Journal articles: 'Hospital utilization Australia'

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Eldridge, Damien S., Ilke Onur, and Malathi Velamuri. "The impact of private hospital insurance on the utilization of hospital care in Australia." Applied Economics 49, no. 1 (July 13, 2016): 78–95. http://dx.doi.org/10.1080/00036846.2016.1192273.

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Palmer, George, and Jean Freeman. "Comparisons of Hospital Bed Utilization in Australia and the United States Using DRGs." QRB - Quality Review Bulletin 13, no. 7 (July 1987): 256–61. http://dx.doi.org/10.1016/s0097-5990(16)30142-7.

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SUNDARARAJAN, V., T. KORMAN, C. MACISAAC, J. J. PRESNEILL, J. F. CADE, and K. VISVANATHAN. "The microbiology and outcome of sepsis in Victoria, Australia." Epidemiology and Infection 134, no. 2 (August 19, 2005): 307–14. http://dx.doi.org/10.1017/s0950268805004796.

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We analysed data from 33741 patients with ICD-10-AM-defined sepsis from an Australian hospital morbidity dataset to investigate the relationships between specific types of organisms, potential risk factors for infection, organ dysfunction, ICU utilization and hospital mortality. A total of 24% of patients received some of their care in an intensive care unit, and the overall hospital mortality rate was 18%. Gram-positive bacteria were isolated in 27% of cases and Gram-negative bacteria in 20%. Sepsis due to Staphylococcus aureus was associated with vascular and joint devices whereas Pseudomonasaeruginosa and Gram-negative rods were more common with genitourinary devices and lymphoproliferative disease. Sepsis-associated organ dysfunction most commonly involved the respiratory system, followed by the renal and circulatory systems. These patterns may provide useful clues to the pathogenesis and therapy of this often fatal syndrome which is a major ongoing problem for hospitalized patients.

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Paterson, NA, JK Peat, CM Mellis, W. Xuan, and AJ Woolcock. "Accuracy of asthma treatment in schoolchildren in NSW, Australia." European Respiratory Journal 10, no. 3 (March 1, 1997): 658–64. http://dx.doi.org/10.1183/09031936.97.10030658.

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Insufficient use of anti-inflammatory drugs, such as inhaled corticosteroids and cromoglycate, may contribute to the disease burden associated with asthma. Conversely, aggressive treatment of mild disease may result in avoidable costs and/or adverse drug effects. The aim of this study was to determine the relationship between asthma severity and inhaled corticosteroid/cromoglycate use in a large (n=4,909) random sample of children, aged 8-11 yrs, in NSW, Australia. Asthma and its treatment were assessed by questionnaire responses. Asthma, defined as diagnosis plus current wheeze, was present in 901 children (18% of the sample), of whom 225 (5%) had moderate asthma, defined as asthma plus additional symptoms (sleep disturbance), utilization (hospital, casualty), or disability (reduced activity, school absence). Use of inhaled corticosteroid/cromoglycate was reported by 636 children (13% of the sample). Determinants of use included: asthma diagnosis, current wheeze, and troublesome dry nocturnal cough. There was also a strong relationship between anti-inflammatory treatment and a multicomponent asthma severity score constructed for each child. Inhaled corticosteroids and/or cromoglycate were used by 56% of the children with asthma (24% daily) and by 76% of children with moderate asthma (42% daily). Undertreatment, defined as less than daily inhaled corticosteroids/cromoglycate in moderate asthma, was identified in 130 children (14% of those with asthma or 3% of the sample). Conversely, apparently aggressive treatment, defined as inhaled corticosteroid/cromoglycate use in children with persistent minimal symptoms (asthma severity score of less than 3) was identified in 101 children (2% of the sample). Although there were significant differences between regions in the choice of anti-inflammatory drugs and in the prevalence both of undertreatment and apparently aggressive treatment, there was no clear relationship to regional utilization of emergency and hospital services for asthma. Nevertheless, the frequency of undertreatment suggests an opportunity to reduce asthma morbidity by more consistent application of current therapeutic guidelines.

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Doessel, D. P., Roman W. Scheurer, David C. Chant, and Harvey Whiteford. "Financial incentives and psychiatric services in Australia: an empirical analysis of three policy changes." Health Economics, Policy and Law 2, no. 1 (January 2007): 7–22. http://dx.doi.org/10.1017/s1744133106006244.

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Australia has a national, compulsory and universal health insurance scheme, called Medicare. In 1996 the Government changed the Medicare Benefit Schedule Book in such a way as to create different financial incentives for consumers or producers of out-of-hospital private psychiatric services, once an individual consumer had received 50 such services in a 12-month period. The Australian Government introduced a new Item (319) to cover some special cases that were affected by the policy change. At the same time, the Commonwealth introduced a ‘fee-freeze’ for all medical services. The purpose of this study is two-fold. First, it is necessary to describe the three policy interventions (the constraints on utilization, the operation of the new Item and the general ‘fee-freeze’.) The new Item policy was essentially a mechanism to ‘dampen’ the effect of the ‘constraint’ policy, and these two policy changes will be consequently analysed as a single intervention. The second objective is to evaluate the policy intervention in terms of the (stated) Australian purpose of reducing utilization of psychiatric services, and thus reducing financial outlays. Thus, it is important to separate out the different effects of the three policies that were introduced at much the same time in November 1996 and January 1997. The econometric results indicate that the composite policy change (constraining services and the new 319 Item) had a statistically significant effect. The analysis of the Medicare Benefit (in constant prices) indicates that the ‘fee-freeze’ policy also had a statistically significant effect. This enables separate determination of the several policy changes. In fact, the empirical results indicate that the Commonwealth Government underestimated the ‘savings’ that would arise from the ‘constraint’ policy.

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Fitzgerald, Paul, Anthony de Castella, Dinesh Arya, W. Robert Simons, Andrew Eggleston, Sharon Meere, and Jayashari Kulkarni. "The Cost of Relapse in Schizophrenia and Schizoaffective Disorder." Australasian Psychiatry 17, no. 4 (January 1, 2009): 265–72. http://dx.doi.org/10.1080/10398560903002998.

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Objective: The aim of this study was to quantify the costs and resource utilization associated with a relapse of schizophrenia or schizoaffective disorder. Methods: The study comprised a retrospective audit of data from 200 patients diagnosed with schizophrenia or schizoaffective disorder who were admitted to hospital for a relapse of their disorder in two mental health services in Australia between 1 June 2001 and 31 May 2002. Resource use and costing data were collected for 12 months before and 12 months after the hospitalization. Results: There was an increase in contacts per month and associated outpatient costs after the index admission which persisted for the full 12 month data collection period (total of AUD $637). There was also a total increase in hospital costs but this did not persist beyond the first 2 months of the follow-up period and is likely explained by the index admission. Conclusions: Increased healthcare resource utilization and costs results from relapse in patients with schizophrenia or schizoaffective disorder. An increase in service use and costs persist for a considerable time period after an episode of relapse.

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Wechkunanukul, Kannikar Hannah, Shahid Ullah, and Justin Beilby. "Variation in Seeking Care for Cardiovascular Disease and Ambulance Utilization among Migrants in Australia: Time, Ethnicity, and Delay (TED) Study III." International Journal of Environmental Research and Public Health 19, no. 3 (January 28, 2022): 1516. http://dx.doi.org/10.3390/ijerph19031516.

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Insight into differences in seeking medical care for chest pain among migrant populations is limited. This study aimed to determine ethnic differences in seeking care behaviors and using ambulances among migrants compared to an Australian-born group. A total of 607 patients presenting with chest pain to a tertiary hospital between 1 July 2012 and 30 June 2014 were randomly selected. Data from the emergency department dataset and medical record reviews were collected and linked for analysis. The migrant group was stratified into nine ethnic groups for analysis based on the Australian Standard Classification of Cultural and Ethnic Groups. The overall median prehospital delay time was 3.7 (1.5, 10.7) h, which ranged from 2.5 (1.0, 10.7) (Southern and Eastern European group) to 6.0 (2.3, 20.6) (Sub-Saharan African group). The median decision time was 2.0 (0.8, 7.9) h, which ranged from 1.5 (Australian-born group) to 4.5 h (Sub-Saharan African group). Five ethnic groups had significantly longer decision times compared to the Australian-born group. Decision time accounted for 58.4% of pre-hospital delay time. Migrant patients were 60% less likely to seek care for chest pain within one hour (odds ratio 0.40, (0.23–0.68), p = 0.001). There was no significant difference in ambulance utilization between migrant and Australian-born groups. In conclusion, ethnic differences in seeking care for chest pain do exist, and ethnicity plays a vital role in a longer delay in seeking care. To reduce the delays and improve patient outcomes, appropriate health campaigns focusing on ethnic differences among migrant populations and normalizing cultural competency into practice are recommended.

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Lystad, Reidar P., Frances Rapport, Andrew Bleasel, Geoffrey Herkes, Armin Nikpour, and Rebecca Mitchell. "Hospital service utilization trajectories of individuals living with epilepsy in New South Wales, Australia, 2012–2016: A population-based study." Epilepsy & Behavior 105 (April 2020): 106941. http://dx.doi.org/10.1016/j.yebeh.2020.106941.

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Nicholls, Wendy, Craig Harper, and Suzanne Robinson. "Data Linkage: Cleft Live-Birth Prevalence and Hospitalizations in Western Australia: 1980 to 2016." Cleft Palate-Craniofacial Journal 57, no. 10 (July 29, 2020): 1155–65. http://dx.doi.org/10.1177/1055665620943423.

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Objective: To provide information on live-birth prevalence and hospitalizations, including anxiety and depression, for cleft lip and/or palate (CL/P) in Western Australia (WA), using live-birth data 1980 to 2015. Design: Retrospective data linkage. Setting: Tertiary hospital. Patients: Cleft cohort consisted of people live-born with CL/P in WA between 1980 and 2015, and a gender and age-matched control group. Measures: Live-birth prevalence for CL/P by year. Hospital event counts, event ages, and length of stay (LOS) days by 18 diagnosis groups and 4 birth year categories between the cleft cohort and control group, and between cleft types. Count of events per alive persons per calendar year, and relative risk for proportions of persons in the cleft cohort and control group by diagnosis group. Results: Live-birth prevalence for CL/P was 19.7 per 10 000 (1 in 522). The cleft cohort had significantly higher event counts, lower event ages, and higher LOS days than the control group. Cleft lip and palate had significantly higher event counts, lower event ages, and higher LOS days than cleft lip or cleft palate only. There were 2 significant differences for anxiety or depression between the cleft cohort and control group, lower event ages, and higher LOS days in 1990s birth year category. Conclusions: This study provides a cleft data reference for WA. Live-birth prevalence for all clefts and by cleft type offers an appropriate method for estimating service utilization and provision. Patients with cleft accessed hospital services more frequently, at an earlier age, with higher LOS days than the control group.

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Wertheimer, Graeme, and Luke R. Bereznicki. "Exploring the Quality of Anticoagulant Prescribed for Patients With Atrial Fibrillation at the St John of God Hawkesbury District Health Centre, New South Wales, Australia." Journal of Cardiovascular Pharmacology and Therapeutics 24, no. 1 (July 1, 2018): 46–53. http://dx.doi.org/10.1177/1074248418786264.

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Background: Limited data are available on the clinical management of atrial fibrillation (AF) and its outcomes from an Australian perspective. Objective: To describe the appropriateness of antithrombotic prescribing for patients who presented with a diagnosis of AF to the Hawkesbury St John of God Hospital, New South Wales, Australia. Methods: This retrospective observational study reviewed patients admitted to St John of God Hawkesbury Hospital with AF between June 2016 and June 2017. We calculated stroke risk using the CHA2DS2-VASc score based on medical records and reviewed the appropriateness of oral anticoagulant (OAC) prescribing compared to the 2016 European Society of Cardiology guidelines. Patients were excluded if they had only 1 episode of AF that reverted either spontaneously or upon cardioversion without any documented recurrences. Results: A total of 200 patients (18 years) were included, with 180 (90%) deemed eligible for anticoagulation. Of these 72.8% (n = 131) were prescribed an OAC. A total of 40.0% of patients at low risk of stroke and 68.4% at intermediate risk were prescribed an OAC, respectively. Apixaban was the direct OAC of choice with 36.6% of patients prescribed an OAC receiving apixaban. Warfarin was prescribed for 25.1% of the patients who were prescribed an OAC. Conclusions: The underutilization of anticoagulant medication in high-risk groups and over utilization in low-risk groups remains an ongoing issue in contemporary AF management, and it highlights the need to improve AF-related stroke prevention in our jurisdiction.

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Raymond, W., G. Ngo, M. Ognjenovic, I. Li, P. Cheah, A. Chakera, A. Mclean-Tooke, and J. “. Nossent. "AB1184 BURDEN OF DISEASE AND DIRECT HEALTH CARE COSTS FOR PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS IN WESTERN AUSTRALIA." Annals of the Rheumatic Diseases 79, Suppl 1 (June 2020): 1882.2–1883. http://dx.doi.org/10.1136/annrheumdis-2020-eular.4219.

