-joint-related reasons (35-days)], (2) VTE non-compliance and VTE outcomes, (3) antibiotic non-compliance and any SSI, and (4) antibiotic non-compliance and deep SSI. Data were analysed for 1875 participants. Guideline non-compliance rates were high: 65% (VTE), 87% (antibiotics) and 95% (composite guideline). Composite non-compliance was not associated with composite complication (12.8% vs 8.3%, adjusted odds ratio [AOR] = 1.41, 95%CI 0.68-3.45, p = 0.40). Non-compliance with VTE guidelines was associated with VTE outcomes (5% vs 2.4%, AOR = 2.83, 95%CI 1.59-5.28,p < 0.001). Non-compliance with antibiotic guidelines was associated with any SSI (14.8% vs 6.1%, AOR = 1.98, 95%CI 1.17-3.62,p = 0.02) but not deep infection (3.7% vs 1.2%,AOR = 2.39, 95%CI 0.85-10.00, p = 0.15). CONCLUSIONS We found high rates of clinical variation and statistically significant associations between non-compliance with VTE and antibiotic guidelines and increased risk of VTE and SSI, respectively. Complications after THR/TKR surgery may be decreased by improving compliance with clinical guidelines.
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Affiliation(s)
- Helen Mary Badge
- Whitlam Orthopaedic Research Centre, Liverpool, Australia
- South Western Sydney Clinical School, UNSW, Liverpool, Australia
- Ingham Institute for Applied Medical Research, Liverpool, Australia
- Australian Catholic University, North Sydney, Australia
| | - Tim Churches
- South Western Sydney Clinical School, UNSW, Liverpool, Australia
- Ingham Institute for Applied Medical Research, Liverpool, Australia
| | - Justine M. Naylor
- Whitlam Orthopaedic Research Centre, Liverpool, Australia
- South Western Sydney Clinical School, UNSW, Liverpool, Australia
- Ingham Institute for Applied Medical Research, Liverpool, Australia
| | - Wei Xuan
- South Western Sydney Clinical School, UNSW, Liverpool, Australia
- Ingham Institute for Applied Medical Research, Liverpool, Australia
| | - Elizabeth Armstrong
- Falls Balance and Injury Research Centre, Neuroscience Research Australia, Randwick, Australia
| | - Leeanne Gray
- South Western Sydney Local Health District, Liverpool, Australia
| | - John Fletcher
- University of Sydney, Camperdown, NSW, Australia
- Westmead Hospital, Westmead, NSW, Australia
| | - Iain Gosbell
- Ingham Institute for Applied Medical Research, Liverpool, Australia
- Western Sydney University, Campbelltown, NSW, Australia
| | - Christine Lin
- Sydney School of Public Health, The University of Sydney, Camperdown, NSW, Australia
| | - Ian A. Harris
- Whitlam Orthopaedic Research Centre, Liverpool, Australia
- South Western Sydney Clinical School, UNSW, Liverpool, Australia
- Ingham Institute for Applied Medical Research, Liverpool, Australia
- South Western Sydney Local Health District, Liverpool, Australia
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Curtis K, Kourouche S, Asha S, Considine J, Fry M, Middleton S, Mitchell R, Munroe B, Shaban RZ, D’Amato A, Skinner C, Wiseman G, Buckley T. Impact of a care bundle for patients with blunt chest injury (ChIP): A multicentre controlled implementation evaluation. PLoS One 2021; 16:e0256027. [PMID: 34618825 PMCID: PMC8496821 DOI: 10.1371/journal.pone.0256027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 07/28/2021] [Indexed: 12/03/2022] Open
Abstract
Background Blunt chest injury leads to significant morbidity and mortality. The aim of this study was to evaluate the effect of a multidisciplinary chest injury care bundle (ChIP) on patient and health service outcomes. ChIP provides guidance in three key pillars of care for blunt chest injury—respiratory support, analgesia and complication prevention. ChIP was implemented using a multi-faceted implementation plan developed using the Behaviour Change Wheel. Methods This controlled pre-and post-test study (two intervention and two non-intervention sites) was conducted from July 2015 to June 2019. The primary outcome measures were unplanned Intensive Care Unit (ICU) admissions, non-invasive ventilation use and mortality. Results There were 1790 patients included. The intervention sites had a 58% decrease in non-invasive ventilation use in the post- period compared to the pre-period (95% CI 0.18–0.96). ChIP was associated with 90% decreased odds of unplanned ICU admissions (95% CI 0.04–0.29) at the intervention sites compared to the control groups in the post- period. There was no significant change in mortality. There were higher odds of health service team reviews (surgical OR 6.6 (95% CI 4.61–9.45), physiotherapy OR 2.17 (95% CI 1.52–3.11), ICU doctor OR 6.13 (95% CI 3.94–9.55), ICU liaison OR 55.75 (95% CI 17.48–177.75), pain team OR 8.15 (95% CI 5.52 –-12.03), analgesia (e.g. patient controlled analgesia OR 2.6 (95% CI 1.64–3.94) and regional analgesia OR 8.8 (95% CI 3.39–22.79), incentive spirometry OR 8.3 (95% CI 4.49–15.37) and, high flow nasal oxygen OR 22.1 (95% CI 12.43–39.2) in the intervention group compared to the control group in the post- period. Conclusion The implementation of a chest injury care bundle using behaviour change theory was associated with a sustained improvement in evidence-based practice resulting in reduced unplanned ICU admissions and non-invasive ventilation requirement. Trial registration ANZCTR: ACTRN12618001548224, approved 17/09/2018
