Australian health review : a publication of the Australian Hospital Association
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Comparative Study
Funding Victoria's public hospitals: the casemix policy of 2000-2001.
On 1 July 1993 Victoria became the first Australian state to use casemix information to set budgets for its public hospitals commencing with casemix funding for inpatient services. Victoria's casemix funding approach now embraces inpatient, outpatient and rehabilitation services.
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There is pessimism regarding the ability of the Acute Health Sector to manage access block for emergency and elective patients. Melbourne Health suffered an acute bed crisis in 2001 resulting in record ambulance diversions and emergency department (ED) delays. We conducted an observational study to reduce access block for emergency patients whilst maintaining elective throughput at Melbourne Health. ⋯ Theatre cancellations were also minimised. We conclude that access block can be improved by clinician-led implementation of proven process improvements over a short time frame. The ability to sustain change over the longer term requires further study.
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Hospital-specific outcome measures based on routine data are useful for stimulating interest in quality of care and for suggesting avenues for more in-depth analyses. They might also identify serious, once-in-a-lifetime failures of health care. ⋯ This is because differences in outcome measures across hospitals can be due to differences in types of patients seen (casemix), differences in data quality, and the play of chance; rather than differences in the quality of care. End-users of such analyses should be aware of these technical difficulties, otherwise skilled health workers in high-quality hospitals might be subjected to unwarranted criticism.
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Safe and high quality health care is an objective that everybody supports. With so much written about it and everybody committed to it, why are we still struggling to achieve it? The successful acceptance and adoption of casemix provides some clues as to the answer. ⋯ The lessons from the casemix story can be applied to advance the safety and quality agenda. A good place to start is a determined campaign focussing on improving safety.
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The renegotiation process for the next Australian Health Care Agreements 2003-2008 presents an opportunity for State and Territory Governments to suggest reforms to improve acute and sub acute health services and health outcomes. Four key issues to Victoria are discussed, emergency departments and primary care interface, workforce planning, aged care and the continuum of care.