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Background:Systemic Lupus Erythematosus (SLE) is a chronic multiorgan disease with an unpredictable disease course, which requires monitoring for disease activity, treatment efficacy and comorbidity. Data on the healthcare utilization and cost of SLE, especially from Australia are scarce.Objectives:To determine the healthcare utilisation and estimated costs of inpatient admissions (IP), emergency (ED) and outpatient (OPD) hospital visits and investigations for SLE patients in Western Australia (WA).Methods:This is a longitudinal cohort study of SLE patients seen at a metropolitan public hospital, with ≥6 months of follow-up (n=179, 95% female; baseline age 36.2 ± 15.2 years). Electronic medical records provided data on OPD, ED and IP visits, and investigations conducted at public hospitals from January 2000 - December 2019. Direct healthcare costs were estimated from public hospital expenditure aggregates in FY2018/19.Results:During a median observation period of 11.0 years (IQR 7.4, 13.5), SLE patients required 13,320 OPD visits for a median of 5.3 (IQR 3.0, 9.3) appointments per annum. The majority of OPD visits were with Rheumatology (n=1,986, 14.9%), Immunology (n=1,527, 11.5%), and allied health services (n=1,952, 14.7%), followed by Ophthalmology (n=1,385,10.4%), maternal & fetal health (n=873,6.6%) and Renal medicine (n=844,6.3%). In total 143 patients (79.9%) attended ED on average of 3 times (IQR 2, 7; ED visit rate 44.0 (95%CI 41.0, 47.0) per 100 person years. Overall, 125 patients (69.8%) were hospitalised at average 3 times (IQR 2, 6), with a mean LOS of 5 days (IQR 3, 12) for an IP rate of 37.6 per 100 patient years (95%CI 34.8, 40.5). Only 12.8% of patients did not attend ED or IP in the public health care system. A total of 367,067 laboratory investigations were performed (median nr. of tests per patient 205 (±290) per year) across fields of haematology/biochemistry (89%), immunology (5%), microbiology (4.5%) and histopathology (<1%). Minimum estimates for direct health care cost during the study period were 25.4 million AUD (IP 11m, OPD 6.3m, ED 0.9m and investigations 9.1m) for a crude annual cost of 14,088 AUD per patient.Conclusion:SLE patients have extensive healthcare utilization across a range of outpatient and inpatient services. The main direct costs for this multidisciplinary health care provision are for disease monitoring and in-hospital treatment. Based on these conservative cost estimates to which medication cost need to be added, total costs for SLE care in WA are projected to be significantly higher than reported from Europe.Table 1.Healthcare resource utilisation of patients with systemic lupus erythematosus between in Western Australia between 2000-2019.OutpatientED VisitsAdmissionsPatients, n (%)179 (100)143 (79.9)125 (69.8)Total events, n13,320794678Visit rate per 100 patient years (95%CI)738.9 (726.3, 751.4)44.0 (41.0, 47.2)37.6 (34.8, 40.5)Patients with ≥ 2 visit per annum, n (%)153 (85.5)110 ()94 (%)Patients with ≥ 4 visits per annum, n (%)112 (62.6)Patients with >10 visits per annum, n (%)37 (20.7)17 (%)13 (%)Discharged from ED, n (%)-684-Admitted from the ED, n (%)-110110Average length of stay, median (IQR)-3.0(2.1, 4.0) hrs3.2 (1.5, 5.85) daysPatients with an overnight admission, n (%)-122 (98)Overnight admissions, median (IQR)-3 (1, 5)Patients with admissions >7 days-53 (42.4)Costs AUD (FY2018/19)$6,273,720$869,430$10,997,485Acknowledgments:The authors wish to acknowledge the support of Arthritis Foundation of WA and Lupus WADisclosure of Interests:warren raymond: None declared, Georgia Ngo: None declared, Milica Ognjenovic: None declared, Ian Li: None declared, Patrick Cheah: None declared, Aron Chakera: None declared, Andrew McLean-Tooke: None declared, Johannes (“Hans”) Nossent Speakers bureau: Janssen

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Merollini, Katharina M. D., Louisa G. Gordon, Joanne F. Aitken, and Michael G. Kimlin. "Lifetime Costs of Surviving Cancer—A Queensland Study (COS-Q): Protocol of a Large Healthcare Data Linkage Study." International Journal of Environmental Research and Public Health 17, no. 8 (April 20, 2020): 2831. http://dx.doi.org/10.3390/ijerph17082831.

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Australia-wide, there are currently more than one million cancer survivors. There are over 32 million world-wide. A trend of increasing cancer incidence, medical innovations and extended survival places growing pressure on healthcare systems to manage the ongoing and late effects of cancer treatment. There are no published studies of the long-term health service use and cost of cancer survivorship on a population basis in Australia. All residents of the state of Queensland, Australia, diagnosed with a first primary malignancy from 1997–2015 formed the cohort of interest. State and national healthcare databases are linked with cancer registry records to capture all health service utilization and healthcare costs for 20 years (or death, if this occurs first), starting from the date of cancer diagnosis, including hospital admissions, emergency presentations, healthcare costing data, Medicare services and pharmaceuticals. Data analyses include regression and economic modeling. We capture the whole journey of health service contact and estimate long-term costs of all cancer patients diagnosed and treated in Queensland by linking routinely collected state and national healthcare data. Our results may improve the understanding of lifetime health effects faced by cancer survivors and estimate related healthcare costs. Research outcomes may inform policy and facilitate future planning for the allocation of healthcare resources according to the burden of disease.

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de Gruchy, Adam, Catherine Granger, and Alexandra Gorelik. "Physical Therapists as Primary Practitioners in the Emergency Department: Six-Month Prospective Practice Analysis." Physical Therapy 95, no. 9 (September 1, 2015): 1207–16. http://dx.doi.org/10.2522/ptj.20130552.

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Background Increasing pressure on the emergency department (ED) throughout the world has meant the introduction of innovative ways of working. One such innovation is the advanced practice physical therapist (APP) acting as a primary contact practitioner. There has been little research into the role beyond identifying patient satisfaction with management, cost-effectiveness, and time efficiency. In order to give further support and assist in development of an APP service in the ED, an increased exploration of patient caseload demographics, resource utilization, and management outcomes is needed. Objectives The purpose of this study was to provide quantitative data regarding patient demographics, time efficiency, resource utilization, and management outcomes to examine the APP role in the ED. Design This was a prospective observational study of practice. Setting The study was conducted in a single ED in Melbourne, Australia. Method Data collection was conducted over a 6-month period. Patient demographics and diagnoses, assessment times, hospital resource utilization, and discharge destinations were recorded. Results One thousand seventeen patients (45% female; median age=34 years, interquartile range=25–52) were managed by the APPs; 89% had conditions triaged as not serious or life threatening, and 97% had musculoskeletal pathologies, with the most common diagnosis being fracture or dislocation. Four-hour length-of-stay targets were met in 95% of the patients. Forty-six percent of the patients seen were managed independently, without any support from medical colleagues. The most frequent discharge destination was a referral back to the primary care physician or to hospital outpatient clinics. When comparing similar diagnostic groups, the APPs were significantly more time-efficient than ED physicians in their patient management. Conclusions This study described in detail the caseload managed by the APP in the ED and identified the role as a valuable asset to an ED, managing a great deal of their caseload independently, safely, and time efficiently.

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Mitchell, Rebecca J., Geoffrey Herkes, Armin Nikpour, Andrew Bleasel, Patti Shih, Sanjyot Vagholkar, and Frances Rapport. "Examining health service utilization, hospital treatment cost, and mortality of individuals with epilepsy and status epilepticus in New South Wales, Australia 2012–2016." Epilepsy & Behavior 79 (February 2018): 9–16. http://dx.doi.org/10.1016/j.yebeh.2017.11.022.

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Yong, Michelle K., Shio Yen Tio, Jake Valentine, Joe Sasadeusz, Lynette C. Y. Chee, Ashish Bajel, David Ritchie, and Monica Slavin. "The Economic and Health Utilization Cost of Clinically Significant Cytomegalovirus Infection Following Allogeneic Hematopoietic Stem Cell Transplantation." Blood 134, Supplement_1 (November 13, 2019): 3437. http://dx.doi.org/10.1182/blood-2019-128227.

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Introduction Understanding the economic impact of managing allogeneic hematopoietic stem cell transplant (HSCT) recipients with cytomegalovirus (CMV) is important for future planning within institutional transplant programs. CMV remains the most frequent viral infection following HSCT of which the clinical impact on transplant outcomes has been well described. However, much less is known about the impact of CMV on health resource utilisation, re-admissions and hospital costs. In addition to antiviral therapy, there are nursing, medical and pharmacy costs to consider. We therefore undertook a study to evaluate the clinical and economic burden of CMV infection following HSCT in a large Australian transplant centre operating under a universal health care system. Methods A retrospective single centre study at the Royal Melbourne Hospital, Melbourne, Australia was performed on all consecutive allogeneic HSCT recipients between January 2015 to December 2017. CMV pre-emptive monitoring using quantitative CMV plasma viral load was performed twice weekly from time of transplant to 100 days or longer in the presence of graft versus host disease. Clinically significant CMV (csCMV) was defined as patients receiving anti-CMV treatment, often with a plasma CMV viral load >400 IU/ml. Throughout the study period, the first line anti-CMV therapy was ganciclovir; either as oral valganciclovir for outpatient management in asymptomatic patients or IV ganciclovir as an inpatient for patients with concerns about oral absorption. Second-line therapy was IV foscarnet. Hospital costing data for the first and subsequent re-admissions for the first 12 months were obtained from the business intelligence unit. Financial year costing was available for FY2015/2016 to FY2017/2018. Ethics was approved by the Melbourne Health Human Ethics Review Committee (HREC 2017.368). Results A total of 255 patients underwent alloHSCT with a median age of 51 years (IQR 40-59) with the most common underlying diagnoses being AML (41%), ALL (11%) and MDS (11%) (Table 1). Thirty-one percent of transplants used myeloablative conditioning, 54% had unrelated donors and 3% had an umbilical cord source. Pre-transplant recipient CMV seropositivity was 62% (n=158), of whom 139 had detectable CMV viremia and 104 (40.8%) experienced clinically significant CMV (csCMV). The median duration of CMV treatment was 33 days (IQR 21-63). Re-admission to hospital within the first 12 months of HSCT occurred in 78.4%. There was a greater number of admissions observed in csCMV patients compared to no csCMV (median 3 vs 2 admissions, p=0.001) with the duration of admitted days within the first 12 months being significantly greater in csCMV patients compared to no csCMV (median 65 vs 36 days, p<0.00001). The mean total cost of treating patients with csCMV for the first 12 months compared to the total cost for patients not requiring CMV treatment was A$196,822 (US$147,616) and A$114503 (US $85,877) (p<0.0001), respectively. Therefore the crude attributable mean cost of treating csCMV was A$82,319 (US$61,739) per patient for the first 12 months of HSCT. The greatest significant contributory costs were from pharmacy A$17,807 (US$13,355), nursing A$16,944 (US$12,708) and medical A$5,898 (US$4,423). Conclusions The health care cost and resource utilisation of treating CMV infection following an allogeneic HSCT is substantial and places a heavy burden on limited health resources. In this study, patients experiencing csCMV had an increased number and longer total duration of admissions days compared to patients who did not require CMV treatment. Interventions aimed at reducing the burden of CMV in alloHSCT recipients are required. Disclosures Yong: Merck Ltd: Honoraria. Bajel:AbbVie: Membership on an entity's Board of Directors or advisory committees, Other: travel funding. Ritchie:Sanofi: Honoraria; Novartis: Honoraria; Imago: Research Funding; Beigene: Research Funding; Takeda: Research Funding; BMS: Research Funding; Pfizer: Consultancy; Amgen: Consultancy, Honoraria, Research Funding. Slavin:Merck Ltd: Honoraria, Research Funding.

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Rodwell, John. "Cumulative Health Drivers of Overnight Hospitalization for Australian Working-Age Adults Living Alone: The Early Warning Potential of Functionality." International Journal of Environmental Research and Public Health 19, no. 22 (November 9, 2022): 14707. http://dx.doi.org/10.3390/ijerph192214707.

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There is a need to better understand the drivers of hospital utilization for the large and growing number of adults living alone. The cumulative effect of health drivers can be assessed by initially considering clinically advised information, then considering issues that a general practitioner or the person themselves may know. Logistic regression analyses were conducted on longitudinal data from the Household, Income, and Labor Dynamics in Australia (HILDA) survey with three time points over four years (n = 1019). The significant predictors of overnight hospitalization were the presence of a long-term health condition (Time 1), hospitalization severity and comorbidity (Time 1), work ability (Time 2), physical functioning (Time 2), being separated/divorced and having one or more health care cards. Health issues were predictive up to four years before the hospitalization window. That baseline risk of hospitalization was modified as symptoms and relatively salient changes in functionality accumulated. Specific sub-groups of hospital users had access due to insurance or special coverage. The impact of living alone on hospitalization may be able to be partly addressed through interventions such as improving access to primary care and using early warning triggers such as decreasing functionality to seek primary care before seeking hospitalization.

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Chuang, Tzu-Yi (Arron), Nathan Yii, Masimba Nyandowe, and Ramesh Iyer. "Examine the impact of the implementation of an electronic medical record system on operating theatre efficiency at a teaching hospital in Australia." International Surgery Journal 6, no. 5 (April 29, 2019): 1453. http://dx.doi.org/10.18203/2349-2902.isj20191865.

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Background: The utilization of electronic medical record (EMR) system has become the mainstay of healthcare system in developed countries. In the last five years, Queensland Health has gradually implemented EMR system for hospitals in Queensland, Australia. As far as we are aware, no study has been conducted to assess the impact of the EMR implementation on operating theatre efficiency in Australia.Methods: A retrospective review of general surgery operating room on time start data was performed for a period of 2 months prior and 2 months following implementation of the EHR. A delay was defined as the time between the scheduled start time and “first in” times. Outcomes measured included the total number of sessions run, number of sessions starting late, average delay time and case cancellations.Results: During the EMR training period, the number of sessions which had delayed increased from 13.2％ to 31.0%. Following implementation of the EMR, delays were present for 88% of sessions for the first month with an average delay time of 21.8 minutes. The second month showed an overall improvement with 69% of sessions delayed and a reduced average delay time of 10.4mins.Conclusions: The implementation of a new electronic medical record system is associated with delays in theatre start times especially during the training period and first month of use. Evidence of recovery of service efficiency however is seen by the second month post-implementation with further expected improvement if trends continue.

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Guo, Xiao Yue, Ben Gunawan, and Jasotha Sanmugarajah. "Preliminary study into the impact of immunotherapy on patterns of care and healthcare service utilization in stage IV non-small cell lung cancer in a tertiary hospital setting." Journal of Clinical Oncology 37, no. 8_suppl (March 10, 2019): 92. http://dx.doi.org/10.1200/jco.2019.37.8_suppl.92.

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92 Background: The advent of immunotherapy for Non-Small Cell Lung Cancer (NSCLC) has dramatically altered cancer care. There is increasing clinical evidence to support immunotherapy improving disease-free progression and survivorship. However, there is limited data on how this impacts healthcare in terms of service utilization. Methods: We conducted a retrospective study on patients newly diagnosed with Stage IV NSCLC at a tertiary referral hospital with a large catchment area in Australia. Data was collected for the years 2013 (pre-immunotherapy) and 2016 (immunotherapy in use) to investigate the impact of immunotherapy on treatment patterns, survivorship and healthcare service utilisation. A total of 62 patients were included in the study with equal numbers in both cohorts. Results: Preliminary analysis indicates that since the introduction of immunotherapy in NSCLC treatment protocols, there has been a trend towards improved survivorship. There was a 19% increase in the number of patients surviving to 12 months in the 2016 cohort compared with 2013 cohort patients. Median survival was 6 months and 8 months for 2013 and 2016 cohorts respectively. There was a significantly greater burden of visits to outpatient clinics and treatment day units in the 2016 cohort. We also found fewer Emergency Department presentations and hospital admissions in the 2016 cohort compared with their 2013 counterparts. Conclusions: In conclusion, our study demonstrates increasing healthcare utilisation in ambulatory cancer services with decreased Emergency presentations and hospital admissions following the introduction of immunotherapy for patients with advanced NSCLC. Although this preliminary study suggested important trends, our sample size was small and these effects need to be confirmed in a larger cohort. [Table: see text]

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Admassie, Endalkachew, Leanne Chalmers, and Luke R. Bereznicki. "Thromboembolism and Mortality in the Tasmanian Atrial Fibrillation Study." Journal of Cardiovascular Pharmacology and Therapeutics 23, no. 4 (April 11, 2018): 329–36. http://dx.doi.org/10.1177/1074248418769638.

