2015 projects

NSW Health
Duration: December 2013 - June 2015

Background

The Aboriginal Injury Prevention and Safety Promotion Demonstration Grants Program was established by NSW Health to improve the well-being of Aboriginal people in NSW by funding promising, evidence-informed intervention projects that aim to prevent the occurrence of injury; and to build knowledge, through evaluation of demonstration projects, about effective approaches for reducing injury in Aboriginal populations. CHSD researchers received funding to evaluate the Illawarra Aboriginal Medical Service (IAMS) Safe Homes Safe Kids program, a home visiting model of early intervention as an injury prevention program for Aboriginal children aged 0-5 and their families.

What we did

The program which has been operating since 2005 focuses on families with new babies, first time parents and teenage parents and is part of the holistic health service offered by the IAMS. Aboriginal family workers conduct home visits and provide intensive family assistance to vulnerable at-risk families utilising a locally produced safety promotion package. The 18-month evaluation of the program provided an opportunity to determine its effectiveness in reducing and preventing child injury.

The evaluation included processes, impact and outcomes components. A program logic model and evaluation framework was developed in collaboration with the IAMS Aboriginal family workers. A targeted literature review on Aboriginal child injury was completed and service mapping of the regional network of relevant child and family sector referral agencies undertaken. Program data was collected in addition to qualitative data from nine semi-structured interviews with IAMS staff, eleven semi-structured interviews with external stakeholder organisations and nine clients. All data was uploaded to NVivo software and framework analysis applied to the interview data.

The evaluation found that the Program addresses an important need for a safety education program delivered by Aboriginal family workers for vulnerable families. Clients expressed a high degree of satisfaction with the family workers’ delivery of the program and the holistic model of service provision offered by the IAMS. Improvements were recorded for each of the main participant groups in line with the expected outcomes in the logic model. Key results included: increased engagement in safety programs; Improved child safety knowledge (parents/carers, children, family workers); improved child safety skills (parents/carers, family worker); increased accessibility for parents/carers, children and families to services; improved attitudes to home and community safety. Parents/carers reported child injuries being prevented and changes in the home environment were observed. Limitations include the small number of clients and the primarily qualitative nature of the evaluation. The evaluation provided opportunities for capacity building in injury prevention, research and evaluation for the Aboriginal family workers. The IAMS ‘Safe homes Safe kids’ program offers a promising program for addressing complex family issues in urban areas.

Evaluation results demonstrate that the Program clearly addresses an important need for a safety education program delivered by Aboriginal family workers for vulnerable families. Clients expressed a high degree of satisfaction with the family workers’ delivery of the program and the holistic model of service provision offered by the IAMS. Improvements were recorded for each of the main participant groups in line with the expected outcomes in the logic model. Key results were: increased engagement in safety programs; Improved child safety knowledge (parents/carers, children, family workers); improved child safety skills (parents/carers, family worker); increased accessibility for parents/carers, children and families to services; improved attitudes to home and community safety.

South Eastern Sydney Local Health District
Duration: August 2014 - June 2015

Background

With the introduction of activity-based funding (ABF) across NSW in 2011/12, the ability for health services to accurately measure costs became critical. The SESLHD understood that it required costing information that supported the optimal operation under ABF and provided high-quality business intelligence for the LHD management team.

The review focused on the clinical costing methods and financial practices that produce the costing results. The overall aim was to ensure that SESLHD adopted a standard approach to clinical costing that was ‘sound’ in its representation of costs and that was aligned, where possible, with the NSW costing standards.

What we did

The review included an examination of costing data files and discussions with key staff responsible for the financial management and costing activities in each of the LHD hospitals. The project was undertaken in three phases with the first two phases addressing the larger hospitals in the northern and southern parts of the LHD. The third phase then wrapped-up with the smaller and 3rd Schedule predominately sub-acute facilities.

The review of costing data files included;

• Costing input files – These are the files prepared for costing that include the hospital expenses and the rules for allocating overhead costs across patient care areas and moving ‘buckets’ of expenses to better align with patient care activities.
• Costing outputs – Comparative data analysis using the results of the costing process to identify anomalies and inconsistencies. This also included a review of costing results against external (NSW) cost benchmarks.

