Australian health review : a publication of the Australian Hospital Association
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Comparative Study
Influenza pandemic 2009/A/H1N1 management policies in primary care: a comparative analysis of three countries.
During the influenza pandemic 2009/A/H1N1, the main burden of managing patients fell on primary care physicians (PCP). This provided an excellent opportunity to investigate the implications of pandemic policies for the PCP role. ⋯ Health authorities need to engage with representatives of PCP to evaluate policies for pandemic planning and management. Adequate support and protection for PCP during different stages of pandemic management should be provided. What is known about the topic? During the influenza pandemic 2009/A/H1N1, the main burden of diagnosing and managing the patients fell on PCP. The prominent role of PCP in the 2009/A/H1N1 pandemic presents an excellent opportunity to investigate implications of pandemic policies for primary care and to tackle the possible problems that these policies may impose on the ability of PCP to effectively participate in the public health response. What does this paper add? This paper examines policies that affected the roles of PCP in managing the influenza pandemic 2009/A/H1N1 in three countries: Australia, Israel and England. Although general evaluations of the pandemic response in different countries have previously been reported, this is the first study that focuses on policies for pandemic management at the primary care level. What are the implications for practitioners? Practitioners (PCP and primary care workers in general) would benefit if pandemic preparedness plans were constructed to provide an adequate system of support and protection to primary care workers during different stages of pandemic management. For policy makers, this analysis may help to overhaul the strategies for primary care engagement in the pandemic response.
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To estimate the risk of functional decline after discharge for older people presenting to, and discharged from, a large emergency department (ED) of a tertiary hospital. ⋯ Elderly patients present to and are discharged from ED every day. The routinely administered HARP instrument scores suggested that approximately half these individuals were at-risk of functional decline in one large hospital ED. Given this instrument's moderate diagnostic accuracy, the true figure may be higher. We suggest that all over-65 year olds presenting at ED without being admitted as an inpatient should be considered for routine screening for potential downstream functional decline, and for intervention if indicated. What is known about the topic? Older individuals often present to ED in lieu of consulting a general medical practitioner, and are not admitted to a hospital bed. Patient demographics, functional and mental capacity and reasons for presentation may be flags for functional decline in the coming months. These could be used by ED staff to implement targeted assessment and intervention. What does this paper add? This paper highlights the high percentage of older individuals who, at time of ED presentation, are at-risk of downstream functional decline. What are the implications for practitioners? Older people who are discharged from ED without a hospital admission may 'slip through the net', as an ED presentation presents a limited window of opportunity for ED staff to undertake targeted assessment, and intervention, to address the potential for downstream functional decline. The busy nature of ED, resource implications and the range of presenting conditions of older people may preclude this. This research suggests a reality that a large percentage of older people who present at ED but do not require a subsequent hospital admission have the potential for functional decline after discharge. Addressing this, in terms of specific screening processes and interventions, requires a rethink of hospital and community resources, and relationships.
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Falls are the leading cause of injury in older people. Rehabilitation services can assist individuals to improve mobility and function after sustaining a fall-related injury. However, the true effect of fall-related injury resulting in hospitalisation is often underestimated because of failure to consider sub-acute and non-acute care provided following the acute hospitalisation episode. ⋯ This is the first study to provide an epidemiological profile of individuals using sub-acute and non-acute care in NSW using linked data. Improvements in data validity and reliability would enhance the quality of the sub-acute and non-acute care data and its ability to be used to inform resource use in this sector. The examination of temporal trends using only the inpatient hospital admissions provides a guide for resource implications for inpatient rehabilitation services. What is known about this topic? Fall-related injuries that result in inpatient hospital admissions are increasing in Australia. However, the extent of the effect of fall-related injuries in the sub-acute and non-acute sector remains unknown, due to data limitations. What does this paper add? Provides the first epidemiological profile of individuals who fall and go on to use sub-acute and non-acute care in NSW using linked data. It highlights where improvements in data quality in the sub-acute and non-acute care data could be made to improve their usefulness to inform resource use in this sector. What are the implications for clinicians? Fall injury prevention and healthy ageing strategies for older individuals remain a priority for clinicians. The current and projected future resource implications for inpatient rehabilitation and follow-up services provide an indication for clinicians of future demand in this area as the population ages. However, data quality needs to improve to provide clinicians with strongly relevant guidance to inform clinical practice.
