Steven Mcphail

• PhD
• Managing Director at Queensland University of Technology

Background: Despite the growing use of mobile health apps in managing chronic heart disease, their integration into routine care remains challenging due to dynamic, context-specific barriers.

Background Effective fall prevention interventions in hospitals require appropriate allocation of resources early in admission. To address this, fall risk prediction tools and models have been developed with the aim to provide fall prevention strategies to patients at high risk. However, fall risk assessment tools have typically been inaccurate for...

BACKGROUND Despite the rise in the use of mobile health applications, their effective integration into routine healthcare remains challenging due to dynamic and context-specific determinants influencing the implementation. OBJECTIVE We aimed to identify the key enablers and challenges of integrating a mobile application for cardiac rehabilitation...

Background Despite the growing use of mobile health apps in managing chronic heart disease, their integration into routine care remains challenging due to dynamic, context-specific barriers. Objective This study aimed to identify the key enablers and challenges of implementing a mobile app for cardiac rehabilitation and healthy lifestyles in patie...

Background A dramatic decline in mental health of people worldwide in the early COVID-19 pandemic years has not recovered. In rural and remote Australia, access to appropriate and timely mental health services has been identified as a major barrier to people seeking help for mental ill-health. From 2020 to 2021 a care navigation model, Navicare, wa...

The current fallback position for the elderly frail nearing the end of life (less than 12 months to live) is hospitalisation. There is a reluctance to use the term ‘terminally ill’ for this population, resulting in overtreatment, overdiagnosis and management that is not consistent with the wishes of people. This is the major contributor to the so‐c...

Introduction Bronchiectasis is a worldwide chronic lung disorder where exacerbations are common. It affects people of all ages, but especially Indigenous populations in high-income nations. Despite being a major contributor to chronic lung disease, there are no licensed therapies for bronchiectasis and there remain relatively few randomised control...

BACKGROUND Utilizing digital health technologies to aid individuals in managing chronic diseases offers a promising solution to overcome health service barriers such as access and affordability. However, their effectiveness depends on adoption and sustained use, influenced by user preferences. OBJECTIVE This study quantifies the preferences of ind...

Objectives: Ablation is emerging as a safe alternative to surgical intervention for patients with early-stage renal cell carcinoma (RCC); however, its cost-effectiveness in Australia remains unclear. We performed a cost-effectiveness analysis to evaluate the relative clinical and economic merits of ablation compared to partial nephrectomy in treati...

Objective: To determine the prevalence, reported harms and factors associated with opioid use among adults with spinal cord injury (SCI) living in the community. Study design: Systematic review and meta-analysis. Methods: Comprehensive literature searches were conducted in PubMed (MEDLINE), EMBASE, CINAHL, Web of Science and Scopus for article...

Background The COVID-19 pandemic necessitated the rapid development and implementation of health ITs to support health care delivery. Health IT implementation is difficult at the best of times, due to complex sociotechnical challenges that vary across contexts and settings; however, it is currently unclear how the pandemic impacted health IT implem...

Objective: To determine the prevalence, reported harms and factors associated with opioid use among adults with spinal cord injury (SCI) living in the community.Study design: Systematic review and meta-analysis. Methods: Comprehensive literature searches were conducted in PubMed (MEDLINE), EMBASE, CINAHL, Web of Science and Scopus for articles publ...

BACKGROUND Electronic standard order sets automate ordering of specific treatment, testing and investigative protocols by physicians. Despite their routine implementation within Electronic Medical Records (EMRs), little is understood regarding how they are used and what are the factors’ that influence their adoption in practice. OBJECTIVE This stu...

Background Electronic standard order sets automate the ordering of specific treatment, testing, and investigative protocols by physicians. These tools may help reduce unwarranted clinical variation and improve health care efficiency. Despite their routine implementation within electronic medical records (EMRs), little is understood about how they a...

