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Objectives: To describe morbidity and multimorbidity patterns among adults readmitted to an Australian regional health service, in terms of occurrence of the same and different morbidities at index admission and readmission. Methods: This cohort study used hospital admissions data for patients admitted between 1 July 2014 and 30 June 2016 to estimate proportions of unplanned readmissions ('early' within 30 days and 'late' within 1–6 months) with the same and different morbidities as the index admission. Readmission rates were estimated by selected sociodemographic, admission and diagnostic characteristics. Results: The majority of early and late readmissions were in different diagnostic groups and for different primary morbidities to the index admission. Only 38.8% of readmissions were in the same major diagnostic group as the index admission and 18.4% in the same Adjacent Diagnosis-Related Group. Twenty one percent of admitted patients were readmitted within six months, with this increasing to 35.3% among multimorbid patients. Conclusion: With increasing prevalence of multimorbidity, particularly among those at increased risk of readmission, it is essential to step away from a single disease focus in the design of both hospital avoidance and chronic disease management programmes. Holistic interventions and strategies that address multiple chronic conditions are required. [ABSTRACT FROM AUTHOR]

Objective. To examine hospital use characteristics of a privately insured cohort including hospital setting (public or private), declared insurance status and category of services received during hospital admission. Methods. The study population consisted of 14 276 people with membership of a private health insurance (PHI) fund in New South Wales, Australia. The final study cohort included 9004 people with at least one hospital admission over a 6-year period from 1 January 2010 to 31 December 2015. PHI claims data were linked with public hospital records from a Local Health District. Hospital utilisation measures include number of admissions and length of stay. Measures were categorised by hospital user group (public only, private only or both), declared insurance status (PHI or public patient), type of service and admission case weight. Results. The study finds that despite having PHI, 40% of people receive services exclusively in a public hospital in the 6-year study period. Additionally, only 62% of overnight hospital admissions for the study population are claimed on PHI. There are differences in hospital utilisation for medical- and surgical-related admissions. Seventy percent of people with a medical admission receive services only in public hospitals, but a similar proportion of people (66%) receive services only in private hospitals for surgical admissions. Conclusions. People with PHI make considerable use of public hospitals both as a public and a private patient. For this privately insured cohort, public hospitals are more frequently used for medical-related admissions and also for more resource-intensive admissions compared with private hospitals. [ABSTRACT FROM AUTHOR]

Objective: To develop and examine a profile of the demographic, hospital admission and clinical characteristics of high users of hospital resources within a cohort of privately insured Australians. Methods: Hospital admissions claims data from a group of private health insurance funds were analysed. The top 1% of hospital users were selected based on three measures of resource utilisation: number of admissions, total bed days and total insurance benefits paid. The demographic, hospital admission and clinical characteristics data were compared for these three measures of resource utilisation. Results: Compared with the general insured population, the three high-use cohorts are older, have more public hospital admissions and have more same-day admissions. The three high-use cohorts have the same top five principal diagnosis categories. These five categories account for more than two-thirds of admissions. The top 1% of users is responsible for a large proportion of total resource utilisation, accounting for 13% of total costs and 21% of total bed days. Conclusions: The highest users of hospital resources have a distinct profile, accounting for a large proportion of total resource utilisation for a narrow range of health conditions. The age and hospital admission profile of this group suggest both policy and service considerations for the targeting of interventions to support this high-needs group. What is known about this topic?: Statistics are regularly published on the uptake and use of private health insurance in Australia but there is little detailed information on resource utilisation in specific subgroups, particularly those with the highest levels of hospitalisation. What does this paper add?: This paper provides a profile of high resource utilisation among a privately insured cohort, describing demographic, hospital admission and clinical characteristics across three measures of resource utilisation. Patterns of use are detailed in this profile, for example the top 1% of users have a higher proportion of public hospital admissions as a private patient. The clinical profile of admissions was similar for the three measures of resource utilisation and there was considerable overlap in the individuals categorised in each high-use group. What are the implications for practitioners?: The narrow demographic and clinical profile of the high resource utilisation groups shows a chronic disease burden that is different to the focus of current chronic disease policy measures. The high-use conditions identified in this study are less amenable to preventive measures and new strategies may be required to target this high-needs group. [ABSTRACT FROM AUTHOR]

