scholarly journals Classifying sub-acute and non-acute patients: Results of the New South Wales Casemix Area Network study

1997 ◽  
Vol 20 (2) ◽  
pp. 26 ◽  
Author(s):  
Kathy Eagar ◽  
David Cromwell
Keyword(s):  
Palliative Care ◽  
Acute Care ◽  
Diagnosis Related Groups ◽  
New South ◽  
Phase 1 ◽  
New South Wales ◽  
Resource Utilisation ◽  
Area Network ◽  
Funding Model ◽  
South Wales

In 1994 the New South Wales Casemix Area Network initiated a study to developa classification and funding model for sub-acute and non-acute care. Thirty-fiverehabilitation, geriatric, psychogeriatric and palliative care services were recruited intothe study throughout eight area health services. The aim of the first phase, summarisedhere, was to capture and analyse a sufficiently large quantity of data to select thosevariables most likely to predict resource utilisation, for subsequent use in a detailedcosting study.It is known that acute care diagnosis related groups are not predictive of costs in sub-acutecare. This phase of the project confirmed that, in New South Wales, the mostpredictive variables were case type, functional status measures, impairment type forrehabilitation, phase for palliative care and severity of symptoms for palliative care.The resultant Phase 1 casemix classification, which has built on recent United Statesexperience and studies in other Australian States, has been termed the New SouthWales Sub-Acute and Non-Acute Patient (SNAP) Version 1 classification.

Inequalities in end-of-life palliative care by country of birth in New South Wales, Australia: a cohort study

2020 ◽  
Author(s):  
Holger Möller ◽  
Hassan Assareh ◽  
Joanne M. Stubbs ◽  
Bin Jalaludin ◽  
Helen M. Achat
Keyword(s):  
Palliative Care ◽  
Cohort Study ◽  
End Of Life ◽  
New South ◽  
New South Wales ◽  
Country Of Birth ◽  
South Wales

scholarly journals Assessing the impact of care pathways on potentially preventable complications and costs for spinal trauma patients: protocol for a data linkage study using cohort study and administrative data

BMJ Open ◽  
2018 ◽  
Vol 8 (11) ◽  
pp. e023785 ◽  
Author(s):  
Bharat Phani Vaikuntam ◽  
James W Middleton ◽  
Patrick McElduff ◽  
Jim Pearse ◽  
John Walsh ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Acute Care ◽  
New South ◽  
New South Wales ◽  
Treatment Costs ◽  
Secondary Complications ◽  
Data Set ◽  
South Wales ◽  
Cord Injury ◽  
The Impact

IntroductionTraumatic spinal cord injuries have significant consequences both for the injured individual and the healthcare system, usually resulting in lifelong disability. Evidence has shown that timely medical and surgical interventions can lead to better patient outcomes with implicit cost savings. Potentially preventable secondary complications are therefore indicators of the effectiveness of acute care following traumatic injury. The extent to which policy and clinical variation within the healthcare service impact on outcomes and acute care costs for patients with traumatic spinal cord injury (TSCI) in Australia is not well described.Methods and analysisA comprehensive data set will be formed using record linkage to combine patient health and administrative records from seven minimum data collections (including costs), with an existing data set of patients with acute TSCI (Access to Care Study), for the time period June 2013 to June 2016. This person-level data set will be analysed to estimate the acute care treatment costs of TSCI in New South Wales, extrapolated nationally. Subgroup analyses will describe the associated costs of secondary complications and regression analysis will identify drivers of higher treatment costs. Mapping patient care and health service pathways of these patients will enable measurement of deviations from best practice care standards and cost-effectiveness analyses of the different pathways.Ethics and disseminationEthics approval has been obtained from the New South Wales Population and Health Services Research Ethics Committee. Dissemination strategies include peer-reviewed publications in scientific journals and conference presentations to enable translation of study findings to clinical and policy audiences.

scholarly journals The use of linked data to develop and validate measures of variation in mortality and readmissions for public reporting purposes in New South Wales, Australia

2017 ◽  
Vol 1 (1) ◽  
Author(s):  
Kim Sutherland ◽  
Sadaf Marashi-Pour ◽  
Huei-Yang Chen ◽  
Jean-Frédéric Lévesque
Keyword(s):  
Socioeconomic Status ◽  
Ischaemic Stroke ◽  
Acute Care ◽  
Risk Adjustment ◽  
Linked Data ◽  
New South ◽  
New South Wales ◽  
Case Mix ◽  
C Statistic ◽  
South Wales

ABSTRACTObjectivesTo investigate variation across 78 New South Wales public hospitals, in mortality in the 30 days following admission and in returns to acute care (readmissions) in the 30 days following discharge for acute myocardial infarction, ischaemic stroke, heart failure, pneumonia, hip fracture surgery. ApproachLinked data were used to (1) construct an analytic unit – an index period of care that comprised concatenated acute, contiguous hospitalisations with the principal diagnosis of interest; (2) to capture outcomes both within the index hospital and following discharge, wherever they occurred; (3) to enhance risk adjustment with one year look back for relevant comorbidities; (4) to assess fair attribution of outcomes. A risk-standardised mortality ratio (RSMR) and a risk standardised readmission ratio (RSRR) were calculated as the ratio of the observed to the expected number events at a given hospital, by developing and validating condition specific system-level prediction models. Funnel plots identified outliers. For the RSRR, the competing risk of death was considered. ResultsFor both outcome indicators, sensitivity was enhanced by the use of linked data (33%-100% more deaths; 23%–32% more returns to acute care or readmissions). For mortality, RSMRs that only capture deaths in hospital, as opposed to deaths within 30 days of admission, were shown to be biased and change the outlier status of about 20% of hospitals. Including socioeconomic status in risk adjustment models altered the outlier status of about 10% of hospitals on the cusp of statistical significance but did not significantly alter the RSMRs. For returns to acute care, sensitivity analyses that included socioeconomic status in the models found there was no significant improvement in discriminatory power. For example, in the case of ischaemic stroke, the c-statistic for the model without inclusion of SES was 0.593 (0.578-0.610); inclusion of SES resulted in a c-statistic of 0.600 (0.583-0.616). There were some changes in hospital-level results but there was no clear evidence of a systematic effect on results. ConclusionThe risk-standardised ratio method, based on linked data, compares a hospital’s results given its case mix with an average New South Wales hospital with the same case mix. Ratio-based indicators have been reported publicly and have proven to be a valuable screening tool to identify hospitals where further investigation may be required locally.