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Affiliation(s)
- Kate Curtis
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
- Emergency Services, Illawarra Shoalhaven Local Health District, Wollongong Hospital, Wollongong, NSW, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia
- * E-mail:
| | - Sarah Kourouche
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
| | - Stephen Asha
- Emergency Department, St George Hospital, Kogarah, NSW, Australia
- St George Clinical School, Faculty of Medicine, University of New South Wales, Kogarah, NSW, Australia
| | - Julie Considine
- School of Nursing and Midwifery and Centre for Quality and Patient Safety Experience in the Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
- Centre for Quality and Patient Safety Experience–Eastern Health Partnership, Box Hill, VIC, Australia
| | - Margaret Fry
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
- Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
- Northern Sydney Local Health District, Hornsby, NSW, Australia
| | - Sandy Middleton
- Nursing Research Institute, St Vincent’s Health Network Sydney, St Vincent’s Hospital Melbourne, Fitzroy, Australia
- Australian Catholic University, Sydney, NSW, Australia
| | - Rebecca Mitchell
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Macquarie Park, NSW, Australia
| | - Belinda Munroe
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
- Emergency Services, Illawarra Shoalhaven Local Health District, Wollongong Hospital, Wollongong, NSW, Australia
| | - Ramon Z. Shaban
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
- Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Camperdown, NSW, Australia
- Division of Infectious Diseases and Sexual Health, Department of Infection Prevention and Control, Westmead Hospital and Western Sydney Local Health District, Westmead, NSW, Australia
- New South Wales Biocontainment Centre, Western Sydney Local Health District and New South Wales Health, Warwick Farm, NSW, Australia
| | - Alfa D’Amato
- NSW Activity Based Funding Taskforce, NSW Ministry of Health, Sydney, Australia
| | - Clare Skinner
- Emergency Department, Hornsby Ku-ring-ai Hospital, Hornsby, NSW, Australia
| | - Glen Wiseman
- Emergency Services, Canterbury Hospital, Campsie, NSW, Australia
| | - Thomas Buckley
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
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Badgery-Parker T, Pearson SA, Elshaug AG. Hospital characteristics associated with low-value care in public hospitals in New South Wales, Australia. BMC Health Serv Res 2020; 20:750. [PMID: 32795365 PMCID: PMC7427854 DOI: 10.1186/s12913-020-05625-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 08/04/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Rates of low-value care vary between hospitals in New South Wales, Australia. Understanding factors associated with this variation will help in understanding the drivers of low-value care and in planning initiatives to reduce low-value care. METHODS For eight low-value procedures, we used Poisson regression of the number of low-value episodes at each hospital to assess the association between low-value care and hospital characteristics. We also used hierarchical clustering on the low-value procedures used and their rates at each hospital to try to identify groups of hospitals with higher or lower rates of low-value care across multiple procedures. RESULTS Some hospital characteristics, such as hospital peer group and proportion of total episodes that involve the specific procedure, showed associations for some procedures, but none were consistent across all eight procedures. We clustered hospitals into five groups, but low-value care rates did not differ much between these groups. CONCLUSION Available hospital variables show little association with rates of low-value care and no patterns across different low-value procedures. We need to investigate factors within hospitals, such as clinician knowledge and beliefs about low-value care.
