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Objective To determine whether there are real differences in emergency department (ED) performance between Australian states and territories. Methods Cross-sectional analysis of 2009-10 attendances at an ED contributing to the Australian non-admitted patient ED care database. The main outcome measure was difference in waiting time across triage categories. Results There were more than 5.8 million ED attendances. Raw ED waiting times varied by a range of factors including jurisdiction, triage category, geographic location and hospital peer group. All variables were significant in a model designed to test the effect of jurisdiction on ED waiting times, including triage category, hospital peer group, patient socioeconomic status and patient remoteness. When the interaction between triage category and jurisdiction entered the model, it was found to have a significant effect on ED waiting times (P < 0.001) and triage was also significant (P < 0.001). Jurisdiction was no longer statistically significant (P = 0.248 using all triage categories and 0.063 using only Australian Triage Scale 2 and 3). Conclusions Although the Council of Australian Governments has adopted raw measures for its key ED performance indicators, raw waiting time statistics are misleading. There are no consistent differences in ED waiting times between states and territories after other factors are accounted for. What is known about the topic? The length of time patients wait to be treated after presenting at an ED is routinely used to measure ED performance. In national health agreements with the federal government, each state and territory in Australia is expected to meet waiting time performance targets for the five ED triage categories. The raw data indicate differences in performance between states and territories. What does this paper add? Measuring ED performance using raw data gives misleading results. There are no consistent differences in ED waiting times between the states and territories af

Purpose Every health care sector including hospice/palliative care needs to systematically improve services using patient-defined outcomes. Data from the national Australian Palliative Care Outcomes Collaboration aims to define whether hospice/palliative care patients' outcomes and the consistency of these outcomes have improved in the last 3 years. Methods Data were analysed by clinical phase (stable, unstable, deteriorating, terminal). Patient-level data included the Symptom Assessment Scale and the Palliative Care Problem Severity Score. Nationally collected point-of-care data were anchored for the period July-December 2008 and subsequently compared to this baseline in six 6-month reporting cycles for all services that submitted data in every time period (n = 30) using individual longitudinal multi-level random coefficient models. Results Data were analysed for 19,747 patients (46 % female; 85 % cancer; 27,928 episodes of care; 65,463 phases). There were significant improvements across all domains (symptom control, family care, psychological and spiritual care) except pain. Simultaneously, the interquartile ranges decreased, jointly indicating that better and more consistent patient outcomes were being achieved. Conclusion These are the first national hospice/palliative care symptom control performance data to demonstrate improvements in clinical outcomes at a service level as a result of routine data collection and systematic feedback.

Palliative care is a vital component of Australia's healthcare services, and is provided to those living with a life‑threatening illness, whether they are adults, adolescents or children. The aim of palliative care is to improve a person's quality of life by managing the symptoms of their illness and providing emotional, spiritual and social support for the person and their family or carers. Unlike other areas in health care, palliative care focuses on addressing the patient's needs rather than the underlying medical diagnosis (see the box on the right).

The Australian National Subacute and Non‐acute Patient Classification Version 4

Participants can expect to be updated on the progress of national and international efforts to develop standardised outcome datasets for evaluating and improving pain services to children. Participants will be offered opportunities to engage in lively discussion in session, and join working groups to shape the future direction of national database development and improvement.

[extract] A quick reminder of recent history Core design features of the National Health Reform Agreement (NHRA) Signed by COAG 31 July 2011

[extract] 'Right care' in the 'right place' - Integrated service delivery is "the organization and management of health services so that people get the care they need, when they need it, in ways that are user-friendly, achieve the desired results and provide value for money"

This paper will draw on the experiences of two national clinical benchmarking and patient outcome measurement centres - the Palliative Care Outcomes Collaboration (PCOC) and the electronic Persistent Pain Outcomes Collaboration (ePPOC) - to identify key issues in measuring patient outcomes. Outcomes reported through both centres will be presented and the lessons from both centres will be discussed.

In this workshop Professor Eagar will provide an overview of the current status of ePPOC. Developments will be compared with AROC (Australasian Rehabilitation Outcomes Centre) and PCOC (Palliative Care Outcomes Collaboration).

[extract] The starting point for the Australian western health care system New South Wales became a (penal) colony in 1788, followed progressively by the other Australian States. Australia didn't became a country until 1901.

Overview - Caveat: focus is on health system - Experts throughout the day will overview ageing and aged care issues and proposed reforms - Structural design of the Australian health system - The constitution and its implications - Recent health reform under Labor (Rudd, Gillard) - Current Coalition health reform agendas - What it might all mean on the ground

Overview - Health reform - where we've been, where we are (probably) going - The IHPA model and variations on a theme - AN-SNAP update

AIMS: An aged care assessment suite to enable elderly people to access community aged care services was redesigned for national application and field tested across Australia (N = 1,011). A 3-tiered model for assessment related to the need for services underpinned the assessment battery: * Level 1-for those requiring basic services such as domestic assistance or transport etc.; * Level 2-for those requiring more substantial use of services including elements of personal care; * Level 3-for those requiring a comprehensive clinical assessment to obtain higher levels of care. The field trial was concerned with the first two levels of assessment and referral to a Level 3 agency.

