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Berlowitz D.J.,Northern Clinical Research Center | Graco M.,University of Melbourne
Australian Health Review | Year: 2010

Background. The Northern Alliance Hospital Admission Risk ProgramChronic Disease Management comprises 13 services delivering care to those with chronic disease and older people with complex care needs, who are frequent hospital users. Aims. To develop and implement a system-wide approach to the evaluation of this existing program. Methods. The Northern Clinical Research Centre audited all existing, routinely collected administrative data within the program and then met with each service to develop service specific outcome measures. The evaluators then developed and implemented a system-wide evaluation approach to measure performance in terms of: client profile; access and entry; service efficiency; client outcomes; and hospital demand. Results. Data are collected electronically and more than 80% are derived from existing, administrative datasets, minimising staff and client burden. Additional data include client outcomes and a health related quality of life measure. The preliminary twelve month data suggest that clients have the equivalent of 'fair' or 'poor' self-reported health status (n≤862) and the average health utility scores are significantly (P0.05) worse than population control data. These analyses reveal, for the first time, that the Northern Alliance Hospital Admission Risk ProgramChronic Disease Management program is targeting appropriate clients. Discussion. This methodology will enable many prospective assessments to be performed including; client outcome evaluation, service model comparisons, and cost-utility analyses. Conclusion. This evaluation approach demonstrates the feasibility of a highly coordinated 'whole of system' evaluation. Such an approach may ultimately contribute to the development of evidence-based policy. What is known about the topic? Program evaluation literature recommends establishing the objectives of a program, and the corresponding evaluation methodology early in the planning phase so that a thorough evaluation can commence with the implementation of the program. What does this paper add? This paper provides an alternative evaluation methodology developed around the available administrative data, thereby maximising efficiency with data collection and analysis with minimal burden on clinicians. This pragmatic approach may be appropriate for large, ongoing programs with an existing administrative dataset and where funding for evaluation is limited. What are the implications for practitioners? This paper has implications for both administrators and clinicians. The methodology is designed to facilitate evidence-based policy and planning at a regional and state level, and to assist with quality improvement at the local service level through ongoing performance monitoring and benchmarking. © AHHA 2010.

De Morton N.A.,Monash University | De Morton N.A.,Northern Clinical Research Center | Davidson M.,La Trobe University | Keating J.L.,Monash University
BMC Geriatrics | Year: 2010

Background: The de Morton Mobility Index (DEMMI) is a new mobility instrument that overcomes the limitations of existing instruments. It is the first mobility instrument that accurately measures the mobility of all older adults. The aim of this study was to provide a detailed report of investigations of the validity, responsiveness to change and minimal clinically important difference (MCID) of the DEMMI during its development in an older acute medical population. Methods: This study was conducted using a head to head comparison design in two independent samples of older acute medical patients (development sample, n = 86; validation sample, n = 106). Consecutive patients ( 65 years) were assessed using the DEMMI, Barthel Index (BI) and Hierarchical Assessment of Balance and Mobility (HABAM) within 48 hours of hospital admission and discharge. Convergent and discriminant validity were investigated using Spearman's rho and known groups validity was investigated using a independent t test to compare DEMMI scores for patients who were discharged to home compared to inpatient rehabilitation. Criterion and distribution based methods were employed for estimating instrument responsiveness to change and the MCID. Results: Significant moderate to high correlations were identified between DEMMI and BI scores (r = 0.76 and r = 0.68) and DEMMI and HABAM scores (r = 0.91 and r = 0.92) in both samples. In both samples, DEMMI scores for patients who were discharged to home were significantly higher than for patients discharged to inpatient rehabilitation and provided evidence of known groups validity. Patients who were discharged to inpatient rehabilitation (n = 8) had a mean DEMMI score of 50.75 (sd = 11.29) at acute hospital discharge compared to patients who were discharged to home (n = 70) with a mean DEMMI score of 62.14 (sd = 18.41). MCID estimates were similar across samples using distribution and criterion based methods. The MCID for the DEMMI was 10 points on the 100 point interval scale. The DEMMI was significantly more responsive to change than the BI using criterion and distribution based methods in the validation sample. Conclusion: This study has validated the DEMMI in two independent samples of older acute medical patients. Estimates of its responsiveness and MCID have also been established. This study confirms that the DEMMI overcomes the limitations of the BI and HABAM and provides an advanced method for objectively assessing mobility for older acute medical patients. © 2010 de Morton et al; licensee BioMed Central Ltd.

