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Australian Health Review Australian Health Review Society
Journal of the Australian Healthcare & Hospitals Association
Australian Health Review

Australian Health Review

Volume 48 Number 2 2024

Special Issue

Value-Based Healthcare

What is known about the topic? To succeed in efforts to implement equitable, sustained value-based healthcare (VBHC), the foundations and ongoing impacts of settler-colonialism and neoliberalism on which the Australian healthcare system is built must be acknowledged and addressed. What does this paper add? The ‘modern’ VBHC movement provides an opportunity to not only reform health care towards a more equitable, community-centred system, but to also acknowledge, honour and learn from global Indigenous knowledge, systems, and ways of valuing knowing, being and doing. What are the implications for practitioners? This article is an invitation to sit, listen and learn.

This article belongs to the Special Issue: Value-based Healthcare.

What is known about the topic? With health expenditure rising unsustainably, there is a growing focus on ways to reduce low-value care to improve health outcomes and eliminate unnecessary costs. What does this paper add? This paper details drivers of low-value care in Australia’s private health system and recommendations to overcome them. Drivers include the Prescribed List of Medical Devices, gaps in safety and quality controls, and conflicts of interest and marketing. What are the implications for practitioners? These insights are relevant to clinicians, researchers, policymakers, consumers and health business leaders with an interest in low-value care.

This article belongs to the Special Issue: Value-based Healthcare.

AH24001Creating a framework for change: transitioning to value-based healthcare in Queensland

Belinda Gavaghan, Jennifer Finch and Katelyn Clarke
pp. 123-128

What is known about the topic? Value-based healthcare provides an approach to restructure healthcare systems to improve health outcomes and the holistic experience of care for people and communities. What does this paper add? This paper details the development of a framework to support health services to transition to a value-based approach. What are the implications for practitioners? By reflecting on the diversity of health practitioners, managers and consumer experiences and the unique opportunities and challenges of individual healthcare services, the framework provides a structure and starting point for services to transition to value-based healthcare.

This article belongs to the Special Issue: Value-Based Healthcare.

AH24002Driving value-based healthcare through a new vision for Queensland’s health system

Madeleine Wellington, Elizabeth Whiting 0000-0002-8998-7539, Damien Searle, Megan Kreis 0000-0001-9127-4389 and Emily Cross
pp. 129-133

What is known about the topic? Vision statements for organisations including health are common. However, there is little information available in the literature regarding approaches to developing a vision for a health system. What does this paper add? An overview of an approach to developing a new health system vision through comprehensive consultation that engages stakeholders broadly to develop an informed vision that has support from all levels of the health system. What are the implications for practitioners? The method used to develop this vision could be replicated across any large-scale organisation. Although time consuming, the outcome is a vision that is widely supported and sets the organisation up for success for implementation.

This article belongs to the Special Issue: Value-based Healthcare.

What is known about the topic? Value-based healthcare (VBHC) has gained significant momentum within the healthcare sector and is seen as a driver for improving patient outcomes and equitable use of resources. What does this paper add? The paper describes firsthand experience and lessons learnt from implementing VBHC within a Victorian public healthcare system; the learnings are applicable to other organisations wanting to implement VBHC. What are the implications for practitioners? In implementing a co-designed VBHC framework, we ensured that its principles are applicable at both patient and population levels, centres on equity of access to care, achieves the best possible health outcomes and sustainable use of resources.

This article belongs to the Special Issue: Value-based Healthcare.

AH24009Designing and implementing a bundle of care for patients with early-stage breast cancer: lessons from a pilot program

Yvonne Zissiadis, Helen Ballal, Nicola Forsyth, Angela Ives 0000-0001-5734-0821, Lee Jackson, Anna Montgomery, Sarah Wise 0000-0003-3513-3471, Wen Chan Yeow and Christobel Saunders 0000-0003-2281-9829
pp. 142-147

What is known about this topic? Enabling value-based healthcare is essential to improve healthcare, focusing on outcomes gained over a full cycle of care. Patients diagnosed with cancer frequently report care to be disjointed and the cause of financial stress, thus can particularly benefit from value-based care models. What does this paper add? This case study describes the design and implementation of a bundled package of care for patients with early-stage breast cancer treated in the private health sector in Australia. What are the implications for practitioners? Lessons learned through this process provide considerations for expansion of this model of care.

