Biomedical subjects

Kathy Eagar

Publications and source records attributed to Kathy Eagar.

15 recordsLinked to original sources

PubMed2006

Ethnicity, deprivation and mental health outcomes.

AIMS: To describe and measure differences between ethnic groups on standard measures of mental health outcome. METHODS: Clinical staff in eight New Zealand Health Districts collected consumer outcomes data at the start, end and review of episodes of care. Consumers were allocated to one of three ethnicity groupings -- Maori, Pacific Island and "All Other". RESULTS: There were large differences between the three ethnicity groupings on the measures. Maori and Pacific Island consumers appeared to demonstrate more psychotic phenomena and overall worse scores, and the All Other group, more depression. Changes in scores between start and end of episodes of care were proportionately similar across the three groups. Differences between ethnic groupings varied according to socio-economic deprivation level. CONCLUSIONS: Potential reasons for some of the effects observed are discussed, including differing pathways to care, clinician and selection bias, and differing models of mental health.

Adult↗

PubMed2005

(Re)form with substance? Restructuring and governance in the Australian health system 2004/05.

The Australian health system has been the subject of multiple reviews and reorganisations over the last twenty years or more. The year 2004-2005 was no different. This paper reviews the reforms, (re)structures and governance arrangements in place at both the national and state/territory levels in the last year. At the national level some progress has been made in 2004/05 through the Australian Health Ministers' Council and there is now a national health reform agenda, albeit not a comprehensive one, endorsed by the Council of Australian Governments (COAG) in June 2005. Quality and safety was an increasing focus in 2004-2005 at both the national and jurisdictional levels, as was the need for workforce reform. Although renewed policy attention was given to the need to better integrate and coordinate health care, there is little evidence of any real progress this last year. More progress was made on a national approach to workforce reform. At the jurisdictional level, the usual rounds of reviews and restructuring occurred in several jurisdictions and, in 2005, they are organisationally very different from each other. The structure and effectiveness of jurisdictional health authorities are now more important. All health authorities are being expected to drive an ambitious set of national and local reforms. At the same time, most have now blurred the boundary between policy and service delivery and are devoting significant resources to centrally 'crisis managing' their service systems. These same reasons led to decentralisation in previous restructuring cycles. While there were many changes in 2004-2005, and a new national report to COAG on health reform is expected at the end of 2005, based on current evidence there is little room for optimism about the prospects for real progress.

Journal Article↗

PubMed2005

Performance of routine outcome measures in adult mental health care.

OBJECTIVE: To examine the performance of two widely used outcome measures in public adult mental health services. METHOD: As part of a larger study, clinical staff in eight New Zealand District Health Board areas collected consumer outcomes data for a period of 6 months. Among other measures, the Health of the Nation Outcome Scales (HoNOS) and Life Skills Profile (LSP-16) were completed at the start and end of episodes of care, as well as at 90-day reviews. RESULTS: The performance of these two measures was examined in relation to compliance with the data collection protocol, item completion rates, certain psychometric properties, the relationship between them and the relationship of each instrument to the age, sex, principal psychiatric diagnosis and legal status of the consumer. Compliance with the HoNOS was superior to the LSP-16, but the reverse was true for completion. The two instruments were strongly correlated, but not enough to suggest that one may substitute for the other. A five-subscale structure for the HoNOS was supported. Certain HoNOS subscales were associated with age, but the total score was not, and differences between the sexes were small. Some large diagnostic differences were observed on both instruments. All LSP-16 summary scores and all HoNOS summary scores apart from Depression were higher (worse) in involuntary episodes. Only one LSP-16 item, relating to work potential, was related to age and men generally scored higher (worse) than women. CONCLUSION: From a technical perspective, the HoNOS and LSP-16 appear suitable for routine collection. New Zealand has adopted the HoNOS for routine use but not the LSP-16 because of local concerns about its appropriateness and acceptability. The clinician-rated measures reported here need to be complemented by both consumer-rated and family/carer measures.

Adult↗

PubMed2005

Lessons from the National Mental Health Integration Program.

Three projects were funded under the national Mental Health Integration Program (MHIP) in 1999, each of which employed a different model aimed at improving linkages between disparate parts of the mental health system. A national evaluation framework guided local evaluations of these projects, and this paper presents a synthesis of the findings. For providers, the projects improved working relationships, created learning opportunities and increased referral and shared care opportunities. For consumers and carers, the projects resulted in a greater range of options and increased continuity of care. For the wider system, the projects achieved significant structural and cultural change. Cost-wise, there were no increases in expenditure, and even some reductions. Many of the lessons from the projects (and their evaluations) may be generalised to other mental health settings and beyond.

Australia↗

PubMed2004

Adult mental health needs and expenditure in Australia.