Background: Transarterial chemoembolisation (TACE), ablation, and selective internal radiation therapy (SIRT) are emerging minimally invasive interventional oncology procedures used in diagnosing, treating, and palliating cancer. A comprehensive understanding of their costs, however, remains limited. The primary aim of this study was to accurately...

Background: Transarterial chemoembolisation (TACE), ablation, and selective internal radiation therapy (SIRT) are emerging minimally invasive interventional oncology procedures used in diagnosing, treating, and palliating cancer. A comprehensive understanding of their costs, however, remains limited. The primary aim of this study was to accurately...

Objective Successful deployment of clinical prediction models (CPMs) relates not only to predictive performance but to integration into the decision making process. Models may demonstrate good discrimination and calibration, but fail to deliver outputs in a format perceived as helpful by practising acute care clinicians who must often receive, inte...

Background: Heart failure is a leading cause of mortality and morbidity worldwide, and Atrial fibrillation (AF) is among many modifiable risk factors for heart failure. No estimates are available on the magnitude of the burden of heart failure associated with AF, and this study estimated the global, regional, and national burdens associated with A...

The extent of the preventable burden of ischaemic stroke associated with atrial fibrillation (AF) remains uncertain to date. To address this knowledge gap, we utilised the comparative risk assessment methodology to estimate the burden of ischaemic stroke associated with AF at both global and regional levels. The population attributable fraction for...

Background: Traditional cardiac rehabilitation programs are centre-based and clinically supervised, with their safety and effectiveness well established. Notwithstanding the established benefits, cardiac rehabilitation remains underutilised. A possible alternative would be a hybrid approach where both centre-based and tele-based methods are combin...

Background With the predicted rise in the burden of ischemic stroke associated with atrial fibrillation (AF), implementing cost-effective interventions for stroke prevention has become increasingly important. Economic evaluations are key to making informed healthcare decisions in this context. However, the poor methodological quality of economic ev...

Background: There is little evidence regarding the efficacy of Regenerative Epidermal Suspension (RES™) management for paediatric partial-thickness burns. The Biobrane® RECELL® Autologous skin Cell suspension and Silver dressings (BRACS) Trial evaluated three dressings for the re-epithelialisation of partial thickness burns in children. Methods: El...

Background: Heart failure is a leading cause of mortality and morbidity worldwide, and Atrial fibrillation (AF) is among many modifiable risk factors for heart failure. No estimates are available on the magnitude of the burden of heart failure associated with AF, and this study estimated the global, regional, and national burdens associated with AF...

Introduction Anterior cruciate ligament injury and reconstruction (ACLR) is often associated with pain, functional loss, poor quality of life and accelerated knee osteoarthritis development. The effectiveness of interventions to enhance outcomes for those at high risk of early-onset osteoarthritis is unknown. This study will investigate if SUpervis...

Introduction Poor patient assessment results in undetected clinical deterioration. Yet, there is no standardised assessment framework for >29 000 Australian emergency nurses. To reduce clinical variation and increase safety and quality of initial emergency nursing care, the evidence-based emergency nursing framework HIRAID (History, Identify Red fl...

We examined systems-level costs before and after the implementation of an emergency department paediatric sepsis screening, recognition and treatment pathway. Aggregated hospital admissions for all children aged < 18y with a diagnosis code of sepsis upon admission in Queensland, Australia were compared for 16 participating and 32 non-participating...

This article considers current capacity issues in health care and the development of quantitative techniques to facilitate a high-level strategic assessment of hospital activity within a region. In providing that assessment, a variety of decision problems are foreseen, and we test the notion that it is useful to provide decision support for those....

Atrial fibrillation (AF) is a prevalent problem worldwide and a common cause of hospitalization, poor quality of life, and increased mortality. Although several treatments are used, the use of ablation and antiarrhythmic drug therapy has increased in the past decade. However, debate continues on the most suitable option for heart rhythm control in...

Background The recent digitisation and uptake of integrated electronic medical records (ieMR) within hospital systems has provided opportunities to improve the performance and usefulness of inpatient fall risk prediction models, including more frequently updated risk estimates for patients throughout their admission. Aims We aimed to develop and i...

