Australian health review : a publication of the Australian Hospital Association
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In 1994 the New South Wales Casemix Area Network initiated a study to develop a classification and funding model for sub-acute and non-acute care. Thirty-five rehabilitation, geriatric, psychogeriatric and palliative care services were recruited into the study throughout eight area health services. ⋯ This phase of the project confirmed that, in New South Wales, the most predictive variables were case type, functional status measures, impairment type for rehabilitation, phase for palliative care and severity of symptoms for palliative care. The resultant Phase 1 casemix classification, which has built on recent United States experience and studies in other Australian States, has been termed the New South Wales Sub-Acute and Non-Acute Patient (SNAP) Version 1 classification.
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Adult intensive care touches the lives of very few while consuming a disproportionately high level of resources. To survive in the future environment of resource restriction and accountability, the unit director must rapidly acquire a wide range of professional management skills. The intensive care unit director must be able to demonstrate to colleagues, health managers and the community that the large amount of resources provided to intensive care, and the remarkable freedom given to intensivists to use those resources, are justified in terms of compassionate evidenced-based care, efficiency, efficacy and appropriateness. While many outcomes may be subjected to audit, intensive care units must publish minimal performance data indexed to severity of illness and including their mortality, hospital mortality and length of stay and an overall indicator of patient acuity to identify patients at low risk who need not be admitted to an expensive intensive care bed.
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This study reviews the extent of evaluation of health outcomes in three general medical journals over the past decade by examining papers published in the original research section of the New England Journal of Medicine (NEJM), The Lancet, and the Medical Journal of Australia (MJA) in 1982 and 1992. Evaluations were identified and classified according to the type of comparison group and the type of outcome measures employed. They were divided into three categories: those employing a comparison group; those employing a before-and-after study design (or own comparison group); and those with no comparison group. ⋯ In the NEJM and The Lancet, 75 per cent of evaluations incorporated comparison groups, in the MJA, less than 40 per cent. Overall, the proportion of papers reporting final outcome measures increased significantly between 1982 and 1992 (p = 0.04) but the change in each journal individually did not reach statistical significance. This study indicates that the reporting of health outcomes evaluations has remained constant but there has been some change in the use of comparison groups and final outcome measures over time.
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The Home Based Rehabilitation Service was established as an allied health early discharge and outreach service from a major metropolitan post-acute teaching hospital. Two hundred and eighty-two patients were discharged to the service according to established criteria from the following specialities: neurology, neurosurgery, rheumatology, amputation, orthopaedic and spinal. ⋯ The cost of home-based services was 11 per cent of the cost of the inpatient services they replaced. There were low rates of hospital readmissions, and users registered high levels of satisfaction with the service.
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The Commonwealth Government and a number of State governments are proposing to introduce legislation based on the Information Privacy Principles contained in the Privacy Act 1988 (Cwlth). This will allow individuals access to any personal information held on them by an organisation or person, including private practitioners, private health facilities and State government agencies. ⋯ Although in the public health area patients can already gain access to their medical records through the use of the various Freedom of Information Acts and, in the case of Commonwealth government agencies, the Privacy Act 1988 (Cwlth), the proposed data protection legislation will provide more than access rights to individuals. The effect of the proposed legislation on the private sector, where no obligation exists on the part of the doctor to grant a patient access to his or her records, will be substantial.