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Journal of the Australian Healthcare & Hospitals Association

Australian Health Review

Australian Health Review

Australian Health Review explores health policy and management including healthcare delivery systems, clinical programs and health financing. Read more about the journalMore

Editor-in-Chief: Sonĵ Hall

Publishing Model: Hybrid. Open Access options available.

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Current Issue

Australian Health Review

Volume 48 Number 2 2024

Special Issue

Value-Based Healthcare

What is known about the topic? To succeed in efforts to implement equitable, sustained value-based healthcare (VBHC), the foundations and ongoing impacts of settler-colonialism and neoliberalism on which the Australian healthcare system is built must be acknowledged and addressed. What does this paper add? The ‘modern’ VBHC movement provides an opportunity to not only reform health care towards a more equitable, community-centred system, but to also acknowledge, honour and learn from global Indigenous knowledge, systems, and ways of valuing knowing, being and doing. What are the implications for practitioners? This article is an invitation to sit, listen and learn.

This article belongs to the Special Issue: Value-based Healthcare.

What is known about the topic? With health expenditure rising unsustainably, there is a growing focus on ways to reduce low-value care to improve health outcomes and eliminate unnecessary costs. What does this paper add? This paper details drivers of low-value care in Australia’s private health system and recommendations to overcome them. Drivers include the Prescribed List of Medical Devices, gaps in safety and quality controls, and conflicts of interest and marketing. What are the implications for practitioners? These insights are relevant to clinicians, researchers, policymakers, consumers and health business leaders with an interest in low-value care.

This article belongs to the Special Issue: Value-based Healthcare.

AH24001Creating a framework for change: transitioning to value-based healthcare in Queensland

Belinda Gavaghan, Jennifer Finch and Katelyn Clarke
pp. 123-128

What is known about the topic? Value-based healthcare provides an approach to restructure healthcare systems to improve health outcomes and the holistic experience of care for people and communities. What does this paper add? This paper details the development of a framework to support health services to transition to a value-based approach. What are the implications for practitioners? By reflecting on the diversity of health practitioners, managers and consumer experiences and the unique opportunities and challenges of individual healthcare services, the framework provides a structure and starting point for services to transition to value-based healthcare.

This article belongs to the Special Issue: Value-Based Healthcare.

AH24002Driving value-based healthcare through a new vision for Queensland’s health system

Madeleine Wellington, Elizabeth Whiting 0000-0002-8998-7539, Damien Searle, Megan Kreis 0000-0001-9127-4389 and Emily Cross
pp. 129-133

What is known about the topic? Vision statements for organisations including health are common. However, there is little information available in the literature regarding approaches to developing a vision for a health system. What does this paper add? An overview of an approach to developing a new health system vision through comprehensive consultation that engages stakeholders broadly to develop an informed vision that has support from all levels of the health system. What are the implications for practitioners? The method used to develop this vision could be replicated across any large-scale organisation. Although time consuming, the outcome is a vision that is widely supported and sets the organisation up for success for implementation.

This article belongs to the Special Issue: Value-based Healthcare.

What is known about the topic? Value-based healthcare (VBHC) has gained significant momentum within the healthcare sector and is seen as a driver for improving patient outcomes and equitable use of resources. What does this paper add? The paper describes firsthand experience and lessons learnt from implementing VBHC within a Victorian public healthcare system; the learnings are applicable to other organisations wanting to implement VBHC. What are the implications for practitioners? In implementing a co-designed VBHC framework, we ensured that its principles are applicable at both patient and population levels, centres on equity of access to care, achieves the best possible health outcomes and sustainable use of resources.

This article belongs to the Special Issue: Value-based Healthcare.

