Australian health review : a publication of the Australian Hospital Association
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The Home Based Rehabilitation Service was established as an allied health early discharge and outreach service from a major metropolitan post-acute teaching hospital. Two hundred and eighty-two patients were discharged to the service according to established criteria from the following specialities: neurology, neurosurgery, rheumatology, amputation, orthopaedic and spinal. ⋯ The cost of home-based services was 11 per cent of the cost of the inpatient services they replaced. There were low rates of hospital readmissions, and users registered high levels of satisfaction with the service.
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This study reviews the extent of evaluation of health outcomes in three general medical journals over the past decade by examining papers published in the original research section of the New England Journal of Medicine (NEJM), The Lancet, and the Medical Journal of Australia (MJA) in 1982 and 1992. Evaluations were identified and classified according to the type of comparison group and the type of outcome measures employed. They were divided into three categories: those employing a comparison group; those employing a before-and-after study design (or own comparison group); and those with no comparison group. ⋯ In the NEJM and The Lancet, 75 per cent of evaluations incorporated comparison groups, in the MJA, less than 40 per cent. Overall, the proportion of papers reporting final outcome measures increased significantly between 1982 and 1992 (p = 0.04) but the change in each journal individually did not reach statistical significance. This study indicates that the reporting of health outcomes evaluations has remained constant but there has been some change in the use of comparison groups and final outcome measures over time.
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A Quick Response Program (QRP) was developed and implemented at St George Hospital during 1995 and 1996. The program sought to improve the service provided to elderly people presenting to the emergency department by offering a new rapid response service pathway to community-based care. Emergency department discharge planning and crisis intervention evolved as important QRP functions during the program's life. ⋯ Health outcomes were not compromised by the program, and patient and general practitioner satisfaction were high. The program grappled with the inherent conflict of interest between the aims of the hospital (acute care services) and those of the community service (support and maintenance). The program sought to bridge the gap between these service parameters in the name of meeting patient needs.
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Consumers regard access to hospital services as one of the key components of quality in health care delivery. A mixed public/private system operates in Victoria, but a morbidity collection from private hospitals was commenced only relatively recently. In 1993-94 the collection covered 82 per cent of private hospital separations, and it was considered timely to examine the utilisation patterns in the private system and compare them with those in the public system. ⋯ Elective surgery waiting list data suggest that while urgent cases are treated within a month, significant proportions wait six months or more for non-urgent surgery. Private health insurance is the main factor in determining access to and the utilisation private hospitals. The current Medicare Agreement and the move to separate the role of purchaser and provider may allow the maximal utilisation of private hospitals and diminish the burden of chronic illness.
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This paper discusses the problems associated with the refurbishing and re-use of medical devices which are sold by manufacturers as 'single use items' by focusing in particular on the re-use of pacemakers. Re-use of single-use devices such as pacemakers does occur in Australia, and in many other parts of the world, but there has been little public awareness of this fact. The paper explains and discloses medical, legal and ethical issues which arise through the re-use of pacemakers. It also discusses the recommendations of the 1995 'Draft report of the NHMRC Expert Panel on Re-Use of Medical Devices Labelled as Single Use'.