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Background: Although utilization of anticoagulation in patients with atrial fibrillation (AF) has increased in recent years, contemporary data regarding thromboembolism and mortality incidence rates are limited outside of clinical trials. This study aimed to investigate the impact of the direct oral anticoagulants (DOACs) on the clinical outcomes of patients with AF included in the Tasmanian Atrial Fibrillation Study. Methods: The medical records of all patients with a primary or secondary diagnosis of AF who presented to public hospitals in Tasmania, Australia, between 2011 and 2015, were retrospectively reviewed. We investigated overall thromboembolic events (TEs), ischemic stroke/transient ischemic attack (IS/TIA), and mortality incidence rates in patients admitted to the Royal Hobart Hospital, the main teaching hospital in the state. We compared outcomes in 2 time periods: prior to the availability of DOACs (pre-DOAC; 2011 to mid-2013) and following their general availability after government subsidization (post-DOAC; mid-2013 to 2015). Results: Of the 2390 patients with AF admitted during the overall study period, 942 patients newly prescribed an antithrombotic medication (465 and 477 from the pre-DOAC and post-DOAC time periods, respectively) were followed. We observed a significant decrease in the incidence rates of overall TE (3.2 vs 1.7 per 100 patient-years [PY]; P < .001) and IS/TIA (2.1 vs 1.3 per 100 PY; P = .022) in the post-DOAC compared to the pre-DOAC period. All-cause mortality was significantly lower in the post-DOAC period (2.9 vs 2.2 per 100 PY, P = .028). Increasing age, prior stroke, and admission in the pre-DOAC era were all risk factors for TE, IS/TIA, and mortality in this study population. The risk of IS/TIA was more than doubled (hazard ratio: 2.54; 95% confidence interval: 1.17-5.52) in current smokers compared to ex- and nonsmokers. Conclusion: Thromboembolic event and all-cause mortality rates were lower following the widespread availability of DOACs in this population.

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Cheng, Terence C., Alfons Palangkaraya, and Jongsay Yong. "Hospital utilization in mixed public–private system: evidence from Australian hospital data." Applied Economics 46, no. 8 (January 21, 2014): 859–70. http://dx.doi.org/10.1080/00036846.2013.854307.

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King, Virginia M., Mary E. Chard, and Tess Elliot. "Utilization of Nursing Diagnosis in Three Australian Hospitals." International Journal of Nursing Terminologies and Classifications 8, no. 3 (July 1997): 99–109. http://dx.doi.org/10.1111/j.1744-618x.1997.tb00318.x.

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Hui, Daphne, Bert Dolcine, and Hannah Loshak. "Approaches to Evaluations of Virtual Care in Primary Care." Canadian Journal of Health Technologies 2, no. 1 (January 12, 2022): es0358. http://dx.doi.org/10.51731/cjht.2022.238.

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A literature search informed this Environmental Scan and identified 11 evaluations of virtual care in primary care health settings and 7 publications alluding to methods, standards, and guidelines (referred to as evaluation guidance documents in this report) being used in various countries to evaluate virtual care in primary care health settings. The majority of included literature was from Australia, the US, and the UK, with 2 evaluation guidance documents published by the Heart and Stroke Foundation of Canada. Evaluation guidance documents recommended using measurements that assess the effectiveness and quality of clinical care including safety outcomes, time and travel, financial and operational impact, participation, health care utilization, technology experience including feasibility, user satisfaction, and barriers and facilitators or measures of health equity. Evaluation guidance documents specified that the following key decisions and considerations should be integrated into the planning of a virtual care evaluation: refining the scope of virtual care services; selecting an appropriate meaningful comparator; and identifying opportune timing and duration for the evaluation to ensure the evaluation is reflective of real-world practice, allows for adequate measurement of outcomes, and is comprehensive, timely, feasible, non-complex, and non–resource-intensive. Evaluation guidance documents highlighted that evaluations should be systematic, performed regularly, and reflect the stage of virtual care implementation to encompass the specific considerations associated with each stage. Additionally, evaluations should assess individual virtual care sessions and the virtual care program as a whole. Regarding economic components of virtual care evaluations, the evaluation guidance documents noted that costs or savings are not limited to monetary or financial measures but can also be represented with time. Cost analyses such as cost-benefit and cost-utility estimates should be performed with a specific emphasis on selecting an appropriate perspective (e.g., patient or provider), as that influences the benefits, effects, and how the outcome is interpreted. Two identified evaluations assessed economic outcomes through cost analyses in the perspective of the patient and provider. Evidence suggests that, in some circumstances, virtual care may be more cost-effective and reduces the cost per episode and patient expenses (e.g., travel and parking costs) compared to in-person care. However, virtual care may increase the number of individuals treated, which would increase overall health care spending. Four identified evaluations assessed health care utilization. The evidence suggests that virtual care reduces the duration of appointments and may be more time-efficient compared to in-person care. However, it is unclear if virtual care reduces the use of medical resources and the need for follow-up appointments, hospital admissions, and emergency department visits compared to in-person care. Five identified evaluations assessed participation outcomes. Evidence was variable, with some evidence reporting that virtual care reduced attendance (e.g., reduced attendance rates) and other evidence noting improved attendance (e.g., increased completion rate and decreased cancellations and no-show rates) compared to in-person care. Three identified evaluations assessed clinical outcomes in various health contexts. Some evidence suggested that virtual care improves clinical outcomes (e.g., in primary care with integrated mental health services, symptom severity decreased) or has a similar effect on clinical outcomes compared to in-person care (e.g., use of virtual care in depression elicited similar results with in-person care). Three identified evaluations assessed the appropriateness of prescribing. Some studies suggested that virtual care improves appropriateness by increasing guideline-based or guideline-concordant antibiotic management, or elicits no difference with in-person care.

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Wales, Kylie, Glenn Salkeld, Lindy Clemson, Natasha A. Lannin, Laura Gitlin, Laurence Rubenstein, Kirsten Howard, Martin Howell, and Ian D. Cameron. "A trial based economic evaluation of occupational therapy discharge planning for older adults: the HOME randomized trial." Clinical Rehabilitation 32, no. 7 (March 23, 2018): 919–29. http://dx.doi.org/10.1177/0269215518764249.

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Objective: To compare the cost effectiveness of two occupational therapy–led discharge planning interventions from the HOME trial. Design: An economic evaluation was conducted within the superiority randomized HOME trial to assess the difference in costs and health-related outcomes associated with the enhanced program and the in-hospital consultation. Total costs of health and community service utilization were used to calculate incremental cost-effectiveness ratios, activities of daily living and quality-adjusted life years. Setting: Medical and acute care wards of Australian hospitals ( n=5). Subjects: A total of 400 people ≥ 70 years of age. Interventions: Participants were randomized to either (1) an enhanced program (HOME), involving pre/post discharge visits and two follow-up phone calls, or (2) an in-hospital consultation using the home and community environment assessment and the Lawton Instrumental Activities of Daily Living assessment. Main measures: Nottingham Extended Activities of Daily Living (global measure of activities of daily living) and SF-12V2, transformed into SF-6D (quality-adjusted life year) measured at baseline and three months post discharge. Results: The cost of the enhanced program was higher than that of the in-hospital consultation. However, a higher proportion of patients showed improvement in activities of daily living in the enhanced program with an incremental cost-effectiveness ratio of $61,906.00 per person with clinically meaningful improvement. Conclusion: Health services would not save money by implementing the enhanced program as a routine intervention in medical and acute care wards. Future research should incorporate longer time horizons and consider which patient groups would benefit from home visits.

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Sawyer, Michael G., Aspasia Sarris, Peter A. Baghurst, Catherine A. Cornish, and Ross S. Kalucy. "The Prevalence of Emotional and Behaviour Disorders and Patterns of Service Utilisation in Children and Adolescents." Australian & New Zealand Journal of Psychiatry 24, no. 3 (September 1990): 323–30. http://dx.doi.org/10.3109/00048679009077699.

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This study compared the prevalence of emotional and behavioural disorders in children attending schools of different socio-economic class. In addition, the study compared the rate of service utilization by children with and without disorders. Using cutoff scores recommended for use with Australian children, the prevalence of disorders in schools of different socio-economic class ranged from 2.3±2.2 to 13.9±5.3 per 100 children, with the highest prevalence being found in the lower socio-economic class schools. Although few children with disorders had been seen in a mental health clinic, advice had been sought from other services with regard to 66% of these children. This high rate of service utilization by children with disorders highlights the key role that general practitioners, school guidance officers and hospital services could play in facilitating the early identification and management of children with emotional and behavioural disorders.

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Rajmokan, M., A. Morton, J. Marquess, E. G. Playford, and M. Jones. "Development of a risk-adjustment model for antimicrobial utilization data in 21 public hospitals in Queensland, Australia (2006–11)." Journal of Antimicrobial Chemotherapy 68, no. 10 (May 19, 2013): 2400–2405. http://dx.doi.org/10.1093/jac/dkt175.

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Chen, Keng, Adrian See, and Stephen Shumack. "Website discussion forums: Results of an Australian project to promote telecommunication in dermatology." Journal of Telemedicine and Telecare 8, no. 3_suppl (December 2002): 5–6. http://dx.doi.org/10.1258/13576330260440673.

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summary Discussion forums on the Internet allow doctors to discuss issues of interest in a rapid, convenient and educational manner. In March 2002, the department of dermatology at the St George Hospital in Sydney launched a national Website with an online discussion forum for dermatologists. Features of the Website forum include the ability to moderate the discussion boards, a choice of public or private discussions and receipt of automatic email notifications. Over three months, three dermatologists posted a total of 13 messages on three different topics. The low rate of participation by dermatologists may have been due to lack of time or familiarity with the technology. Increased promotion to and education of dermatologists who are most likely to use the discussion forum may improve utilization of this means of communication.

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Sezgin, Gorkem, Ling Li, Roger Wilson, Johanna I. Westbrook, Robert Lindeman, Elia Vecellio, and Andrew Georgiou. "Laboratory Test Utilization and Repeat Testing for Inpatients of Age 80 and Over in Australia: A Retrospective Observational Study." Journal of Applied Laboratory Medicine 4, no. 2 (September 1, 2019): 143–51. http://dx.doi.org/10.1373/jalm.2019.029025.

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Abstract Introduction Repeat laboratory testing is often necessary in hospitals. However, frequent blood draws can be harmful to older patients. The objective of this study was to identify the most frequently ordered laboratory tests and repeat testing rates for these tests among older inpatients. Methods A retrospective observational study of inpatients of age 80 years and over in 4 public hospitals in New South Wales, Australia, was conducted between 2008 and 2013. Proportions of laboratory tests and proportions of repeated tests among the most frequently used tests were reported. Results There were 42739 patients with 108003 admissions (56.2% women; 43.2% of ages 80–84). Of these admissions, 95.9% had a laboratory test, with 3012577 tests recorded. Five tests accounted for 62% of all tests and were present in 98.5% of admissions: electrolytes urea and creatinine (EUC; 18% of all tests ordered), complete blood count (CBC; 16.7%), calcium magnesium phosphate (CaMgPhos; 10.2%), liver function test (LFT; 9.0%), and C-reactive protein (CRP; 8.0%). Proportions of repeat tests for this group performed outside recommended minimum repeat intervals were 10.3% EUC, 8.9% CBC, 41.5% CRP, 68.2% CaMgPhos, and 65.2% LFT tests. An exponential increase in repeat testing for all 5 tests was observed around 24 h after a previous test. Conclusion Compliance with guidelines on repeat testing intervals among older patients is variable. A better understanding of the underlying reasons for repeat testing would allow targeting of interventions, including decision support, to improve laboratory use for older inpatients.

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Parthasarathi, Gurumurthy, Madhan Ramesh, Karin Nyfort-Hansen, and Bahubali Gundappa Nagavi. "Clinical Pharmacy in a South Indian Teaching Hospital." Annals of Pharmacotherapy 36, no. 5 (May 2002): 927–32. http://dx.doi.org/10.1345/aph.1a223.

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OBJECTIVE: To describe how clinical pharmacy is helping to improve medication use at a South Indian teaching hospital by addressing medication use problems, which are commonly encountered in India. SUMMARY: Clinical pharmacy is practiced in many countries and makes a significant contribution to improved drug therapy and patient care. India is a country with significant problems with medication use, but until recently Indian pharmacists have not been educated for a patient-care role. Postgraduate pharmacy practice programs have been established at 2 pharmacy colleges in South India as a result of a joint Indo-Australian program of cooperation. At a teaching hospital associated with the colleges, clinical pharmacy services such as drug information, medication counseling, drug therapy review, adverse drug reaction reporting, and the preparation of antibiotic guidelines are assisting clinicians to improve drug therapy and patient care. Seven hundred twenty-seven requests for drug information were received from July 1997 to February 2001, and 543 suspected adverse drug reactions were evaluated from November 1997 to February 2001. The most common drug classes causing adverse drug reactions were antibiotics, nonsteroidal antiinflammatory drugs, and antitubercular agents. Physician opinion and service utilization have also been surveyed: 82% of respondents had sought drug information from the Clinical Pharmacy Department and 71% of respondents had sought advice on individual patient management. The success of this program is raising awareness of clinical pharmacy among pharmacy educators elsewhere in India and has led to the introduction of clinical pharmacy services at other Indian hospitals.

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Pandya, Ekta Yogeshkumar, Elizabeth Anderson, Clara Chow, Yishen Wang, and Beata Bajorek. "Contemporary utilization of antithrombotic therapy for stroke prevention in patients with atrial fibrillation: an audit in an Australian hospital setting." Therapeutic Advances in Drug Safety 9, no. 2 (December 13, 2017): 97–111. http://dx.doi.org/10.1177/2042098617744926.

