A Private Healthcare Journey through Quality and Research

Mr Andrew Currie1

1 Healthscope, Vic/Tas

Allied health clinicians play an integral role in ensuring high quality, evidence based practice in private hospitals throughout Australia. There are more than 45,000 allied health clinicians in Australia and more than 20 allied health disciplines.  Across Healthscope’s 45 hospitals in Australia there are currently 2,500 allied health clinicians, with many physiotherapists, psychologists, dieticians, social workers, occupational therapists, podiatrists and speech pathologists. The majority of patients in the private sector are funded by an insurance fund. Increasingly they are focused on improved patient outcomes. Healthscope has been a leader in publishing patient outcome indicators on its myhealthscope.com.au web site, for each of its hospitals. There is a large role for the allied health workforce to work with other Healthscope clinicians in order to improve the quality of our patient care, and resultant outcomes. This presentation will explore the quality journey Healthscope has taken to date to improve its indicators. In order to drive quality further than simple comparative indicators, Healthscope is working with key research programs to drive evidence based approaches to our care delivery, again designed to improve our quality outcomes. This presentation explores how managers and clinicians can foster and support evidence-based practice, through quality indicators and a research focus, and how this can positively impact patient outcomes, efficiency and reputation.

Advancing allied health evidence based practice in the private sector

Prof. Meg Morris1, Mr Simon Keating2, Ms Cathy Jones2

1La Trobe University, Melbourne, Australia

2Healthscope, Melbourne, Australia

 

Aim: To optimise quality in the private healthcare sector through embedding clinical research into allied health practice and culture.

 

Method: A new private-public research partnership was created between La Trobe University and Healthscope to generate allied health research highly relevant to the sector and to translate clinical research findings to clinicians and consumers.

 

Results: A new Professor of Clinical and Rehabilitation Practice was appointed to the joint role in April 2016, with links to allied health governance through relationships with allied health managers, quality managers and hospital general managers, as well as the Healthscope corporate team and the La Trobe University College of Science, Health and Engineering. The main roles of the professor were to be a knowledge generator, knowledge broker, quality champion and allied health advocate. New projects have commenced on patient reported outcome measures, health program evaluations and rehabilitation outcomes. Joint teams have been formed and funding gained to resource new joint projects. Publications, conference presentations, workshops and research higher degree student projects are some of the early outputs.

 

Significance of the findings to allied health: Building a culture of evidence based practice by strengthening the connections between clinical research and quality processes aims to optimise patient outcomes and patient satisfaction. Collaborative quality initiatives of this type also foster allied health staff recruitment, retention and discretionary effort to achieve workplace goals.

Investigating nutritional adequacy and patient satisfaction of the free fluid diet at Cabrini Malvern

Mrs  Bek Anderson1

1Cabrini, Malvern, Australia

Aim: To investigate nutritional adequacy and patient satisfaction of the free fluids diet at Cabrini Malvern.

Method: A 15 day cross-sectional study comprised of nutritional analysis of default, ordered and consumed meals, a plate wastage audit, a patient satisfaction survey, and a benchmarking survey.

Results: The free fluids diet did not meet nutritional requirements for energy and protein in comparison to the referenced population. Plate wastage (consumption) data revealed patients only met 13-16% of energy and 10-13% of protein requirements. 75% of patients on the free fluids diet surveyed were either satisfied or very satisfied with the free fluids diet. However, 60% of patients reported areas for improvement with food provision (i.e. offering more flavours or more savoury options), 80% of patients were not offered a mid-meal snack and 40% of patients did not have their menu choices explained to them.

Significance of findings to allied health:

In the gastrointestinal setting, the free fluids diet is prescribed as a post-operative transitional diet, towards a regular diet. The free fluids diet is a restrictive diet (fluids and fluid based foods only), commonly associated with patient dissatisfaction. Furthermore, internationally-endorsed evidence-based Enhanced Recovery After Surgery (ERAS®) guidelines, suggest that it is safe to resume normal hospital food after anaesthesia. Results from this project will assist Cabrini Dietetic Services advocate for the implementation of Enhanced Recovery After Surgery (ERAS®) guidelines within the private setting, which will ultimately reduce the time spent on restrictive diets and improve patient satisfaction at Cabrini.