This article belongs to the Special Issue: Value-based Healthcare.

What is known about the topic? While much has been written about the benefits of digital health, there are few practical examples of how a digital initiative, developed and implemented with clinicians and consumers, can positively change a healthcare service. What does this paper add? This paper discusses the importance of developing new digital healthcare services with the end user through co-design. A fully automated lung cancer digital care pathway and the lessons learned in implementation of the pathway are presented. This initiative was implemented within a public hospital to provide a service that has a vision of value-based health care and a person centric approach to care. What are the implications for practitioners? This study illustrates how the implementation of a digital care pathway for the monitoring and treatment of lung cancer can provide an approach that moves from reactive to proactive care. The implementation of the digital care pathway has positively changed the lung cancer service in a rapidly growing area.

This article belongs to the Special Issue: Value-based Healthcare.

AH23278Taking a value based commissioning approach to non-clinical and clinical support services

Trinette Kinsman, Samantha Reid and Hayley Arnott
pp. 154-159

What is known about the topic? Value based healthcare is a way of making transparent and equitable decisions about resource allocation to deliver better outcomes for individuals, health services and the system. What does this paper add? This paper reflects on the opportunity to deliver value based healthcare beyond clinical models of care, including in non-clinical and clinical support services, using a commissioning approach. What are the implications for practitioners? The learnings shared through the case studies presented can be applied by practitioners to their own projects to support value based approaches across all aspects of health care.

This article belongs to the Special Issue: Value-based Healthcare.

AH24003Measuring clinician experience in value-based healthcare initiatives: a 10-item core clinician experience measure (CEM-10)

Reema Harrison 0000-0002-8609-9827, Louise A Ellis, Maryam Sina, Ramya Walsan 0000-0002-4359-6794, Rebecca Mitchell, Ramesh Walpola, Glen Maberly, Catherine Chan and Liz Hay
pp. 160-166

What is known about the topic? Clinician experience of providing care is an outcome of interest for health systems and services internationally who are implementing value-based care initiatives. Review evidence indicates that measurement of clinician’s experience of providing care should address experiences of being able to deliver quality care, collaborate with colleagues, experience psychological safety and engagement in decision-making in the workplace. What does this paper add? The paper reports the development of the short form clinician experience measure (CEM-10) and its initial validation in four value-based healthcare initiatives of NSW Health. What are the practical implications for practitioners? The CEM-10 can be used as a core set of items embedded within evaluations of value-based care initiatives to benchmark and examine experiences across clinician cohorts.

This article belongs to the Special Issue: Value-based Healthcare.

AH24020Marked variations in medical provider and out-of-pocket costs for radical prostatectomy procedures in Australia

Ramya Walsan 0000-0002-4359-6794, Rebecca J. Mitchell, Jeffrey Braithwaite, Johanna Westbrook, Peter Hibbert, Virginia Mumford and Reema Harrison 0000-0002-8609-9827
pp. 167-171

What is known about the topic? Unwarranted clinical variations in radical prostatectomy procedures are well documented in the literature; however, variations in cost are less widely reported. What does this paper add? This paper aims to highlight the cost variations in radical prostatectomy procedures in Australia, discussing their plausible causes, implications and proposing potential policy opportunities. What are the implications for practitioners? Excessive fees imposed by medical providers may contribute to inequalities in healthcare access. Enhancing transparency of individual medical provider costs and implementing fee regulations may be useful in controlling unwarranted variations in procedure costs.

This article belongs to the Special Issue: Value-based Healthcare.

