Susannah Ahern

Medical residents' perceptions of their competencies and training needs in health care management: an international comparison

BackgroundPrevious research has shown that Dutch medical residents feel inadequate in certain management areas: 85% had a need for management training and reported preferences on the format of such training. Our objective was to explore if the perceived deficiencies and needs among Dutch residents were similar to those of their peers in other countries, and if a longer duration of the incorporation of the CanMEDS competency framework into curricula as well as management training had an influence on these perceptions.MethodsMedical residents from Denmark, Canada and Australia were approached for participation. The questionnaire used to survey the perceptions of Dutch residents was slightly modified, translated into English and sent by email to all international participants.ResultsResponse rates were; Denmark 719/2105 (34%), Canada 177/500 (35%) and Australia 194/1213 (16%) respectively. The Danish as well as the Canadian residents rated their negotiating skills poorly. In Australia the residents found their knowledge on how their specialist department was organized to be insufficient, while residents in the Netherlands rated their knowledge on how the healthcare system was organized as inadequate. In all of the countries, more than 70% of the residents reported a perceived need for management training.ConclusionsA majority of the residents in all countries felt the need for specific training in developing their management competencies. The adoption of the CanMEDS framework alone seems to be insufficient in meeting residents’ perceived educational needs in this area.

Australian Breast Device Registry: breast device safety transformed

It has been 6 years since news broke of the poly implant prothese (PIP) implants crisis, in which non-medical grade silicone was used in breast implants and was associated with an increased rupture rate. This led to a worldwide recall of non-implanted PIP implants, and a programme of mass explantation in some countries. In Australia, the voluntary, patient-funded Breast Implant Registry (BIR), established in 1998, was estimated to have captured only 3.4% of the PIP implants used in an estimated 12 000 women. An ensuing enquiry by the Australian Senate into the use of medical devices including specifically PIP breast implants, recommended establishing an opt out registry for breast implants as a priority. The aims of such a registry were to address the recognized deficiencies of the BIR and included: • Compliance with clinical quality registry standards and operating procedures established in 2008 • Complete registry capture of breast device procedures undertaken in Australia and their complications • Sufficient data quality and reliability to address high risk circumstances such as device recall and potentially serious complications • Surgeon review of their own data and outcomes • Benchmarking of process and outcome indicators The Australian Breast Device Registry (ABDR) was established in pilot form in 2011, and commenced national roll out in 2015. The ABDR is a clinical quality registry, compliant with the Australian Commission on Safety and Quality in Health Care Operating Principles. The registry design addresses the major weaknesses of its predecessor, the BIR, in a number of important ways. The BIR data collection was disjointed and cumbersome. The ABDR collects a core data set which is epidemiologically sound through being simple, objective and reproducible. The data collection form can be completed within 2 minutes at the time of operation. Obtaining patient consent and a cost of

Clinical quality registries for clinician-level reporting: strengths and limitations.