Relationship between knowledge of pain neurophysiology and fear avoidance in people with chronic pain

Mrs Claire Fletcher2

1Healthscope, Melbourne, Australia

2Flinders University Clinical Rehabilitation Department , Adelaide, Australia

Aim:

To explore the relationship between knowledge of pain neurophysiology and fear avoidance in individuals diagnosed with chronic pain.

Method:

Twenty nine people (20 female) with a mean age of 48.6(SD11.3) with chronic pain of a mean duration of 79.2 (SD108.6) months took part in this point in time observational study. Participants completed validated tests of pain including the revised Neurophysiology of Pain Questionnaire (rNPQ) to determine their understanding of chronic pain mechanisms. They were also tested on the Tampa Scale of Kinesiophobia (TSK), to assess the degree of their fear avoidance beliefs. Perceived disability, educational level, and compensable status were also examined.

Results:

Patients had experienced pain for greater than 6 months and had been given a diagnosis of with chronic pain by a pain rehabilitation specialist. Those with higher pain knowledge reported less fear avoidance (r=-0.41, p=0.029) and lower perceived disability (r=-0.45, p=0.014) related to pain. There was no relationship with educational level or compensable status for either variable.

Significance of finding to Allied Health:

The findings show that kinesiophobia may be positively influenced by the neurophysiological and psychological determinants of pain education, as a higher levels of pain knowledge was associated with less activity-related fear. Reducing fear avoidance by providing pain education to people with chronic pain may deliver an effective strategy to help manage the fear avoidance behaviours and related disability. Pain education can provide a cost effective and easy to apply intervention in the clinical setting for people living with chronic pain.

Effective use of Google Calendar to increase daily function in TBI population

Mrs Susan Petrie1, Associate Professor  Natasha Lannin2,3, Ms Kate Phillips1, Ms Carla Thompson4

1Independent Rehabilitation Services, Ashburton, Australia, 2La Trobe University, Melbourne, Australia, 3Alfred Health, Melbourne, Australia, 4Memory Matters, Melbourne, Australia

 

Aim

To provide evidence that Google Calendar is an effective strategy to reduce the impact of prospective memory impairments in adults with traumatic brain injury (TBI).

Method

Participants for this mixed-methods study were recruited from a community neurorehabilitation service. Post 2-week baseline period, participants received 8-weeks of Google Calendar intervention, provided by specifically trained occupational therapists using the errorless learning technique to help achieve their functional goals.  Goals were identified and rated at baseline and post intervention using the Canadian Occupational Performance Measure and the Goal Attainment Scale.  Participants underwent brief neuropsychological testing pre-intervention and completed the Rivermead Behavioural Memory Test 3 (RBMT 3) pre and post intervention.

Results

Despite the severity of the study population, the GAS and COPM changes scores were statistically significant for all participants. All 12 participants continued to use Google Calendar after their participation in the study was completed. The intensity and training approach of the occupational therapist was found to be a significant factor in the success of the intervention.

Significance of findings for allied health

This study provides evidence that Google Calendar is an effective strategy within the Victorian TBI population to allow greater independence in functional activities.  This is significant for allied health as opportunities to increase independence in this client group are rare, therefore this opportunity should be maximised, particularly given that Google Calendar is a mainstream tool and free to use.

Barriers to primary care clinician adherence to clinical guidelines for the management of low back pain: A systematic review and meta-synthesis of qualitative studies

Dr Susan Slade1,2

11Dept of Epidemiology & Preventive Medicine, Monash University, Melbourne, Australia, 22Dept.of Clinical Epidemiology, Cabrini Institute, Melbourne, Australia

Introduction

Low back pain is the highest ranked condition contributing to years lived with disabilityand associated with significant cost. Despite consistent evidence-based recommendations primary care management remains suboptimal.

Aim

To summarise what primary care clinicians believe about clinical practice guidelines for low back pain.