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Background: To document antithrombotic utilization in patients with nonvalvular atrial fibrillation (NVAF), particularly, recently approved NOACs (nonvitamin K antagonist oral anticoagulants) and warfarin; and identify factors predicting the use of NOACs versus warfarin. Methods: A retrospective audit was conducted in an Australian hospital. Data pertaining to inpatients diagnosed with atrial fibrillation (AF) admitted between January and December 2014 were extracted. This included patient demographics, risk factors (stroke, bleeding), social history, medical conditions, medication history, medication safety issues, medication adherence, and antithrombotic prescribed at admission and discharge. Results: Among 199 patients reviewed, 84.0% were discharged on antithrombotics. Anticoagulants (± antiplatelets) were most frequently (52.0%) prescribed (two-thirds were prescribed warfarin, the remainder NOACs), followed by antiplatelets (33.0%). Among 41 patients receiving NOACs, 59.0% were prescribed rivaroxaban, 24.0% dabigatran, and 17.0% apixaban. Among patients aged 75 years and over, antiplatelets were most frequently used (37.0%), followed by warfarin (33.0%), then NOACs (14.0%). Compared with their younger counterparts, patients aged 75 years and over were significantly less likely to receive NOACs (14.0% versus 28.0%, p = 0.01). Among the ‘most eligible’ patients (Congestive Cardiac Failure, Hypertension (, Age ⩾ 75 years, Age= 65-74 years, Diabetes Mellitus, Stroke/ Transient Ischaemic Attack/ Thromboembolism, Vascular disease, Sex female[CHA2DS2-VASc] score ⩾2 and no bleeding risk factors), 46.0% were not anticoagulated on discharge. Patients with anaemia (68.0% versus 86.0%, p = 0.04) or a history of bleeding (65.0% versus 87.0%, p = 0.01) were less likely to receive antithrombotics compared with those without these risk factors. Warfarin therapy was less frequently prescribed among patients with cognitive impairment compared with patients with no cognitive issues (12.0% versus 23.0%, p = 0.01). Multivariate logistic regression modelling identified that patients with renal impairment were 3.6 times more likely to receive warfarin compared with NOACs (odds ratio = 3.6, 95% confidence interval = 0.08–0.90, p = 0.03, 60.0% correctly predicted; Cox and Snell R2 = 0.51, Nagelkerke R2 = 0.69). Conclusion: Despite the availability of NOACs, warfarin remains a preferred treatment option, particularly among patients with renal impairment. The high proportion of eligible patients still being prescribed antiplatelet therapy or ‘no therapy’ needs to be addressed.

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Jones, Rodney P. "A Model to Compare International Hospital Bed Numbers, including a Case Study on the Role of Indigenous People on Acute ‘Occupied’ Bed Demand in Australian States." International Journal of Environmental Research and Public Health 19, no. 18 (September 7, 2022): 11239. http://dx.doi.org/10.3390/ijerph191811239.

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Comparing international or regional hospital bed numbers is not an easy matter, and a pragmatic method has been proposed that plots the number of beds per 1000 deaths versus the log of deaths per 1000 population. This method relies on the fact that 55% of a person’s lifetime hospital bed utilization occurs in the last year of life—irrespective of the age at death. This is called the nearness to death effect. The slope and intercept of the logarithmic relationship between the two are highly correlated. This study demonstrates how lines of equivalent bed provision can be constructed based on the value of the intercept. Sweden looks to be the most bed-efficient country due to long-term investment in integrated care. The potential limitations of the method are illustrated using data from English Clinical Commissioning Groups. The main limitation is that maternity, paediatric, and mental health care do not conform to the nearness to death effect, and hence, the method mainly applies to adult acute care, especially medical and critical care bed numbers. It is also suggested that sensible comparison can only be made by comparing levels of occupied beds rather than available beds. Occupied beds measure the expressed bed demand (although often constrained by access to care issues), while available beds measure supply. The issue of bed supply is made complex by the role of hospital size on the average occupancy margin. Smaller hospitals are forced to operate at a lower average occupancy; hence, countries with many smaller hospitals such as Germany and the USA appear to have very high numbers of available beds. The so-called 85% occupancy rule is an “urban myth” and has no fundamental basis whatsoever. The very high number of “hospital” beds in Japan is simply an artefact arising from “nursing home” beds being counted as a “hospital” bed in this country. Finally, the new method is applied to the expressed demand for occupied acute beds in Australian states. Using data specific to acute care, i.e., excluding mental health and maternity, a long-standing deficit of beds was identified in Tasmania, while an unusually high level of occupied beds in the Northern Territory (NT) was revealed. The high level of demand for beds in the NT appears due to an exceptionally large population of indigenous people in this state, who are recognized to have elevated health care needs relative to non-indigenous Australians. In this respect, indigenous Australians use 3.5 times more occupied bed days per 1000 deaths (1509 versus 429 beds per 1000 deaths) and 6 times more occupied bed days per 1000 population (90 versus 15 beds per 1000 population) than their non-indigenous counterparts. The figure of 1509 beds per 1000 deaths (or 4.13 occupied beds per 1000 deaths) for indigenous Australians is indicative of a high level of “acute” nursing care in the last months of life, probably because nursing home care is not readily available due to remoteness. A lack of acute beds in the NT then results in an extremely high average bed occupancy rate with contingent efficiency and delayed access implications.

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Fowler, Nathan H., Michael Dickinson, Monalisa Ghosh, Andy Chen, Charalambos Andreadis, Ranjan Tiwari, Aisha Masood, et al. "Assessment of Healthcare Resource Utilization and Costs in Patients with Relapsed or Refractory Follicular Lymphoma Undergoing CAR-T Cell Therapy with Tisagenlecleucel: Results from the Elara Study." Blood 138, Supplement 1 (November 5, 2021): 3533. http://dx.doi.org/10.1182/blood-2021-145741.

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Abstract Background: Follicular lymphoma (FL) is the second most frequently diagnosed Non-Hodgkin lymphoma subtype in Western countries. Patients often undergo multiple lines of therapy over many years throughout the course of their disease with worse survival after each successive line of therapy. Recent findings from the ELARA trial showed that tisagenlecleucel, a chimeric antigen receptor (CAR)-T cell therapy, had durable complete response rate of 66.0%, with a probability of 79% (95% CI, 66%-87%) to remain in response ≥6 months (overall response rate 86.2%) in patients with relapsed or refractory (r/r) FL. Prior evidence in patients with r/r diffuse large B-cell lymphoma demonstrated that tisagenlecleucel can be safely infused in an outpatient setting and may reduce healthcare resource utilization (HCRU) (Lyman et al, 2020). we present the first HCRU among patients with r/r FL who received tisagenlecleucel in the ELARA trial. Methods: ELARA is a Phase II, single-arm, multicenter study of tisagenlecleucel in adult patients with r/r FL. All patients underwent lymphodepleting chemotherapy with fludarabine and cyclophosphamide or bendamustine, before receiving a single IV infusion of tisagenlecleucel (0.6-6×10 8 CAR-positive viable T cells) that was administered at the investigator's discretion in either the inpatient or outpatient setting. Patients were followed for a median of 11 months, and HCRU was characterized using hospitalization data collected from the first day of infusion up to the second month after treatment, the time period wherein occurrence of CAR-T cell-related adverse events (AEs) such as cytokine release syndrome and immune effector cell-associated neurotoxicity syndrome are most frequent. Information on the length of stay (dates of admission), hospital facilities used, and discharge information were assessed. Healthcare costs associated with hospitalizations and intensive care unit (ICU) admissions were estimated by applying unit costs obtained from published literature. All costs were from healthcare system perspective and were inflated to 2020 US Dollars. Results: Among 97 patients with r/r FL who received tisagenlecleucel infusion, 17 patients (18%) were infused in an outpatient setting and 80 patients (82%) were admitted for inpatient infusion and monitoring. Of the 30 clinical trial sites, 4 sites in US and 1 site in Australia used outpatient administration; at these sites, 68% (17 of 25) of the patients were treated in an outpatient setting. Patients treated in the outpatient setting were more likely to have ECOG performance status of 0 and a more favorable FLIPI score, but more frequently had grade 3A FL, primary refractory disease, and >5 lines of prior antineoplastic therapy than in the inpatient setting (Table). In the outpatient setting, 6 of 17 patients (35%) did not require any hospitalization during the first 2 months post-infusion, whereas 11 of 17 patients (65%) were hospitalized for AEs at a median of 3 days (range 1-25) post-infusion. Patients treated in the inpatient setting had longer total hospitalization days (mean ± SD: 14.3 ± 8.42 vs 5.0 ± 2.16 days) and longer average length of stay (mean ± SD: 13.8 ± 8.54 vs 4.3 ± 1.4 days) compared with the outpatient group. None of the outpatients required ICU admission during the 2 months post-infusion, whereas 7 patients (9%) in the inpatient setting were admitted to the ICU, for a total mean ± SD duration of 5.6 ± 4.47 days (Table). Mean overall hospitalization costs for inpatients were $40,054 per patient, which included $36,351 for inpatient stays and $3,703 for ICU, and $7,477 per patient for outpatients, which are only for inpatient stays as there were no ICU stays. Conclusions: In the ELARA trial, hospitalization and ICU patterns varied substantially between inpatient and outpatient settings and favored HCRU in the outpatient setting. Among patients treated in the outpatient setting, one third of patients did not require hospitalization during the post-infusion period; those who did had a lower average length of stay than the patients infused in an inpatient setting. The mean hospitalization costs in the post-infusion period were substantially lower in the outpatient versus inpatient setting due to the lack of ICU admissions. These data suggest that tisagenlecleucel can be safely administered in the outpatient setting, which may reduce HCRU for patients with r/r FL. Clinical trial information: NCT03568461 Figure 1 Figure 1. Disclosures Fowler: BostonGene, Corp: Current Employment, Current holder of stock options in a privately-held company; Bristol Myers Squibb, F. Hoffmann-La Roche Ltd, TG Therapeutics and Novartis: Membership on an entity's Board of Directors or advisory committees, Research Funding. Dickinson: Gilead Sciences: Consultancy, Honoraria, Speakers Bureau; MSD: Consultancy, Honoraria, Research Funding, Speakers Bureau; Janssen: Consultancy, Honoraria; Bristol-Myers Squibb: Consultancy, Honoraria; Takeda: Research Funding; Celgene: Research Funding; Amgen: Honoraria; Roche: Consultancy, Honoraria, Other: travel, accommodation, expenses, Research Funding, Speakers Bureau; Novartis: Consultancy, Honoraria, Research Funding, Speakers Bureau. Chen: Mesolbast: Honoraria; Morphosys: Honoraria. Andreadis: GenMAB: Research Funding; Epizyme: Honoraria; Atara: Consultancy, Honoraria; Crispr Therapeutics: Research Funding; Novartis: Research Funding; BMS/Celgene: Research Funding; Karyopharm: Honoraria; Incyte: Honoraria; Kite: Honoraria; Merck: Research Funding; Roche: Current equity holder in publicly-traded company, Ended employment in the past 24 months; TG Therapeutics: Honoraria. Tiwari: Novartis Healthcare private limited: Current Employment. Masood: Novartis: Current Employment, Current holder of stock options in a privately-held company. Ramos: Novartis: Current Employment, Current equity holder in publicly-traded company. Bollu: Novartis: Current Employment, Current equity holder in publicly-traded company. Jousseaume: Novartis: Current Employment, Current equity holder in publicly-traded company. Thieblemont: Kyte: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel, Accommodations, Expenses ; Janssen: Honoraria, Membership on an entity's Board of Directors or advisory committees; Roche: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel, Accommodations, Expenses , Research Funding; Takeda: Honoraria, Membership on an entity's Board of Directors or advisory committees; Gilead Sciences: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel, Accommodations, Expenses ; Novartis: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel, Accommodations, Expenses ; Bristol Myers Squibb/Celgene: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel, Accommodations, Expenses ; Incyte: Honoraria, Membership on an entity's Board of Directors or advisory committees; Abbvie: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel, Accommodations, Expenses ; Cellectis: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel, Accommodations, Expenses ; Hospira: Research Funding; Bayer: Honoraria; Amgen: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel, Accommodations, Expenses . Dreyling: BeiGene: Consultancy; Astra Zeneca: Consultancy, Speakers Bureau; Janssen: Consultancy, Research Funding, Speakers Bureau; Novartis: Consultancy, Speakers Bureau; Roche: Consultancy, Research Funding, Speakers Bureau; Abbvie: Research Funding; Celgene: Consultancy, Research Funding, Speakers Bureau; Amgen: Speakers Bureau; Genmab: Consultancy; Incyte: Consultancy, Speakers Bureau; Gilead/Kite: Consultancy, Research Funding, Speakers Bureau; Bayer HealthCare Pharmaceuticals: Consultancy, Research Funding, Speakers Bureau. Schuster: Celgene: Consultancy, Honoraria, Research Funding; Nordic Nanovector: Consultancy; Novartis: Consultancy, Honoraria, Patents & Royalties, Research Funding; Abbvie: Consultancy, Research Funding; Acerta Pharma/AstraZeneca: Consultancy; Alimera Sciences: Consultancy; BeiGene: Consultancy; Juno Theraputics: Consultancy, Research Funding; Loxo Oncology: Consultancy; Tessa Theraputics: Consultancy; Genentech/Roche: Consultancy, Research Funding; Pharmaclyclics: Research Funding; Adaptive Biotechnologies: Research Funding; Merck: Research Funding; Incyte: Research Funding; TG Theraputics: Research Funding; DTRM: Research Funding.

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Salmasi, S., A. Kelly, S. J. Bartlett, M. De Wit, L. March, A. Tong, P. Tugwell, K. Tymms, S. Verstappen, and M. De Vera. "THU0565 RESEARCHERS’ PERSPECTIVES ON ADHERENCE INTERVENTION RESEARCH AND OUTCOMES IN RHEUMATOLOGY: AN INTERNATIONAL QUALITATIVE STUDY." Annals of the Rheumatic Diseases 79, Suppl 1 (June 2020): 524.2–524. http://dx.doi.org/10.1136/annrheumdis-2020-eular.4787.