Stakeholder consultations involved a review of costing decisions while also exploring issues of communication, coordination, consistency and innovation in costing practices across the District.

A summary of findings and recommendations that would improve the quality of costing information within SESLHD were delivered for consideration and implementation. The recommendations involved changes at both District and hospital levels.

Improved coordination of the costing process and the sharing of ideas and new initiatives in costing will significantly improve the accuracy and the value of costing data within SESLHD.

South East Sydney Local Health District
Duration: November - December 2015

Background

In the review of costing undertaken for South East Sydney Local Health District (SESLHD) in early 2015, the NCCC noted that the method for determining campus overheads charged to the Mental Health (MH) Program was not agreed between MH and the hospital sites, nor did it reflect the use of hospital campus infrastructure by MH. The NCCC was engaged to undertake a more detailed review of campus overheads and develop a methodology for determining an appropriate charge to the MH Program.

A smaller separate project involved the review of a new SESLHD MH initiative - The Recovery College Model – and the development recommendations for appropriate funding.

What we did

The project approach for the development of the campus overhead charging methodology was an iterative process. Proposals from each hospital regarding the types of overhead services that should be included in the charge and the preferred cost allocation method were reviewed. The MH Program also developed a set of proposals regarding their use of campus overheads and provided suggestions for appropriate allocation methods at each hospital site.

Issues and questions that arose from the review of proposals were addressed at the subsequent face to face meetings with each of the hospitals and MH. The issues discussed included;

• The suitability of overhead allocation statistics currently in use.
• Consistency in the use of overhead allocation statistics between hospitals.
• Financial data management issues that affect overhead allocations.
• The capacity to collect more utilisation data for overhead services.
• Charging on a user pays (invoice) basis versus regular monthly charges based on anticipated utilisation.
• The provision of corporate support services to off-site MH services.

The recommended methodology and guidelines for the application of the methodology were developed and submitted for comment and acceptance.

The Recovery College Model was reviewed with regard to the key classification and pricing elements of activity-based funding (ABF). Further information was sought regarding the nature and volume of Recovery College activities. The funding under ABF was modelled for 2015 and compared to cost.

Key finding:

1. A more meaningful allocation of hospital campus overheads may be achieved by refining the cost data and using improved allocation statistics.

2. The Recovery College Model would not be financially sustainable under ABF and should be included in a block funded allocation until suitable classification and counting systems are developed.

Cancer Institute NSW
May - December 2015

Background

CHSD was engaged by the Cancer Institute NSW to identify a model of care that would facilitate rapid access to assessment for NSW patients suspected of having lung cancer. The model of care needed to be adaptable, sustainable and suitable for implementation in Local Health Districts across NSW recognising the differing service delivery contexts in rural, regional and metropolitan Local Health Districts. It also needed to rely on existing resources and the redesign of existing services as no additional funding was to be provided to facilitate the introduction of this service.

What we did

An evidence appraisal was undertaken to demonstrate that the proposed service model for rapid access to assessment for lung cancer was grounded in best practice and to support the case for change. This appraisal identified best practice examples of models and a number of key elements that were likely to contribute to the success of a rapid access model. In addition to the evidence appraisal, analysis of existing population health data was undertaken to demonstrate the scale and impact of lung cancer on the NSW population and health system. Interviews were also completed with 21 key stakeholders to secure expert opinion to inform the design of the service model, implementation and funding strategy. This was supplemented by discussions with experts in Activity Based Funding about various cost components of the rapid assessment model, and how they are currently funded, as well as discussions with representatives of the Cancer Institute NSW about the applicability of options for rapid assessment models given the NSW cancer service delivery context.

Department of Social Services
Duration: September 2012 – May 2015

Background

The Encouraging Better Practice in Aged Care (EBPAC) program was funded by the Australian Government over three rounds with the aim of encouraging the uptake of evidence-based practice in both the residential and community aged care sectors. This Round Three initiative is an extension of the former Encouraging Best Practice in Residential Aged Care (EBPRAC) Program (Rounds 1 and 2) which funded 13 projects focusing solely on residential aged care.