Objective: The aim of this work was to analyze routine assessments recorded, when a patient was documented as likely to die in hours to days, to determine the prevalence, intensity, and associations of physical symptoms. Background: Although death inevitably occurs, very little prospective data describe at population level the physical symptoms confronting imminently dying people. Methods: Using prospectively collected data from participating palliative care services in the Australian Palliative Care Outcomes Collaboration between July 1, 2013, and December 31, 2014, factors associated with worse symptom experiences were explored using logistic regression modeling. Results: The experiences of 18,975 patients who died after being identified as imminently terminal were analyzed, with 75% ( n = 14,238) of these being cancer deaths. Seventy percent ( n = 13,051) occurred in a palliative care unit, 8.7% ( n = 1657) in an acute hospital with palliative care support, and 22.5% ( n = 4266) at home. More than half were assessed as experiencing acceptable symptom control especially those with nonmalignant disease. The notable exception was breathing problems, where compared to cancer patients, those with nonmalignant disease were 34% more likely to experience distressing breathlessness (odds ratio 1.34; 95% confidence interval 1.23-147). Regardless of the cause, deaths in a community setting were more likely to be complicated by more severe symptoms with the exception of breathlessness, where those dying in acute hospitals were most likely to be assessed as requiring further help. Discussion: The terminal phase is perceived as a time where the majority will experience distressing symptoms, but this work suggests a contrary view. However, there did seem to be a detrimental effect depending on place of care with more significant problems recorded when people were dying at home. More work is needed to clarify this given the current push for more home deaths. [ABSTRACT FROM AUTHOR]

The article cites a study which tests the reliability and acceptability of revised definitions of Palliative Care Phase in Australia. The study participants were clinicians from 10 Australian palliative care services. It is concluded that policy makers, funders and clinicians are confident that Palliative Care Phase is a reliable and acceptable measure that can be used for care planning, quality improvement and funding purposes.

The article focuses on emergency departments are crucial for surveillance of self-harm and suicide related behaviours. It mentions despite awareness raising, prevention strategies, treatment and significant government investment, suicidal behaviour remains a leading cause of death and disability. It also mentions EDs are stressed work places and suicidal behaviours are complex and multifactorial and constraints around documentation.

Quantitative and qualitative data, including service utilisation, health records, a provider survey and participant observation, were used to describe the impact of a new model of palliative care on patients, carers and staff in rural Australia. A total of 95 patients were enrolled between October 2001 and February 2003, for an average of 147 days. Deaths per month averaged 3.5. Participating general practitioners were positive about the model. The experiences of 14 patients or carers and 3 people who had cared for a relative with terminal illness prior to the new model were also positive. As one illustration, patients and carers commented that trips to the emergency department prior to the GAPS programme often involved long waiting times and unnecessary investigations and that this had now improved. The elements of the model that worked most effectively were weekly case conferences, the on-call nursing roster, patient-held records and shared protocols and procedures. The model achieved its aim of improving palliative care services and still continues with some modifications. The generalisability of the model is now being tested in eight rural and remote communities across Australia. [ABSTRACT FROM AUTHOR]

Objective: To review the definition of ‘primary care’ and ‘inappropriate’ patients in ED and develop a generally acceptable working definition of a ‘primary care’ presentation in ED. Method: A Medline review of articles on primary care in ED and the definitions used. Results: A total of 34 reviewed papers contained a proposed definition or comment on the definition for potential ‘primary care’, ‘general practice’, or ‘inappropriate’ patients in ED. A representative definition was developed premised on the common factors in these papers: • Low urgency/acuity – triage categories four or five in the Australasian Triage Scale • Self-referred – by definition, patients referred by general practitioner/community primary medical services are not primary care cases because a primary care service has referred them on • Presenting for a new episode of care (i.e. not a planned return because planned returns are not self-referred) • Unlikely to be admitted (in the opinion of Emergency Nurse interviewers) or ultimately not admitted Discussion: This definition can be applied either prospectively or retrospectively, depending on the purpose. Appropriateness must be considered in light of a legitimate role for ED in primary care and the balance of resources between primary care and emergency medicine in local settings. [ABSTRACT FROM AUTHOR]