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Biomedical subjects

Stephen J Duckett

Publications and source records attributed to Stephen J Duckett.

13 recordsLinked to original sources
PubMed2006

The incidence and cost of adverse events in Victorian hospitals 2003-04.

OBJECTIVES: To determine the incidence of adverse events in patients admitted in the year 2003-04 to selected Victorian hospitals; to identify the main hospital-acquired diagnoses; and to estimate the cost of these complications to the Victorian and Australian health system. DESIGN: The patient-level costing dataset for major Victorian public hospitals, 1 July 2003-30 June 2004, was analysed for adverse events by identifying C-prefixed diagnosis codes denoting complications, preventable or otherwise, arising during the course of hospital treatment. The in-hospital cost of adverse events was estimated using linear regression modelling, adjusting for age and comorbidity. MAIN OUTCOME MEASURES: Cost of each patient admission ("admitted episode"), length of stay and mortality. RESULTS: During the designated timeframe, 979,834 admitted episodes were in the sample, of which 67,435 (6.88%) had at least one adverse event. Patients with adverse events stayed about 10 days longer and had over seven times the risk of in-hospital death than those without complications. After adjusting for age and comorbidity, the presence of an adverse event adds dollar 6826 to the cost of each admitted episode. The total cost of adverse events in this dataset in 2003-04 was dollar 460.311 million, representing 15.7% of the total expenditure on direct hospital costs, or an additional 18.6% of the total inpatient hospital budget. CONCLUSION: Adverse events are associated with significant costs. Administrative datasets are a cost-effective source of information that can be used for a range of clinical governance activities to prevent adverse events.

Adolescent↗
PubMed2006

Evaluation of NHMRC funded research completed in 1992, 1997 and 2003: gains in knowledge, health and wealth.

OBJECTIVE: To report on strategies for, and outcomes of, evaluation of knowledge (publications), health and wealth (commercial) gains from medical research funded by the Australian Government through the National Health and Medical Research Council (NHMRC). DESIGN AND METHODS: End-of-grant reports submitted by researchers within 6 months of completion of NHMRC funded project grants which terminated in 2003 were used to capture self-reported publication number, health and wealth gains. Self-reported gains were also examined in retrospective surveys of grants completed in 1992 and 1997 and awards primarily supporting people ("people awards") held between 1992 and 2002. RESULTS: The response rate for the 1992 sample was too low for meaningful analysis. The mean number of publications per grant in the basic biomedical, clinical and health services research areas was very similar in 1997 and 2003. The publication output for population health was somewhat higher in the 2003 than in the 1997 analysis. For grants completed in 1997, 24% (31/131) affected clinical practice; 14% (18/131) public health practice; 9% (12/131) health policy; and 41% (54/131) had commercial potential with 20% (26/131) resulting in patents. Most respondents (89%) agreed that NHMRC people awards improved their career prospects. Interpretation is limited by the relatively low response rates (50% or less). CONCLUSIONS: A mechanism has been developed for ongoing assessment of NHMRC funded research. This process will improve accountability to the community and to government, and refine current funding mechanisms to most efficiently deliver health and economic returns for Australia.

Australia↗
PubMed2006

Developing a policy simulator at the acute-aged care interface.

This paper describes the development of a computer simulation of the interactions between the acute and aged care systems in Australia, using system dynamics modeling enhanced by agent-based techniques. National and regional simulations will be developed, enabling the impact of a variety of policy scenarios to be forecast over the next 10 years. The paper includes a description of the relevant policy environment and some of the associated key policy issues.

Aged↗
PubMed2005

Private care and public waiting.

Waiting time for public hospital care is a regular matter for political debate One political response has been to suggest that expanding private sector activity will reduce public waiting times. This paper tests the hypothesis that increased private activity in the health system is associated with reduced waiting times using secondary analysis of hospital activity data for 2001-02. Median waiting time is shown to be inversely related to the proportion of public patients. Policymakers should therefore be cautious about assuming that additional support for the private sector will take pressure off the public sector and reduce waiting times for public patients.

Australia↗
PubMed2005

Health workforce design for the 21st century.

The Australian health workforce has changed dramatically over the last 4 years, growing in size and changing composition. However, more changes will be needed in the future to respond to the epidemiological and demographic transition of the Australian population. A critical issue will be whether the supply of health professionals will keep pace with demand. There are current recorded shortages of most health professionals, but this paper argues that future workforce planning should not be based on providing more of the same. Rather, the roles of health professionals will need to change and workforce planning needs to place a stronger emphasis on issues of workforce substitution, that is, a different mix of responsibilities. This will also require changes in educational preparation, in particular an increased emphasis on interprofessional work and common foundation learning.

Australia↗
PubMed2005

Board self-evaluation: the Bayside Health experience.

Board evaluation is a critical component of good governance in any organisation. This paper describes the board self-evaluation process used by Bayside Health, a public health service in Melbourne. The question of how governing boards can assess their performance has received increasing attention over the past decade. In particular, the increasing demand for accountability to shareholders and regulators experienced by corporate sector Boards has resulted in greater scrutiny of board performance, with the market and the balance sheet providing some basis for assessment. Performance evaluation of governing boards in the public sector has been more challenging. Performance evaluation is complex in a sector that is not simply driven by the bottom line, where the stakeholders involve both government and the broader community, and where access to, and the quality and safety of the services provided, are often the major public criteria by which performance may be judged. While some practices from the corporate sector can be applied successfully in the public sector, this is not always the case, and public sector boards such as the Board of Directors of Bayside Health have been developing ways to evaluate and improve their performance.

Efficiency, Organizational↗
PubMed2004

The Australian Health Care Agreements 2003-2008.