The EBPAC program consisted of eleven projects with the broad objective of achieving practice and evidence-based improvements for people receiving aged care services, staff providing those services, the aged care system and the broader community. The majority of projects were funded for a two and a half year period between June 2012 and December 2014. There were three broad groups of projects: leadership and organisational change; evidence translation in community care; and evidence translation in residential aged care.

What we did

Our evaluation resulted in a better understanding of what works in aged care, and what needs to be in place in order for innovations to succeed. The heterogeneous and dynamic nature of the aged care sector means there is no one simple formula to facilitating change in a consistent and coherent manner. The complex interaction between consumer, workforce, organisational and systemic factors will continue to pose challenges to the provision of evidence-based practice and will need to be explicitly addressed to ensure that the benefits of any future investments are realised. What is clear from the emerging research evidence, and the experience of the EBPAC program however, is that the development of resources and delivery of education alone will not lead to sustainable outcomes. We were also able to highlight the importance of stakeholder input and multi-level strategies to support implementation and sustainability.

What was clear from the overall program evaluation was the importance of any new initiative to be underpinned by the evidence regarding implementation. There is no doubt that the EBPAC program has built capacity amongst the many project leaders, team members and participants; developed and strengthened intra- and inter-sector partnerships; and, significantly, initiated and/or revived enthusiasm and commitment amongst those directly responsible for the day to day support and care of aged care clients. However, it is apparent that such sector development initiatives need to be coordinated across government and in partnership with stakeholder representatives to ensure the multiple perspectives are appropriately captured, optimise learnings and avoid duplication of effort. Also, any future sector development initiatives need to reflect contemporary evidence-based practice and utilise multi-level interventions if they are to succeed.

Collectively, the three rounds of EBPAC represented a significant investment to improve the delivery of evidence-based practice for aged care recipients whether they reside in a facility or in the community. Aged care workers were upskilled through their participation in training events such as workshops. Tools were developed to promote organisational uptake of the innovations and effort was made to align innovations with regulatory frameworks and strategic reforms.

View the Australian Government Department of Health's EBPAC website.

Download the final report

Fildes D, Westera A and Masso M, Gordon R, Grootemaat P, Williams K, Morris D, Kobel C and Samsa P (2015) Evaluation of the Encouraging Better Practice in Aged Care (EBPAC) Initiative: Final Report. Centre for Health Service Development, Australian Health Services Research Institute, University of Wollongong.

Department of Social Services
Duration: June 2013 - June 2015

Background

The Centre for Health Service Development (CHSD) undertook the evaluation of the Better Health Care Connections (BHCC): Models for Short Term, More Intensive Health Care for Aged Care Recipients Program. The BHCC was funded by the Australian Government Department of Social Services.

The objectives of the BHCC were to:

• develop innovative models to build better health care connections between existing health and aged care services, that are cost effective and improve the way the aged care system works within the broader health system
• improve access to complex health care services for aged care recipients
• increase awareness and information on successful models amongst aged care and health care service providers
• diversify the aged care sector to include more complex community and residential health care services for aged care recipients.

The BHCC aimed to achieve the following outcomes:

• Cost effective innovative models of health care that demonstrate that aged care recipients have received high quality health care.
• Effective referral pathways between aged care and health care service providers that ensure that aged care recipients have improved access to health care.
• Reduction of unnecessary hospital admissions and shortening of length of hospital stays for aged care recipients.
• Improvement in the quality of health care services provided to aged care recipients.
• Development of a more skilled and flexible aged care sector.

This project consisted of a formative and summative evaluation of the Better Health Care Connections: Models for Short term, More Intensive Health Care for Aged Care Recipients Program. The program provided seed grants to aged care providers to develop new models of health care for aged care recipients as part of the Living Longer Living Better aged care reform package. The models aimed to deliver a more flexible aged care system, responding to the changing needs of Australians and the economic and social challenges of an ageing population. Thirteen projects were funded under the program to a total of $5.4 million, involving both residential and community aged care providers.

What we did

The framework for the evaluation built on the evaluation framework which has been used by the CHSD since 2003, with some modifications to fit the nature of the program. Data sources for the evaluation included the extensive documentation produced by each project, the available literature, site visits, key stakeholder interviews and tools developed specifically for the evaluation. The program (and hence the evaluation of the program) had at its core a question of fundamental importance: how can the connections between health and aged care be improved for the benefit of all concerned – consumers (aged care recipients and their families and carers), the individuals providing care for aged care recipients, and the ‘system’ within which individual providers work.