Methods

Systematic review methods conformed to Cochrane guidelines and PRISMA and ENTREQ Checklist.  Inclusion criteria: English-language studies of primary care clinicians and qualitative methods for data collection and analysis. Eight electronic databases were searched until July 2014.

Results

From a yield of 1880 titles, 17 papers, with a total of 705 participants, fulfilled inclusion criteria. Studies were conducted in UK, Canada, USA, Netherlands, Germany, Israel, New Zealand and Norway and included general practitioners, physical therapists, chiropractors, osteopaths and occupational therapists.Many studies failed to report  key study components, such as researcher influence, data saturation and explicit data analysis steps, to allow full assessment of trustworthiness. We identified three key themes: (1) beliefs/perceptions about guidelines; (2) maintaining the patient-clinician relationship; (3) barriers to guideline adherence.

Significance to allied health

Clinicians believe that: guidelines are categorical, prescriptive and constraining; popular clinical practices supersede the guidelines; imaging referrals can be used to manage consultations. Guidelines are perceived as at odds with individual patient needs and practitioner preferences, and the complex nature of persistent low back pain.  Clinicians’ perceptions reflect lack of content knowledge and understanding of guidelines development. We recommend clinician engagement in guideline development; empowering clinicians with communication skills and concise guideline summaries; and discipline-specific implementation strategies.

Keywords

low back pain, clinical practice guidelines, qualitative, primary care

Consensus on exercise reporting template (cert): Guideline development and implementation

Dr Susan Slade

1Monash Department Clinical Epidemiology, Cabrini Institute, Melbourne, Australia, 2Department  Epidemiology & Preventive Medicine, Monash University, Melbourne, Australia

Background: Exercise is effective for  a range of health conditions and includes aerobic, resistance, yoga, Pilates, and movement ms The 16-item internationally endorsed Consensus on Exercise Reporting Template (CERT) was developed to address the recognized poor reporting of exercise programs.

Aims: Develop a standardized method for reporting exercise programs and provide implementation guidance.

Methods:  Informed by EQUATOR Network methods for developing reporting guidelines. We invited 137 exercise experts into a Delphi consensus study to rate 41 items identified from a systematic review of exercise. We used three sequential rounds of anonymous online questionnaires and a Delphi workshop; finalized and panel consensus.

Results: There were 57, 54 and 49 respondents to Rounds 1-3 respectively from 11 countries and a range of disciplines. The 16-item CERT provides guidance on a minimum set of items considered essential to report replicable exercise programs. The contents may be included in online supplementary material; published protocols; dedicated websites and electronic repositories. The Explanation and Elaboration Statement is designed to facilitate implementation of the CERT.

Conclusions: The CERT is an internationally endorsed guideline designed specifically for  reporting  exercise programs across all  exercise research study designs. It contains seven categories: materials, provider, delivery, location, dosage, tailoring, and compliance. The CERT can be used by authors,  reviewers and editors, and by readers of  published information.

Significance to allied health: The CERT will encourage transparency, improve trial interpretation and replication, facilitate implementation of effective exercise interventions into practice, reduce research waste, and improve patient outcomes.

Key Words: Exercise prescription, Delphi study, Reporting Guidelines, Clinical practice, Publication quality

Advancing allied health evidence based practice in the private sector

Prof. Meg Morris1, Mr Simon Keating1, Ms Cathy Jones1

1Healthscope, Bundoora, Australia, 2School Allied Health, La Trobe University, Australia

 

Title: Advancing allied health evidence based practice in the private sector.

Aim: To optimise quality in the private healthcare sector through embedding clinical research into allied health practice and culture.

Method: A new private-public research partnership was created between La Trobe University and Healthscope to generate allied health research highly relevant to the sector and to translate clinical research findings to clinicians and consumers.

Results: A new Professor of Clinical and Rehabilitation Practice was appointed to the joint role in April 2016, with links to allied health governance through relationships with allied health managers, quality managers and hospital general managers, as well as the Healthscope corporate team and the La Trobe University College of Science, Health and Engineering. The main roles of the professor were to be a knowledge generator, knowledge broker, quality champion and allied health advocate. New projects have commenced on patient reported outcome measures, health program evaluations and rehabilitation outcomes. Joint teams have been formed and funding gained to resource new joint projects. Publications, conference presentations, workshops and research higher degree student projects are some of the early outputs.

