Variation in fees for surgery

Three open access articles in a recent issue of Medical Journal of Australia discuss the considerable variation in fees for surgery, noting the considerable out-of-pocket (OOP) costs for patients, and the possible consequences for sustainability. The Royal Australasian College of Surgeons (RACS) and Medibank, Australia’s largest private health insurer, have published reports on surgical variance, which detail the cost and outcomes of care in selected high volume procedures for general surgery, otolaryngology, urology, orthopaedics and vascular surgery.  For example, prices for hip prostheses varied from $4908 and $16178, with a median of $10727.

• Ian S McRae and Kees C van Gool. (2017). Variation in the fees of medical specialists: problems, causes, solutions . Med J Aust, 206 (4): 162-163. 

• Gary L Freed and Amy R Allen. (2017). Variation in outpatient consultant physician fees in Australia by specialty and state and territory. Med J Aust, 206 (4): 176-180.

• David J Hillis, David AK Watters, Lawrie Malisano, Nick Bailey and David Rankin. (2017). Variation in the costs of surgery: seeking value . Med J Aust 206 (4): 153-154

View the Surgical Variance Reports (access the latest reports here)  

Controlling healthcare professionals: human resource management

Studies in 20 Australian hospitals by UNSW Business School researchers reveal human resources practices rely too much on control and are preventing medical staff from using their discretion to make autonomous decisions on some basic people management tasks, including hiring to replace a departing staff member.
The upshot of too much control is disengagement and burnout among healthcare professionals and a delay in the introduction of improved standards for patient care. The findings revealed a predominance of a control-based approach to people management.

 Cogin, Julie Ann, Ju Li Ng and Ilro Lee, (2016). Controlling healthcare professionals: how human resource management influences job attitudes and operational efficiency. Human Resources for Health, 14:55 (open access)
  

Experiences of maternity care in NSW public hospitals: Patient Perspectives

This report from the Bureau of Health Information provides detailed information about the experiences of care for women during various stages of the maternity journey, highlighting where NSW performs well, and potential areas for improvement. 
Most women said they were engaged in decisions about their care although women who gave birth to their first baby, and women who had a caesarean section responded to many survey questions less positively. 

 Experiences of maternity care in NSW public hospitals: Patient Perspectives. January to December 2015, Bureau of Health Information. 2017  

End of Life Care for Adults

This quality standard (UK) covers care for adults (aged 18 and over) who are approaching the end of their life. This includes people who are likely to die within 12 months, people with advanced, progressive, incurable conditions and people with life-threatening acute conditions. It also includes support for their families and carers and care provided by health and social care staff in all settings is covered.

End of life care for adults. Quality standard [QS13]. NICE. Updated march 2017

Developing an Organizational Model for Improvement

To meet the goal of achieving the highest quality of care through evidence-informed translation and application in practice, organizations should outline a plan for developing, organizing, implementing, and evaluating evidence-informed improvement interventions. The purpose of this article is to provide an example for developing an organizational model for improvement from concept to application.
Polancich, Shea. (2017). Developing an Organizational Model for Improvement: From Translation to Practice. Journal For Healthcare Quality, 39(1), 28-33   

Cardiometabolic comorbidities, readmission, and costs in schizophrenia and bipolar disorder

Mental illnesses are associated with increased risk of cardiometabolic comorbidities. In this study, Correll et al. evaluate the prevalence of these comorbidities, hospitalisation outcomes and costs among patients with schizophrenia and bipolar disorder. They find that more than 60% of inpatients with these disorders also have cardiometabolic comorbidities, and that increased comorbidity burden was associated with greater likelihood of readmission.

Christoph U. Correll, Daisy S. Ng-Mak, Dana Stafkey-Mailey, Eileen Farrelly, Krithika Rajagopalan and Antony Loebel. (2017). Cardiometabolic comorbidities, readmission, and costs in schizophrenia and bipolar disorder: a real-world analysis. Annals of General Psychiatry, 16(9)   
 

Hospital care for patients aged 85 years and over 2014-15

AIHW has published Hospital care for patients aged 85 years and over 2014-15 which expands the 85 years and over age-group into four 5 year age-groups up to ages 100+ and reports on aspects of admitted patient care provided to these very old patients.
It looks at the admitted patient care provided for the oldest of patients in Australian hospitals in 2014–15 and presents information on the amount of activity there was for patients aged 85 years and over and how this has changed over time. It includes information on who used the hospital services, the length of stay in hospital, the overall type of care provided, the types of conditions patients received care for, the type of procedures undergone by the patients, and who funded the hospital stay.

Can Australia cope with a growing life expectancy?

"Life expectancy (years) at birth by sex" by AIHW

This is the title of an ABC report on PM recently, looking at a global study of life expectancy of people in the developed world, which is continuing to rise. Australians, for example, will have a life expectancy of 84 years by 2030. This has obvious implications for social and health structures in the years ahead, and planning needs to be in place for the needs of the ageing population. 

The study referred to here is from the Imperial College London and is available freely for download:  Projections of life expectancy in 35 industrialised countries: Projections with a Bayesian model ensemble. People in South Korea are projected to have the highest life expectancy, most likely being over 90 for women by 2030.

