SAFety, Effectiveness of care and Resource use among Australian Hospitals (SAFER Hospitals): a protocol for a population-wide cohort study of outcomes of hospital care.

INTRODUCTION: Despite global concerns about the safety and quality of health care, population-wide studies of hospital outcomes are uncommon. The SAFety, Effectiveness of care and Resource use among Australian Hospitals (SAFER Hospitals) study seeks to estimate the incidence of serious adverse events, mortality, unplanned rehospitalisations and direct costs following hospital encounters using nationwide data, and to assess the variation and trends in these outcomes. METHODS AND ANALYSIS: SAFER Hospitals is a cohort study with retrospective and prospective components. The retrospective component uses data from 2012 to 2018 on all hospitalised patients age ≥18 years included in each State and Territories' Admitted Patient Collections. These routinely collected datasets record every hospital encounter from all public and most private hospitals using a standardised set of variables including patient demographics, primary and secondary diagnoses, procedures and patient status at discharge. The study outcomes are deaths, adverse events, readmissions and emergency care visits. Hospitalisation data will be linked to subsequent hospitalisations and each region's Emergency Department Data Collections and Death Registries to assess readmissions, emergency care encounters and deaths after discharge. Direct hospital costs associated with adverse outcomes will be estimated using data from the National Cost Data Collection. Variation in these outcomes among hospitals will be assessed adjusting for differences in hospitals' case-mix. The prospective component of the study will evaluate the temporal change in outcomes every 4 years from 2019 until 2030. ETHICS AND DISSEMINATION: Human Research Ethics Committees of the respective Australian states and territories provided ethical approval to conduct this study. A waiver of informed consent was granted for the use of de-identified patient data. Study findings will be disseminated via presentations at conferences and publications in peer-reviewed journals.

Elements of cultural competence in an Australian Aboriginal maternity program.

BACKGROUND: Pregnancy, labour and neonatal health outcomes for Australian Aboriginal women and their infants are frequently worse than those of the general population. Provision of culturally competent services may reduce these differences by improving access to timely and regular antenatal care. In an effort to address these issues, the Aboriginal Maternity Group Practice Program commenced in south metropolitan Perth, Western Australia, in 2011. The program employed Aboriginal Grandmothers, Aboriginal Health Officers and midwives working in a partnership model with pre-existing maternity services in the area. AIM: To identify elements of the Aboriginal Maternity Group Practice Program that contributed to the provision of a culturally competent service. METHODS: The Organisational Cultural Competence Assessment Tool was used to analyse qualitative data obtained from surveys of 16 program clients and 22 individuals from partner organisations, and interviews with 15 staff. FINDINGS: The study found that the partnership model positively impacted on the level of culturally appropriate care provided by other health service staff, particularly in hospitals. Two-way learning was a feature. Providing transport, team home visits and employing Aboriginal staff improved access to care. Grandmothers successfully brought young pregnant women into the program through their community networks, and were able to positively influence healthy lifestyle behaviours for clients. CONCLUSION: Many elements of the Aboriginal Maternity Group Practice Program contributed to the provision of a culturally competent service. These features could be considered for inclusion in antenatal care models under development in other regions with culturally diverse populations.

Success in Closing the Gap: favourable neonatal outcomes in a metropolitan Aboriginal Maternity Group Practice Program.

OBJECTIVES: To report differences in neonatal health outcomes for a community-based antenatal program, the Aboriginal Maternity Group Practice Program (AMGPP; the intervention group), compared with two matched control groups eligible for standard antenatal care. DESIGN: Non-randomised intervention study using data from the Western Australian Midwives Notification System. Regression models were used to report adjusted odds ratios (aORs) for defined neonatal health outcomes. SETTING: The AMGPP employed Aboriginal grandmothers, Aboriginal Health Officers, and midwives working in partnership with existing antenatal services to provide care for pregnant Aboriginal women residing in south metropolitan Perth. PARTICIPANTS: 343 women (with 350 pregnancies) who participated in the AMGPP and gave birth between 1 July 2011 and 31 December 2012; historical and contemporary control groups of pregnant Aboriginal women (each including 350 pregnancies), frequency matched for maternal age and gravidity. MAIN OUTCOME MEASURES: Preterm births, birthweight, neonatal resuscitation, neonatal hospital length of stay longer than 5 days. RESULTS: Babies born to AMGPP participants were significantly less likely to be born preterm (AMGPP, 9.1% v historical controls, 15.9% [aOR, 0.56; 95% CI, 0.35-0.92]; v contemporary controls, 15.3% [aOR, 0.75; 95% CI, 0.58-0.95]); to require resuscitation at birth (AMGPP, 17.8% v historical controls, 24.4% [aOR, 0.68; 95% CI, 0.47-0.98]; v contemporary controls, 31.2% [aOR, 0.71; 95% CI, 0.60-0.85]), or to have a hospital length of stay of more than 5 days (AMGPP, 4.0% v historical controls, 11.3% [aOR, 0.34; 95% CI, 0.18-0.64]; v contemporary controls, 11.6% [aOR, 0.56; 95% CI, 0.41-0.77]). CONCLUSION: Participation in the AMGPP in south metropolitan Perth was associated with significantly improved neonatal health outcomes.

Finding the 'who' in whooping cough: vaccinated siblings are important pertussis sources in infants 6 months of age and under.

OBJECTIVES: To describe the epidemiology of pertussis, and to identify changes in the source of pertussis in infants 6 months of age and under, during the 2008-2012 epidemic in south metropolitan Perth. DESIGN AND SETTING: Analysis of all pertussis cases notified to the South Metropolitan Population Health Unit and recorded on the Western Australian Notifiable Infectious Disease Database over the study period. Information on the source of pertussis was obtained from enhanced surveillance data. RESULTS: Notification rates were highest in the 5-9 years age group, followed by the 0-4 years and 10-14 years age groups. There was a significant increase in the proportion of known sources who were siblings from the early epidemic period of 2008-2010, compared with the peak epidemic period of 2011-2012 (14.3% versus 51.4%, p = 0.002). The majority of sibling sources were fully vaccinated children aged 2 and 3 years. CONCLUSIONS: The incidence of pertussis was highest in children aged 12 years and under in this epidemic. At its peak, siblings were the most important sources of pertussis in infants 6 months and younger, particularly fully vaccinated children aged 2 and 3 years. Waning immunity before the booster at 4 years may leave this age group susceptible to infection. Even if cocooning programs could achieve full vaccination coverage of parents and ensure all siblings were fully vaccinated according to national schedules, waning immunity in siblings could provide a means for ongoing transmission to infants. Recent evidence suggests that maternal antenatal vaccination would significantly reduce the risk of pertussis in infants 3 months of age and under.