Background Hospitalisation rates for older people are increasing, with end-of-life care becoming a more medicalised experience. Innovative approaches are warranted to support early identification of the end-of-life phase, communicate prognosis, provide care consistent with people’s preferences, and improve the use of healthcare resources. The Inter...

Optimal burn scar management has the potential to markedly improve the lives of children, but can require substantial healthcare resources. The study aimed to examine the cost-effectiveness of three scar management interventions: pressure garment; topical silicone gel; combined pressure garment and topical silicone gel therapy, alongside a randomis...

Introduction Due to the increase in participation and risk of anterior cruciate ligament (ACL) injuries and concussion in women’s Australian Football, an injury prevention programme (Prep-to-Play) was codesigned with consumers (eg, coaches, players) and stakeholders (eg, the Australian Football League). The impact of supported and unsupported inter...

Introduction: Head and neck lymphedema can occur in the internal or external structures of the head and neck region. Little is known about the development of this condition over the course of treatment for head and neck cancer. This study aimed to observe the development of internal and external lymphedema from diagnosis to 12 weeks postacute trea...

Aims: The provision of guideline-based care for patients with diabetes-related foot ulcers (DFU) in clinical practice is sub-optimal. We estimated the cost-effectiveness of higher rates of guideline-based care, compared with current practice. Methods: The costs and quality-adjusted life-years (QALYs) associated with current practice (30% of pati...

Antenatal depression (AND) affects 1 in 10 fathers, potentially negatively impacting maternal mental health and well-being during and after the transition to parenthood. However, few studies have assessed the social predictors of paternal AND or their possible associations with maternal mental health. We analysed data from 180 couples participating...

Introduction: The digitization of hospital systems, including integrated electronic medical records, has provided opportunities to improve the prediction performance of inpatient fall risk models and their application to computerized clinical decision support systems. This review describes the data sources and scope of methods reported in studies...

Background and purpose: Exercise interventions can improve physical recovery and reduce falls in older adults following hospitalization. The aim of the study was to identify factors associated with exercise engagement after hospital discharge. Methods: This study was a secondary analysis of data collected as part of a randomized controlled trial...

Introduction: There is a severe shortage of donor organs globally. There is growing interest in understanding how a 'soft opt-out' organ donation system could help bridge the supply and demand gap for donor organs. This research aims to estimate the cost-effectiveness and budget impact of implementing a 'soft opt-out' organ donation system for kid...

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Background Hospital patients experiencing clinical deterioration are at greater risk of adverse events. Monitoring patients through early warning systems is widespread, despite limited published evidence that they improve patient outcomes. Current limitations including infrequent or incorrect risk calculations may be mitigated by integration into e...

Background: Evaluating integrated care programs is complex. Integration benefits may not become apparent within short evaluation timeframes, and many programs provide a wide variety of health and non-health benefits. To address these challenges, we illustrate a mixed methods approach for evaluating multiple integrated care programs using multi-cri...

Background There are very few developed countries where physical isolation and low community transmission has been reported for COVID-19 but this has been the experience of Australia. The impact of physical isolation combined with low disease transmission on the mental health of pregnant women is currently unknown and there have been no studies exa...

Background Falls remain a common and debilitating problem in hospitals worldwide. The aim of this study was to investigate the effects of falls prevention interventions on falls rates and the risk of falling in hospital. Design Systematic review and meta-analysis. Participants Hospitalised adults. Intervention Prevention methods included staff a...

Introduction: Primary ciliary dyskinesia (PCD) is a rare, progressive, inherited ciliopathic disorder, which is incurable and frequently complicated by the development of bronchiectasis. There are few randomised controlled trials (RCTs) involving children and adults with PCD and thus evidence of efficacy for interventions are usually extrapolated...