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Background:Medication non-adherence is a significant problem among patients with rheumatic diseases. Research on adherence interventions in rheumatology is limited and disappointing, with studies using heterogeneous outcomes. Understanding these limitations is needed to inform the design of better interventions and research studies.Objectives:To describe researchers’ perspectives and experiences on adherence intervention research and outcomes in rheumatology.Methods:Semi-structured interviews using video conference were conducted with researchers who had been an investigator on an adherence study of any design in the past 10 years. Interviews were recorded and transcribed verbatim. Participants were asked about their experiences with conducting adherence research and perspectives on introduction of a core domain set of outcomes for adherence intervention trials in rheumatology. Data collection and thematic analysis were conducted iteratively, until saturation.Results:We interviewed 13 researchers from seven countries (Australia, Belgium, Canada, Netherland, Thailand, UK, and USA). A majority worked in academia (75%), specialized in epidemiology and/or health services research (62%) and had led between 2-5 adherence studies in the past five years (62%).Three themes were identified:1) challenges in designing, conducting and evaluating adherence studies;2) current outcomes in adherence intervention studies and their relevance; and3) implementing a core domain set of outcomes for adherence intervention studies.Major challenges in conducting adherence research included inconsistent adherence terminology and measurement. Participants noted a lack of guidance on outcome selection and measurement when evaluating the effectiveness of an adherence intervention and indicated their preference for research to report adherence, intervention-specific, and health-related outcomes. Finally, implementing a core domain set of outcomes was thought to be challenging but valuable in strengthening the evidence (by facilitating meta-analysis), and improving clinical outcomes (by informing clinicians about the effectiveness of interventions).Conclusion:Adherence research in rheumatology has been hindered by lack of standardization and guidance on terminology, measurement and outcome selection. Our findings form the basis for recommendations for improving the design, conduct and evaluation of adherence intervention studies in rheumatology, particularly for developing a core domain set of outcomes to improve consistency and facilitate comparisons.Table 1.Themes and representative quotations.Theme 1: Challenges in designing, conducting and evaluating studies of adherence interventions“…the people you often most want in your sample are the people who are non-adherent and often the people who are non-adherent are the people who are hardest to recruit.”“Long term the issue has been about measurements because people confuse and conflate various aspects of medication adherence.Theme 2: Current outcomes in adherence intervention studies and their relevance“you have a whole range of outcomes…psychological outcomes…there’s measures of health care utilization and things like attendance at hospital, nurse appointments and duration, things like times off work,, and also all the relevant clinical outcomes.”Theme 3: Implementing a core domain set of outcomes for adherence intervention studies“…will make trials more comparable and increase the likelihood that you’d be able to combine efforts internationally”Disclosure of Interests:Shahrzad Salmasi: None declared, Ayano Kelly: None declared, Susan J. Bartlett Consultant of: Pfizer, UCB, Lilly, Novartis, Merck, Janssen, Abbvie, Speakers bureau: Pfizer, UCB, Lilly, Novartis, Merck, Janssen, Abbvie, Maarten de Wit Grant/research support from: Dr. de Wit reports personal fees from Ely Lilly, 2019, personal fees from Celgene, 2019, personal fees from Pfizer, 2019, personal fees from Janssen-Cilag, 2017, outside the submitted work., Consultant of: Dr. de Wit reports personal fees from Ely Lilly, 2019, personal fees from Celgene, 2019, personal fees from Pfizer, 2019, personal fees from Janssen-Cilag, 2017, outside the submitted work., Speakers bureau: Dr. de Wit reports personal fees from Ely Lilly, 2019, personal fees from Celgene, 2019, personal fees from Pfizer, 2019, personal fees from Janssen-Cilag, 2017, outside the submitted work., Lyn March: None declared, Allison Tong: None declared, Peter Tugwell: None declared, Kathleen Tymms: None declared, Suzanne Verstappen Grant/research support from: BMS, Consultant of: Celltrion, Speakers bureau: Pfizer, Mary De Vera: None declared

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Siddiqui, Emaduddin, Muhammad Daniyal, Muhammad Abdul Raffay Khan, Saif ul Islam Siddiqui, Zain ul Islam Siddiqui, and Walid Farooqi. "Triage for low income countries: is ESI truly the way forward?" International Journal Of Community Medicine And Public Health 5, no. 11 (October 25, 2018): 5003. http://dx.doi.org/10.18203/2394-6040.ijcmph20184606.

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A triage desk at the doorstep of an emergency department (ED) is to “sort, select or prioritize” presenting patients as per their clinical needs. Many triage systems exist globally, however, the need and/or practical applicability of any triage is dictated by the hospital system and setting. In low-income/developing countries, the triage system must be capable and proficient enough to pair the right patient with the most appropriate management. Ineffective and/or in-efficient triage leads to overcrowding, delays, inappropriate resource utilization and patient dissatisfaction. A sizeable proportion of triage systems rely on three to five levels/tiers. Five level triage systems, such as the Australian Triage System (ATS) and the Canadian Triage Acuity Scale (CTAS), to name a few, are widely used worldwide. Based on door-to-physician time, these systems not only allow the institution to monitor and meet the timelines recommended by the institution policies, but have also been identified as an effective triage tool hence widely adopted in hospitals of developed countries. However, both ATS and CTAS are time-consuming and require skilled and qualified nursing staff to process it. On the other hand, the ESI (Emergency Severity Index) scale which is also a 5-level triage system, categorizes patients based on resource requirement and severity of the patient’s condition. Although ESI is in the developing phase, it is proving to be nurse-friendly and reliable in both intra and inter-rated conditions. The aim of this paper is to critically analyze the merits and pitfalls of the ESI system, in addition to proposing further modifications, in order to fulfill the needs of a developing country.

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Steel, Zachary, Robert Mcdonald, Derrick Silove, Adrian Bauman, Phil Sandford, Jennifer Herron, and I. Harry Minas. "Pathways to the First Contact with Specialist Mental Health Care." Australian & New Zealand Journal of Psychiatry 40, no. 4 (April 2006): 347–54. http://dx.doi.org/10.1080/j.1440-1614.2006.01801.x.

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Objective: To examine the pathways to mental health care followed by patients presenting for the first time to community- and hospital-based services and the degree to which individual characteristics, cultural background, illness type, severity and service-related variables influence the time and pathways taken to reach care. Method: One hundred and forty-six consecutive Australian-born, Asian and Arabicspeaking patients making their first lifetime contact with mental health services in two area health regions were included. Symptom severity was assessed using the Health of the Nations Outcome Scales. Illness explanatory models, social support, English-language proficiency and acculturation were also assessed. Results: An average of three professional consultations were made prior to first contact with public mental health services. Family physicians occupied a pivotal role in the helpseeking pathway with 53% of patients consulting a general practitioner. The median time taken to reach specialist mental health services was 6 months, with significantly shorter time for patients with psychotic disorders. Individual variables such as gender, social support, ethnicity and English flency were not associated with delays in receiving public mental health care. Ethnicity was associated with lower utilization of allied health professionals. Conclusions: The data suggest that social and cultural factors influence the range of professionals consulted by those with a mental illness but do not delay their presentation to public mental health services.

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Rawstorn, Jonathan Charles, Kylie Ball, Brian Oldenburg, Clara K. Chow, Sarah A. McNaughton, Karen Elaine Lamb, Lan Gao, et al. "Smartphone Cardiac Rehabilitation, Assisted Self-Management Versus Usual Care: Protocol for a Multicenter Randomized Controlled Trial to Compare Effects and Costs Among People With Coronary Heart Disease." JMIR Research Protocols 9, no. 1 (January 27, 2020): e15022. http://dx.doi.org/10.2196/15022.

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Background Alternative evidence-based cardiac rehabilitation (CR) delivery models that overcome significant barriers to access and delivery are needed to address persistent low utilization. Models utilizing contemporary digital technologies could significantly improve reach and fidelity as complementary alternatives to traditional center-based programs. Objective The aim of this study is to compare the effects and costs of the innovative Smartphone Cardiac Rehabilitation, Assisted self-Management (SCRAM) intervention with usual care CR. Methods In this investigator-, assessor-, and statistician-blinded parallel 2-arm randomized controlled trial, 220 adults (18+ years) with coronary heart disease are being recruited from 3 hospitals in metropolitan and regional Victoria, Australia. Participants are randomized (1:1) to receive advice to engage with usual care CR or the SCRAM intervention. SCRAM is a 24-week dual-phase intervention that includes 12 weeks of real-time remote exercise supervision and coaching from exercise physiologists, which is followed by 12 weeks of data-driven nonreal-time remote coaching via telephone. Both intervention phases include evidence- and theory-based multifactorial behavior change support delivered via smartphone push notifications. Outcomes assessed at baseline, 12 weeks, and 24 weeks include maximal aerobic exercise capacity (primary outcome at 24 weeks), modifiable cardiovascular risk factors, exercise adherence, secondary prevention self-management behaviors, health-related quality of life, and adverse events. Economic and process evaluations will determine cost-effectiveness and participant perceptions of the treatment arms, respectively. Results The trial was funded in November 2017 and received ethical approval in June 2018. Recruitment began in November 2018. As of September 2019, 54 participants have been randomized into the trial. Conclusions The innovative multiphase SCRAM intervention delivers real-time remote exercise supervision and evidence-based self-management behavioral support to participants, regardless of their geographic proximity to traditional center-based CR facilities. Our trial will provide unique and valuable information about effects of SCRAM on outcomes associated with cardiac and all-cause mortality, as well as acceptability and cost-effectiveness. These findings will be important to inform health care providers about the potential for innovative program delivery models, such as SCRAM, to be implemented at scale, as a complement to existing CR programs. The inclusion of a cohort comprising metropolitan-, regional-, and rural-dwelling participants will help to understand the role of this delivery model across health care contexts with diverse needs. Trial Registration Australian New Zealand Clinical Trials Registry (ACTRN): 12618001458224; anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374508. International Registered Report Identifier (IRRID) DERR1-10.2196/15022

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Maurer, Matthew J., Vit K. Prochazka, Christopher R. Flowers, Lasse H. Jakobsen, Diego Villa, Caroline Weibull, Elliot J. Cahn, et al. "Event-Free and Overall Survival in over 6,000 Patients Treated with Frontline Immunochemotherapy for Follicular Lymphoma between 2002-2018: First Report from the International FLIPI24 Consortium." Blood 138, Supplement 1 (November 5, 2021): 3527. http://dx.doi.org/10.1182/blood-2021-145883.

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Abstract Background: CD20 antibody plus alkylator and/or anthracycline based immunochemotherapy (IC) is a standard frontline therapy for patients with follicular lymphoma (FL) with 10-year event-free survival (EFS) and overall survival (OS) rates of approximately 50% and 80% respectively in long-term follow-up of clinical trials. Currently available clinical prognostic indices for FL have been designed using PFS and OS endpoints. Early events, commonly defined as progression of disease within 24 months (POD24) or early transformation to a more aggressive histology, are associated with inferior outcomes and increased risk of death due to refractory FL. Timely identification of the minority of patients with elevated mortality risk might enhance clinical management and research strategies. The FLIPI24 Consortium was created to develop a clinical prognostic index using early events as the primary endpoint. We report the outcomes for the pooled cohort and investigate the implications of therapy patterns on potential model development. Methods: Individual patient data were pooled and harmonized from 11 prospective observational cohorts from Europe, North America, and Australia. Patients who were diagnosed with grades 1-3A FL and initiated frontline IC were eligible. EFS was defined as time from start of IC to progression, relapse, retreatment (2nd line), histologic transformation, or death due to any cause. Early events were defined using status at 24 months from start of IC. OS was defined as time from start of IC to death due to any cause. Kaplan Meier curves and Cox proportional hazards models were used to evaluate outcomes by clinical features and therapy types. Results: 9006 patients were abstracted and harmonized, 6111 patients initiated frontline IC between 2002 and 2018 and were included in this analysis. Median age at diagnosis was 61 years (IQR 52-69) and 50% were male. Complete FLIPI data were available in 5637 patients (92%) and 46%, 32%, and 22% were low, intermediate, and high risk, respectively. IC type was 3079 R-CHOP or like (50%) , 1529 R-CVP or like (25%), 918 R-bendamustine (B-R) or like (15%), and 585 fludarabine or other alkylator based IC (10%); 3187 received CD20 antibody maintenance (52%). Patients receiving R-CHOP were younger, more frequently grade 3A, and more frequently had elevated LDH; differences in other characteristics by IC type were not clinically meaningful. At median follow-up of 42 months (IQR 17-72), 2647 patients (43%) had an event (any) and 1494 patients (25%) died. Median survival after an early (non-death) event was 49 months (95% CI: 41-58); 5-year OS was 46% (95% CI: 43-49) compared to 89% (95% CI: 88-90) in patients without POD24. Across all IC types, EFS estimates at 2 and 10 years from start of IC were 80% (95% CI:79-81) and 49% (95% CI:48-51) and OS estimates were 92% (95% CI: 91-92) and 70% (95% CI: 69-72), respectively. FLIPI was highly associated with both EFS (c-statistic=0.61) and OS (c-statistic=0.65) from the initiation of IC (both p<0.0001). There were significant differences in EFS and OS by IC type (both p<0.0001) and use of maintenance was associated with prolonged EFS in landmark analyses at both 6 and 12 months from initiation of IC (both p<0.0001). Treatment patterns changed significantly over the study timeframe. Use of B-R and/or maintenance increased to 30% and 70% respectively in N=2937 patients treated in 2010-2018 (Era2) compared to <1% and 40% respectively in N=3174 patients treated 2002-2009 (Era1). EFS was significantly higher for Era2 compared to Era1 (HR=0.77, 95% CI: 0.71-0.83), which remained significant after adjustment for FLIPI (EFS HR=0.82, 95% CI: 0.76-0.89). However, the association between treatment eras and overall survival was weaker (HR=0.89, 95% CI: 0.79-0.99) and not significant after adjusting for baseline FLIPI (OS HR=0.99, 95% CI: 0.88-1.10). Conclusion: EFS and OS from this large pooled analysis of observational cohorts is similar to long-term follow-up of randomized clinical trials in the IC era and support the use of these data for model development. Modeling efforts for early events should adjust for initial IC selection and use of maintenance therapy. Utilization of bendamustine and/or maintenance therapy increased over the study timeframe from 2002-2018, and Era2 was associated with improved EFS but not OS. This cohort provides comprehensive and robust observational data to define clinical predictors in IC treated patients. Figure 1 Figure 1. Disclosures Maurer: Genentech: Research Funding; Morphosys: Membership on an entity's Board of Directors or advisory committees, Research Funding; Kite Pharma: Membership on an entity's Board of Directors or advisory committees; BMS: Research Funding; Pfizer: Membership on an entity's Board of Directors or advisory committees; Nanostring: Research Funding. Flowers: Janssen: Research Funding; Takeda: Research Funding; National Cancer Institute: Research Funding; Biopharma: Consultancy; BeiGene: Consultancy; Amgen: Research Funding; Celgene: Consultancy, Research Funding; Xencor: Research Funding; Acerta: Research Funding; Bayer: Consultancy, Research Funding; Sanofi: Research Funding; 4D: Research Funding; Adaptimmune: Research Funding; Allogene: Research Funding; EMD: Research Funding; TG Therapeutics: Research Funding; Burroughs Wellcome Fund: Research Funding; Kite: Research Funding; AbbVie: Consultancy, Research Funding; Cellectis: Research Funding; Denovo: Consultancy; Cancer Prevention and Research Institute of Texas: CPRIT Scholar in Cancer Research: Research Funding; Karyopharm: Consultancy; Gilead: Consultancy, Research Funding; Genmab: Consultancy; Epizyme, Inc.: Consultancy; Novartis: Research Funding; Nektar: Research Funding; Morphosys: Research Funding; Iovance: Research Funding; Spectrum: Consultancy; Pfizer: Research Funding; Ziopharm: Research Funding; Guardant: Research Funding; Eastern Cooperative Oncology Group: Research Funding; SeaGen: Consultancy; Pharmacyclics/Janssen: Consultancy; Genentech/Roche: Consultancy, Research Funding; Pharmacyclics: Research Funding. Villa: Janssen: Honoraria; Gilead: Honoraria; AstraZeneca: Honoraria; AbbVie: Honoraria; Seattle Genetics: Honoraria; Celgene: Honoraria; Lundbeck: Honoraria; Roche: Honoraria; NanoString Technologies: Honoraria. Weibull: Jansen-Cilag: Other: part of a research collaboration between Karolinska Institutet and Janssen Pharmaceutica NV for which Karolinska Institutet has received grant support. Ghesquieres: Janssen: Honoraria; Mundipharma: Consultancy, Honoraria; Roche: Consultancy; Celgene: Consultancy, Honoraria; Gilead Science: Consultancy, Honoraria. Kridel: Gilead Sciences: Research Funding. Gandhi: Janssen: Research Funding; Novartis: Honoraria. Cheah: Celgene: Research Funding; TG Therapeutics: Consultancy, Honoraria, Other: advisory; Loxo/Lilly: Consultancy, Honoraria, Other: advisory; AstraZeneca: Consultancy, Honoraria, Other: advisory; AbbVie: Research Funding; Beigene: Consultancy, Honoraria, Other: advisory; Ascentage pharma: Consultancy, Honoraria, Other: advisory; Gilead: Consultancy, Honoraria, Other: advisory; MSD: Consultancy, Honoraria, Other: advisory, Research Funding; Janssen: Consultancy, Honoraria, Other: advisory; Roche: Consultancy, Honoraria, Other: advisory and travel expenses, Research Funding. Hawkes: Gilead: Membership on an entity's Board of Directors or advisory committees; Merck Sharpe Dohme: Membership on an entity's Board of Directors or advisory committees; Antigene: Membership on an entity's Board of Directors or advisory committees; Regeneron: Speakers Bureau; Novartis: Membership on an entity's Board of Directors or advisory committees; Bristol Myers Squib/Celgene: Membership on an entity's Board of Directors or advisory committees, Research Funding; Merck KgA: Research Funding; Specialised Therapeutics: Consultancy; Astra Zeneca: Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Roche: Membership on an entity's Board of Directors or advisory committees, Other: Travel and accommodation expenses, Research Funding, Speakers Bureau; Janssen: Speakers Bureau. Seymour: Takeda: Honoraria, Membership on an entity's Board of Directors or advisory committees; Sunesis: Honoraria, Membership on an entity's Board of Directors or advisory committees; Janssen: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; AstraZeneca: Honoraria, Membership on an entity's Board of Directors or advisory committees; BMS: Honoraria, Membership on an entity's Board of Directors or advisory committees; Gilead: Honoraria, Membership on an entity's Board of Directors or advisory committees; AbbVie: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Mei Pharma: Honoraria, Membership on an entity's Board of Directors or advisory committees; Morphosys: Honoraria, Membership on an entity's Board of Directors or advisory committees; F. Hoffmann-La Roche Ltd: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Celgene: Consultancy, Research Funding, Speakers Bureau. Freeman: Amgen: Honoraria; Celgene: Honoraria; Sanofi: Honoraria, Speakers Bureau; Incyte: Honoraria; Abbvie: Honoraria; Teva: Research Funding; Roche: Research Funding; Janssen: Honoraria, Speakers Bureau; Seattle Genetics: Honoraria; Bristol Myers Squibb: Honoraria, Speakers Bureau. Clausen: Abbvie: Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel expences ASH 2019; Gilead: Consultancy, Other: Travel expences 15th ICML ; Janssen: Honoraria, Membership on an entity's Board of Directors or advisory committees. Wahlin: Gilead Sciences: Research Funding; Roche: Consultancy, Research Funding. Link: Novartis, Jannsen: Research Funding; Genentech/Roche: Consultancy, Research Funding; MEI: Consultancy. Ekstroem Smedby: Janssen Cilag: Research Funding; Takeda: Consultancy. Sehn: Genmab: Consultancy; Novartis: Consultancy; Debiopharm: Consultancy. Trněný: Roche: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel, Accommodations, Expenses; Portola: Honoraria, Membership on an entity's Board of Directors or advisory committees; Novartis: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; 1st Faculty of Medicine, Charles University, General Hospital in Prague: Current Employment; Celgene: Consultancy; Takeda: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel, Accommodations, Expenses; Janssen: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel, Accommodations, Expenses; Bristol-Myers Squibb: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel, Accommodations, Expenses; Amgen: Consultancy, Honoraria; AbbVie: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel, Accommodations, Expenses; MorphoSys: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; AstraZeneca: Honoraria; Gilead Sciences: Consultancy, Honoraria, Other: Travel, Accommodations, Expenses; Incyte: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees. El-Galaly: ROCHE Ltd: Ended employment in the past 24 months; Abbvie: Other: Speakers fee. Cerhan: Celgene/BMS: Other: Connect Lymphoma Scientific Steering Committee, Research Funding; Regeneron Genetics Center: Other: Research Collaboration; Genentech: Research Funding; NanoString: Research Funding.

