Copyright (c) 2009 University of Wollongong All rights reserved. http://ro.uow.edu.au/chsd Recent documents in Centre for Health Service Development - CHSD en-us Wed, 11 Nov 2009 16:03:02 PST 3600 http://ro.uow.edu.au/chsd/29 http://ro.uow.edu.au/chsd/29 Mon, 13 Oct 2008 17:40:44 PDT The NSW SAFTE Care Program is a pilot program, which targets older people living in the community who are at risk of presenting to an Emergency Department. It is based on the premise that by providing rapid response multi-disciplinary assessment and diagnostic services, together with coordinated care services, that ED attendance and/or hospital admission can be prevented and/or delayed or shortened. A secondary premise is that the cost of the provision of these services is equal to, or less than, the cost of the avoided ED and inpatient services. This is the Final Report of the Independent Evaluation of the NSW Sub Acute Fast Track Elderly (SAFTE) Care Program. The Interim Report of the Evaluation1 presented the results of the evaluation of the Program from its commencement in March 2006 to August 2006 and concluded that while many elements of the model are working well, the overall model needs refinement if the program's goals are to be met. This Final Report has repeated the type of analysis included in the Interim Report for the period up until the end of January 2007, and includes additional information based on client and stakeholder feedback and a comprehensive literature review. This evaluation has considered the program's impact on three levels - consumers (patients, carers), providers (health and community care) and the system (structures and processes, networks, relationships). A. Westera http://ro.uow.edu.au/chsd/28 http://ro.uow.edu.au/chsd/28 Mon, 13 Oct 2008 17:16:42 PDT The review has identified that there is a significant shortage of rehabilitation services in Tasmania. Further, as the population ages over the next decade, the need for rehabilitation will significantly increase. Key findings in relation to the need for rehabilitation include: § Relative to national standards, Tasmania is under-supplied with rehabilitation beds with the current shortfall estimated at around 50-60 beds. § Medical and allied health staffing levels fall well short of recommended standards. § With only 47-49 designated rehabilitation beds in Tasmanian public hospitals, at least 70 other beds are being used by patients formally classified as undergoing rehabilitation. Further, it is estimated that up to 195 beds, including up to 100 acute beds, are being used by patients requiring rehabilitation or restorative care. § The lack of ambulatory rehabilitation services in the North and North West regions limits alternative options to provide rehabilitation to those who require it. § The projected 45% increase in the population aged 70+ from 2003 to 2018 has major implications for rehabilitation and other sub-acute care needs. § Demand for inpatient rehabilitation services in Tasmanian public hospitals is projected to more than double between 2004-05 and 2016, with around 150 beds being needed at that time if current patterns of use are maintained. § Current outcome data suggest that shortages of allied health staff and alternative rehabilitation service options may be having a negative impact on outcomes and/or length of stay. The review has identified a range of issues that need to be addressed as part of the development of a network of rehabilitation services that will meet the needs of Tasmanians over the next decade. These are set out in Section 4 and are briefly discussed below. Perhaps the most important issue to be addressed is the status of rehabilitation within Tasmania's health system. Consultations have highlighted the relatively poor status accorded rehabilitation relative to acute care services in Tasmania, in spite of the needs arising from population ageing Page 2 Tasmanian Rehabilitation Review and Plan and increasing frailty. The need for strong clinical leadership to raise the profile of rehabilitation services and drive service development is evident. There is, at present, a lack of clarity around the rehabilitation role. There are apparent overlaps and some blurring of service roles between rehabilitation services and other services including stroke, geriatric management, restorative care and maintenance therapy. In spite of some changes that have been made in recent years, the formal organisational structure presents some barriers to the development and delivery of an effective system of rehabilitation services. Not least is the separate management of hospital and primary health sectors, which runs counter to the integrated model of delivery required to support an effective rehabilitation service. In this context, ongoing planning and cooperation between the Acute Health Services Group and the Community Health Services Group of the Department will be critical. This review has highlighted a need to strengthen overall clinical direction for rehabilitation services, both Statewide and at Regional level, with the capacity for program planning and management across both hospital and community settings. A range of specific issues has also been identified. These include clinical staffing levels, referral and assessment protocols, admission, discharge and case management, specialist rehabilitation needs, orthotic and prosthetic services and outcomes measurement. Finally, the review has highlighted three main infrastructure issues. These relate to improved facilities, equipment and transport and are summarised in Section 4.11 (page 24). P. Milne http://ro.uow.edu.au/chsd/27 http://ro.uow.edu.au/chsd/27 Mon, 13 Oct 2008 15:45:23 PDT This report on Effective