AH24009Designing and implementing a bundle of care for patients with early-stage breast cancer: lessons from a pilot program

Yvonne Zissiadis, Helen Ballal, Nicola Forsyth, Angela Ives 0000-0001-5734-0821, Lee Jackson, Anna Montgomery, Sarah Wise 0000-0003-3513-3471, Wen Chan Yeow and Christobel Saunders 0000-0003-2281-9829
pp. 142-147

What is known about this topic? Enabling value-based healthcare is essential to improve healthcare, focusing on outcomes gained over a full cycle of care. Patients diagnosed with cancer frequently report care to be disjointed and the cause of financial stress, thus can particularly benefit from value-based care models. What does this paper add? This case study describes the design and implementation of a bundled package of care for patients with early-stage breast cancer treated in the private health sector in Australia. What are the implications for practitioners? Lessons learned through this process provide considerations for expansion of this model of care.

This article belongs to the Special Issue: Value-based Healthcare.

What is known about the topic? While much has been written about the benefits of digital health, there are few practical examples of how a digital initiative, developed and implemented with clinicians and consumers, can positively change a healthcare service. What does this paper add? This paper discusses the importance of developing new digital healthcare services with the end user through co-design. A fully automated lung cancer digital care pathway and the lessons learned in implementation of the pathway are presented. This initiative was implemented within a public hospital to provide a service that has a vision of value-based health care and a person centric approach to care. What are the implications for practitioners? This study illustrates how the implementation of a digital care pathway for the monitoring and treatment of lung cancer can provide an approach that moves from reactive to proactive care. The implementation of the digital care pathway has positively changed the lung cancer service in a rapidly growing area.

This article belongs to the Special Issue: Value-based Healthcare.

AH23278Taking a value based commissioning approach to non-clinical and clinical support services

Trinette Kinsman, Samantha Reid and Hayley Arnott
pp. 154-159

What is known about the topic? Value based healthcare is a way of making transparent and equitable decisions about resource allocation to deliver better outcomes for individuals, health services and the system. What does this paper add? This paper reflects on the opportunity to deliver value based healthcare beyond clinical models of care, including in non-clinical and clinical support services, using a commissioning approach. What are the implications for practitioners? The learnings shared through the case studies presented can be applied by practitioners to their own projects to support value based approaches across all aspects of health care.

This article belongs to the Special Issue: Value-based Healthcare.

AH24003Measuring clinician experience in value-based healthcare initiatives: a 10-item core clinician experience measure (CEM-10)

Reema Harrison 0000-0002-8609-9827, Louise A Ellis, Maryam Sina, Ramya Walsan 0000-0002-4359-6794, Rebecca Mitchell, Ramesh Walpola, Glen Maberly, Catherine Chan and Liz Hay
pp. 160-166

What is known about the topic? Clinician experience of providing care is an outcome of interest for health systems and services internationally who are implementing value-based care initiatives. Review evidence indicates that measurement of clinician’s experience of providing care should address experiences of being able to deliver quality care, collaborate with colleagues, experience psychological safety and engagement in decision-making in the workplace. What does this paper add? The paper reports the development of the short form clinician experience measure (CEM-10) and its initial validation in four value-based healthcare initiatives of NSW Health. What are the practical implications for practitioners? The CEM-10 can be used as a core set of items embedded within evaluations of value-based care initiatives to benchmark and examine experiences across clinician cohorts.

This article belongs to the Special Issue: Value-based Healthcare.

AH24020Marked variations in medical provider and out-of-pocket costs for radical prostatectomy procedures in Australia

Ramya Walsan 0000-0002-4359-6794, Rebecca J. Mitchell, Jeffrey Braithwaite, Johanna Westbrook, Peter Hibbert, Virginia Mumford and Reema Harrison 0000-0002-8609-9827
pp. 167-171

What is known about the topic? Unwarranted clinical variations in radical prostatectomy procedures are well documented in the literature; however, variations in cost are less widely reported. What does this paper add? This paper aims to highlight the cost variations in radical prostatectomy procedures in Australia, discussing their plausible causes, implications and proposing potential policy opportunities. What are the implications for practitioners? Excessive fees imposed by medical providers may contribute to inequalities in healthcare access. Enhancing transparency of individual medical provider costs and implementing fee regulations may be useful in controlling unwarranted variations in procedure costs.

This article belongs to the Special Issue: Value-based Healthcare.