25 per implant were major barriers for patients entering the BIR. The ABDR has adopted opt out consent meaning that data can be collected from all eligible patients once their surgeons and hospitals are participating in the registry, at no cost to patients. Reliability of the data is ensured by high levels of registry participation, data completeness and quality. As of August 2016, less than 1% of participants have opted out of the registry, meaning that over 99% of eligible patients at participating registry sites are retained, reflecting data from over 7800 patients and over 8600 procedures. Compared with the BIR which had no audit process, the ABDR is establishing quality measures to ensure the robustness of the data, including (i) validation of case ascertainment by regular comparison of reported cases with relevant hospital discharge codes; and (ii) limited medical record audits to ensure individual data record quality. Any surgeon using breast implants or other devices, such as tissue expanders, can contribute data, unlike with the BIR, which was restricted to plastic surgeons. The initial legacy of this is that plastic surgeons currently form the bulk of the surgeons contributing data. Yet as the ABDR has been endorsed by all of the major craft groups (including the Australasian College of Cosmetic Surgeons, BreastSurg ANZ and Australian Society of Plastic Surgeons), and both the Royal Australasian College of Surgeons and Australasian College of Cosmetic Surgeons have recently recognized the ABDR as an audit activity for continuing professional development, the ABDR has recently seen an increase in participation by cosmetic surgeons. However, the number of surgeons who are not registered with these organizations is unknown, presenting a significant challenge to obtaining the projected 95% of surgeons required for highquality data capture. As of August 2016, we estimate that 45% of known surgeons are contributing to the ABDR. Funding for the ABDR is provided by the Commonwealth Government, and it is housed within the Department of Epidemiology and Preventive Medicine at Monash University, an independent academic organization. The ABDR has a collaborative governance model, with deliberately broad representation on the steering committee, including academia, government, craft groups, industry and consumers. The steering committee approve applications for clinical research derived from registry data in accordance with the registry data access policy. The data outputs generated by the ABDR will help to guide breast device surgery clinical practice and improve the quality of patient care. Site-level reporting of registry data has commenced, using comparative data from the greater ABDR database. Risk-adjusted benchmarking will be incorporated in outcomes reporting, and clinical indicators are being developed to facilitate this at the surgeon level, and also at the device level. An outlier policy will come into effect as the database matures. Work is being undertaken to allow individual surgeons to review their own data and outcomes in real time. Patient reported outcome measures based on the internationally recognized BREAST-Q questionnaire are being piloted to incorporate into the outcome measures. Establishing a national registry such as the ABDR requires time. As the database matures more information will become available on complications and revisions, including by device. These data will become richer and better able to inform clinical practice. The minimum dataset was formulated through an international collaboration to enable data harmonization and outcomes amplification in the future. The ABDR is assisting with the development of a

Optimism, opportunities, outcomes: the Australian Cystic Fibrosis Data Registry

linical registries systematically collect clinically relevant data regarding specific diseases or Chealth events using standard procedures and definitions across multiple institutions. They originated as an epidemiological construct, and were designed to measure health outcomes across whole populations, originally for epidemiological and health planning purposes. More recently, the term “clinical quality registry” (CQR) has been introduced to define registries that use specific clinical quality indicators for regular confidential and benchmarked reporting to participating sites. CQR reporting at a hospital level acknowledges the often inextricable links between the many factors affecting patient care, including practitioner performance, support staff, facilities, care processes, and preand postoperative care. CQR reporting may provide early warning of potential quality issues, and when hospitals with outlying results internally review their data and processes, it may be an effective stimulus for clinical practice change.

Collecting patient-reported outcome measures: Brief Communications

The Australian Cystic Fibrosis Data Registry is positioning itself as an exemplar of a rare disease registry for the future. While it continues to inform cystic fibrosis (CF) clinicians of patterns of CF disease and quality of care, its capability is increasing as a resource for further research into CF subpopulations, as a platform for clinical trials, and as an interface for patient experiences.

Evaluating the impact of 2006 Australasian Clinical Practice Guidelines for nutrition in children with cystic fibrosis in Australia

Patient‐reported outcome measures (PROM) are potentially useful outcome measures that may be reported at the individual clinical, health service and/or health system level. PROM require clearly defined patient populations to enable comparisons, and are most meaningful when integrated with clinical data sets. Where possible PROM should be measured pre‐ and post‐intervention using reliable and validated tools. A variety of PROM collection methods exist which each have strengths and limitations, with selection depending on their purpose and patient factors. PROM programmes should be developed with high levels of clinician support and patient input to maximise collection of clinically relevant information.

Symptoms and feelings valued by patients after a percutaneous coronary intervention: a discrete-choice experiment to inform development of a new patient-reported outcome