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Roizblatt, Daniel, Gilgamesh Eamer, Derek Roberts, Chad Ball, Joanne Banfield, Brittany Greene, Precilla Veigas, et al. "Trauma Association of Canada Annual Scientific Meeting, Westin Calgary Calgary, Alberta, Apr. 10–11, 2015Outcomes and opportunities for improvement in self-inflicted blunt and penetrating traumaAbdominal compartment syndrome in the childActive negative pressure peritoneal therapy after abbreviated laparotomy: The intraperitoneal vacuum randomized controlled trialUse of a novel combined RFA/saline energy instrument for arresting ongoing hemorrhage from solid organ injuriesHealth care costs of burn patients from homes without fire sprinklersPenetrating trauma in eastern Ontario: a descriptive analysisThresholds of rotational thrombelastometry (ROTEM) used for the diagnosis and management of bleeding trauma patients: a systematic reviewA quality indicator to measure hospital complications for injury admissionsThromboelastography (TEG) in the management of trauma: implications for the developing worldPotential role of the rural trauma team development course (RTTDC) in the United Arab Emirates (UAE)Applicability of the advanced disaster medical response (ADMR) course, Trinidad and TobagoInflammatory mediators in intra-abdominal sepsis or injury: a scoping reviewEvaluation of the online Concussion Awareness Training Toolkit (CATT) for parents, players and coachesUltrasound assessment of optic nerve sheath diameter (ONSD) in healthy volunteersThe benefits of epidural analgesia in flail chest injuriesMandatory reporting rates of injured alcohol-impaired drivers with suspected alcohol dependence in a level 1 Canadian trauma centre: a single institution’s experienceSimulation implementation in a new pediatric residency program in Haiti: trauma specificsManagement of skull fractures in children younger than 1 year of ageResource use in patients who have sustained a traumatic brain injury within an integrated Canadian trauma system: a multicentre cohort studyResource use intensity in a mature, integrated Canadian trauma system: a multicentre cohort studyRates and determinants of unplanned emergency department visits and readmissions within 30 days following discharge from the trauma service — the Ottawa Hospital experienceAlcohol — screening, brief intervention and referral to treatment (SBIRT): Is it readily available in Canadian trauma centres?Management of traumatic occult hemothorax: a survey among trauma providers in CanadaAn audit of venous thromboembolism prophylaxis: a quality assurance project at our level 1 trauma centreCatecholamines as outcome markers in traumatic brain injuryAre we missing the missed injury? The burden of traumatic missed injuries diagnosed after hospital dischargeThe use of fibrinogen concentrate in trauma: a descriptive systematic reviewVery early initiation of chemical venous thromboembolism prophylaxis after solid organ injury is safe: a call for a national prospective multicentre studyThe 2 student to 1 faculty (2:1) model of teaching the Advanced Trauma Operative Management (ATOM) courseTrauma transfusion in the elderlyCocaine and benzodiazepines are more predictive of an injury severity score greater than 15 compared to alcohol or tetrahydrocannabinol in trauma patients under 18 years oldAre we missing traumatic bowel and mesenteric injuries?The marriage of surgical simulation and telementoring for damage control surgical training of operational first-respondersAdding remote ultrasound control to remote just-in-time telementored trauma ultrasound: a pilot studyDescriptive analysis of morbidity and mortality associated with falls at a level 1trauma centreDevelopment of an ICU transition questionnaire: evaluating the transfer process from ICU, ward, and patient/family stakeholder perspectivesUse of IO devices in trauma: A survey of trauma practitioners in Canada, Australia and New ZealandTime to reversal of medication-induced coagulopathy in traumatic intracranial hemorrhageMeta-analysis of randomized control trials of hospital based violence interventions on repeat intentional injuryBlunt injury of a horseshoe kidney, case report and review of the literatureLegal consequences for alcohol-impaired drivers involved in motor vehicle collisions: a systematic reviewA characterization of major adult sport-related trauma in Nova Scotia, 2000–2013Is hockey the most dangerous pediatric sport? An evaluation of pediatric sport-related injuries treated in Nova ScotiaInterim results of a pilot randomized control trial of an ED-based violence intervention programPre-intubation resuscitation by Canadian physicians: results of a national surveyFirst-responder accuracy using SALT during mass-casualty incident simulationEmergent endotracheal intubation: medications and device choices by Canadian resuscitation physicians“Oh the weather outside is frightful”: Severe injury secondary to falls while installing residential Christmas lightsCan we speak the same language? Understanding Quebec’s inclusive trauma systemAn unusual segmental clavicle fracture treated with titanium elastic nailImpact of the age of stored blood on trauma patient mortality: a systematic reviewInterhospital transfer of traumatic brain injury: utilization of helicopter transportCheerleading injuries: a Canadian perspectivePre-hospital mode of transport in a rural trauma system: air versus groundAnalysis of 15 000 patient transfers to level 1 trauma centre: Injury severity does not matter — just drive, drive, drive!The effects of legislation on morbidity and mortality associated with all-terrain vehicle and motorcycle crashes in Puerto RicoAssessing how pediatric trauma patients are supported nutritionally at McMaster Children’s HospitalOutcomes of conservative versus operative management of stable penetrating abdominal traumaS.T.A.R.T.T. — Evolution of a true multidisciplinary trauma crisis resource management simulation courseDevelopment of criteria to identify traumatic brain injury patients NOT requiring intensive care unit monitoringAssigning costs to visits for injuries due to youth violence — the first step in a cost-effectiveness analysisThere’s no TRIK to it — development of the Trauma Resuscitation in Kids courseResilient despite childhood trauma experiencesA five-year, single-centre review of toxic epidermal necrolysis managementAll in the family: creating and implementing an inclusive provincial trauma registryLessons learned from a provincial trauma transfer systemThe NB Trauma Program: 5 years laterProvincial coordination of injury prevention: the New Brunswick (NB) experienceImproving access and uptake of trauma nursing core course (TNCC): a provincial approachULTRASIM: ultrasound in trauma simultation. Does the use of ultrasound during simulated trauma scenarios improve diagnostic abilities?Traumatic tale of 2 cities, part 1: Does being treated by different EMS affect outcomes in trauma patients destined for transport to level 1 trauma centres in Halifax and Saint John?Traumatic tale of 2 cities, part 2: Does being treated by different hospitals affect outcome in trauma patients destined for transport to Level 1trauma centres in Halifax and Saint John?Protective devices use in road traffic injuries in a developing countryFunctional and anatomical connectivity and communication impairments in moderate to severe traumatic brain injuryCaring and communicating in critical cases: Westlock trauma form, a resource for rural physiciansMonitoring of ocular nerve sheath in traumatic raised intracranial pressure (Moonstrip Study): a prospective blinded observational trialEstablishing an alcohol screening and brief intervention for trauma patients in a multicultural setting in the Middle East: challenges and opportunitiesThe poor compliance to seat belt use in Montréal: an 18 461 road user iPhone-based studyAn iPad-based data acquisition for core trauma registry data in 6 Tanzanian hospitals: 1 year and 13 462 patients later“The Triple-Q Algorithm”: a practical approach to the identification of liver topographyA pan-Canadian bicycle helmet use observational studyDoor to decompression: the new benchmark in trauma craniotomiesAre missed doses of pharmacological thromboprophylaxis a risk factor for thromboembolic complications?Complications following admission for traumatic brain injuryExcessive crystalloid infusion in the first 24 hours is not associated with increased complications or mortalitySBIRT: plant, tend, growReal time electronic injury surveillance in an African trauma centreSBIRT in concert: establishing a new initiativeReview of the current knowledge of the pathophysiology of acute traumatic coagulopathy: implications for current trauma resuscitation practicesFactors associated with primary fascial closure rates in patients undergoing damage control laparotomyFree intraperitoneal fluid on CT abdomen in blunt trauma: Is hospital admission necessary?The need for speed — the time cost of off-site helipadsEndovascular management of penetrating Zone III retroperitoneal injuries in selective patients: a case reportMeasured resting energy expenditure in patients with open abdomens: preliminary data of a prospective pilot studyTraumatic inferior gluteal artery pseudoaneurysm: case report and review of literaturePancreatico duodenectomy, SMA, SMV repair and delayed reconstruction following blunt abdominal trauma. A case report with discussion of trauma whipple and complex pancreatico duodenal injuriesA retrospective evaluation of the effect of the Trauma Team Training program in TanzaniaDoes procalcitonin measurement predict clinical outcomes in critically ill/injured adults managed with the open abdomen technique?In trauma, conventional ROTEM and TEG results are not interchangeable but are similar in clinical applicabilitySevere trauma in the province of New Brunswick: a descriptive epidemiological studyPartnering for success — a road safety strategy for London and regionEvaluation of a patient safety initiative of rapid removal of backboards in the emergency departmentActive negative pressure peritoneal therapy and C-reactive protein levels after abbreviated laparotomy for abdominal trauma or intra-abdominal sepsisA comparison of outcomes: Direct admissions vs. interhospital transfers April 2009–March 2014YEE HA or YEE OUCH! A 5-year review of large animal-related incidentsEarly goal-directed therapy for prevention of hypothermia-related transfusion, morbidity and mortality in severely injured trauma patientsImproving care of adolescent trauma patients admitted to adult trauma centres by fostering collaboration between adult and pediatric partnersExpediting operational damage control laparotomy closure: iTClam v. suturing during damage control surgical simulation trainingAre conventional coagulation tests inadequate in the assessment of acute traumatic coagulopathy?Predictors of long-term outcomes in patients admitted to emergency general surgery services: a systematic review of literatureUse of the iTClamp versus standard suturing techniques for securing chest tubes: A randomized cadaver studyiTClamp application for control of simulated massive upper extremity arterial hemorrhage by tactical policeAssessing performance in the trauma roomThe deadly need for methadone/opiate educationTrends in the management of major abdominal vascular injuries: 2000–2014Addressing high school seniors’ risky behaviours through a hospital-based and peer teaching outreach programScreening for risk of post-traumatic stress disorder after injury in acutely injured children: a systematic reviewThe impact of trauma centre designation levels on surgical delay, mortality and complications: a multicentre cohort studyHow many acutely injured children report subsequent stress symptoms?The frequency of coagulopathy and its significance in an emergency neurotrauma facilityPsychosocial care for injured children: The views of 2500 emergency department physicians and nurses from around the worldDevelopment of the Trauma Electronic Document (TED)Development of trauma team activation criteria for an urban trauma centreBrains and brawn: evaluation of a sports skills and concussion awareness campRegional trauma networks: a tale of 2 pilotsContinuous data quality improvement in a provincial trauma registryDoes the Rural Trauma Team Development Course shorten transfer time?Epidemiology of trauma in Puerto RicoCT scans facilitate early discharge of trauma patientsFeasibility of data collection in a conflict zone to assess the impact on emergency health care deliveryConsent for Emergency Research (CONfER): a national survey of Canadian research ethics board practicesMaking handover safer for our trauma patients through the lens of trauma team leadersChallenges and opportunities to improve trauma transitions of care from emergency to intensive care nursingPhysical disorder following major injury: a population-based studyToward an inclusive trauma system: regional trauma system development in OntarioTraumatic brain injury in British Columbia: current incidence, injury patterns and risk factorsAcute cytokine and chemokine profiles in brain-injured patients: relationship to sympathetic activation and outcomeMultidisciplinary trauma simulation training in a tertiary care centreNon-operative management of blunt splenic injuries: routine radiologic follow-up may reduce the time of activity restrictionModified triple layer peritoneal-aponeurotic transposition: a new strategy to close the open abdomenMesenchymal stem cells locate and differentiate to the trauma site in a blunt rat liver trauma model: preliminary resultsThree indications for the “open abdomen”, anatomical, logistical and physiological: How are they different?Development of an urban trauma centre using lean methodologyThe impact of standardized care in 191 patients with chest tube thoracostomyComplex abdominal wall reconstruction: recommendations from the Canadian Abdominal Wall Reconstruction GroupCompensatory behaviours and cognitions in persons with history of traumaDevelopment of the Kenyatta National Hospital — University of Alberta Orthopedic Trauma Assessment Tool: phase 1 resultsRisk-taking behaviour negatively affects outcome in burn patients." Canadian Journal of Surgery 58, no. 2 Suppl 1 (April 2015): S1—S42. http://dx.doi.org/10.1503/cjs.003415.