AH23231The impact of management option on out-of-pocket costs and perceived financial burden among men with localised prostate cancer in Australia within 6 months of diagnosis

Daniel Lindsay, Penelope Schofield, Doreen Nabukalu, Matthew J. Roberts, John Yaxley, Stephen Quinn, Natalie Richards, Mark Frydenberg, Robert Gardiner, Nathan Lawrentschuk, Ilona Juraskova, Declan G. Murphy and Louisa G. Gordon 0000-0002-3159-4249
pp. 172-181

What is known about the topic? International evidence suggests that men with low-risk prostate cancer managed with active surveillance initially incur lower out-of-pocket costs than those managed with active treatment. What does this paper add? Australian men with low-risk prostate cancer report low out-of-pocket costs and financial burden in the first 6 months post-diagnosis. Compared with those managed with active surveillance, men having active treatment had 6–7 times greater out-of-pocket expenses. What are the implications for practitioners? Being managed by active surveillance as the primary management option for low-risk prostate cancer reduces the financial burdens associated with a cancer diagnosis.

AH24019Hospitalisations and emergency department presentations by older individuals accessing long-term aged care in Australia

Stephanie L. Harrison, Catherine Lang, Tesfahun C. Eshetie, Maria Crotty, Craig Whitehead, Keith Evans, Megan Corlis, Steve Wesselingh, Gillian E. Caughey and Maria C. Inacio
pp. 182-190

What is known about the topic? Unplanned hospitalisations and emergency department presentations are frequent and burdensome for older people receiving long-term aged care. What does this paper add? While unplanned hospitalisations and emergency department presentations were high in all people receiving long-term care, these events were higher in people receiving home care packages than those in residential aged care. What are the implications for practitioners? Further efforts to address the high unplanned hospitalisations and emergency department presentations experienced by the increasing number of older adults accessing home care packages are required to allow this population to remain at home successfully.

This article belongs to the Special Issue: Value-based Healthcare.

AH23225Consumer perspectives of allied health involvement in a public hospital setting: cross-sectional survey and electronic health record review

Laura Jolliffe 0000-0002-1369-9442, Cylie M. Williams 0000-0002-0223-9141, Natalie Bozyk, Taya A. Collyer 0000-0001-8612-1724, Kirsten Caspers and David A. Snowdon 0000-0003-2041-3120
pp. 191-200

What is known about the topic? Research on consumer acceptance of out-of-hours or weekend allied health services is lacking, with an assumption of consumer willingness and demand for these service models. What does this paper add? Hospital inpatients are generally indifferent to the day of allied health services, preferring weekday or weekend day equally, typically between 8 am and 4 pm, while outpatients favour weekday mornings. Although consumers reported that their needs were met by allied health services, there was a lack of awareness about the specific services they received. What are the implications for practitioners? Results highlight the importance of not only aligning service delivery with consumer preferences for timing, but also enhancing awareness and understanding of the available allied health services for consumers.

AH23272Development and implementation of the Specialist Palliative Care in Aged Care (SPACE) Project across Queensland

Rebecca Smith, Gregory Merlo, Andrew M Broadbent, Caitlin Lock, Sharon Mickan and Nicola Morgan
pp. 201-206

What is known about the topic? There is limited palliative care support for the 36% of Australians who die in residential aged care. What does this paper add? This paper describes the development of the Specialist Palliative Care in Aged Care (SPACE) Project, using locally tailored models of care to improve palliative and end-of-life care in aged care facilities across Queensland. What are the implications for practitioners? Critical elements for improving residents’ palliative and end-of-life care included creation of an expert working group to define the innovation state-wide, a central project team that supported implementation, a community of practice, and local facilitation.

AH23262Clinical research imperatives: principles and priorities from the perspective of Allied Health executives and managers

Susan Hillier 0000-0002-6071-6137, Duncan Lodge, Jo Nolan, Rosalie Yandell, Anna Chur-Hansen, Stacey George and Elizabeth Lynch
pp. 207-217

What is known about the topic? Allied Health are well equipped to engage in research but have limited capacity. What does this paper add? We have identified key priorities and principles to inform Allied Health research activity. What are the implications for practitioners? Practitioners, funders and other stakeholders can develop these identified principles and priorities to direct research time and resources for the most impact on health outcomes.