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Affiliation(s)
- Tim Badgery-Parker
- Faculty of Medicine and Health, School of Public Health, Menzies Centre for Health Policy, Charles Perkins Centre, The University of Sydney, Sydney, Australia
- Research Fellow, Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Sallie-Anne Pearson
- Faculty of Medicine and Health, School of Public Health, Menzies Centre for Health Policy, Charles Perkins Centre, The University of Sydney, Sydney, Australia
- Centre for Big Data Research in Health, University of New South Wales, Kensington, Australia
| | - Adam G. Elshaug
- Faculty of Medicine and Health, School of Public Health, Menzies Centre for Health Policy, Charles Perkins Centre, The University of Sydney, Sydney, Australia
- The Brookings Institution, USC-Brookings Schaeffer Initiative for Health Policy, Washington, D.C., USA
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Tracy LM, Singer Y, Schrale R, Gong J, Darton A, Wood F, Kurmis R, Edgar D, Cleland H, Gabbe BJ. Epidemiology of burn injury in older adults: An Australian and New Zealand perspective. Scars Burn Heal 2020; 6:2059513120952336. [PMID: 33062309 PMCID: PMC7534068 DOI: 10.1177/2059513120952336] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION The ageing global population presents a novel set of challenges for trauma systems. Less research has focused on the older adult population with burns and how they differ compared to younger patients. This study aimed to describe, and compare with younger peers, the number, causes and surgical management of older adults with burn injuries in Australia and New Zealand. METHODS The Burns Registry of Australia and New Zealand was used to identify patients with burn injuries between 1 July 2009 and 31 December 2018. Temporal trends in incidence rates were evaluated and categorised by age at injury. Patient demographics, injury severity and event characteristics, surgical intervention and in-hospital outcomes were investigated. RESULTS There were 2394 burn-injured older adults admitted during the study period, accounting for 13.4% of adult admissions. Scalds were the most common cause of burn injury in older adults. The incidence of older adult burns increased by 2.96% each year (incidence rate ratio = 1.030, 95% confidence interval = 1.013-1.046, P < 0.001). Compared to their younger peers, a smaller proportion of older adult patients were taken to theatre for a surgical procedure, though a larger proportion of older adults received a skin graft. DISCUSSION Differences in patient and injury characteristics, surgical management and in-hospital outcomes were observed for older adults. These findings provide the Australian and New Zealand burn care community with a greater understanding of burn injury and their treatments in a unique group of patients who are at risk of poorer outcomes than younger people. LAY SUMMARY The number and proportion of older persons in every country of the world is growing. This may create challenges for healthcare systems. While burn injuries are a unique subset of trauma that affect individuals of all ages, less is known about burns in older adults and how they differ from younger patients.We wanted to look at the number, type, management, and outcomes of burns in older adults in Australia and New Zealand. To do this, we used data from the Burns Registry of Australia and New Zealand, or BRANZ. The BRANZ is a database that collects information on patients that present to Australian and New Zealand hospitals that have a specialist burns unit.Our research found that one in eight adult burns patients was over the age of 65, and that the rate of burn injuries in older adults has increased over the last decade. Older adult burns patients were most commonly affected by scalds after coming in contact with wet heat such as boiling liquids or steam. Fewer older adults went to theatre for an operation or surgical procedure compared to their younger counterparts. However, a larger proportion of older adults that went to theatre had a skin graft (where skin is removed from an uninjured part of the body and placed over the injured part).This research provides important information about a unique and growing group of patients to the local burn care community. It also highlights potential avenues for injury prevention initiatives.