OBJECTIVES To determine the association between the implementation of the 2006 Australasian Clinical Practice Guidelines for Nutrition in Cystic Fibrosis (CF) and the nutritional status of children participating in the Australian Cystic Fibrosis Data Registry (ACFDR). METHODS This research consisted of a quantitative study using ACFDR data and a survey of clinicians and dietitians treating children with CF. Two independent cohorts of children (2-5 years and 6-11 years) were selected from ACFDR between 1998 and 2014 (N = 2304). Generalised estimating equation model was used to assess weight, height and body mass index (BMI) z-scores for each patient before and after the implementation of the nutrition guidelines. A nationwide online survey was sent to 48 clinicians to explore the enablers and barriers to implementation of the guidelines. RESULTS Data analysis showed significant increase (p < 0.05) in mean weight, height and BMI z-scores ranging from 0.06 to 0.18 after implementation of the guidelines in both cohorts of children. Nineteen (39%) clinicians participated in the survey. The majority of the respondents adopted the recommendations into their practice and used the guidelines as part of their professional development. Structural barriers included a lack of adequate staff resources and clinic space for consultations, inappropriate staff classification, high staff turnover and lack of mentoring support. CONCLUSION In children participating in the ACFDR, nutritional status improved after the implementation of the 2006 guidelines. Survey results revealed enablers and barriers to guideline implementation and will inform implementation strategies for the revised Australasian nutrition guidelines for CF, released in 2017.

Towards a strategy for clinical quality registries in Australia

Objective To inform the development of a patient-reported outcome measure, the aim of this study was to identify which symptoms and feelings following percutaneous coronary intervention (PCI) are most important to patients. Design Discrete-choice experiment consisting of two hypothetical scenarios of 10 symptoms and feelings (pain or discomfort; shortness of breath; concern/worry about heart problems; tiredness; confidence to do usual activities; ability to do usual activities; happiness; sleep disturbance; dizziness or light-headedness and bruising) experienced after PCI, described by three levels (never, some of the time, most of the time). Preference weights were estimated using a conditional logit model. Setting Four Australian public hospitals that contribute to the Victorian Cardiac Outcomes Registry (VCOR) and a private insurer’s claim database. Participants 138 people aged >18 years who had undergone a PCI in the previous 6 months. Main outcome measures Patient preferences via trade-offs between 10 feelings and symptoms. Results Of the 138 individuals recruited, 129 (93%) completed all 16 choice sets. Conditional logit parameter estimates were mostly monotonic (eg, moving to worse levels for each individual symptom and feeling made the option less attractive). When comparing the magnitude of the coefficients (based on the coefficient of the worst level relative to best level in each item), feeling unhappy was the symptom or feeling that most influenced perception of a least-preferred PCI outcome (OR 0.42, 95% CI 0.34 to 0.51, p<0.0001) and the least influential was bruising (OR 0.81, 95% CI 0.67 to 0.99, p=0.04). Conclusion This study provides new insights into how patients value symptoms and feelings they experience following a PCI.

Cosmetic tourism for breast augmentation: A systematic review

The healthcare value of Australian clinical quality registries (CQRs) has recently been highlighted by the Australian Commission of Safety and Quality in Health Care (ACSQHC) as being similar to the benefits of CQRs reported internationally. However, the development of CQRs in Australia is currently limited by a lack of coordination and strategic planning, leading to governance and funding processes that are varied and non-sustainable. Despite this, Australia has achieved recognised success with exemplar clinical registries where funding has been sustained at least partly by public funds. To this end, Australia can learn from international CQR governance and funding models to support CQR sustainability, most notably those from European and Scandinavian countries. Further, following the release of the ACSQHCs prioritised domains for CQRs and anticipated funding from the Medical Research Future Fund, the ACSQHC is well positioned to lead a national strategic approach for clinical registries. Together with medical leadership and engagement, operational and data management support from the jurisdictions and financial support from both the public and private sectors, a prioritised and coordinated approach may soon become a reality.

Monitoring outcomes in spine surgery: rationale behind the Australian Spine Registry: Monitoring outcomes in spine surgery: rationale behind the Australian Spine Registry a national spine registry is needed

The medical tourism industry, and in particular cosmetic tourism for breast augmentation, is becoming an increasingly popular global phenomenon. The objective of this study is to determine the extent of medical literature and the patient risk profiles associated with cosmetic tourism for breast augmentation both locally and abroad. Data sources: OVID MEDLINE, OVID Embase, Cochrane Central and Proquest electronic databases.