Caring aims to identify the needs of carers including the factors that sustain carers in their caring role, identify effective interventions and to develop and set out a prioritised research agenda in this area. The Effective Caring project has been carried out in several stages: § An international literature review § A workshop of key service delivery and academic experts aiming to identify: § Priorities for improving routine practice in carer support networks § Priorities for building a coherent research and development agenda § This final report that incorporates both the literature review and the outcomes of the workshop. This report addresses what has been gathered through a review of Australian and international academic and practice literature, and a concurrent analysis of policy and practice in Australia. The findings are designed to provide an evidence base, both for carer interventions and for a research agenda that complements and extends the work already done on understanding and assessing carers' needs. The findings are presented in two volumes, one containing the background and methods and the findings set out as a synthesis of the evidence, and a second volume of attachments containing the detailed description of the material found in the search strategies. The national legislative and policy context shows a progressive growth of sophistication in the way that carers and their roles are understood, from marginal to more central in policy formation, and from a generalised part of the community care 'integration problem', to being treated as a segment of the population and a focus in the community care sector to be understood in its own right. The continuation of this trend towards a more central role for carers appears inevitable and has a number of implications. Within the specific carer support programs there is likely to be continued development and expansion of the National Respite for Carers Program (NRCP) and State and Territory based carer support programs. The focus on carer support interventions within the mainstream of service provision implies a more consistent approach to carers across the range of human service programs. If that likely growth is underpinned by coherent and effective intervention strategies, then the essential next step is a carefully prioritised and sequenced program of research and development. From the review carried out for this project the States and Territories and advocacy groups point out there is clearly scope for work within the carer support sector toward a clearer division of labour and combined effort, a focus on restorative and rehabilitation strategies, and providing a common a base for training and support for carers and workers in the community care sector. If improving the focus on carer support interventions is to avoid fragmentation and to mesh with the wider system reform agendas, then that implies a consistent approach (at the very least): between sub-programs within the NRCP; the systems of income support for carers; the disability sector; and State and Territory based carer support programs. K. Eagar http://ro.uow.edu.au/chsd/26 http://ro.uow.edu.au/chsd/26 Mon, 13 Oct 2008 15:29:20 PDT This is the final report of an independent review for the Department of Veterans' Affairs of the capability of its Veterans' Home Care (VHC) Program and model to continue to meet the needs of veterans1 in terms of quality of life, independence and health, in particular, maintaining independent functioning within the home environment. It is not a review of the way that VHC currently operates. The purpose is to identify options for the future. The central strand of inquiry within the review has been to pose and seek answers to the question 'Does the VHC Program (as it is currently constituted) meet the changing needs of the VHC client population, which is ageing, becoming more frail and increasingly demanding both higher level services and additional services not currently available through the program?' Two examples of this changing demographic are the average age of VHC clients, now 83 and a greater representation of females, in particular war widows. The outcome of the review is a set of options, set out in Section 5, on possible future changes to the VHC Program. The goal is to ensure that the VHC Program, as part of the broader health and community care system, is capable of delivering specified quality of life, independence and health outcomes that respond to the changing patterns of veteran need. These options have been informed by an analysis of a wide range of data/information sources (outlined below), extensive and in-depth stakeholder consultations, the findings from previous research and the findings from an evaluation of the outcomes currently achieved by the VHC Program. The review has involved a series of related steps, which aim to evaluate the way that the program operates currently and to predict the impact of current and future demographic trends on the level and type of resources required to serve the veteran community in the future. Available databases, a literature review, previous VHC review documents, and program guidelines have been analysed for relevant information. Veteran participants and service and program-level informants have been invited to fill in surveys and/or be interviewed, attend focus groups and respond to key questions and the findings of the review process and draft reports. The five review inputs have been: 1. Demographic data; 2. Demand and utilisation data; 3. Reports of previous internal and external VHC Program reviews; 4. The findings of an international literature review; and 5. Stakeholder engagement and consultation. Further details