Measuring The Productive Efficiency Of Hospitals - A Comparison Of Parametric And Non-parametric Approaches
Funder
National Health and Medical Research Council
Funding Amount
$61,815.00
Summary
In the face of rising health service costs, an ageing population, and falling private health insurance rates, the efficient use of scarce health service resources has become a central theme in health system reform. Productive (or technical) efficiency is a key aspect of health system reform - that given health services are produced with the minimum feasible amount of resources. Despite the importance of technical efficiency there have been few published studies in Australia which measure technic ....In the face of rising health service costs, an ageing population, and falling private health insurance rates, the efficient use of scarce health service resources has become a central theme in health system reform. Productive (or technical) efficiency is a key aspect of health system reform - that given health services are produced with the minimum feasible amount of resources. Despite the importance of technical efficiency there have been few published studies in Australia which measure technical efficiency in the health sector. This study will develop theoretical and empirical approaches to measuring technical efficiency in the production of hospital services using data from Victoria. Measures of hospital technical efficiency will be developed using two quantitative modelling approaches: stochastic frontier modelling and data envelopment analysis. Results will be used to investigate the impact of patient and hospital characteristics on efficiency, and to identify economies of scale and scope in the provision of hospital services. The robustness of results to changes in variables, the sample of hospitals studied, and model assumptions will be tested, and two techniques will be compared to assess their appropriateness in the health services context which has not previously been done. Criteria for assessing the approaches include the degree to which: assumptions affect the robustness of results; the techniques capture the salient features of health services production; and the techniques produce similar rankings and estimates of inefficiency. The methods used will represent a significant contribution to international knowledge of hospital efficiency measurement, and the relationships between hospital characteristics, casemix, and efficiency. The study wil provide improved measures of hospital efficiency in Victoria, and will inform debate on hospital funding policy.Read moreRead less
A Randomised Trial Of Core Cooling Versus Surface Cooling In Comatose Survivors Of Prehospital Cardiac Arrest
Funder
National Health and Medical Research Council
Funding Amount
$309,000.00
Summary
Pre-hospital sudden cardiac arrest (SCA) is a major public health problem that is estimated to cause around one death per thousand adults per year. The aetiology of SCA is usually ischaemic heart disease causing ventricular fibrillation (VF). The current medical response to this condition involves a Chain of Survival, including early call to 000, bystander CPR, early defibrillation and early advanced cardiac life support. Following successful cardiac resuscitation, patients are transported to ho ....Pre-hospital sudden cardiac arrest (SCA) is a major public health problem that is estimated to cause around one death per thousand adults per year. The aetiology of SCA is usually ischaemic heart disease causing ventricular fibrillation (VF). The current medical response to this condition involves a Chain of Survival, including early call to 000, bystander CPR, early defibrillation and early advanced cardiac life support. Following successful cardiac resuscitation, patients are transported to hospital for further care. Despite this approach and recent improvements such as decreased ambulance response times, outcome remains poor and there are very few survivors who make a good recovery. This proposal is for funding to conduct a randomised, controlled trial, which compares two different techniques of induction of hypothermia in patients who are resuscitated from pre-hospital sudden cardiac arrest. Recently available data suggests that the outcome from SCA is significantly improved if moderate hypothermia is used as a treatment of neurological injury. However, the technique of induction of hypothermia requires further research. This study compares core-cooling using large-volume ice-cold intravenous fluid with the current technique of using ice packs for surface cooling, initiated in the field by ambulance paramedics and continued in hospital for a total of 12 hours. This study has the potential to demonstrate a significant improvement in outcome in a common clinical condition, which currently carries a very high mortality rate. This will be the first trial internationally which assess core versus surface cooling initiated pre-hospital, in SCA patients. It is highly likely that with the successful results from this trial that induced hypothermia in SCA patients will become standard care. The use of induced hypothermia could lead to over 500 lives saved per year accross Australia.Read moreRead less
‘Defying The Odds’: Exploring The Impact Of Perinatal Outcomes, Maternal Social And Health Outcomes And Level Of Culturally Appropriate Service Availability On The Health Of Western Australian Aboriginal Infants And Children
Funder
National Health and Medical Research Council
Funding Amount
$659,356.00
Summary
A healthy start to life is essential for life-long health. Currently, Aboriginal children have greater rates of death and hospitalisation than other Australians. This study will determine individual, community and service-related risk and protective factors for health outcomes among Aboriginal children (0-5yrs) using whole-of-population linked health data from multigenerational Aboriginal families in WA. Findings will support effective service development to help those at-risk ‘defy the odds’.