The Australian Health Care Agreements for the five years 1 July 2003 to 30 June 2008 were signed in August 2003 after vituperative debate and intransigence from the Commonwealth that vitiated the negotiation process. The new Agreements, which were not as generous as the Agreements they replaced, increase accountability on the States, requiring States to match increases in Commonwealth funding, and de-emphasise the prospects for further reform in Commonwealth-State relations during the course of the Agreements. This paper describes the new Australian Health Care Agreements and the process which led to them.

Journal Article↗
PubMed2004

Australia and New Zealand Health Policy: a new journal.

Australia and New Zealand Health Policy is a new journal which aims to promote debate and understanding about contemporary health policy developments in Australia and New Zealand. Although there are other international journals focussing on health policy, there are no Australian or New Zealand journals with this focus.One of the aims of Australia and New Zealand Health Policy is to focus on contemporary critiques and contemporary developments. Accordingly an e-journal format is particularly appropriate. Australian and New Zealand Health Policy is an open access journal which means that all articles will be freely and universally accessible online which, amongst other things, means that all articles will be freely and universally accessible online without any barriers to access, which increases their visibility.

Journal Article↗
PubMed2004

Validity of the AusTOM scales: a comparison of the AusTOMs and EuroQol-5D.

BACKGROUND: Clinicians require brief outcome measures in their busy daily practice to document global client outcomes. Based on the UK Therapy Outcome Measure, the Australian Therapy Outcome Measures were designed to capture global therapy outcomes of occupational therapy, physiotherapy and speech pathology in the Australian clinical context. The aim of this study was to investigate the construct (convergent) validity of the Australian Therapy Outcome Measures (AusTOMs) by comparing it with the EuroQuol-5D (EQ-5D). METHODS: The research was a prospective, longitudinal cohort study, with data collected over a seven month time period. The study was conducted at a total of 13 metropolitan and rural health-care sites including acute, sub-acute and community facilities. Two-hundred and five clients were asked to score themselves on the EQ-5D, and the same clients were scored by approximately 115 therapists (physiotherapists, speech pathologists and occupational therapists) using the AusTOMs at admission and discharge. Clients were consecutive admissions who agreed to participate in the study. Clients of all diagnoses, aged 18 years and over (a criteria of the EQ-5D), and able to give informed consent were scored on the measures. Spearman rank order correlation coefficients were used to analyze the relationships between scores from the two tools. The clients were scored on the AusTOMs and EQ-5D. RESULTS: There were many health care areas where correlations were expected and found between scores on the AusTOMs and the EQ-5D. CONCLUSION: In the quest to measure the effectiveness of therapy services, managers, health care founders and clinicians are urgently seeking to undertake the first step by identifying tools that can measure therapy outcome. AusTOMs is one tool that can measure global client outcomes following therapy. In this study, it was found that on the whole, the AusTOMs and the EQ-5D measure similar constructs. Hence, although the validity of a tool is never 'proven', this study offers preliminary support for the construct validity of AusTOMs.

Acute Disease↗
PubMed2004

Trends in the use of hospital beds by older people in Australia: 1993-2002.

OBJECTIVE: To determine trends in use of Australian acute hospital inpatient services by older patients. DESIGN AND DATA SOURCES: Secondary analysis of hospital data from the Australian Institute of Health and Welfare in the period 1993-94 to 2001-02, with population data for this period from the Australian Bureau of Statistics. OUTCOME MEASURES: Population-based rates of hospital separations and bed utilisation. RESULTS: The Australian aged population (65 years and older) increased by 18% compared with total population growth of 10%, yet the proportion of hospital beds occupied by older patients remained stable at 47%. The most substantial changes were observed in the population aged 75 years and older, with separations increasing by 89%, length of stay reducing by 35% and bed utilisation increasing by 23%. However, rates of bed utilisation (in relation to population) declined among older groups (10% decline in per capita use in population 75 years and older), but increased in the younger population (1% increase in per capita use in people younger than 65 years). CONCLUSION: Important trends in use of inpatient services were identified in this study. These trends are contrary to common perception. Ageing of the Australian population was not associated with an increase in the proportion of hospital beds used by older patients.

Acute Disease↗
PubMed2004

Describing Chinese hospital activity with diagnosis related groups (DRGs). A case study in Chengdu.

OBJECTIVE: To examine the applicability of an Australian casemix classification system to the description of Chinese hospital activity. DESIGN: A total of 161,478 inpatient episodes from three Chengdu hospitals with demographic, diagnosis, procedure and billing data for the year 1998/1999, 1999/2000 and 2000/2001 were grouped using the Australian refined-diagnosis related groups (AR-DRGs) (version 4.0) grouper. MAIN OUTCOME MEASURES: Reduction in variance (R2) and coefficient of variation (CV). RESULTS: Untrimmed reduction in variance (R2) was 0.12 and 0.17 for length of stay (LOS) and cost respectively. After trimming, R2 values were 0.45 and 0.59 for length of stay and cost respectively. CONCLUSIONS: The Australian refined DRGs provide a good basis for developing a Chinese grouper.

China↗
PubMed2004

Drug policy down under: Australia's pharmaceutical benefits scheme.

Australia has had a government subsidized universal system of pharmaceutical provision for 50 years. The Pharmaceutical Benefits Scheme (PBS) consumes around 14 percent of total government health care expenditures and has grown substantially in both range of drugs covered, and expenditure since it was first introduced in 1950. It incorporates patient copayments (with differentials for the general population compared with concessional beneficiaries). Prior to listing a drug on the PBS it is subject to a rigorous cost-effectiveness analysis.

Australia↗