AH23231The impact of management option on out-of-pocket costs and perceived financial burden among men with localised prostate cancer in Australia within 6 months of diagnosis

Daniel Lindsay, Penelope Schofield, Doreen Nabukalu, Matthew J. Roberts, John Yaxley, Stephen Quinn, Natalie Richards, Mark Frydenberg, Robert Gardiner, Nathan Lawrentschuk, Ilona Juraskova, Declan G. Murphy and Louisa G. Gordon 0000-0002-3159-4249
pp. 172-181

What is known about the topic? International evidence suggests that men with low-risk prostate cancer managed with active surveillance initially incur lower out-of-pocket costs than those managed with active treatment. What does this paper add? Australian men with low-risk prostate cancer report low out-of-pocket costs and financial burden in the first 6 months post-diagnosis. Compared with those managed with active surveillance, men having active treatment had 6–7 times greater out-of-pocket expenses. What are the implications for practitioners? Being managed by active surveillance as the primary management option for low-risk prostate cancer reduces the financial burdens associated with a cancer diagnosis.

AH24019Hospitalisations and emergency department presentations by older individuals accessing long-term aged care in Australia

Stephanie L. Harrison, Catherine Lang, Tesfahun C. Eshetie, Maria Crotty, Craig Whitehead, Keith Evans, Megan Corlis, Steve Wesselingh, Gillian E. Caughey and Maria C. Inacio
pp. 182-190

What is known about the topic? Unplanned hospitalisations and emergency department presentations are frequent and burdensome for older people receiving long-term aged care. What does this paper add? While unplanned hospitalisations and emergency department presentations were high in all people receiving long-term care, these events were higher in people receiving home care packages than those in residential aged care. What are the implications for practitioners? Further efforts to address the high unplanned hospitalisations and emergency department presentations experienced by the increasing number of older adults accessing home care packages are required to allow this population to remain at home successfully.

This article belongs to the Special Issue: Value-based Healthcare.

AH23225Consumer perspectives of allied health involvement in a public hospital setting: cross-sectional survey and electronic health record review

Laura Jolliffe 0000-0002-1369-9442, Cylie M. Williams 0000-0002-0223-9141, Natalie Bozyk, Taya A. Collyer 0000-0001-8612-1724, Kirsten Caspers and David A. Snowdon 0000-0003-2041-3120
pp. 191-200

What is known about the topic? Research on consumer acceptance of out-of-hours or weekend allied health services is lacking, with an assumption of consumer willingness and demand for these service models. What does this paper add? Hospital inpatients are generally indifferent to the day of allied health services, preferring weekday or weekend day equally, typically between 8 am and 4 pm, while outpatients favour weekday mornings. Although consumers reported that their needs were met by allied health services, there was a lack of awareness about the specific services they received. What are the implications for practitioners? Results highlight the importance of not only aligning service delivery with consumer preferences for timing, but also enhancing awareness and understanding of the available allied health services for consumers.

AH23272Development and implementation of the Specialist Palliative Care in Aged Care (SPACE) Project across Queensland

Rebecca Smith, Gregory Merlo, Andrew M Broadbent, Caitlin Lock, Sharon Mickan and Nicola Morgan
pp. 201-206

What is known about the topic? There is limited palliative care support for the 36% of Australians who die in residential aged care. What does this paper add? This paper describes the development of the Specialist Palliative Care in Aged Care (SPACE) Project, using locally tailored models of care to improve palliative and end-of-life care in aged care facilities across Queensland. What are the implications for practitioners? Critical elements for improving residents’ palliative and end-of-life care included creation of an expert working group to define the innovation state-wide, a central project team that supported implementation, a community of practice, and local facilitation.

AH23262Clinical research imperatives: principles and priorities from the perspective of Allied Health executives and managers

Susan Hillier 0000-0002-6071-6137, Duncan Lodge, Jo Nolan, Rosalie Yandell, Anna Chur-Hansen, Stacey George and Elizabeth Lynch
pp. 207-217

What is known about the topic? Allied Health are well equipped to engage in research but have limited capacity. What does this paper add? We have identified key priorities and principles to inform Allied Health research activity. What are the implications for practitioners? Practitioners, funders and other stakeholders can develop these identified principles and priorities to direct research time and resources for the most impact on health outcomes.

Committee on Publication Ethics

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