Recent enhancements to subacute care services are threatened due to the uncertain future of federal-state funding agreements.

Prepared by The University of Queensland for the Independent Hospital Pricing Authority to assist the development and specification of a mental health classification system.

Prepared by The University of Queensland for the Independent Hospital Pricing Authority to assist the development and specification of a mental health classification system.

The Centre for Health Service Development (CHSD), University of Wollongong, was appointed in June 2012 to undertake the program evaluation of the Health Workforce Australia - Expanded Scopes of Practice (HWA-ESOP) program. Health Workforce Australia (HWA) currently funds 26 organisational projects across Australia. Several organisations have more than one implementation site. The focus of this first evaluation progress report is the set-up phase; it is consequently formative - providing a view of the progress and development of the four sub-projects: - Advanced Practice in Endoscopy Nursing (APEN) - Physiotherapists in the Emergency Department (PED) - Nurses in the Emergency Department (NED) - Extending the Role of Paramedics (ERP)

Australia has recently implemented an activity-based funding system for public hospitals. Policymakers and providers are keen to ensure that the price paid for health care services stimulates improvements in quality and safety, but some remain sceptical that this can be achieved through pricing mechanisms.

This is the Final Report of the Validation and Field Trials of the Assessment Framework and Tool for Aged Care project. This report provides details of the field testing of the Aged Care Assessment Tool for Level 1 and Level 2 Assessment at seven sites across Australia. Our previous report, A Model and Proposed Items for the New Assessment System for Aged Care (Sansoni et al., 2012c) detailed an assessment system with three levels of Assessment related to need for services

This literature review is part of a larger work program being managed jointly by the Australian Commission on Safety and Quality in Health Care (the Commission) and the Independent Hospital Pricing Authority (IHPA). The purpose of this literature review is to review the evidence on existing mechanisms in operation which aim to integrate quality and safety into the pricing or funding arrangements for health care. This literature review will also inform a consultation paper that will explore the options the IHPA and the Commission may recommend to its boards for including quality and safety in its future iterations of the Pricing Framework for Australian Public Hospital Services. The focus of both this literature review and the subsequent consultation paper is on quality and safety in relation to pricing and not on quality and safety per se.

Objective. Examine demographics, clinical characteristics and rehabilitation outcomes of lower-limb amputees, using the Australasian Rehabilitation Outcomes Centre (AROC) database. Methods. Lower-limb amputee rehabilitation separations between 2004 and 2010 were identified using AROC impairment codes 5.3-5.7.1 Analysis was conducted by year, impairment code, Australian National Sub-acute and Non-Acute Patient (AN-SNAP) classification (S2-224, Functional Independence Measure (FIM) motor(Mot) score 72-91; S2-225, FIM (Mot) score 14-71) and states of Australia. Results. Mean length of stay (LOS) for all lower-limb amputee episodes was 36.1 days (95% confidence interval (CI): 35.4-36.9). Majority of episodes were unilateral below knee (63.6%), males (71.8%) with a mean age of 67.9 years (95% CI: 67.6-68.3). Year-on-year analysis revealed a trend for increasing LOS and decreasing age. Analysis by impairment code demonstrated no significant difference in rehabilitation outcomes. Analysis by AN-SNAP found that LOS was 16.2 days longer for S2-225 than for S2-224 (95% CI: 14.7-17.8,P < 0.001), andFIM(Mot) change was 12.0 points higher for S2-225 than for S2-224 (95% CI: 11.5-12.6, P < 0.001). Analysis by states revealed significant variation in LOS, FIM (Mot) change and FIM (Mot) efficiency which may be associated with variations in organisation of rehabilitation services across states. Conclusion. Although amputees represented a comparatively small proportion of all rehabilitation episodes in Australia, their LOS was significant. Unlike many other rehabilitation conditions, there was no evidence of decreasing LOS over time. AN-SNAP classes were effective in distinguishing rehabilitation outcomes, and could potentially be used more effectively in planning rehabilitation programs.

Background A range of health outcomes at a population level are related to differences in levels of social disadvantage. Understanding the impact of any such differences in palliative care is important. The aim of this study was to assess, by level of socio-economic disadvantage, referral patterns to specialist palliative care and proximity to inpatient services. Methods All inpatient and community palliative care services nationally were geocoded (using postcode) to one nationally standardised measure of socio-economic deprivation - Socio- Economic Index for Areas (SEIFA; 2006 census data). Referral to palliative care services and characteristics of referrals were described through data collected routinely at clinical encounters. Inpatient location was measured from each person's home postcode, and stratified by socio-economic disadvantage. Results This study covered July - December 2009 with data from 10,064 patients. People from the highest SEIFA group (least disadvantaged) were significantly less likely to be referred to a specialist palliative care service, likely to be referred closer to death and to have more episodes of inpatient care for longer time. Physical proximity of a person's home to inpatient care showed a gradient with increasing distance by decreasing levels of socio-economic advantage. Conclusion These data suggest that a simple relationship of low socioeconomic status and poor access to a referral-based specialty such as palliative care does not exist. Different patterns of referral and hence different patterns of care emerge.