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Affiliation(s)
- Lincoln M Tracy
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Yvonne Singer
- Victorian Adult Burns Service, Alfred Hospital, Melbourne, VIC, Australia
| | - Rebecca Schrale
- Tasmanian Burns Unit, Royal Hobart Hospital, Hobart, TAS, Australia
| | - Jennifer Gong
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Anne Darton
- Statewide Burn Injury Service, NSW Agency for Clinical Innovation, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Fiona Wood
- Burn Injury Research Unit, University of Western Australia, Perth, WA, Australia
- State Adult Burn Unit, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Rochelle Kurmis
- Adult Burns Service, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Dale Edgar
- Burn Injury Research Unit, University of Western Australia, Perth, WA, Australia
- State Adult Burn Unit, Fiona Stanley Hospital, Murdoch, WA, Australia
- Burn Injury Research Node, The University of Notre Dame, Fremantle, WA, Australia
| | - Heather Cleland
- Victorian Adult Burns Service, Alfred Hospital, Melbourne, VIC, Australia
- Department of Surgery, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Belinda J Gabbe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Health Data Research UK, Swansea University Medical School, Swansea University, Singleton Park, Swansea, Wales
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Abstract
OBJECTIVE To examine the prevalence, costs and trends (2010-2014) for 21 low-value inpatient procedures in a privately insured Australian patient cohort. DESIGN We developed indicators for 21 low-value procedures from evidence-based lists such as Choosing Wisely, and applied them to a claims data set of hospital admissions. We used narrow and broad indicators where multiple low-value procedure definitions exist. SETTING AND PARTICIPANTS A cohort of 376 354 patients who claimed for an inpatient service from any of 13 insurance funds in calendar years 2010-2014; approximately 7% of the privately insured Australian population. MAIN OUTCOME MEASURES Counts and proportions of low-value procedures in 2014, and relative change between 2010 and 2014. We also report both the Medicare (Australian government) and the private insurance financial contributions to these low-value admissions. RESULTS Of the 14 662 patients with admissions for at least 1 of the 21 procedures in 2014, 20.8%-32.0% were low-value using the narrow and broad indicators, respectively. Of the 21 procedures, admissions for knee arthroscopy were highest in both the volume and the proportion that were low-value (1607-2956; 44.4%-81.7%).Seven low-value procedures decreased in use between 2010 and 2014, while admissions for low-value percutaneous coronary interventions and inpatient intravitreal injections increased (51% and 8%, respectively).For this sample, we estimated 2014 Medicare contributions for admissions with low-value procedures to be between $A1.8 and $A2.9 million, and total charges between $A12.4 and $A22.7 million. CONCLUSIONS The Australian federal government is currently reviewing low-value healthcare covered by Medicare and private health insurers. Estimates from this study can provide crucial baseline data and inform design and assessment of policy strategies within the Australian private healthcare sector aimed at curtailing the high volume and/or proportions of low-value procedures.