The final report of the evaluation was delivered in June 2015. In total, 2,374 people benefited from the program, 69% living in residential care and 31% living in the community, with 37% benefiting directly from services funded by the program and 63% benefiting from improved connections between existing services. Over 3,000 aged care employees benefited from access to educational material, either developed by the program or adapted from existing resources. All 13 aged care providers funded under the program developed, in a variety of ways, some form of 'improved connection’ between aged care services and health services.

The major barrier to establishing better health care connections was the existing ‘silos’ of primary care, aged care and acute health services. Interviews with stakeholders identified that building relationships to span the gap produced by these silos is challenging, time-consuming and resource-intensive and relies heavily on establishing personal relationships based on trust and mutual respect. Due to the high turnover of staff in both aged care and health sectors, these relationships need constant ‘building and maintaining’.

NSW Health
Duration: December 2013 – June 2015

Background

The Aboriginal Injury Prevention and Safety Promotion Demonstration Grants Program was established by NSW Health to improve the well-being of Aboriginal people in NSW by funding promising, evidence-informed intervention projects that aim to prevent the occurrence of injury; and to build knowledge, through evaluation of demonstration projects, about effective approaches for reducing injury in Aboriginal populations. CHSD researchers received funding to evaluate the Illawarra Aboriginal Medical Service (IAMS) Safe Homes Safe Kids program, a home visiting model of early intervention as an injury prevention program for Aboriginal children aged 0-5 and their families.

What we did

The program which has been operating since 2005 focuses on families with new babies, first time parents and teenage parents and is part of the holistic health service offered by the IAMS. Aboriginal family workers conduct home visits and provide intensive family assistance to vulnerable at-risk families utilising a locally produced safety promotion package. The 18-month evaluation of the program provided an opportunity to determine its effectiveness in reducing and preventing child injury.

The evaluation included processes, impact and outcomes components. A program logic model and evaluation framework was developed in collaboration with the IAMS Aboriginal family workers. A targeted literature review on Aboriginal child injury was completed and service mapping of the regional network of relevant child and family sector referral agencies undertaken. Program data was collected in addition to qualitative data from nine semi-structured interviews with IAMS staff, eleven semi-structured interviews with external stakeholder organisations and nine clients. All data was uploaded to NVivo software and framework analysis applied to the interview data.

The evaluation found that the Program addresses an important need for a safety education program delivered by Aboriginal family workers for vulnerable families. Clients expressed a high degree of satisfaction with the family workers’ delivery of the program and the holistic model of service provision offered by the IAMS. Improvements were recorded for each of the main participant groups in line with the expected outcomes in the logic model. Key results included: increased engagement in safety programs; Improved child safety knowledge (parents/carers, children, family workers); improved child safety skills (parents/carers, family worker); increased accessibility for parents/carers, children and families to services; improved attitudes to home and community safety. Parents/carers reported child injuries being prevented and changes in the home environment were observed. Limitations include the small number of clients and the primarily qualitative nature of the evaluation. The evaluation provided opportunities for capacity building in injury prevention, research and evaluation for the Aboriginal family workers. The IAMS ‘Safe homes Safe kids’ program offers a promising program for addressing complex family issues in urban areas.

Evaluation results demonstrate that the Program clearly addresses an important need for a safety education program delivered by Aboriginal family workers for vulnerable families. Clients expressed a high degree of satisfaction with the family workers’ delivery of the program and the holistic model of service provision offered by the IAMS. Improvements were recorded for each of the main participant groups in line with the expected outcomes in the logic model. Key results were: increased engagement in safety programs; Improved child safety knowledge (parents/carers, children, family workers); improved child safety skills (parents/carers, family worker); increased accessibility for parents/carers, children and families to services; improved attitudes to home and community safety.