scholarly journals The Need for Structured Strategies to Improve Stroke Care in a Rural Telestroke Network in Northern New South Wales, Australia: An Observational Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Yumi Tomari Kashida ◽  
Carlos Garcia-Esperon ◽  
Thomas Lillicrap ◽  
Ferdinand Miteff ◽  
Pablo Garcia-Bermejo ◽  
...  
Keyword(s):  
Acute Stroke ◽  
New South ◽  
Phase 1 ◽  
New South Wales ◽  
Stroke Care ◽  
Decision Time ◽  
Phase 2 ◽  
South Wales ◽  
Two Phases ◽  
Over Time

Introduction: A telestroke network in Northern New South Wales, Australia has been developed since 2017. We theorized that the telestroke network development would drive a progressive improvement in stroke care metrics over time.Aim: This study aimed to describe changes in acute stroke workflow metrics over time to determine whether they improved with network experience.Methods: We prospectively collected data of patients assessed by telestroke who received multimodal computed tomography (mCT) and were diagnosed with ischemic stroke or transient ischemic attack from January 2017 to July 2019. The period was divided into two phases (phase 1: January 2017 – October 2018 and phase 2: November 2018 – July 2019). We compared median door-to-call, door-to-image, and door-to-decision time between the two phases.Results: We included 433 patients (243 in phase 1 and 190 in phase 2). Each spoke site treated 1.5–5.2 patients per month. There were Door-to-call time (median 39 in phase 1, 35 min in phase 2, p = 0.18), and door-to-decision time (median 81.5 vs. 83 min, p = 0.31) were not improved significantly. Similarly, in the reperfusion therapy subgroup, door-to-call time (median 29 vs. 24.5 min, p = 0.12) and door-to-decision time (median 70.5 vs. 67.5 min, p = 0.75) remained substantially unchanged. Regression analysis showed no association between time in the network and door-to-decision time (coefficient 1.5, p = 0.32).Conclusion: In our telestroke network, acute stroke timing metrics did not improve over time. There is the need for targeted education and training focusing on both stroke reperfusion competencies and the technical aspects of telestroke in areas with limited workforce and high turnover.

St. James Hospital: A Case in Crisis Management

2003 ◽  
Vol 9 (2) ◽  
pp. 75-78
Author(s):  
Charles H. Patti
Keyword(s):  
Crisis Management ◽  
Acute Care ◽  
Psychiatric Care ◽  
Community Hospital ◽  
New South ◽  
New South Wales ◽  
Demographic Characteristics ◽  
Care Services ◽  
South Wales ◽  
Communication Challenges

This definitely was not the type of day that St. James Hospital CEO, Paul Ryan, was expecting. As the groundbreaking ceremonies for the Hospital's new addition were about to begin, Paul found himself facing an unsympathetic press and an angry group of protesters. Clearly, he had a crisis on his hands.St. James Hospital in Parramatta (Western Sydney area of New South Wales, Australia) is a 400-bed multi-specialty community hospital providing ambulatory care, acute care, and psychiatric care services to residents living within the five suburbs of Auburn, Holroyd, Parramatta, Blacktown, and Baulkhaum Hills in the area of Western Sydney. The population of this area is multi-cultural with nearly one-third of the population born overseas and thirty percent speaking a language other than English. The area's population also differs from the population of New South Wales in other demographic characteristics. Table 1 shows some of these differences, although the data do not always allow direct comparisons. These differences have presented the management and staff of St. James Hospital with special socio-cultural, financial, and communication challenges.

scholarly journals Projecting subacute inpatient activity in New South Wales

2009 ◽  
Vol 33 (4) ◽  
pp. 601 ◽  
Author(s):  
Andrew Gibbs ◽  
James E Pearse ◽  
Neill Jones ◽  
Jennifer A Sheehan ◽  
Kathleen T Meleady ◽  
...  
Keyword(s):  
Time Series ◽  
Palliative Care ◽  
Data Quality ◽  
New South ◽  
Local Level ◽  
New South Wales ◽  
Linear Regression Equation ◽  
South Wales ◽  
Bed Days ◽  
Ongoing Monitoring

We describe the development of a method for estimating and modelling future demand for sub- and non-acute inpatient activity across New South Wales, Australia to 2016. A time series linear regression equation was used, which is consistent with projection models found in the literature. Results of the modelling indicated an increase in rehabilitation, palliative care and maintenance episodes and bed-days. Projections for other categories of care are problematic due to smaller levels of activity and data quality issues. This project indicated a need for ongoing monitoring of type-changing by facilities and management of data quality. Local planners will need to consider a range of factors when considering the applicability activity projections at a local level, particularly within the specific age and clinical groupings.

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