Evaluation Of Nitrous Oxide In The Gas Mixture For Anaesthesia: A Randomised Controlled Trial (The ENIGMA Trial)
Funder
National Health and Medical Research Council
Funding Amount
$490,125.00
Summary
There are about 2 million anaesthetics given each year in Australia (1:10 Australians), with more than 1 million Australians being exposed to nitrous oxide (laughing gas). Despite being around for more than 150 years, there has yet to be a large trial of the safety and benefits of nitrous oxide, particularly when compared with newer (safer?) anaesthetic drugs. Nitrous oxide is not a particularly strong anaesthetic and so it must be mixed with other drugs. Current practice in Australia and around ....There are about 2 million anaesthetics given each year in Australia (1:10 Australians), with more than 1 million Australians being exposed to nitrous oxide (laughing gas). Despite being around for more than 150 years, there has yet to be a large trial of the safety and benefits of nitrous oxide, particularly when compared with newer (safer?) anaesthetic drugs. Nitrous oxide is not a particularly strong anaesthetic and so it must be mixed with other drugs. Current practice in Australia and around the world is to give 70% nitrous oxide in oxygen along with another anaesthetic gas in order to produce a depth of anaesthesia sufficient for surgery. This is despite knowledge that nitrous oxide interferes with the production of DNA. DNA is used to programme cell division and function - it is the building block of cell and tisue growth. It is known that nitrous oxide can impair some tissue functions, such that anaemia and, possibly birth defects can occur. Such effects are rare, but recent evidence suggests that milder abnormalities may occur more commonly than previously thought. There is also good evidence that nitrous oxide increases the risk of severe nausea and vomiting after surgery. The adverse effects on DNA production raises the possibility of nitrous oxide causing immune deficiency, heart ischaemia, (angina), nerve and spinal cord damage, and increased cancer risk in hospital staff chronically exposed to low levels of nitrous oxide. The prevailing view is that nitrous oxide is a cheap, relatively safe drug that can reduce the exposure to other anaesthetic drugs. However, the development of many new anaesthetic drugs demands a re-evaluation of the role of nitrous oxide in current anaesthetic practice.Read moreRead less
Improved electrophoretic analyser for water quality monitoring. This proposal will advance the Australian made Eco Detection portable electrophoretic analyser for autonomous monitoring of water chemistry - the Eco Sensor. We will re-design and miniaturise the fluidic manifold to reduce capital- and per-sample cost, increase the sensitivity of nutrients - nitrate and phospate - by 100-times in both fresh- and sea-waters, and develop new ultra-sensitive reagents for heavy metal detection at enviro ....Improved electrophoretic analyser for water quality monitoring. This proposal will advance the Australian made Eco Detection portable electrophoretic analyser for autonomous monitoring of water chemistry - the Eco Sensor. We will re-design and miniaturise the fluidic manifold to reduce capital- and per-sample cost, increase the sensitivity of nutrients - nitrate and phospate - by 100-times in both fresh- and sea-waters, and develop new ultra-sensitive reagents for heavy metal detection at environmentally regulated levels. This will provide a single platform for at-site near-real-time monitoring of water chemistry for agricultural, mining, water corporations and other industries that use and/or discharge water to the environment. Read moreRead less