Project team: Kathleen Clapham, Keziah Bennett-Brook, Courtney Callister, David Fildes

Noah's Ark Centre of Shoalhaven Inc.
Duration: December 2013 - May 2015

Background

Noah’s Shoalhaven, a non-government organisation located in Nowra, New South Wales, developed the Kids Together Program to address inclusion and the needs of pre-school aged children with disability / additional needs in mainstream early learning environments in preparation for the introduction of the National Disability Insurance Scheme (NDIS). Kids Together involves a multi-disciplinary team of key workers (occupational therapist, speech therapist, psychologist, early childhood education specialist) supporting parents and carers through home visiting, group training at the early childhood education centre and during transition when starting preschool and moving into school. The program was piloted in one early childhood education centre in 2013 and subsequently implemented across 15 centres in 2014. Having completed a literature review on the inclusion of children with disabilities / additional needs in early childhood mainstream education in 2013, CHSD was commissioned to undertake a program evaluation of the Kids Together Program over the 2014 school year.

What we did

The overarching goal of the 18-month program evaluation was to bring together lessons learnt in the delivery of the program, to capture evidence of its impact and effectiveness from all sites and to assess the suitability of the program for scale up across a broader range of sites. A realist evaluation approach was adopted in order to understand how the program works and in what circumstances it was effective. A steering committee was established to oversee the evaluation included industry and policy representation as well as Noah’s Shoalhaven, and University of Wollongong academics. In order to obtain a clear picture or model of the underlying rationale or logic of the Kids Together Program a program logic model was developed in collaboration with Noah’s Shoalhaven and an evaluation framework set up. The evaluation involved the collection of quantitative and qualitative data. Qualitative data was collected at five of the centres at the commencement and again towards the end of the program; it included semi-structured interviews with Noah’s Shoalhaven staff, centre directors, and parents, and focus groups with centre staff, as well as observation of key workers, children and centre staff. A survey of early childhood education staff was implemented at all sites at the end of the program period and program data was collected including goal attainment scores for children with additional needs. The final report was completed in November 2015. The evaluation identified the strengths of the model, challenges encountered in its implementation, and lessons learnt. Recommendations were made for increasing the capacity and ensuring the sustainability of the model. Options for the expansion of the model in the context of the NDIS introduction were discussed.

Evaluation results demonstrate that Kids Together was successfully implemented across ECECC, home settings and some community settings, with the capacity to demonstrate effectiveness across a broader range of community settings over time. Parents and carers, directors, ECEC centre staff all reported a high degree of satisfaction with the program. ECEC centre directors were highly supportive, enthusiastic and committed to its success. Strong evidence was provided for the attainment of each of the short and medium term outcomes represented in the Kids Together Logic Model. This includes outcomes at the individual, organisational and community levels. Good evidence was provided that some of the long term outcomes such as successful transitioning to school for children with additional needs were being attained and that the program provides opportunities for more meaningful participation by these children in society.

Independent Hospital Pricing Authority
Duration: June 2015 - August 2015

Background

In 2013 the Independent Hospital Pricing Authority (IHPA) had commissioned CHSD to develop version 4 of the Australian National Subacute and Non-acute Patient (AN-SNAP) classification. In addition to extensive stakeholder consultation this project included data analysis of national data as well as data obtained from AROC and PCOC. The new classification included classification variables that were previously not part of the national admitted patient collection.

In order to facilitate its current costing and pricing work for the National Efficient Price 2016-17 (NEP16) IHPA contracted CHSD to group its national activity data from 2012-13 and 2013-14 to AN-SNAP version 4.

What we did

The objective of this project was to maximise the number of grouped records in the national data. While some records of the national admitted patient data could have been grouped alone, supplementing the dataset with data from AROC and PCOC greatly increased the number of grouped records because AROC and PCOC included the newly introduced classification variables. The datasets were grouped using the AHSRI QuickSnap grouper software. Due to the absence of a unique identifier, statistical matching had to be used to match records from the different datasets in order to amend AN-SNAP version 4 classes to the national dataset.

In summary, CHSD was able to send back to IHPA the national dataset including the appended AN-SNAP version 4 classes which will be used for NEP16 determination. For the future IHPA has amended its data collection requirements.