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Hillock, Nadine T., Erin Connor, Courtenay Wilson, and Brendan Kennedy. "Comparative analysis of Australian hospital antimicrobial utilization, using the WHO AWaRe classification system and the adapted Australian Priority Antimicrobial List (PAL)." JAC-Antimicrobial Resistance 3, no. 1 (January 18, 2021). http://dx.doi.org/10.1093/jacamr/dlab017.

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Abstract Background In 2020 the Australian Priority Antibacterial List (PAL) was developed to support national surveillance of antibacterial usage. Objectives To compare the WHO AwaRe classification system with the Australian PAL to analyse antibacterial utilization in Australian acute care hospitals. Methods Monthly antibacterial usage rates (defined daily dose per 1000 occupied bed days) were calculated using pharmacy dispensing records together with patient occupancy data for all acute care hospitals contributing to the National Antimicrobial Utilisation Surveillance Program for 2015–19. Annual usage rates as a proportion were determined using the WHO AWaRe and Australian PAL categorization systems. Results In 2019, 70.0% of total-hospital aggregate antibacterial use in Australian acute-care hospitals fell into the WHO Access category, with 29.4% of usage in Watch and 0.6% in the Reserve category. Analysis using the PAL classification system showed 40.1% of hospital usage fell into the Access category, 55.6% in Curb and 3.8% in the Contain categories. On average, cefazolin usage comprised 12.5% of acute hospital usage. Conclusions Cefazolin, a first-line agent for surgical prophylaxis in Australia, was identified as a key antibacterial driving the differing results seen between the two classification systems. Data on the proportions of day surgery relative to inpatient surgical cases would assist the accuracy of benchmarking usage between hospitals using the PAL categorization system. The use of a targeted, nationally approved prioritized classification system can provide a focus for antimicrobial stewardship at a national level, however a clear understanding of the consumption metric used, as well as its limitations, are required for interpretation.

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Eldridge, Damien Sean, Ilke Onur, Malathi R. Velamuri, and Cagatay Koc. "The Impact of Private Hospital Insurance on the Utilization of Hospital Care in Australia." SSRN Electronic Journal, 2013. http://dx.doi.org/10.2139/ssrn.2285383.

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Cox, Ingrid A., Barbara de Graaff, Hasnat Ahmed, Julie Campbell, Petr Otahal, Tamera J. Corte, Yuben Moodley, et al. "The economic burden of idiopathic pulmonary fibrosis in Australia: a cost of illness study." European Journal of Health Economics, October 27, 2022. http://dx.doi.org/10.1007/s10198-022-01538-7.

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Abstract Purpose Idiopathic pulmonary fibrosis (IPF) is a type of interstitial lung disease found mostly in elderly persons, characterized by a high symptom burden and frequent encounters with health services. This study aimed to quantify the economic burden of IPF in Australia with a focus on resource utilization and associated direct costs. Methods Participants were recruited from the Australian IPF Registry (AIPFR) between August 2018 and December 2019. Data on resource utilization and costs were collected via cost diaries and linked administrative data. Clinical data were collected from the AIPFR. A “bottom up” costing methodology was utilized, and the costing was performed from a partial societal perspective focusing primarily on direct medical and non-medical costs. Costs were standardized to 2021 Australian dollars ($). Results The average annual total direct costs per person with IPF was $31,655 (95% confidence interval (95% CI): $27,723–$35,757). Extrapolating costs based on prevalence estimates, the total annual costs in Australia are projected to be $299 million (95% CI: $262 million–$338 million). Costs were mainly driven by antifibrotic medication, hospital admissions and medications for comorbidities. Disease severity, comorbidities and antifibrotic medication all had varying impacts on resource utilization and costs. Conclusion This cost-of-illness study provides the first comprehensive assessment of IPF-related direct costs in Australia, identifies the key cost drivers and provides a framework for future health economic analyses. Additionally, it provided insight into the major cost drivers which include antifibrotic medication, hospital admissions and medications related to comorbidities. Our findings emphasize the importance of the appropriate management of comorbidities in the care of people with IPF as this was one of the main reasons for hospitalizations.

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Velamuri, Malathi R., Damien Sean Eldridge, Cagatay Koc, and Ilke Onur. "The Impact of Private Hospital Insurance on Utilization of Hospital Care in Australia: Evidence from the National Health Survey." SSRN Electronic Journal, 2010. http://dx.doi.org/10.2139/ssrn.1741682.

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Arakawa Martins, Beatriz, Helen Barrie, Renuka Visvanathan, Lyrian Daniel, Larissa Arakawa Martins, Damith Ranasinghe, Anne Wilson, and Veronica Soebarto. "A Multidisciplinary Exploratory Approach for Investigating the Experience of Older Adults Attending Hospital Services." HERD: Health Environments Research & Design Journal, May 26, 2020, 193758672092085. http://dx.doi.org/10.1177/1937586720920858.

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Background: The public areas of the hospital built environment have hardly been investigated for their age-friendliness. Objective: This exploratory, multidisciplinary pilot study investigates the relationship between the physical environment and design of hospital spaces and older people’s outpatient experience. Methods: Sixteen participants were recruited from a geriatric Outpatient Clinic at a metropolitan public hospital in Australia. Participants were engaged in a concurrent mixed-method approach, comprising a comprehensive geriatric survey, walking observation, semi-structured interview and an independent architectural audit. Results: Several elements arising from the hospital environment were identified as facilitators and barriers for its utilization and intrinsically related to participants’ physical capacity. Discussion: Age-friendly hospital design needs to consider strategies to remove barriers for older adults of different capacities, thus promoting healthy aging.

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Viergutz, Hannah-Kathrin Silja, and Michael Apple. "A Comparison of Hospital Area Measurement in Germany, Canada, Australia, and the United States: Part 1." HERD: Health Environments Research & Design Journal, March 16, 2022, 193758672210788. http://dx.doi.org/10.1177/19375867221078838.

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Objectives: This article compares national standards for area measurements of healthcare facilities in four countries and examines the risks and differences that can arise when comparing building areas of healthcare facilities internationally. Background: In the planning and management of healthcare facilities, the utilization and comparison of building floor areas plays a major role. Differences in terminology, classification, and methodology help to reduce planning and cost risks when applied on a local and national level. The proper allocation of building floor space is vital in the design of room programs, determination of floor space, construction costs, and operating costs. Methods: Each of the four hospital area measurement standards is compared to discern similarities and differences. Results: Most countries use a three-tier system of hospital area measurement: building gross area, department gross area, and department net area. Few differences were found between country standards for department area, though the German standards do not fully address this tier. Variation is found in whether a country includes certain functions in the hospital area—such as research space, shell space, or central energy plants—which can have a significant impact on the overall hospital area. Conclusions: This article informs further development of individual country standards and highlights principles to consider for international hospital area comparison.

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Ngo, Linh T., Anand N. Ganesan, Billingsley Kaambwa, Richard Woodman, Karen Hay, and Isuru Ranasinghe. "Abstract 11846: Excess Healthcare Costs and Bed Days Associated With Complications Following Catheter Ablation of Atrial Fibrillation." Circulation 144, Suppl_1 (November 16, 2021). http://dx.doi.org/10.1161/circ.144.suppl_1.11846.

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Background: Complications following catheter ablation of atrial fibrillation (AF) have been extensively examined but little is known about their associated economic burden. Hypothesis: Complications of AF ablations were associated with a significant increase in healthcare resources utilization. Methods: All patients >18 years undergoing AF ablations in the financial years of 2011-2017 in Australia with available cost data from the National Hospital Cost Data Collection were included. The primary outcome was occurrence of any complications up to 30-days post-discharge. All costs were adjusted to 2021 Australian dollars. The increase in length of stay (LOS) and in cost associated with complications, adjusting for patient characteristics, was evaluated using generalized linear models and negative binomial regression. Results: Our study included 19,916 patients (mean age 62.6±11.3 years, 30.2% females). The median length of stay was 1 day (interquartile range [IQR] 1-2 days) and the median cost per hospitalization was $6,646.5 (IQR $5,979.7-$10,210.5). A total of 1,074 patients (5.39%) experienced a complication (4.24% during the hospital stay and 1.37% post-discharge). The most common complications were bleeding (3.18%), pericardial effusion (0.66%), and vascular injury (0.43%). On average, the occurrence of a complication was associated with 2.8 excess bed-days and a $6,119.4 (95%CI $5,491.2-$6,747.7) increase in hospitalization cost (totaling nearly $6.6 millions). Complications that required cardiac surgery were associated with the highest incremental cost per patient ($19,958.5 [95%CI $17,304.5-$22,612.6]) but most of excess cost was attributable to bleeding ($4,808.5 per patient, $3,048,596.1 in total, 44.4% of total excess cost) and pericardial effusion ($6,064.8 per patient, $1,073,094.9 in total, 16.3% of total excess cost). Conclusions: The occurrence of any complication following AF ablation is associated with a significant economic burden, most of which was attributable to bleeding and pericardial effusion. Strategies to improve procedural safety and reduce healthcare cost should focus on these complications.

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Wabe, Nasir, Ling Li, Robert Lindeman, Ruth Yimsung, Maria R. Dahm, Susan McLennan, Kate Clezy, Johanna I. Westbrook, and Andrew Georgiou. "Impact of Rapid Molecular Diagnostic Testing of Respiratory Viruses on Outcomes of Adults Hospitalized with Respiratory Illness: a Multicenter Quasi-experimental Study." Journal of Clinical Microbiology 57, no. 4 (December 12, 2018). http://dx.doi.org/10.1128/jcm.01727-18.

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ABSTRACT A standard multiplex PCR offers comprehensive testing for respiratory viruses. However, it has traditionally been performed in a referral laboratory with a lengthy turnaround time, which can reduce patient flow through the hospital. We aimed to determine whether the introduction of a rapid PCR, but with limited targets (Cepheid Xpert Flu/RSV XC), was associated with improved outcomes for adults hospitalized with respiratory illness. A controlled quasi-experimental study was conducted across three hospitals in New South Wales, Australia. Intervention groups received standard multiplex PCR during the preimplementation, July to December 2016 (n = 953), and rapid PCR during the postimplementation, July to December 2017 (n = 1,209). Control groups (preimplementation, n = 937, and postimplementation, n = 1,102) were randomly selected from adults hospitalized with respiratory illness during the same periods. The outcomes were hospital length of stay (LOS) and microbiology test utilization (blood culture, urine culture, sputum culture, and respiratory bacterial and virus serologies). The introduction of rapid PCR was associated with a nonsignificant 8.9-h reduction in median LOS (95% confidence interval [CI], −21.5 h to 3.7 h; P = 0.17) for all patients and a significant 21.5-h reduction in median LOS (95% CI, −36.8 h to −6.2 h; P < 0.01) among patients with positive test results in an adjusted difference-in-differences analysis. For patients receiving test results before disposition, rapid PCR use was associated with a significant reduction in LOS, irrespective of test results. Compared with standard PCR testing, rapid PCR use was significantly associated with fewer blood culture (adjusted odds ratio [aOR], 0.67; 95% CI, 0.5 to 0.82; P < 0.001), sputum culture (aOR, 0.56; 95% CI, 0.47 to 0.68, P < 0.001), bacterial serology (aOR, 0.44; 95% CI, 0.35 to 0.55, P < 0.001) and viral serology (aOR, 0.42; 95% CI, 0.33 to 0.53, P < 0.001) tests, but not with fewer urine culture tests (aOR, 0.94; 95% CI, 0.78 to 1.12, P = 0.48). Rapid PCR testing of adults hospitalized with respiratory illnesses can deliver benefits to patients and reduce resource utilization. Future research should consider a formal economic analysis and assess its potential impacts on clinical decision making.

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Menon, Bijoy K., and Mayank Goyal. "Abstract 146: Optimal Workflow and Process Based Performance Measures for Endovascular Therapy in Acute Ischemic Strokes From the Star Registry." Stroke 45, suppl_1 (February 2014). http://dx.doi.org/10.1161/str.45.suppl_1.146.

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Introduction: We report on workflow and process based performance measures and its impact on clinical outcome in STAR, a recent international, multi-center, prospective, single-arm study of Solitaire FR thrombectomy in patients with large vessel anterior circulation strokes treated within 8 hrs of symptom onset. Methods: A total of 202 patients were enrolled across 14 comprehensive stroke centers in Europe, Canada and Australia. The following time intervals were measured: stroke onset to ED arrival; ED to baseline CT; CT to groin puncture; groin puncture to thrombus identification; thrombus identification to start of IA therapy and start of IA therapy to reperfusion. Effects of time of day, general anesthesia (GA) utilization and multi-modal imaging on workflow were evaluated. Patient characteristics and workflow processes associated with prolonged interval times and good clinical outcome (90-day mRS 0-2) were analyzed. Results: Distribution of all interval times are illustrated in Figure 1a. Median hospital arrival to final DSA run time was 150 mins (IQR=97 mins). Hospital arrival to final DSA run time was faster in women than men (158 vs. 139 mins). General anesthesia increased CT to groin puncture time by 22 mins and groin puncture to final DSA run by 13 minutes. Time of day or week did not effect interval times. CT based multi-modal imaging reduced time from CT to groin puncture by 24 mins. For each 60-minute increase in time from symptom onset to TICI 2b/3 (or final DSA run), a 33% decrease in odds of good clinical outcome (p<0.01) was noted independent of the effect of increased age (p<0.01), higher baseline NIHSS (p=0.02), and lower ASPECTS score (p=0.02). (Figure 1b) Conclusion: Interval times in the STAR study is a reflection of current IA therapy for patients with acute ischemic stroke. Improving workflow processes and reducing time to reperfusion could improve clinical outcomes further.