BACKGROUND: Relatively little international work has examined whether mental health resource allocation matches need. This study aimed to determine whether adult mental health resources in Australia are being distributed equitably. METHOD: Individual measures of need were extrapolated to Australian Areas, and Area-based proxies of need were considered. Particular attention was paid to the prevalence of mental health problems, since this is arguably the most objective measure of need. The extent to which these measures predicted public sector, private sector and total adult mental health expenditure at an Area level was examined. RESULTS: In the public sector, 41.6% of expenditure variation was explained by the prevalence of affective disorders, personality disorders, cognitive impairment and psychosis, as well as the Area's level of economic resources and State/Territory effects. In the private sector, 72.4% of expenditure variation was explained by service use and State/Territory effects (with an alternative model incorporating service use and State/Territory supply of private psychiatrists explaining 69.4% of expenditure variation). A relatively high proportion (58.7%) of total expenditure variation could be explained by service utilisation and State/Territory effects. CONCLUSIONS: For services to be delivered equitably, the majority of variation in expenditure would have to be accounted for by appropriate measures of need. The best model for public sector expenditure included an appropriate measure of need but had relatively poor explanatory power. The models for private sector and total expenditure had greater explanatory power, but relied on less appropriate measures of need. It is concluded that mental health services in Australia are not yet being delivered equitably.

Adolescent↗

PubMed2004

The weakest link?

Explore the source record for details and available documents.

Journal Article↗

PubMed2004

An Australian casemix classification for palliative care: technical development and results.

OBJECTIVES: To develop a palliative care casemix classification for use in all settings including hospital, hospice and home-based care. SAMPLE: 3866 palliative care patients who, in a three-month period, had 4596 episodes of care provided by 58 palliative care services in Australia and New Zealand. METHOD: A detailed clinical and service utilization profile was collected on each patient with staff time and other resources measured on a daily basis. Each day of care was costed using actual cost data from each study site. Regression tree analysis was used to group episodes of care with similar costs and clinical characteristics. RESULTS: In the resulting classification, the Australian National Sub-acute and Non-acute Patient (AN-SNAP) Classification Version 1, the branch for classifying inpatient palliative care episodes (including hospice care) has 11 classes and explains 20.98% of the variance in inpatient palliative care phase costs using trimmed data. There are 22 classes in the ambulatory palliative care branch that explains 17.14% variation in ambulatory phase cost using trimmed data. DISCUSSION: The term 'subacute' is used in Australia to describe health care in which the goal--a change in functional status or improvement in quality of life--is a better predictor of the need for, and the cost of, care than the patient's underlying diagnosis. The results suggest that phase of care (stage of illness) is the best predictor of the cost of Australian palliative care. Other predictors of cost are functional status and age. In the ambulatory setting, symptom severity and the model of palliative care are also predictive of cost. These variables are used in the AN-SNAP Version 1 classification to create 33 palliative care classes. The classification has clinical meaning but the overall statistical performance is only moderate. The structure of the classification allows for it to be improved over time as models of palliative care service delivery develop.

Ambulatory Care↗

PubMed2004

An Australian casemix classification for palliative care: lessons and policy implications of a national study.

OBJECTIVES: To provide a nontechnical discussion of the development of a palliative care casemix classification and some policy implications of its implementation. SAMPLE: 3866 palliative care patients who, in a three month period, had 4596 episodes of care provided by 58 palliative care services in Australia and New Zealand. METHOD: A detailed clinical and service utilization profile was collected on each patient with staff time and other resources measured on a daily basis. A statistical summary of the clinical variables was compiled as the first stage of the analysis. RESULTS: Palliative care phase was found to be a good predictor of resource use, with patients fairly evenly distributed across the five categories. Clients treated in an inpatient setting had poorer function and higher symptom severity scores than those treated in an ambulatory setting, a result that is not surprising in this Australian setting. DISCUSSION: Implementation of the resultant AN-SNAP classification has been proceeding since 1998 in some Australian jurisdictions. The development and implementation of a classification such as AN-SNAP provides the possibility of having a consistent approach to collecting palliative care data in Australia as well as a growing body of experience on how to progressively improve the classification over time.

Algorithms↗

PubMed2004

Developing a New Zealand casemix classification for mental health services.

This study aimed to develop a casemix classification of characteristics of New Zealand mental health services users. Over a six month period, patient information, staff time and service costs were collected from 8 district health boards. This information was analysed seeking the classification of service user characteristics which best predicted the cost drivers of the services provided. A classification emerged which explained more than two thirds of the variance in service user costs. It can be used to inform service management and funding, but it is premature to have it determine funding.

Journal Article↗

PubMed2003

The performance of instrumental activities of daily living scale in screening for cognitive impairment in elderly community residents.