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Affiliation(s)
- Kelsey Chalmers
- Menzies Centre for Health Policy, University of Sydney School of Public Health, Sydney, New South Wales, Australia
- Health Market Quality Program, Capital Markets CRC Ltd, Sydney, New South Wales, Australia
| | - Sallie-Anne Pearson
- Medicines Policy Research Unit, University of New South Wales, UNSW, New South Wales, Australia
| | - Tim Badgery-Parker
- Menzies Centre for Health Policy, University of Sydney School of Public Health, Sydney, New South Wales, Australia
- Health Market Quality Program, Capital Markets CRC Ltd, Sydney, New South Wales, Australia
| | - Jonathan Brett
- Medicines Policy Research Unit, University of New South Wales, UNSW, New South Wales, Australia
| | - Ian A Scott
- Department of Internal Medicine and Clinical Epidemiology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Centre for Health Services Research, University of Queensland, Brisbane, Queensland, Australia
| | - Adam G Elshaug
- Menzies Centre for Health Policy, University of Sydney School of Public Health, Sydney, New South Wales, Australia
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Nijagal MA, Wissig S, Stowell C, Olson E, Amer-Wahlin I, Bonsel G, Brooks A, Coleman M, Devi Karalasingam S, Duffy JMN, Flanagan T, Gebhardt S, Greene ME, Groenendaal F, R Jeganathan JR, Kowaliw T, Lamain-de-Ruiter M, Main E, Owens M, Petersen R, Reiss I, Sakala C, Speciale AM, Thompson R, Okunade O, Franx A. Standardized outcome measures for pregnancy and childbirth, an ICHOM proposal. BMC Health Serv Res 2018; 18:953. [PMID: 30537958 PMCID: PMC6290550 DOI: 10.1186/s12913-018-3732-3] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 11/19/2018] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Value-based health care aims to optimize the balance of patient outcomes and health care costs. To improve value in perinatal care using this strategy, standard outcomes must first be defined. The objective of this work was to define a minimum, internationally appropriate set of outcome measures for evaluating and improving perinatal care with a focus on outcomes that matter to women and their families. METHODS An interdisciplinary and international Working Group was assembled. Existing literature and current measurement initiatives were reviewed. Serial guided discussions and validation surveys provided consumer input. A series of nine teleconferences, incorporating a modified Delphi process, were held to reach consensus on the proposed Standard Set. RESULTS The Working Group selected 24 outcome measures to evaluate care during pregnancy and up to 6 months postpartum. These include clinical outcomes such as maternal and neonatal mortality and morbidity, stillbirth, preterm birth, birth injury and patient-reported outcome measures (PROMs) that assess health-related quality of life (HRQoL), mental health, mother-infant bonding, confidence and success with breastfeeding, incontinence, and satisfaction with care and birth experience. To support analysis of these outcome measures, pertinent baseline characteristics and risk factor metrics were also defined. CONCLUSIONS We propose a set of outcome measures for evaluating the care that women and infants receive during pregnancy and the postpartum period. While validation and refinement via pilot implementation projects are needed, we view this as an important initial step towards value-based improvements in care.
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Affiliation(s)
- Malini Anand Nijagal
- University of California, Zuckerberg San Francisco General Hospital, San Francisco, CA USA
| | - Stephanie Wissig
- International Consortium for Health Outcomes Measurement, Cambridge, MA USA
| | - Caleb Stowell
- International Consortium for Health Outcomes Measurement, Cambridge, MA USA
| | - Elizabeth Olson
- International Consortium for Health Outcomes Measurement, Cambridge, MA USA
- University of Maryland School of Medicine, Baltimore, MD 21201 USA
| | | | | | - Allyson Brooks
- Hoag Memorial Hospital Presbyterian, Newport Beach, CA USA
| | | | | | - James M N Duffy
- Balliol College, University of Oxford, Oxford, UK
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - Stefan Gebhardt
- Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | | | | | | | - Tessa Kowaliw
- South Australian Maternity Reform Association (SAMRA) Inc, Adelaide, Australia
| | | | - Elliott Main
- California Maternal Quality Care Collaborative, Stanford, CA USA
| | - Michelle Owens
- University of Mississippi Medical Center, Jackson, MS USA
| | - Rod Petersen
- Women and Children’s Health Network, North Adelaide, South Australia
| | - Irwin Reiss
- University Hospital Southampton, Hampshire, UK
| | - Carol Sakala
- National Partnership for Women & Families, Washington, D.C., USA
| | | | - Rachel Thompson
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH USA
| | - Oluwakemi Okunade
- International Consortium for Health Outcomes Measurement, Cambridge, MA USA
| | - Arie Franx