NSW Child Death Review Team, NSW Ombudsman
Duration: May - September 2015

Background

The NSW Ombudsman engaged the CHSD to prepare a report for the NSW Child Death Review Team that provided an initial overview of the current infrastructure for childhood injury and disease prevention in NSW. Infrastructure included frameworks and policies, data collections and regular reports, as well as childhood injury and disease prevention structures and activities (including groups or organisations both government and non-government).

The NSW Ombudsman has an important role in improving the delivery of public services through scrutinising agency systems, overseeing investigations or reviewing the delivery of services. The Office has a particular role in relation to children, which includes maintaining oversight of organisations delivering services to children – including schools and child-care centres and monitoring the causes and patterns of deaths of children and people with disabilities in care and specific functions relating to the protection of children in NSW.

The NSW Child Death Review Team has been associated with the NSW Ombudsman’s office since 2011 after a prior history with the NSW Commission for Children and Young People. The purpose of the Team is to prevent and reduce deaths of children in NSW.

What we did

The scan was completed through a process of desktop review. Government and non-government websites were systematically searched for relevant international, national and NSW information on policy and legislation, data sources, stakeholders and coordination in the field of childhood injury and disease prevention. Several experts working in the field of childhood injury and disease prevention were consulted, particularly for advice when web-based searching produced limited information. Reference lists of key government reports were scrutinised to identify relevant information.

The structure of the report reflected the approach taken to describe childhood injury and disease prevention infrastructure in NSW by:

• defining key concepts;
• summarising the policy framework nationally and within NSW;
• identifying the major existing sources of data and information relevant to childhood injury and disease prevention;
• reviewing key stakeholders; and
• exploring existing mechanisms of coordination.

The major finding of the preliminary scan of childhood injury and disease prevention infrastructure was that there is a need for stronger leadership and coordination to deliver further improvements in childhood injury and disease prevention in NSW.

The report, ‘A scan of childhood injury and disease prevention infrastructure in NSW’, was issued as a special report to Parliament in late 2015.

In addition, a briefing paper was produced that provided a suggested study methodology that built upon the findings of the scan. Advice on the need for and scope of a further and more detailed study was provided, including defining study parameters, availability and nature of published information and study methodology options.

Mental Health and Drug and Alcohol Office, NSW Ministry of Health
Duration: May 2015 - July 2015

Background

People at risk of suicide are known to present to generalist health (i.e. non-mental-health) services before they are at the point of attempting suicide. This highlights the importance of these health services in being aware of potential risk factors and signs of suicidal thoughts and behaviours, and being able to support and/or refer suicidal individuals for appropriate expert assistance. NSW Health commissioned a scoping study to investigate the current status of suicide prevention education and training for health professionals working in public sector settings, to identify current best practice in suicide prevention training, and to present options and recommendations for developing an effective strategy for training development and implementation.

What we did

The project comprised two main activities: a targeted literature review of academic and grey literature; and interviews with 26 key informants across a range of stakeholder groups. It was an information-gathering exercise for the purpose of informing policy and practice on suicide prevention training in NSW Health facilities, not a comprehensive study of the subject or a systematic literature review.

The project team developed a scoping survey to gather information relevant to the project aims. This questionnaire was designed to elicit the views of stakeholders on key questions such as needs and priorities for suicide prevention training in NSW and appropriate quality and accreditation criteria. It provided the basis for telephone interviews using a semi-structured interview format. A selected group of stakeholders, including representatives from NSW Local Health Districts, suicide prevention experts at key research institutes and non-government organisations, health professionals, representative groups and external training providers, including the university sector, were sought. The sampling strategy was designed to capture the full range of relevant knowledge and opinions.

A targeted and selective search of the peer-reviewed academic literature was conducted to identify evidence relevant to suicide prevention training. In addition, an internet-based search of current suicide prevention education and training available to non-mental health professionals was conducted. The search strategy covered government and non-government strategic documents and reports, documents from universities and non-government training providers, and training resources produced by peak bodies and consumer groups.

The project identified a number of well-supported ‘gatekeeper’ training programs currently being delivered in NSW, numerous other established programs that could be more widely used in this state, and several locally developed suicide prevention training programs that show promise, subject to further rigorous evaluation. Health organisations seeking to commission external training would benefit from easier access to information about the available options, the quality of providers and the evidence base of particular programs.

