Despite the significant government investment in rural health education, the University of Sydney experience demonstrates that this does not necessarily translate into adequate internal resources available for every course or program to optimise performance for rural health workforce outcomes. In an environment of competing priorities, benefits are likely to accrue from strategies that draw on the existing resource base and operate through greater collaborative action, coordinated at the institutional level.

Objective: To examine the trend in unplanned readmissions (URs) to Dubbo Base Hospital (DBH) over the period 1996-2005 and assess possible correlations with basic demographic data. Results: URs increased over the study period, both as a total number and as a proportion of total admissions (from 4.7 to 5.4%), while average length of stay decreased from 5.3 to 4.4 days and available hospital beds decreased from 156 to 116. The proportion of URs for people aged 75 years has more than doubled over the same period. There were clear temporal variations in URs (greatest number occurring on Fridays and in late winter/early spring) and variations with age and gender (greatest number in young males; peaks for males in 0-10 and 71-80-year deciles and for females in 0-10, 21-30 and 71-80 year deciles). Fifty percent of URs occurred within 7 days of discharge. There was a statistically significant but small correlation between length of prior admission and time to readmission (Spearman correlation coefficient, 0.068; P < 0.01) although the time to readmission did not change over the study period. Chronic obstructive pulmonary disease (3.8%), complications of procedures (3.6%), heart failure and pneumonia (each 2.2%), angina (2.1%) and acute bronchiolitis (1.8%) were the top causes of URs. Conclusion: URs are becoming more frequent in DBH; analysis of associations and trends over time are the first step in determining targeted HOSPITAL READMISSION RATES have been increasing during the last 5 years in developed 1-3 as well as developing countries. 4 Major concerns of readmission are the cost to the health services, financial implications and emotional distress to patients and their families and perpetuating dependency behaviour among patients. Furthermore, a recent statement by the then Australian Government Minister for Health and Ageing suggests that a range of indicators including unplanned readmission rates are likely to be used to compare hospital performance into the future. 5 It has been reported that a lower quality of inpatient care increases the risk for unplanned early readmission in patients with heart failure, diabetes, or obstructive lung disease, 6 and a recent study concluded that adjusted rates of What is known about the topic? Hospital readmission rates have been reported to be rising but there is little published Australian data, and no comprehensive hospital studies. It has been suggested that unplanned readmission might relate to premature discharge and quality of care, and unplanned readmission rates have been proposed as a potential key performance indicator for comparisons between hospitals in Australia, as is already occurring overseas. What does this paper add?This paper confirms that the unplanned readmission rate to a major regional public hospital has risen over the last 10 years and that there is a small but significant negative correlation with prior length of stay. It highlights some key demographic factors that are associated with high rates of unplanned readmissions, and diseases which...

Significant differences exist between rural and metropolitan IODMs in terms of less attendance at antenatal consultations, less neonatal withdrawal requiring treatment, shorter average length of hospital stay for the infant and less documented DoCS involvement. These differences maybe a reflection of a different diagnostic and management approach. Ethnicity had no major clinical impact in either the rural or the metropolitan settings. Future research comparing the long-term outcomes would be of interest.