- International Consortium for Health Outcomes Measurement, Cambridge, MA USA
- Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, 3508 AB The Netherlands
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Chalmers K, Badgery-Parker T, Pearson SA, Brett J, Scott IA, Elshaug AG. Developing indicators for measuring low-value care: mapping Choosing Wisely recommendations to hospital data. BMC Res Notes 2018; 11:163. [PMID: 29506573 PMCID: PMC5836437 DOI: 10.1186/s13104-018-3270-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 02/24/2018] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Low-value health care refers to interventions where the risk of harm or costs exceeds the likely benefit for a patient. We aimed to develop indicators of low-value care, based on selected Choosing Wisely (CW) recommendations, applicable to routinely collected, hospital claims data. RESULTS We assessed 824 recommendations from the United States, Canada, Australia and the United Kingdom CW lists regarding their capacity to be measured in administrative hospital admissions datasets. We selected recommendations if they met the following criteria: the service occurred in the hospital setting (observable in setting); a claim recorded the use of the service (record of service); the appropriate/inappropriate use of the service could be mapped to information within the hospital claim (indication); and the service is consistently recorded in the claims (consistent documentation). We identified 17 recommendations (15 services) as measurable. We then developed low-value care indicators for two hospital datasets based on the selected recommendations, previously published indicators, and clinical input.
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Affiliation(s)
- Kelsey Chalmers
- Menzies Centre for Health Policy, School of Public Health, Charles Perkins Centre, University of Sydney, Sydney, NSW 2006 Australia
- Health Market Quality Program, Capital Markets Cooperative Research Centre, Sydney, NSW 2000 Australia
| | - Tim Badgery-Parker
- Menzies Centre for Health Policy, School of Public Health, Charles Perkins Centre, University of Sydney, Sydney, NSW 2006 Australia
- Health Market Quality Program, Capital Markets Cooperative Research Centre, Sydney, NSW 2000 Australia
| | - Sallie-Anne Pearson
- Medicines Policy Research Unit, Centre for Big Data Research in Health, University of New South Wales, Level 1, AGSM Building, Sydney, NSW 2052 Australia
| | - Jonathan Brett
- Medicines Policy Research Unit, Centre for Big Data Research in Health, University of New South Wales, Level 1, AGSM Building, Sydney, NSW 2052 Australia
| | - Ian A. Scott
- Princess Alexandra Hospital, Brisbane, QLD 4102 Australia
- University of Queensland, Brisbane, QLD 4072 Australia
| | - Adam G. Elshaug
- Menzies Centre for Health Policy, School of Public Health, Charles Perkins Centre, University of Sydney, Sydney, NSW 2006 Australia
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Altmann E, Stirling C, Broad L. Experiences and decision making during paediatric transitions to continuous sub-cutaneous insulin infusion (CSII): A mixed method study. Digit Health 2018; 4:2055207618806083. [PMID: 30364424 PMCID: PMC6196618 DOI: 10.1177/2055207618806083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 09/19/2018] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES We aimed to improve the decision quality and outcomes for families with children or adolescents with diabetes considering continuous sub-cutaneous insulin infusion (CSII). METHODS A mixed method study involved three focus groups with youth, parents and clinicians to provide experience information as background to the development of a decision aid (DA). A pre-test (T1) and post-test (T2) evaluation of the DA with a convenience sample of five families considering initiating CSII. RESULTS The focus group data showed that families found the move to CSII to be generally empowering with adolescents engaging with the technology quickly, and that experiential information from others was important in the process. Participants increased their knowledge and decreased decisional conflict after using the DA from T1 to T2. Preferred option measurement indicated that at T1, three participants were 'unsure' and two participants' preferred option was CSII. After exposure to the DA at T2, those who were previously unsure had a preferred option of CSII with a resulting five people with a preferred option of CSII. CONCLUSIONS The results from this study suggest that transitioning to CSII for paediatric and adolescent patients and their carers may be assisted by a DA and that participants felt empowered to a make decision regarding CSII when using the PANDANI DA. The quasi-experimental design without randomisation or control group was a study limitation caused by the small number of participants. Expanding this pilot research into a randomised control trial would decrease the threat to validity from other possible explanations for the improvement in decisional conflict, such as nurse educators.