A retrospective analysis of Short Orientation-Memory-Concentration (OMC) and Lawton's IADL data was performed to assess the association between instrumental activities of daily living (IADL) and a rating of cognitive impairment, and to test whether IADL measures can be used to screen for dementia. The study analyzed data from 1,095 elderly community residents who were regarded as potentially benefiting from care coordination. Three IADL items (telephone use, self-medication, and handling finances) were statistically associated with cognitive impairment (OMC cutoff 10/11), independent of age and sex. An IADL indicator based on these items had only modest power in predicting cognitive impairment, its highest sensitivity being 0.71. Specificity was 0.75 at this point, but increased to 0.97 if higher indicator scores were used to define a positive result. In conclusion, the usefulness of an IADL indicator seems limited to ruling out further cognitive assessment rather than positively identify those with dementia.

Activities of Daily Living↗

PubMed2003

Health services research and development in practice: an Australian experience.

While there is a growing literature on how health services research can inform health policy decisions, the practical challenge is for health services researchers to develop an effective interface with health policy-making processes and to produce outputs that lead to outcomes. The experience of the Centre for Health Service Development at the University of Wollongong, Australia, is used to illustrate the issues so commonly described in the literature and to reflect on our experience of trying to remain viable while producing relevant and valid research. A case study in a specific policy area - namely, the development of case-mix classifications and information systems to inform policy and funding in the subacute and non-acute hospital and community care sectors - is used as a practical example of the research-policy interface.

Cooperative Behavior↗

PubMed2002

End-stage renal disease in the Northern Territory: current and future treatment costs.

OBJECTIVE: To compare hospital costs of Aboriginal and non-Aboriginal patients having haemodialysis treatment and forecast the future treatment cost. METHODS: The costs of patients with HD in the "Top End" of Australia's Northern Territory were estimated for the financial years 1996/97 and 1997/98 using a hospital costing model. We used an Autoregression Integrated Moving Average model to predict future demand. RESULTS: 165 patients (101 Aboriginal and 64 non-Aboriginal) were treated at a total cost of $12.4 million in this two-year period. These 165 patients represented 0.7% of inpatients, 8.8% of total inpatient costs and 31.6% of total inpatient episodes of care in the Top End region. $9.5 million (77%) was spent on routine haemodialysis treatment and $2.9m (23%) on other hospitalisations. The average cost per routine haemodialysis treatment over the two-year period was $527, or $78 600 per patient treatment year. Hospitalisations for comorbidities occurred in 86% of Aboriginal and 39% of non-Aboriginal patients. Average cost per patient, number of admissions and length of hospital stays were all significantly greater for Aboriginals. We predict an average increase in the number of treatments of 12% each year over the next five years and a five-year cost of $49.8m. CONCLUSIONS: A multipronged strategy designed to reduce the prevalence and costs of renal failure is required.

Hospital Costs↗

PubMed2002

Training in routine mental health outcome assessment: an evaluation of the Victorian experience.

This paper evaluates training in the use of measures of outcomes and casemix provided to four pilot agencies in Victoria, Australia. The training program is outlined along with key evaluation findings. The knowledge and skills of participants developed during training is described. Deficiencies in the training program are identified and opportunities for improvement outlined.

Diagnosis-Related Groups↗

PubMed2002

Training in routine mental health outcome assessment: the Victorian experience.

The routine assessment of client outcomes was set as an objective in the Australian National Mental Health Policy in 1992. Victoria was the first jurisdiction to begin the implementation. This paper reports this process, and describes the background to outcome measurement in mental health, assembly of the implementation team, certain key concepts, development of the training materials, the approach to training, and a brief description of the evaluation. We end with a number of observations and recommendations that arose out of the project.

Australia↗

PubMedDate not supplied

Primary care patients in the emergency department: who are they? A review of the definition of the 'primary care patient' in the emergency department.

OBJECTIVE: To review the definition of 'primary care' and 'inappropriate' patients in ED and develop a generally acceptable working definition of a 'primary care' presentation in ED. METHOD: A Medline review of articles on primary care in ED and the definitions used. RESULTS: A total of 34 reviewed papers contained a proposed definition or comment on the definition for potential 'primary care', 'general practice', or 'inappropriate' patients in ED. A representative definition was developed premised on the common factors in these papers: low urgency/acuity--triage categories four or five in the Australasian Triage Scale, self-referred--by definition, patients referred by general practitioner/community primary medical services are not primary care cases because a primary care service has referred them on, presenting for a new episode of care (i.e. not a planned return because planned returns are not self-referred), unlikely to be admitted (in the opinion of Emergency Nurse interviewers) or ultimately not admitted. DISCUSSION: This definition can be applied either prospectively or retrospectively, depending on the purpose. Appropriateness must be considered in light of a legitimate role for ED in primary care and the balance of resources between primary care and emergency medicine in local settings.

Acute Disease↗