ObjectiveLow quality and unwarranted clinical variation harm patients and increase unnecessary costs. Effective approaches to improve clinical and economic value have been difficult. The Ochsner Health System looked to improve clinical care quality and reduce unnecessary costs in cardiology using active measurement and customised feedback.MethodsWe serially measured care decisions using online, simulated cases to capture clinical details of cardiology practice and provide individual feedback. Fifty cardiologists cared for two simulated patients in each of six assessment rounds occurring 4 months apart. Simulated patients presented with heart failure (HF), coronary artery disease (CAD), supraventricular tachyarrhythmia (SVT) or valvular heart disease. Using Ochsner’s patient-level data, we performed real-world pre–post analyses of physician practice changes, patient outcomes and costs.ResultsBetween baseline and final rounds, overall simulated quality-of-care scores improved 14.1% (p<0.001). In the same period, we found cost-of-care variation decreased in patient-level data, with larger decreases for more severely ill patients. The total per-patient direct costs decreased $493 in SVT, $305 in HF and $55 in CAD (p<0.05 for SVT and HF). Readmission rates fell significantly for HF (from 20.0% to 11.9%) and SVT (from 14.5% to 7.8%) (both p<0.001) and non-significantly for CAD (from 13.7% to 11.3%, p=0.112). The cost avoidance/revenue generation opportunity from reduced readmissions and direct costs amounted to annual savings of $4.34 million, with no significant changes to in-hospital mortality rates (p>0.05).ConclusionsUsing simulated patients to serially measure and provide individual feedback on clinical practice significantly raises quality and reduces practice variation and costs without negatively impacting outcomes.
Objective To investigate the perceived value of handrails and how they are used in Australian aged care facilities (ACFs). Such information aims to contribute to the body of knowledge available about handrails, their design features and application. Methods This study adopted a descriptive cross‐sectional research design. Online surveys were distributed to members of Australian professional networks, collecting information about handrail use, mobility supports and handrail design in ACFs. Results There were 112 participants (80% female), aged 18‐55 years or older. Many identified that handrails in ACF corridors are used by a residents, staff and visitors, and that circular‐shaped handrails should be installed in ACF corridors to assist with mobility and safety. Conclusion Handrails in ACF corridors offer an alternate support to those who experience an unexpected loss of balance and those without or unable to use a mobility aid, ultimately enabling users’ mobility and assisting staff to carry out work duties.
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