on the methods used can be found in Section 2. The results of the review are then set out in Section 3 (beginning on page 12). These results are followed by a discussion of key findings in the context of options for the future (Section 4, page 51). The final section, Section 5 (page 57), sets out options for the future. Volume 2 of the report contains five appendices. Appendix 1 provides a summary that compares VHC and other Australian Government funded programs. Appendix 2 contains an extensive literature review. It covers the academic, the practice and the policy literature. This includes a summary of existing program documentation and previous reviews. Appendix 3 outlines the 1 References to 'veterans' in the context of this review should be read to include war widows/widowers unless otherwise stated. Centre for Health Service Development Page ii Options for the future of Veterans' Home Care - Final Report technical methods and the assumptions that have been used in making projections about the future demand for VHC. Appendix 4 provides the results of a national survey of veterans and war widows. Finally, Appendix 5 provides the results of a national survey of VHC service providers. K. Eagar http://ro.uow.edu.au/aroc/7 http://ro.uow.edu.au/aroc/7 Tue, 30 Sep 2008 23:19:01 PDT Utilizing a national benchmarking database for rehabilitation services to explore injury rehabilitation in Australia: 1. Australian Health Care system; 2. Rehabilitation following injury; 3. Rehabilitation outcomes Australasian Rehabilitation Outcomes Centre; 4. Rehabilitation funding Sub-acute and Non-acute Patient Classification system; 5. Injury Rehabilitation data C. Poulos http://ro.uow.edu.au/aroc/6 http://ro.uow.edu.au/aroc/6 Tue, 30 Sep 2008 23:15:30 PDT This is the second comprehensive annual report that describes patients discharged from subacute inpatient rehabilitation programs provided by facilities that are members of the Australasian Rehabilitation Outcomes Centre (AROC). The inaugural annual report was published in April 2007 and described the 2005 data. F. Simmonds http://ro.uow.edu.au/aroc/5 http://ro.uow.edu.au/aroc/5 Tue, 30 Sep 2008 23:08:56 PDT This is the inaugural comprehensive annual report that describes patients discharged from subacute inpatient rehabilitation programs provided by facilities that are members of the Australasian Rehabilitation Outcomes Centre (AROC). Collection of a standardised dataset has enabled the provision of a national benchmarking system, which in turn has led to an improved understanding of factors that influence rehabilitation outcomes and costs, Aust Health Rev 2007: 31 Suppl 1: S31-S53 and therefore performance of the sector. F. Simmonds http://ro.uow.edu.au/chsd/25 http://ro.uow.edu.au/chsd/25 Thu, 16 Nov 2006 20:32:01 PST Background - Although the effects of resistant starch (RS) on postprandial glycemia and insulinemia have been extensively studied, little is known about the impact of RS on fat metabolism. This study examines the relationship between the RS content of a meal and postprandial/post-absorbative fat oxidation. Results - 12 subjects consumed meals containing 0%, 2.7%, 5.4%, and 10.7% RS (as a percentage of total carbohydrate). Blood samples were taken and analyzed for glucose, insulin, triacylglycerol (TAG) and free fatty acid (FFA) concentrations. Respiratory quotient was measured hourly. The 0%, 5.4%, and 10.7% meals contained 50 μCi [1-14C]-triolein with breath samples collected hourly following the meal, and gluteal fat biopsies obtained at 0 and 24 h. RS, regardless of dose, had no effect on fasting or postprandial insulin, glucose, FFA or TAG concentration, nor on meal fat storage. However, data from indirect calorimetry and oxidation of [1-14C]-triolein to 14CO2 showed that addition of 5.4% RS to the diet significantly increased fat oxidation. In fact, postprandial oxidation of [1-14C]-triolein was 23% greater with the 5.4% RS meal than the 0% meal (p = 0.0062). Conclusions - These data indicate that replacement of 5.4% of total dietary carbohydrate with RS significantly increased post-prandial lipid oxidation and therefore could decrease fat accumulation in the long-term. J. A. Higgins http://ro.uow.edu.au/chsd/24 http://ro.uow.edu.au/chsd/24 Thu, 16 Nov 2006 20:10:13 PST 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. M. Rix http://ro.uow.edu.au/chsd/23 http://ro.uow.edu.au/chsd/23 Thu, 16 Nov 2006 16:39:10 PST Background - The Working Together For Mental Health course is an 8-hour course designed to demystify mental illness and mental health services. The main target group for the course is people working in human service organisations who provide services for people with mental illness. Methods - A questionnaire was administered to all participants attending the course during 2003 (n = 165). Participants completed the questionnaire before and immediately after the course, and at three month follow-up. Results - A response rate of 69% was achieved with 114 people completing the questionnaire on all three occasions. The responses showed a significant improvement in the self-assessed knowledge and confidence of participants to provide human services to people with a mental health problem or disorder, three months after the course. There was no significant improvement in participants' attitudes or beliefs about people with a mental health problem or disorder at three month follow-up; however, participants' attitudes were largely positive before entering the course. Conclusion - The Working Together For Mental Health course was successful in improving participants' confidence and knowledge around providing human services to people with a mental health illness. P. Grootemaat