Online Early

The peer-reviewed and edited version of record published online before inclusion in an issue

Published online 15 April 2024

AH23107Is HealthPathways viewed as a useful and trustworthy source of information by health professionals?

Rebecca Tretheway, Victoria Visser and Sarah Mollard
 

What is known about the topic? Evidence from New Zealand suggests that HealthPathways is viewed as a useful and trusted source of information by health professionals during critical and emergency events, and when information needs are subject to frequent change. What does this paper add? This paper provides evidence in the Australian context that health professionals access specific pages in HealthPathways at higher rates during critical and emergency events. What are the implications for practitioners? HealthPathways has the capacity to provide timely and accurate information to health professionals during critical and emergency events, as well as to identify their emerging information needs.

Published online 15 April 2024

AH23239Application of the Australian Bureau of Statistics Socio-Economic Indexes for Areas in cardiovascular disease research: a scoping review identifying implications for research

Hannah Beks, Sandra M. Walsh, Sarah Wood, Suzanne Clayden, Laura Alston, Neil T. Coffee and Vincent L. Versace
 

What is known about the topic? A socio-economic status (SES) gradient is well established for cardiovascular disease (CVD). Research has generally applied two approaches to classifying SES: at an individual level using income, education or occupation data, and at an area level using a range of existing socio-economic information, including the Australian Bureau of Statistics (ABS) Socio-Economic Indexes for Areas (SEIFA). What does this paper add? This review examined how SEIFA has been applied to measure SES in Australian peer-reviewed CVD research and to identify any variations in research practice. What are the implications for practitioners? It is recommended that researchers provide a clear explanation in the methods section of research papers as to which SEIFA version and index was applied, how it was applied, at what spatial unit, and whether the spatial unit was an ABS or non-ABS unit.

Published online 15 April 2024

AH23229Maintaining the health of people with and without COVID-19 during isolation: a case study

Caoimhe Scales 0009-0001-8711-4072, Ling-Ling Tsai 0000-0002-4617-7667, Sarah Whitney 0009-0007-4988-4432, Miranda Shaw 0000-0002-9358-8258, Lil Vrklevski 0000-0003-0200-9714, Sharon Carey 0000-0003-4155-5240, Owen Hutchings, Lissa Spencer 0000-0002-2358-0736 and Jennifer Alison 0000-0002-2011-4756
 

What is known about the topic? Quarantine during the COVID-19 pandemic could negatively impact physical and mental health. What does this paper add? A health package of light intensity exercise, advice on anxiety management and nutritional information demonstrated maintenance of physical and mental health and reduced fatigue in people with and without mild COVID-19 in hotel quarantine. What are the implications for practitioners? Practitioners should consider providing a health package of exercise, anxiety management and nutritional information to help people in quarantine to cope with the physical and mental isolation. Adequate staffing is required to enable implementation.

Published online 05 April 2024

AH23180Health systems model for chronic disease secondary prevention in rural and remote areas – Chronic disease: Road to health

Pat Field, Richard C. Franklin, Ruth Barker, Ian Ring and Peter Leggat
 

What is known about the topic? Cardiac rehabilitation is known to improve health outcomes and reduce hospitalisations, but referrals and attendance are low (30%). What does this paper add? A revised systems-based model for improved access to secondary prevention for people with heart and related chronic diseases in rural and remote areas of North Queensland is proposed: Chronic disease: Road to health. What are the implications for practitioners? A functional system from hospitalisation to local healthcare services has been designed to improve access to secondary prevention. Staff require support and education to improve skills, better manage care and improve job satisfaction.

