Australian health review : a publication of the Australian Hospital Association
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The establishment of the Grampians After-Hours Service has led to the development of a quality framework for nurse telephone triage. The service providers believe this framework is the basis for the service's success. ⋯ It also involves a continuous and non-punitive quality review process that operates at the individual, small group, organisation and whole-system level. The framework will continue to improve and at this time provides a foundation for discussion and further application in the pursuit of quality improvement in rural after-hours health services.
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To describe the epidemiological and other characteristics of emergency department (ED) presentations diagnosed with acute upper respiratory infection (URI). ⋯ Further investigation is needed into whether alternative medical care services would be appropriate and acceptable for patients with less severe acute URIs.
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We sought to examine potential predictors of readmission after coronary artery bypass graft (CABG) surgery. ⋯ 7.1%, 15.2%, and 32.3% of the study population were readmitted at 7 days, 30 days and 6 months respectively. In a multivariable regression model Charlson comorbidity index was associated with 30-day (OR = 1.18; 95% CI 1.11-1.24; P < 0.01) and 6-month readmission (OR = 1.20; 95% CI 1.15-1.26; P < 0.01). Multiple ED visits were associated with 7 day (OR = 1.75; 95% CI 1.28-2.38; P < 0.01), 30 day (OR = 1.53; 95% CI 1.22-1.93; P < 0.01) and 6 month (OR = 1.80; 95% CI 1.49-2.18; P < 0.01) readmission. Waiting time was not a statistically significant predictor of readmission.
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Pay-for-performance (P4P) programs which reward clinical providers with incentive payments based on one or more measures of quality of care are now common in the United States and the United Kingdom and it is likely they will attract increasing interest in Australia. However, empirical evidence demonstrating effectiveness of such programs is limited and many existing programs have not had rigorous outcome evaluation. ⋯ Based on a review of published trials, program evaluations and position statements, the following principles that may guide future program design and implementation were synthesised: 1) formulate a rationale and a business case for P4P; 2) use established evidence-based performance measures; 3) use rigorous and verifiable methods of data collection and analysis; 4) define performance targets using absolute and relative thresholds; 5) use rewards that are sufficient, equitable and transparent; 6) address appropriateness of provider responses and avoid perverse incentives; 7) implement communication and feedback strategies; 8) use existing organisational structures to implement P4P programs; 9) attribute credit for performance to participants in ways that foster population-based perspectives; and 10) invest in outcomes and health service research. Recommendations flowing from these principles relevant to Australian settings are provided.