In the interviews, experts nominated a range of public sector health settings in which suicide training would be valuable, and had clear views regarding the essential content of such training. Most felt that in-service training in the public health system should be accessible, mandatory and regularly refreshed or ‘topped up’. Deeper and more frequent training would be needed depending on the person’s role and level of exposure to suicidal individuals in the course of their duties. Initiatives to formalise provision of suicide prevention training for health professionals in public sector settings are most likely to succeed when integrated within a broader policy and practice framework.

An Evidence Check rapid review brokered by the Sax Institute for the NSW Agency for Clinical Innovation
Duration: March - June 2015

Background

A rapid review examined the evidence concerning risk factors which may be significant predictors of hospital service utilisation. Risk factors have been used in predictive models to stratify and select patients for integrated care interventions with the view to reducing potentially preventable hospitalisations. This review also critically examined the evidence as to whether the use of such risk models and factors to target integrated care programs was effective in reducing hospitalisations and associated costs.

What we did

A comprehensive search of electronic research databases combined with internet searches for other relevant literature was conducted. A total of 1,064 records were identified for possible inclusion in the review. There were 256 articles selected which were related to predictors of hospital utilisation or were studies that examined interventions associated with risk stratification.

The review indicated that age; gender; socio-economic status or social disadvantage; living alone; rural and remote location; and Aboriginal and Torres Strait Islander status and ethnicity had good evidence for inclusion as predictors in risk stratification models. Important clinical risk factors included comorbidity; severity of illness; key diagnoses; self-rated health; falls history; functional status; physical activity; long term disability; cognitive impairment; and multiple medication use.

However, the predictive accuracy of current risk stratification tools was only moderate. The adverse effects of false positive and false negative results and the benefits of true positive and true negative results required further consideration. Otherwise targeted individuals may receive programs that are not appropriate or fail to receive programs that are appropriate for them. The benefits of these models need to outweigh their costs.

Many of the integrated care interventions based on risk stratification appeared to increase cost and few interventions showed a reduction in hospital admissions.

Download the final report:

Sansoni JE, Grootemaat P, Seraji MH, Blanchard M and Snoek M (2015) Targeting integrated care to those most likely to need frequent health care: A review of social and clinical risk factors. Centre for Health Service Development, Australian Health Services Research Institute, University of Wollongong.

Duration: October 2013 – June 2015

Background

Health service planning is core business for jurisdictions and local areas. Traditionally age-sex standardised utilisation rates for individual DRGs have been applied to ABS population projections to predict the future need for subacute services. However, improved methods are required to address the acknowledged underservicing of subacute care. In this project, funded as a component of the suite of projects lead by the Commission on the Delivery of Health Services in Tasmania, AHSRI incorporated the concept of “rehabilitation-sensitive” AR-DRGs to develop a predictive tool to assess demand for rehabilitation and Geriatric Evaluation and Management (GEM) care following acute inpatient episodes provided in public sector facilities.

What we did

A set of acute care AR-DRGs from which patients were more likely to require subsequent rehabilitation had been identified previously and designated “rehabilitation-sensitive”. This work was extended in the current project by:

• Updating the version of AR-DRG from 5.2 to 7.0 and revising “rehabilitation-sensitive” list;
• Extending the concept by quantifying the degree of sensitivity and by incorporating the age distribution of patients; and
• Expanding the scope from just rehabilitation to rehabilitation and GEM, primarily because of inconsistencies between jurisdictions in the allocation of patients to these two care types.

Data available for the project included the 2010/11 and 2011/12 admitted patient dataset provided by the Australian Institute of Health and Welfare and additional data sourced from AROC. Logistic regression and other statistical techniques enabled a predictive model to be built. Consultations with clinicians and jurisdictional representatives guaranteed that the results were clinically valid and that the method was an improvement on others currently available.

The predictive model takes the form of tables of probabilities that patients will require rehabilitation or GEM care after an acute episode and can be applied to acute inpatient administrative datasets in any Australian jurisdiction or local area. Its use of patient-level characteristics will enable service planners to improve their forecasting of demand for these services.

The model was tested using Tasmanian data. The use of a national dataset in the model development and the series of national clinical consultations undertaken during the project, however, ensured that the model is suitable for application in all jurisdictions.