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Affiliation(s)
- Erika Altmann
- School of Social Sciences, University of Tasmania, Hobart, Australia
| | - Christine Stirling
- School of Health Sciences, College of Health and Medicine, University of Tasmania, Hobart, Australia
| | - Liz Broad
- Women, Adolescent and Children and Services, Department of Health & Human Services, Hobart, Australia
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Foot H, Freeman C, Hemming K, Scott I, Coombes ID, Williams ID, Connelly L, Whitty JA, Sturman N, Kirsa S, Nicholson C, Russell G, Kirkpatrick C, Cottrell N. Reducing Medical Admissions into Hospital through Optimising Medicines (REMAIN HOME) Study: protocol for a stepped-wedge, cluster-randomised trial. BMJ Open 2017; 7:e015301. [PMID: 28408545 PMCID: PMC5719661 DOI: 10.1136/bmjopen-2016-015301] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION A model of general practitioner (GP) and pharmacist collaboration in primary care may be an effective strategy to reduce medication-related problems and provide better support to patients after discharge. The aim of this study is to investigate whether a model of structured pharmacist and GP care reduces hospital readmissions in high-risk patients. METHODS AND ANALYSIS This protocol details a stepped-wedge, cluster-randomised trial that will recruit participants over 9 months with a 12-month follow-up. There will be 14 clusters each representing a different general practice medical centre. A total of 2240 participants will be recruited from hospital who attend an enrolled medical centre, take five or more long-term medicines or whose reason for admission was related to heart failure or chronic obstructive pulmonary disease.The intervention is a multifaceted service, involving a pharmacist integrated into a medical centre to assist patients after hospitalisation. Participants will meet with the practice pharmacist and their GP after discharge to review and reconcile their medicines and discuss changes made in hospital. The pharmacist will follow-up with the participant and liaise with other health professionals involved in the participant's care. The control will be usual care, which usually involves a patient self-organising a visit to their GP after hospital discharge.The primary outcome is the rate of unplanned, all-cause hospital readmissions over 12 months, which will be analysed using a mixed effects Poisson regression model with a random effect for cluster and a fixed effect to account for any temporal trend. A cost analysis will be undertaken to compare the healthcare costs associated with the intervention to those of usual care. ETHICS AND DISSEMINATION The study has received ethical approval (HREC/16/QRBW/410). The study findings will be disseminated through peer-reviewed publications, conferences and reports to key stakeholders. TRIAL REGISTRATION NUMBER ACTRN12616001627448.