Barclay K.L.,Northern Health | Barclay K.L.,University of Melbourne | Zhu Y.-Y.,University of Melbourne | Tacey M.A.,Northern Clinical Research Center | Tacey M.A.,University of Melbourne
ANZ Journal of Surgery | Year: 2015

Background: Although patterns of return of bowel function (ROBF) following colorectal surgery with enhanced recovery after surgery (ERAS) programmes have been well delineated, regular morphine use is uncommon. This study describes the patterns of post-operative nausea and vomiting (PONV) and ROBF in this context. Method: Patients undergoing elective major colorectal surgery on an ERAS programme over 1 year were included. Patient details, intra-operative course, post-operative management, outcomes and complications were collected retrospectively from clinical records. Statistical analysis was performed using Stata version 12. Results: A total of 136/142 (96%) patients received morphine for post-operative analgesia. Most (112/142, 79%) experienced either no vomiting (87/142, 61%) or small amounts (25/142, 18%). On average, patients without an ileostomy passed flatus and opened their bowels after 2.4 and 4.3 days, those with an ileostomy taking 1.5 and 2.1 days. Vomiting was not related to ROBF (P = 0.370) or overall complications; wound complications (odds ratio (OR) = 8.1, 95% confidence interval (CI): 2.0-32.5), electrolyte abnormalities (OR = 2.9, 95% CI: 1.2-7.1) and length of stay (hazard ratio = 1.3, 95% CI: 1.2-1.5) were related. Conclusion: Most patients do not experience PONV in this context. ROBF is predictable without prolonged delays. This information could be used to allow confident early discharge and identify patients whose deviation from normal may indicate complications. © 2015 Royal Australasian College of Surgeons.

Page K.N.,Australian Catholic University | Barker A.L.,Northern Clinical Research Center | Barker A.L.,Monash University | Kamar J.,Injury Prevention Unit
Wound Repair and Regeneration | Year: 2011

The purpose of this study was to develop and validate a pressure ulcer risk assessment for acute hospitals. This tool was developed in a cohort of 342 patients with a mean age 63 years (SD 19.82) and validated in a second cohort of 165 patients with a mean age 68 years (SD 18.40). Risk factors for inclusion on The Northern Hospital Pressure Ulcer Prevention Plan (TNH-PUPP) were identified from the literature then examined and weighted using logistic regression. Risk factors included on the TNH-PUPP were requires assistance to move in bed (odds ratio [OR] 5.15; 95% confidence interval [CI]: 2.49-10.65), admission to intensive care during current admission (OR 2.98; 95% CI: 1.33-6.67), aged â¥65 years (OR 2.81; 95% CI: 1.24-6.36), reduced sensation (OR 2.29; 95% CI: 1.19-4.42), and cognitive impairment (OR 2.26; 95% CI: 1.09-4.67). The TNH-PUPP was validated in a prospective sample. The new tool had high diagnostic validity (area under the receiver operating curve=0.86), consistent in the validation sample (area under the receiver operating curve=0.90). The TNH-PUPP has a moderate positive predictive value (development=0.50; validation=0.13), and a high negative predictive value (development=0.94; validation=0.99) enabling low-risk patients to be screened out, as noncandidates for pressure ulcer prevention interventions. An accurate pressure ulcer risk assessment has been developed and validated, which identifies a high-risk group to whom limited pressure ulcer prevention resources should be directed. The TNH-PUPP facilitates effective resource allocation and is likely to reduce unnecessary patient harm and costs from pressure ulcers in acute hospitals. © 2010 by the Wound Healing Society.

Duke G.J.,Box Hill Hospital | Barker A.,Monash University | Rasekaba T.,Northern Health | Hutchinson A.,Northern Health | And 2 more authors.
Critical Care and Resuscitation | Year: 2013

Objective: To revise and validate the accuracy of the critical care outcome prediction equation (COPE) model, version 4. Design, participants and setting: Observational cohort analysis of 214 616 adult consecutive intensive care unit admissions recorded from 23 ICUs over 12 years. Data derived from the Victorian Admitted Episode Database (VAED) were used to identify treatment-independent risk factors consistently associated with hospital mortality. A revised version of the COPE-4 model using a random-intercept hierarchical logistic regression model was developed in a sample of 35 878 (16.7%) consecutive ICU separations. Main outcome measures: Accuracy was tested by comparing observed and predicted mortality in the remaining 178 741 (83.3%) records and in 23 institutional cohorts. Stability was assessed using the standardised mortality ratio, Hosmer-Lemeshow H10 statistic, calibration plot and Brier score. Results: The COPE-4 model had satisfactory overall discrimination with an area under receiver operating characteristic curve of 0.82 for both datasets. The development and validation datasets demonstrated good overall calibration with H10 statistics of 13.38 (P = 0.10) and 14.84 (P = 0.06) and calibration plot slopes of 0.99 and 1.034, respectively. Discrimination was satisfactory in all 23 hospitals and one or more calibration criteria were achieved in 19 hospitals (83%). Conclusions: COPE-4 model prediction of hospital mortality for ICU admissions has satisfactory performance for use as a risk-adjustment tool in Victoria. Model refinement may further improve its performance.

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