Janine Alan

Evidence for the long term cost effectiveness of home care reablement programs.

Background The objectives of this study were to determine whether older individuals who participated in a reablement (restorative) program rather than immediately receiving conventional home care services had a reduced need for ongoing support and lower home care costs over the next 57 months (nearly 5 years). Materials and methods Data linkage was used to examine retrospectively the service records of older individuals who had received a reablement service versus a conventional home care service to ascertain their use of home care services over time. Results Individuals who had received a reablement service were less likely to use a personal care service throughout the follow-up period or any other type of home care over the next 3 years. This reduced use of home care services was associated with median cost savings per person of approximately AU

Identification of risk factors associated with the development of skin tears in hospitalised older persons: a case-control study.

12,500 over nearly 5 years. Conclusion The inclusion of reablement as the starting point for individuals referred for home care within Australia’s reformed aged care system could increase the system’s cost effectiveness and ensure that all older Australians have the opportunity to maximize their independence as they age.

Cross-border hospital use: analysis using data linkage across four Australian states

To identify the risk factors associated with the development of skin tears in older persons four hundred and fifty three patients (151 cases and 302 controls) were enrolled in a case–control study in a 500‐bed metropolitan tertiary hospital in Western Australia between December 2008 and June 2009. Case eligibility was defined by a skin tear on admission, which had occurred in the last 5 days; or, a skin tear developed during hospitalisation. For each case, two controls who did not have a skin tear and had been admitted within 1 day of the case, were also enrolled. Data collected from the nursing staff and inpatient medical records included characteristics known, or hypothesised, to be associated with increased vulnerability to skin tears. Data analysis included a series of multivariate stepwise regressions to identify a number of different potential explanatory models. The most parsimonious model for predicting skin tear development comprised six variables: ecchymosis (bruising); senile purpura; haematoma; evidence of a previously healed skin tear; oedema; and inability to reposition oneself independently. The ability of these six characteristics to predict who among older patients could subsequently develop a skin tear now needs to be determined by a prospective study.

Pre-sentence mental health service use by adult offenders in Western Australia: Baseline results from a longitudinal whole-population cohort study

Objective: To determine the quality and effectiveness of national data linkage capacity by performing a proof‐of‐concept project investigating cross‐border hospital use and hospital‐related deaths.

Influence of offence type and prior imprisonment on risk of death following release from prison: A whole-population linked data study

BACKGROUND Little is known about community mental health service use prior to offending. AIM This study aimed to investigate the 1-year community mental health service use by adult offenders (18-44 years) prior to their first ever criminal sentence in Western Australia. METHODS Administrative mental health service data were compared between all offenders (n = 23,755) commencing their first ever criminal sentence in Western Australia during 1985-1994 and a matched community group of 21,977 non-offenders. RESULTS Just over 8% of offenders had used mental health services prior to sentence compared with 1% of non-offenders. After adjusting for age, offenders were more likely to have used these services than non-offenders in all gender-race groups, but the effect was strongest for non-Indigenous women, who were over 12 times more likely to have used such services, and weakest among Indigenous men, who were about twice as likely to have used them as their non-offending peers. Service use for substance use disorder, the most common diagnosis, was about one and a half times more prevalent among Indigenous than non-Indigenous offenders, regardless of gender. For non-Indigenous offenders, prevalence of any mental health service contact was higher for violent than non-violent offenders, irrespective of gender. Service use was no different between offenders receiving custodial or non-custodial sentences in all gender-race groups. CONCLUSION The higher likelihood of mental health service use by offenders in the year prior to their first ever sentence than by non-offenders suggests that, insofar as the disorder was relevant to offending, there were some opportunities for preventive measures during that time. Differential service use according to gender and Indigenous/non-Indigenous status is of concern. It would be important to understand more about this apparently unequal service access, not least because Indigenous populations tend to be over-represented in prison.

Predictors of post-sentence mental health service use in a population cohort of first-time adult offenders in Western Australia

PURPOSE The purpose of this paper is to examine the influence of offence type, prior imprisonment and various socio-demographic characteristics on mortality at 28 and 365 days following prison release. DESIGN/METHODOLOGY/APPROACH Using whole-population linked, routinely collected administrative state-based imprisonment and mortality data, the authors conducted a retrospective study of 12,677 offenders released from Western Australian prisons in the period 1994-2003. Cox proportional hazards regression was used to examine the association between mortality at 28 and 365 days post-release and offence type, prior imprisonment, and a range of socio-demographic characteristics (age, gender, social disadvantage and Indigenous status). FINDINGS Overall, 135 (1.1 per cent) died during the 365 days follow-up period, of these, 17.8 per cent (n=24) died within the first 28 days (four weeks) of their index release. Ex-prisoners who had committed drug-related offences had significantly higher risk of 28-day post-release mortality (HR=28.4; 95 per cent CI: 1.3-615.3, p=0.033), than those who had committed violent (non-sexual) offences. A significant association was also found between the number of previous incarcerations and post-release mortality at 28 days post-release, with three prior prison terms carrying the highest mortality risk (HR=73.8; 95 per cent CI: 1.8-3,092.5, p=0.024). No association between mortality and either offence type or prior imprisonment was seen at 365 days post-release. ORIGINALITY/VALUE Post-release mortality at 28 days was significantly associated with offence type (with drug-related offences carrying the greatest risk) and with prior imprisonment, but associations did not persist to 365 days after release. Targeting of short-term transitional programmes to reduce preventable deaths after return to the community could be tailored to these high-risk ex-prisoners.