Published online 05 April 2024

AH24041Improving the pre-medical emergency team: the case for a behavioural theoretical lens

Judy Currey 0000-0002-0574-0054, Stephanie K. Sprogis 0000-0003-4259-6976, Daryl Jones 0000-0002-6446-3595 and Julie Considine AO 0000-0003-3801-2456
 

What is known about the topic? The pre-medical emergency team (pre-MET) was implemented to enhance hospital patient safety; however, there is evidence that it is underused by health professionals. What does this paper add? We argue that health professionals’ behaviours within the pre-MET be understood differently by using the 'Behaviour Change Wheel’, where behaviour is driven by capability, opportunity, and motivation. What are the implications for practitioners? To improve patient safety and assist in formulating theory-based solutions, hospital leaders and health services researchers are called upon to examine the pre-MET using behaviour change theory.

Published online 04 April 2024

AH23253Younger people with dementia registered to public mental health services in Victoria, Australia

Samantha M. Loi 0000-0002-4953-4500, Dhamidhu Eratne and Dennis Velakoulis
 

What is known about the topic? Young-onset dementia refers to a dementia with onset at an age less than 65 years. Accessing age-appropriate services for these people is difficult as they fall through the gaps of adult and aged services due to their age. What does this paper add? Due to the behavioural and psychiatric manifestations related to young-onset dementia, data is provided about mental health service involvement for these people. What are the implications for practitioners? There is a need to upskill mental health clinicians, especially in rural areas, as younger people with dementia are accessing these services.

What is known about the topic? The scale of non-compliant Medicare billing is contested. What does this paper add? This Perspective frames non-compliant Medicare billing (and denial of its existence) as a ubiquitous cultural problem. What are the implications for practitioners? Strategies aimed at reducing non-compliant Medicare billing need to target the normative behaviour of societal actors as well as individual practitioners.

Published online 26 March 2024

AH23236Workforce training needs to address social and emotional wellbeing in home-based Aboriginal and Torres Strait Islander aged care

Adriana Parrella, Jonathon Zagler 0009-0002-5573-248X, Matilda D’Antoine, Tina Brodie, Kate Smith, Aunty Martha Watts, Tameeka Ieremia, Graham Aitken, Alex Brown and Odette Pearson 0000-0001-9877-6509
 

What is known about the topic? Supporting social and emotional wellbeing is an important aspect of delivering quality aged care for Aboriginal and Torres Strait Islander peoples. What does this paper add? Insights into workforce training needs which support the social and emotional wellbeing of Aboriginal and Torres Strait Islander peoples in home-based aged care. What are the implications for practitioners? Ongoing practice-based learning opportunities, training and resources are needed to enhance peer-learning and support workforce in supporting Aboriginal and Torres Strait Islander peoples’ social and emotional wellbeing in aged care.

Published online 25 March 2024

AH23191Using an under-utilised rural hospital to reduce surgical waiting lists

Tracey Edwards, Andrea Boerkamp, Kimberley J. Davis 0000-0002-7835-7259 and Steven Craig 0000-0001-6403-7863
 

What is known about the topic? Waitlist reduction strategies are required to deal with long surgical waitlists. Rural surgical services are declining due to centralisation of these services in larger hospitals. What does this paper add? Significant positive benefits arise from providing an ambulatory, rural surgical service. This paper provides an evidence base for rural hospitals to explore the benefits of re-activating, or increasing utilisation of, existing operating theatre facilities. What are the implications for practitioners? Significant reductions in surgical waitlists within health services can be safely achieved by servicing rural patients at their local hospital for some ambulatory procedures.

What is known about the topic? Minimal empirical evaluation of the 5th edition standards for accreditation have occurred since their implementation. What does this paper add? Our findings suggest that more than half of the indicators currently do not adequately distinguish practices at the site assessment. What are the implications for practitioners? These findings may suggest that a review of individual indicators and the standards structure is required.