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Stephens, Jacqueline, Victoria Sinka, Marianne Kerr, Michelle Dickson, Armando Teixeira-Pinto, Germaine Wong, Martin Howell, Stephen Alexander, Allison Tong, and Jonathan Craig. "1454Renal disease in Aboriginal children and young adults (ARDAC): evolution to a data linkage study." International Journal of Epidemiology 50, Supplement_1 (September 1, 2021). http://dx.doi.org/10.1093/ije/dyab168.637.

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Abstract Focus of Presentation The ‘Antecedents of Renal Disease in Aboriginal Children and Young Adults’ (ARDAC) Study was the first large population-based longitudinal cohort study seeking to identify the early emergence and trajectory of kidney disease among Aboriginal and non-Aboriginal children. Since 2002, 3758 young people (2155 Aboriginal and 1603 non-Aboriginal) from across New South Wales, Australia, were enrolled, with clinical data collected every two years. However, the confluence of a maturing cohort, local issues (bushfires), and the COVID19 pandemic made follow-up screenings a challenge. As such, in 2021, ARDAC evolved into a data linkage to evaluate the cohort’s healthcare utilization and kidney health trajectory. Findings The ARDAC dataset contains 340 variables, which have been linked to a further 878 variables from state and federal government agency administrative datasets. Data incorporated in the linkage includes perinatal, pharmaceutical, hospital admissions, literacy, kidney health, kidney transplant, and death data. Preliminary findings from this unique and important linkage will be the focus of this presentation. Conclusions/Implications The breadth and scope of this data linkage makes it the largest on the kidney health of First Nations Peoples internationally. Analysis will provide a detailed understanding of the healthcare usage of this population and identify critical gender-specific timepoints and risk factors to inform the development of co-designed, community-driven strategies for future action. Key messages With governance provided by a strong Investigator-Advisory Group nexus, with extensive representation from Aboriginal and Torres Strait Islander researchers, patients, and community leaders, ARDAC is an exemplar of Aboriginal community-led research.

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Choi, Stephanie K. Y., Christos Venetis, William Ledger, Alys Havard, Katie Harris, Robert J. Norman, Louisa R. Jorm, and Georgina M. Chambers. "Population-wide contribution of medically assisted reproductive technologies to overall births in Australia: temporal trends and parental characteristics." Human Reproduction, February 27, 2022. http://dx.doi.org/10.1093/humrep/deac032.

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Abstract STUDY QUESTION In a country with supportive funding for medically assisted reproduction (MAR) technologies, what is the proportion of MAR births over-time? SUMMARY ANSWER In 2017, 6.7% of births were conceived by MAR (4.8% ART and 1.9% ovulation induction (OI)/IUI) with a 55% increase in ART births and a stable contribution from OI/IUI births over the past decade. WHAT IS KNOWN ALREADY There is considerable global variation in utilization rates of ART despite a similar infertility prevalence worldwide. While the overall contribution of ART to national births is known in many countries because of ART registries, very little is known about the contribution of OI/IUI treatment or the socio-demographic characteristics of the parents. Australia provides supportive public funding for all forms of MAR with no restrictions based on male or female age, and thus provides a unique setting to investigate the contribution of MAR to national births as well as the socio-demographic characteristics of parents across the different types of MAR births. STUDY DESIGN, SIZE, DURATION This is a novel population-based birth cohort study of 898 084 births using linked ART registry data and administrative data including birth registrations, medical services, pharmaceuticals, hospital admissions and deaths. Birth (a live or still birth of at least one baby of ≥400 g birthweight or ≥20 weeks’ gestation) was the unit of analysis in this study. Multiple births were considered as one birth in our analysis. PARTICIPANTS/MATERIALS, SETTING, METHODS This study included a total of 898 084 births (606 488 mothers) in New South Wales and the Australian Capital Territory, Australia 2009–2017. We calculated the prevalence of all categories of MAR-conceived births over the study period. Generalized estimating equations were used to examine the association between parental characteristics (parent’s age, parity, socio-economic status, maternal country of birth, remoteness of mother’s dwelling, pre-existing medical conditions, smoking, etc.) and ART and OI/IUI births relative to naturally conceived births. MAIN RESULTS AND THE ROLE OF CHANCE The proportion of MAR births increased from 5.1% of all births in 2009 to 6.7% in 2017, representing a 30% increase over the decade. The proportion of OI/IUI births remained stable at around 2% of all births, representing 32% of all MAR births. Over the study period, ART births conceived by frozen embryo-transfer increased nearly 3-fold. OI/IUI births conceived using clomiphene citrate decreased by 39%, while OI/IUI births conceived using letrozole increased 56-fold. Overall, there was a 55% increase over the study period in the number of ART-conceived births, rising to 56% of births to mothers aged 40 years and older. In 2017, almost one in six births (17.6%) to mothers aged 40 years and over were conceived using ART treatment. Conversely, the proportion of OI/IUI births was similar across different mother’s age groups and remained stable over the study period. ART children, but not OI/IUI children, were more likely to have parents who were socio-economically advantaged compared to naturally conceived children. For example, compared to naturally conceived births, ART births were 16% less likely to be born to mothers who live in the disadvantaged neighbourhoods after accounting for other covariates (adjusted relative risk (aRR): 0.84 [95% CI: 0.81–0.88]). ART- or OI/IUI-conceived children were 25% less likely to be born to immigrant mothers than births after natural conception (aRR: 0.75 [0.74–0.77]). LIMITATIONS, REASONS FOR CAUTION The social inequalities that we observed between the parents of children born using ART and naturally conceived children may not directly reflect disparities in accessing fertility care for individuals seeking treatment. WIDER IMPLICATIONS OF THE FINDINGS With the ubiquitous decline in fertility rates around the world and the increasing trend to delay childbearing, this population-based study enhances our understanding of the contribution of different types of MARs to population profiles among births in high-income countries. The parental socio-demographic characteristics of MAR-conceived children differ significantly from naturally conceived children and this highlights the importance of accounting for such differences in studies investigating the health and development of MAR-conceived children. STUDY FUNDING/COMPETING INTEREST(S) This study was funded through Australian National Health and Medical Research Council (NHMRC) grant: APP1127437. G.M.C. is an employee of The University of New South Wales (UNSW) and Director of the National Perinatal Epidemiology and Statistics Unit (NPESU), UNSW. The NPESU manages the Australian and New Zealand Assisted Reproduction Database with funding support from the Fertility Society of Australia and New Zealand. C.V. is an employee of The University of New South Wales (UNSW), Director of Clinical Research of IVFAustralia, Member of the Board of the Fertility Society of Australia and New Zealand, and Member of Research Committee of School of Women’s and Children’s Health, UNSW. C.V. reports grants from Australian National Health and Medical Research Council (NHMRC), and Merck KGaA. C.V. reports consulting fees, and payment or honoraria for lectures, presentations, speakers, bureaus, manuscript, writing or educational events or attending meeting or travel from Merck, Merck Sparpe & Dohme, Ferring, Gedon-Richter and Besins outside this submitted work. C.V. reported stock or stock options from Virtus Health Limited outside this submitted work. R.J.N. is an employee of The University of Adelaide, and Chair DSMC for natural therapies trial of The University of Hong Kong. R.J.N. reports grants from NHMRC. R.J.N. reports lecture fees and support for attending or travelling for lecture from Merck Serono which is outside this submitted work. L.R.J. is an employee of The UNSW and Foundation Director of the Centre for Big Data Research in Health at UNSW Sydney. L.R.J. reports grants from NHMRC. The other co-authors have no conflict of interest. TRIAL REGISTRATION NUMBER N/A.

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Andrew, Nadine, Monique Kilkenny, Vijaya Sundararajan, Joosup Kim, Amanda Thrift, Trisha Johnston, Rohan Grimley, et al. "Describing hospital utilisation and associated factors following stroke using linked clinical registry and hospital administrative data." International Journal of Population Data Science 3, no. 4 (September 5, 2018). http://dx.doi.org/10.23889/ijpds.v3i4.865.

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IntroductionSurvivors of stroke have complex needs from ongoing disabilities and have increased risk of cardiovascular diseases. The societal costs are therefore substantial. Person-level longitudinal data on the longer-term hospital utilizations of patients with stroke in Australia, and the factors that may influence usage in this setting, are rarely reported. Objectives and ApproachWe used person-level linkages between the Australian Stroke Clinical Registry (AuSCR: 2009-2013) and hospital admission and Emergency Department (ED) data from four states to examine determinants of hospital utilisation following stroke. The index event was the first event recorded in AuSCR. The rate of hospital contacts/person/year was calculated from contacts 30-365 days post-discharge. Disability was determined from responses to EQ-5D-3L data collected at 90-180 days post-stroke. Comorbidities were identified using ICD-10 discharge diagnosis codes (5 year look back including the index event). Negative binomial regression was used adjusting for patient clustering by hospital and pre-stroke contacts and stratified by disability. ResultsAmong 10,082 adults with acute stroke (55% male, median age 74 years, 81% ischaemic, 14% hemorrhagic, 5% undetermined, 44% with disability) from 39 hospitals, 57% had a hospital admission or ED contact in the first 30-365 days post-hospital discharge, with median contacts/person/year post-stroke of 1.09 (Q1, Q3: 0, 3.27) compared to a pre-contact rate of 0 (Q1, Q3: 0, 2.18). The strongest associations with subsequent hospital contacts were prior contacts (IRR:1.10, 95%CI:1.07, 1.13), not able to walk on admission (stroke severity) (IRR:1.19, 95%CI 1.07, 1.31) and having a higher comorbidity index score (IRR:1.18, 95%CI:1.14, 1.22). Within stratified cohorts younger age was associated with increased contacts in those with disability ( Conclusion/ImplicationsIn a large linked cohort of patients we have demonstrated the substantial ongoing burden that stroke imposes on hospital systems, particularly regarding survivors with other comorbidities and younger survivors with disability. Knowledge of disability and comorbidity burden may assist with targeting community and hospital interventions to reduce post-stroke hospital usage.

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Rastogi, Anjay, Sofia Schiavo, Dilip Makhija, Darrin Benjumea, Saba Gidey, Phil Mcewan, Silvia Rabar, and Todd Berner. "MO800: A Systematic Literature Review on the Costs and Healthcare Resource Utilization Associated With Dialysis And Anemia Management by Dialysis Modality in Patients With End-Stage Kidney Disease." Nephrology Dialysis Transplantation 37, Supplement_3 (May 2022). http://dx.doi.org/10.1093/ndt/gfac081.005.

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Abstract BACKGROUND AND AIMS End-stage kidney disease (ESKD) is associated with a high clinical and economic burden. Dialysis modalities include in-center hemodialysis (ICHD) and home dialysis [home hemodialysis (HHD) or peritoneal dialysis (PD)]. The prevalence of anemia in ESKD is estimated to be > 50% and is associated with an increased risk of comorbidities and a lower quality of life [1]. Understanding the economic consequences of dialysis by modality of care, in the general ESKD population and the anemia-related ESKD population, is an essential aspect of the value of home dialysis. This study assessed the extent to which the economic burden of dialysis in ESKD and the management of anemia in ESKD have been characterized in the literature based on modality of care (HHD versus PD versus ICHD). METHOD A systematic literature review (SLR) was conducted to characterize costs and healthcare resource use (HCRU) in patients receiving ICHD, HHD or PD, and to further assess the impact of anemia. Data extracted included, but were not limited to, the cost of dialysis, hospitalizations, erythropoiesis-stimulating agents (ESAs) and other drug costs. Database searches were conducted in Embase, Medline, EconLit, Cochrane Library and University of York Center for Reviews and Dissemination (2011–21). RESULTS Searches identified 1105 records, of which 43 met the inclusion criteria (costs = 26, HCRU = 8, costs and HCRU = 9). Studies were conducted in Europe (n = 18), North America (n = 14), Asia (n = 7), Australia (n = 2), South America (n = 1) and mixed continents (n = 1). A total of 15 studies were observational/database analyses, and 28 were economic evaluations. Most studies compared costs, including direct (medical and pharmacy) and indirect, and/or HCRU for ICHD, HHD and PD (n = 22), while 11 compared ICHD and HHD and 10 compared ICHD and PD. A summary of results is reported in the Table 1. A total of 14 primary cost studies reported total dialysis costs and showed that ICHD was more expensive than HHD/PD per patient per year. A total of 16 economic models presented relevant outputs in the form of total dialysis costs. The majority of these (n = 13) reported that ICHD is more costly than HHD/PD, with 11 studies concluding that HHD/PD is cost-effective or even dominant compared with ICHD. HCRU was presented in 17 studies, with hospitalizations the most frequently reported (n = 12). Some studies reported that ICHD patients incurred more all-cause hospitalizations than HHD/PD patients, while others reported the opposite (especially for high-dose or frequent modalities). Four studies reported that patients receiving HHD/PD had more in-hospital days than ICHD. There was limited evidence for anemia-related outcomes, with only 11 studies showing either costs and/or HCRU relating to ESA or iron use (Table 1). Five studies reported that the use and dose of epoetin alfa or general ESAs were higher in ICHD patients than in HHD/PD patients (Fig. 1). Of these, one study reported the same trend for IV iron use but the opposite for darbepoetin alfa using baseline data. Four studies reported the same ESA costs for different modalities. An additional four studies reported a higher ESA cost for ICHD patients compared with HHD/PD, with three of the studies indicating that this is related to differences in dosage and use of ESAs. One economic evaluation modeled that ESA and iron costs were higher for HHD than ICHD, though not statistically significant (Table 1). CONCLUSION Most studies reported a higher total dialysis cost for ICHD compared with home dialysis, with evidence that home dialysis is cost-effective. There was a paucity of evidence characterizing anemia in ESKD. In this SLR, more ICHD patients used ESAs and at higher doses than HHD/PD patients, thus incurring a higher cost. Global interests highlight increasing home dialysis penetration; therefore, it is important to understand the cost differences and drivers of these differences in ESKD patients with anemia.

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Journal articles on the topic 'Hospital utilization Australia'

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