Multi‐jurisdictional linkage in Australia: proving a concept

BACKGROUND Little is known about whether or how offenders use mental health services after sentence completion. AIM This study aimed to determine the likelihood of such service use by adult (18-44 years) first-time offenders up to 5 years after sentence completion and possible predictor variables. METHODS Pre-sentence and post-sentence mental health service use was obtained from whole-population linked administrative data on 23,661 adult offenders. Cox proportional hazard models were used to determine which socio-demographic, offending and pre-sentence health service variables were associated with such post-sentence service use. RESULTS The estimated 5-year probability of any post-sentence mental health service use was 12% for offenders who had not previously used such services, but still only 42% for those who had. For the latter, best predictors of post-sentence use were past psychiatric diagnosis and history of self-harm; history of self-harm also predicted post-sentence use among new mental health services users and so also did past physical illness. Indigenous offenders had a greater likelihood of service use for any mental disorder or for substance use disorders than non-Indigenous offenders, irrespective of pre-sentence use. Among those with pre-sentence service contact, imprisoned offenders were less likely to use mental health services after sentence than those under community penalties; in its absence, socio-economic disadvantage and geographic accessibility were associated with greater likelihood of post-sentence use. CONCLUSIONS Our findings highlight the discontinuity of mental healthcare for most sentenced offenders, but especially prisoners, and suggest a need for better management strategies for these vulnerable groups with mental disorders.

Improving the Estimation of Risk-Adjusted Grouped Hospital Standardized Mortality Ratios Using Cross-Jurisdictional Linked Administrative Data: A Retrospective Cohort Study

asymptomatic women. Our positivity rate is similar to the NAAT-detected TV prevalence reported previously at another sexual health clinic in Sydney,5 but substantially lower than the 4.8% prevalence found in another Sydney-based study.6 This may reflect the use of a different in-house NAAT in that study, and their inclusion criterion of clinical cervicitis. In the two Australian studies of TV using NAAT that included men,7,9 the positivity rate of TV was lower in men than women. TV infection in men is not commonly associated with adverse clinical outcomes;1 therefore, men were not included in this study.

A randomised controlled trial of the Home Independence Program, an Australian restorative home-care programme for older adults

Background Hospitals and death registries in Australia are operated under individual state government jurisdictions. Some state borders are located in heavily populated areas or are located near to major capital cities. Mortality indicators for hospital located near state borders may not be estimated accurately if patients are lost as they cross state borders. The aim of this study was to evaluate how cross-jurisdictional linkage of state hospital and death records across state borders may improve estimation of the hospital standardized mortality ratio (HSMR), a tool used in Australia as a hospital performance indicator. Method Retrospective cohort study of 7.7 million hospital patients from July 2004 to June 2009. Inhospital deaths and deaths within 30 days of hospital discharge from four state jurisdictions were used to estimate the standardized mortality ratio of hospital groups defined by geography and type of hospital (grouped HSMR) under three record linkage scenarios, as follows: (1) cross-jurisdictional person-level linkage, (2) within-jurisdictional (state-based) person-level linkage, and (3) unlinked records. All public and private hospitals in New South Wales, Queensland, Western Australia, and public hospitals in South Australia were included in this study. Death registrations from all four states were obtained from state-based registries of births, deaths, and marriages. Results Cross-jurisdictional linkage identified 11,116 cross-border hospital transfers of which 170 resulted in a cross-border inhospital death. An additional 496 cross-border deaths occurred within 30 days of hospital discharge. The inclusion of cross-jurisdictional person-level links to unlinked hospital records reduced the coefficient of variation among the grouped HSMRs from 0.19 to 0.15; the inclusion of 30-day deaths reduced the coefficient of variation further to 0.11. There were minor changes in grouped HSMRs between cross-jurisdictional and within-jurisdictional linkages, although the impact of cross-jurisdictional linkage increased when restricted to regions with high cross-border hospital use. Conclusion Cross-jurisdictional linkage modified estimates of grouped HSMRs in hospital groups likely to receive a high proportion of cross-border users. Hospital identifiers will be required to confirm whether individual hospital performance indicators change.