Published online 12 March 2024

AH23183Adapting to change: exploring perceptions and demands of the coronavirus (COVID-19) workforce changes – an Australian multi-institutional radiation oncology survey

Honor Magon, Justin Smith 0000-0002-8870-3282, Jacqueline Besson, Eric Hau, Suzanne Taylor, Jeremy Ruben, Diana Jones, Kira Mabb, Jamie Feldman, Leily Gholam Rezaei and Yoo Young Lee 0000-0003-4325-349X
 

What is known about the topic? During the coronavirus disease 2019 (COVID-19) pandemic there were significant adaptations required to the delivery of clinical care. What does this paper add? There is a strong preference for ongoing work from home arrangements, especially for administrative and non-clinical work. Most radiation oncologists feel more confident using telehealth and favour its ongoing use post-pandemic. Burnout and stress remain prevalent within the workforce. What are the implications for practitioners? There is a high demand among the radiation oncology workforce for adoption of technological advances to improve work satisfaction including remote access to enable flexible work arrangements.

Published online 07 March 2024

AH23179Personal and organisational attributes that support transformational leadership in acute healthcare: scoping review

Julie Considine 0000-0003-3801-2456, Jenny Dempster 0009-0007-5237-4863, Nga Man Wendy Wong, Noelleen Kiprillis 0000-0002-0052-2701 and Leanne Boyd 0000-0001-9957-6357
 

What is known about the topic? Transformational leadership has clear benefits for patients, staff and organisations. What does this paper add? The personal and organisational attributes supporting transformation leadership are not well understood. What are the implications for practitioners? Transformational leadership was unrelated to gender or years of experience but was strongly associated with manager educational preparation and emotional intelligence.

What is known about the topic? There is a need to undertake more proactive and in-depth analyses of the general practice accreditation process and outcomes to improve the quality and safety within this healthcare sector. What does this paper add? Attempt of the self-assessment does not predict indicator conformity at the site visit overall, and appropriate levels of consistency of indicator assessment between surveyors at the site visit were identified. What are the implications for practitioners? We present empirical evidence as to the consistency of assessment with general practice accreditation to inform future standards and (re)accreditation assessments.

What is known about the topic? Since the introduction of Lifetime Health Cover (LHC) in mid-2000, the participation rate for private health insurance that includes hospital cover (PHI-HC) has remained relatively stable, but the PHI-HC population has aged faster than the general population. What does this paper add? This paper makes a novel distinction between ‘active’ and ‘passive’ age-based adverse selection to explain LHC’s role in the excess ageing of the PHI-HC risk pool. What are the implications for practitioners? Governments need to be vigilant for the emergence of distortions in the age distribution of the PHI-HC risk pool and respond with targeted interventions to normalise the age distribution, or risk problematic passive age-based adverse selection.

Published online 06 February 2024

AH24016What are the cost and resource implications of voluntary assisted dying and euthanasia?

Peter Hudson 0000-0001-5891-8197, David Marco 0000-0001-8634-3036, Richard De Abreu Lourenco 0000-0002-5978-8774 and Jennifer Philip 0000-0002-3312-0645
 

What is known about the topic? Voluntary assisted dying (VAD) legislation has now been passed in all Australian states. Although VAD has been operating internationally for a considerable time, there have been calls for more data to understand the resources required to implement VAD. What does this paper add? We found a paucity of empirically informed detail regarding the actual costs required to implement VAD. Hence, we tabulated a list of potential costs that could be used for subsequent evaluation and outline a research agenda. What are the implications for practitioners? Given that a significant number of practitioners may be directly or indirectly involved in VAD it is important that associated costs are clearly outlined so that appropriate resource allocation can be considered.

Just Accepted

These articles have been peer reviewed and accepted for publication. They are still in production and have not been edited, so may differ from the final published form.

AH23265, Accepted 15 April 2024

A Survey of Australian Public Opinion on Using Comorbidity to Triage Intensive Care Patients in a Pandemic

Winston Cheung, Vasi Naganathan, John Myburgh, Manoj Saxena, Blyth Fiona, Ian Seppelt, Michael Parr, Claire Hooker, Ian Kerridge, Nhi Nguyen, Sean Kelly, George Skowronski, Naomi Hammond, Antony Attokaran, Debbie Chalmers, Kalpesh Gandhi, Mark Kol, Shay McGuinness, Priya Nair, Vineet Nayyar, Neil Orford, Rachael Parke, Asim Shah and Atul Wagh
 

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