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This study aimed to better understand the carbon emission impact of haemodialysis (HD) throughout Australia by determining its carbon footprint, the relative contributions of various sectors to this footprint, and how contributions from electricity and water consumption are affected by local factors. ⋯ State-by-state contributions of energy and water use to the carbon footprint of satellite HD appear to vary significantly. Performing emissions planning and target setting at the state level may be more appropriate in the Australian context. What is known about the topic? Healthcare provision carries a significant environmental footprint. In particular, conventional HD uses substantial amounts of electricity and water. In the UK, provision of HD and peritoneal dialysis was found to have an annual per-patient carbon footprint of 7.1t CO2-eq. What does this paper add? This is the first carbon-footprinting study of HD in Australia. In Victoria, the annual per-patient carbon footprint of satellite conventional HD is 10.2t CO2-eq. Notably, the contributions of electricity and water consumption to the carbon footprint varies significantly throughout Australia when local factors are taken into account. What are the implications for practitioners? We recommend that healthcare providers consider local factors when planning emissions reduction strategies, and target setting should be performed at the state, as opposed to national, level. There is a need for more comprehensive and current emissions data to enable healthcare providers to do so.
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This study aimed to measure the prevalence of malnutrition risk and assessed malnutrition in patients admitted to a cancer-specific public hospital, and to model the potential hospital funding opportunity associated with implementing routine malnutrition screening. ⋯ Early identification of malnutrition may expedite appropriate nutritional management and improve patient outcomes in addition to contributing to casemix-based reimbursement funding for health services. A successful business case for additional clinical resources to improve nutritional care was aided by demonstrating the link between malnutrition screening, hospital reimbursements and improved nutritional care. What is known about the topic? It is known that between 20 and 50% of hospital patients are malnourished and oncology patients are 1.7 times more likely to be malnourished than are other hospitalised patients. Despite the existence of practice guidelines for malnutrition screening of at-risk oncology patients, these are not routinely implemented. Identification of malnutrition in hospitalised patients is linked to casemix funding via DRG. Casemix reimbursement for malnutrition can be enhanced if: (1) malnutrition risk is identified; (2) malnutrition is diagnosed; (3) the word 'malnutrition' and an associated action plan is documented in the medical record; and (4) malnutrition is recognised and recorded by the clinical coder. Amendments to the ICD-10-AM in 2008 allowing malnutrition to be recognised as a complication for coding when it is documented by a dietitian in the medical history has hospital reimbursement implications for dietetic practice. Reimbursement potential for malnutrition has been calculated in public hospitals in Australia with varying results. What does this paper add? This paper reports the components of a successful business case made to enhance resources for identification and treatment of malnutrition on the basis of improved treatment as well as enhanced reimbursement potential resulting from changes to the ICD-10-AM. The present study adds to the body of literature showing that malnutrition coding contributes to casemix funding in Australian public hospitals, as well as internationally, and highlights the previously unreported opportunity for a cancer-specific health service. This work demonstrated that reassignment of a DRG based on a diagnosis of malnutrition altered the overall casemix funding value for 12% of audited patients. This compares with the findings of other authors who demonstrated hypothetical DRG changes and financial reallocation. What are the implications for practitioners? This paper highlights that practitioner-centred strategies are needed to enhance malnutrition identification, diagnosis, documentation and coding to maximise casemix reimbursement and better treat malnutrition in hospitals. Strategies include education of the dietetics, medical and health-information workforce. This manuscript provides a description of the conduct of quality-improvement activities that may support successful business cases for increased dietetic resources in future.