Parents' attitudes to vaccination

Very topical yet again is the question of vaccination in Australia. Here are three recent publications discussing parental attitudes and practices in this area:

Child Vaccination: perspectives of Australian parents gives the results of the Australian Child Health Poll from the Royal Children's Hospital in Melbourne.  This is the source of the media reports about unvaccinated children being refused treatment by health care providers. See the comments at the end of the landing page for discussion about this.  The report of the 2000 families surveyed also showed that 95% of them kept their children's vaccines up to date.

Parental attitudes, beliefs, behaviours and concerns towards childhood vaccinations in Australia: a national online survey reports on a study of 452 parents who responded to a survey in 2012. 92% reported they had kept their children's vaccines up to date, but 52% had concerns. The authors of the paper concluded that GPs need to communicate better with parents to improved their knowledge and trust in vaccination.

Maria Yui Kwan Chow et al, Australian Family Physician 46 (3) : 145-51, March 2017.

And in The Conversation, three public health academics emphasise that Australians' attitudes to vaccination are more complex than a simple 'pro' or 'anti' label.  It cites their own research, plus others (including the two surveys reported above) indicating that parents want more detailed information about vaccination safety. The authors are developing a package of support and information for parents called SKAI: Sharing Knowledge About Immunisation. They have already prepared some factsheets for the Australian Department of Health.

Experiences of maternity care in NSW public hospitals

Experiences of maternity care in NSW public hospitals: January to December 2015 has been released by the Bureau of Health Information this month.

It shows that most women giving birth in 2015 in a NSW public hospital had a good experience, with 79% saying they would speak highly about the hospital where they had their baby. 80% of these women felt that their length of stay was about right, but 13% felt it was "too short". Most felt that they had received adequate information and were engaged in decisions about their care. There was variation across LHDs about time waiting to be seen at antenatal appointments and cleanliness of toilets and bathrooms (MNCLHD scored highly on cleanliness and hygiene).

ADHD brains are different

A recent study published in The Lancet Psychiatry involved a mega-analysis of the neuroimaging of several regions of the brains of people with and without ADHD. It showed that the brains of people diagnosed with attention-deficit hyperactivity disorder tended to be smaller overall, and slightly smaller in some specific regions.

A clear explanation of the article by the University of Sydney's Alison Poulton was published in The Conversaton, Imaging study confirms differences in ADHD brains.

Martine Hoogman, et al. Subcortical brain volume differences in participants with attention deficit hyperactivity disorder in children and adults: a cross-sectional mega-analysis. The Lancet Psychiatry. Published online 15 February 2017. http://dx.doi.org/10.1016/S2215-0366(17)30049-4.

Access via CIAP, or contact your health librarian.

Effect of walking on days spent in hospital

A study recently published in the Medical Journal of Australia has shown that "more active people require less hospital care, and an achievable extra 4300 steps per day would result in an average of one less day in hospital for each 3 years of life".

The authors of the study, Daily step count and the need for hospital care in subsequent years in a community-based sample of older Australians, measured the step counts of over 3000 residents of Newcastle, who were over 55 years of age.  They wore pedometers for a week during 2005-2007 and their hospital data was analysed approximately eight years later. There was a statistically significant reduction in the number of hospital bed days associated with higher step counts.

Ben Ewald, one of the authors of the study from the University of Newcastle, summarised the results in The Conversation, New study shows more time walking means less time in hospital, and it was also reported by the ABC, Increasing daily step count reduces days in hospital, study shows 

Ben D Ewald, Christopher Oldmeadow and John R Attia. Med J Aust 2017; 206 (3): 126-130

Hospitalisation for intentional self-harm 2014-2015

Hospitalisations for mental health conditions and intentional self-harm in 2014-15 has been updated by the Australian Institute of Health and Welfare. It provides data for the 31 Primary Health Network areas, as well as over 300 smaller local areas across Australia. The site also includes some downloadable PDF resource pages and infographics.

This update shows that in 2014-2015, there were 223,882 overnight hospitalisations in Australia for mental health conditions. The rate in the North Cosat PHN area was particularly high.  There were 36,696 hospital admissions for intentional self-harm in that year.  

Stress and burnout in intensive care medicine

The authors of an opinion piece just published in the Medical Journal of Australia warn of an increasing risk of burnout in intensive care medicine, which could have a major impact on patient care.  ICU doctors and nurses have been shown to have higher rates of burnout symptoms than workers in other health specialties including emotional exhaustion, depersonalisation and reduced professional achievement. 

The article points out that intensive care medicine is becoming increasingly complex, with repeated exposure to “high stakes, ethically challenging decision-making processes”. The authors call for a multilevel response to improve the welfare and sustainability of the intensive care medicine workforce.

Simpson N, Knott CI. Stress and burnout in intensive care medicine: an Australian perspective
Medical Journal of Australia. 2017;206(3):107-8.

Understanding health research tool

Understanding health research: A tool for making sense of health studies is a tool designed to help people understand and review published health research to decide how dependable and relevant a particular study is.  

The tool askes a series of questions to ask about the specific study the user is concerned about, and explains what the answers to those questions mean in terms of the quality of the research.  Funded by the Medical Research Council in the UK, the site also has some very useful links to sources of pre-appraised research, other critical appraisal tools and handy scientific information like common sources of bias, correlation versus causation and sampling methods.