Significance of the findings to allied health: Building a culture of evidence based practice by strengthening the connections between clinical research and quality processes aims to optimise patient outcomes and patient satisfaction. Collaborative quality initiatives of this type also foster allied health staff recruitment, retention and discretionary effort to achieve workplace goals.

Clinician-led implementation of clinical guidelines for stroke

Dr Natasha Brusco1, Mr  Doug  McCaskie1, Associate Professor  Helena Frawley1, Mrs Sarah  Foster1

1Cabrini Health, Malvern, Australia, 2La Trobe University, Bundoora, Australia

 

Aim: To evaluate the impact of implementation of clinical guidelines for stroke management (CGSM) across a private health service.

Method:  A pragmatic, clinician-led implementation of CGSM across a private health service occurred pre-evaluation. The implementation process was reviewed against an evidence-based implementation framework, and for fidelity between the CGSM criteria and the health service stroke policies. The primary outcome was post-implementation, versus pre-implementation, adherence to CGSM criteria across allied health, medical and nursing. Secondary outcomes included post-implementation versus pre-implementation patient satisfaction and cost-effectiveness, and implementation barriers /facilitators, and cost.

Results: The implementation process followed most, but not all, aspects of an evidence-based implementation framework, with inconsistencies between the CGSM and the stroke policies. Post-implementation, adherence to the CGSM criteria significantly improved for 11 (15%) and reduced for one (1%); patient satisfaction (n=8) positively trended; acute admissions (n=100) reported non-significant cost saving [AUD$269 (95%CI: -$1,621 to $2,160)] and non-significant functional improvement [0.02 Modified Rankin Scale (95%CI: -0.45 to 0.48)]; and rehabilitation admissions (n=19) reported significant functional improvement [FIM 10.45 (95%CI: 0.4 to 20.5)]. Barriers to implementation included multi-disciplinary staff collaboration, culture and availability of resources; facilitators included evidence-based policies and a stroke education program. Cost of implementation was ~AUD$155K and involved over 2,000 staff hours. Overall, there was a positive trend post-implementation; however, effectiveness may have been compromised by implementation process limitations.

Significance of the findings to allied health:  These findings support allied health utilising an evidence-based implementation framework to guide implementation of evidenced-based practice, to improve likelihood of desired outcomes.

Malnutrition identification, coding and costs

Ms Sarah Ryan1

1Bundoora, Australia, 2Professor Meg Morris, Bundoora, Australia

Aim: To assess the viability of conducting a pilot study to further investigate potential clinical and cost implications of current malnutrition identification, diagnosis and coding practices at a Healthscope Hospital.

Method: A small sample of General Medical patients admitted to a Healthscope Hospital with a diagnosis of malnutrition were analysed to determine whether there was an uplift to their Diagnostic Related Grouping (DRG) and the hospital reimbursement received as a result of having their malnutrition correctly identified, diagnosed and coded.

Results: Changes to the Diagnostic Related Grouping (DRG) and additional hospital reimbursement was generated by correct identification, diagnosis and coding in 18% of patients with malnutrition. There was an average additional hospital reimbursement of approximately $2,400 in patients that did have an uplift to their DRG.

The potential for a DRG uplift in patients diagnosed with malnutrition in a private hospital setting is dependent on several factors including their hospital health fund contract, primary admission reason and co-morbidities. This case study indicates that a pilot study further investigating clinical and cost implications of current malnutrition-related practices in this setting is viable.

Significance of the findings to Allied Health: Hospital patients identified as being at risk of malnutrition should be promptly referred to an Accredited Practising Dietitian for a thorough nutrition assessment, diagnosis and commencement of a nutrition management plan. Further research into the clinical and cost outcomes of nutrition-related practices in a Healthscope Hospital will contribute to our understanding of how dietitians can work as an effective part of the multidisciplinary workforce to improve patient outcomes in private hospitals.

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