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Affiliation(s)
- Holly Foot
- School of Pharmacy, University of Queensland, Brisbane, Queensland, Australia
| | - Christopher Freeman
- School of Pharmacy, University of Queensland, Brisbane, Queensland, Australia
| | - Karla Hemming
- Department of Public Health, Epidemiology and Biostatistics, University of Birmingham, Birmingham, UK
| | - Ian Scott
- Department of Internal Medicine and Clinical Epidemiology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Southern School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Ian D Coombes
- School of Pharmacy, University of Queensland, Brisbane, Queensland, Australia
- Department of Pharmacy, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
| | - Ian D Williams
- Brisbane South PHN, Brisbane, Australia
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Luke Connelly
- Centre for the Business and Economics of Health, University of Queensland, Brisbane, Queensland, Australia
- Poche Centre for Indigenous Health, University of Queensland, Brisbane, Queensland, Australia
| | - Jennifer A Whitty
- School of Pharmacy, University of Queensland, Brisbane, Queensland, Australia
- Faculty of Medicine and Health Sciences, University of East Anglia Norwich Medical School, Norwich, UK
| | - Nancy Sturman
- School of Pharmacy, University of Queensland, Brisbane, Queensland, Australia
| | - Sue Kirsa
- Department of Pharmacy, Monash Health, Clayton, Victoria, Australia
- Centre for Medicine Use and Safety, Monash University Faculty of Pharmacy and Pharmaceutical Sciences, Parkville, Victoria, Australia
| | - Caroline Nicholson
- Mater Misericordiae Health Services Brisbane Ltd, South Brisbane, Queensland, Australia
| | - Grant Russell
- School of Primary Health Care, Monash University, Notting Hill, Victoria, Australia
| | - Carl Kirkpatrick
- Centre for Medicine Use and Safety, Monash University Faculty of Pharmacy and Pharmaceutical Sciences, Parkville, Victoria, Australia
| | - Neil Cottrell
- School of Pharmacy, University of Queensland, Brisbane, Queensland, Australia
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Partridge SR, McGeechan K, Bauman A, Phongsavan P, Allman-Farinelli M. Improved eating behaviours mediate weight gain prevention of young adults: moderation and mediation results of a randomised controlled trial of TXT2BFiT, mHealth program. Int J Behav Nutr Phys Act 2016; 13:44. [PMID: 27039178 PMCID: PMC4818870 DOI: 10.1186/s12966-016-0368-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 03/29/2016] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Explanatory evaluation of interventions for prevention of weight gain is required beyond changes in weight, to determine for whom the intervention works and the underlying mechanisms of change. It was hypothesised that participant characteristics moderate intervention effect on weight change and improved eating and physical activity behaviours during the 3-month program mediate the relationship between intervention and weight. METHODS In our randomised controlled trial, young adults at risk of weight gain (n = 250) were assigned either to an intervention group that received a 3-month mHealth (TXT2BFiT) program with 6-month maintenance or to a control group. Data were collected via online self-report surveys. Hypothesised moderators and mediators of the intervention effect on weight were independently assessed in PROCESS macro models for 3 and 9-month weight change. RESULTS Males (P = 0.01), mid-20s age group (P = 0.04), and higher income earners (P = 0.02) moderated intervention effects on weight change at 3-months and males only at 9-months (P = 0.02). Weight change at 3 (-1.12 kg) and 9-months (-1.38 kg) remained significant when 3-month nutrition and physical activity behaviours were specified as mediators (P <0.01 and P = 0.01 respectively). Indirect paths explained 39% (0.72/1.85 kg) and 40 % (0.92/2.3 kg) of total effect on weight change at 3 and 9-months respectively. Increased vegetable intake by intervention group at 3-months accounted for 19 and 17% and decreased sugar-sweetened beverages accounted for 8 and 13% of indirect weight change effects at 3 and 9-months respectively. CONCLUSIONS TXT2BFiT was effective for both young men and women. Small sustained behavioural changes, including increased vegetable intake and decreased sugar-sweetened beverages consumption significantly mediated the intervention's effects on weight change. Improved eating behaviours and increased physical activity accounted for approximately 40% of the weight change. TRIAL REGISTRATION The trial is registered with the Australian New Zealand Clinical Trials Registry ( ACTRN12612000924853 ).
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Affiliation(s)
- Stephanie R. Partridge
- />School of Life and Environmental Sciences, Charles Perkins Centre, University of Sydney, Sydney, NSW 2006 Australia
| | - Kevin McGeechan
- />Sydney School of Public Health, Charles Perkins Centre, University of Sydney, Sydney, NSW 2006 Australia
| | - Adrian Bauman
- />Sydney School of Public Health, Charles Perkins Centre, University of Sydney, Sydney, NSW 2006 Australia
| | - Philayrath Phongsavan
- />Sydney School of Public Health, Charles Perkins Centre, University of Sydney, Sydney, NSW 2006 Australia
| | - Margaret Allman-Farinelli
- />School of Life and Environmental Sciences, Charles Perkins Centre, University of Sydney, Sydney, NSW 2006 Australia
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