Introduction Cancer-related fatigue (CRF) is one of the most common and debilitating adverse effects of cancer and its treatment reported by cancer survivors. Physical activity, psychological interventions and management of concurrent symptoms have been shown to be effective in alleviating CRF. This pilot randomised controlled trial (RCT) will dete...

Background Non-alcoholic fatty liver disease (NAFLD) is an emerging epidemic that affects approximately half of all people with type 2 diabetes. Those with type 2 diabetes are a high-risk NAFLD subgroup because of their increased risk of clinically significant liver-related outcomes from NAFLD which include hepatocellular carcinoma, cirrhosis-relat...

Aims This study described emergency department (ED) resource use patterns and associated costs among patients with heart disease in their last 3 years of life in a high-income country. Methods This study used linked data from ED and death registry databases in Australia. A random sample of 1000 patients who died due to any cause in 2017, and who h...

Objectives: The EuroQoL 3-level version of EQ-5D and 5-level version of EQ-5D questionnaires are often used to quantify health states. They include ordinal responses across 5 health dimensions (EQ-5D index) and an EQ-visual analog scale (EQ-VAS) overall health rating. We investigated the value of incorporating the EQ-VAS to update health utility e...

Aims: To investigate factors independently associated with time-to-(being)-ulcer-free, time-varying effects and predict adjusted ulcer-free probabilities, in a large prospective cohort with diabetes-related foot ulcers (DFU) followed-up for 24 months. Methods: Patients presenting with DFU(s) to 65 Diabetic Foot Services across Queensland, Austra...

Objectives To evaluate the effect of introducing a physiotherapist-led paediatric Soft Tissue Injury Clinic model as an alternative to a medically led Fracture Clinic model for conservative hospital management of soft-tissue injuries on: patient wait times; healthcare resource use; and cost-effectiveness. Design Interrupted time-series analysis (i...

PurposeThe MacNew Heart Disease Health-Related Quality of Life Instrument (MacNew) is a validated, clinically sensitive, 27-item disease-specific questionnaire. This study aimed to develop a new heart disease-specific classification system for the MacNew amenable for use in health state valuation.Methods Patients with heart disease attending outpat...

The provision of effective care models for children with neurodevelopmental delay or disability can be challenging in resource constrained healthcare systems. Economic evaluations have an important role in informing resource allocation decisions. This review systematically examined the scope and methods of economic models evaluating interventions f...

Objective: The aim of this study was to explore whether information captured in falls reports in incident management systems could be used to explain how and why the falls occurred, with a view to identifying whether such reports can be a source of subsequent learnings that inform practice change. Methods: An analysis of prospectively collected...

Background Diabetes-related foot disease (DFD) is a leading cause of global hospitalisation, amputation and disability burdens; yet, the epidemiology of the DFD burden is unclear in Australia. We aimed to systematically review the literature reporting the prevalence and incidence of risk factors for DFD (e.g. neuropathy, peripheral artery disease),...

Background Implementation of guideline-based care for diabetes-related foot ulcers (DFU) in clinical practice is typically sub-optimal. We aimed to evaluate the cost-effectiveness of implementing different incremental increases in guideline-based care scenarios, compared with current practice, using discrete event simulation models. Methods The co...

Background Diabetes-related foot ulcers (DFU) take months to heal, reduce patient’s quality-of-life, and induce large healthcare expenditure. Various factors have been identified to influence DFU healing at fixed periods, however, data on factors associated with time-to-healing is scarce. Methods Patients presenting with DFU to Diabetic Foot Servi...

Introduction Falls remain one of the most prevalent adverse events in hospitals and are associated with substantial negative health impacts and costs. Approaches to assess patients’ fall risk have been implemented in hospitals internationally, ranging from brief screening questions to multifactorial risk assessments and complex prediction models, d...

INTRODUCTION: The HealthPathways programme is an online health information system used mainly in primary health care to promote a consistent and integrated approach to patient care. AIM: The aim of this study is to perform a scoping review of the methodologies used in published impact and outcomes evaluations of HealthPathways programmes. METHODS...

Negative pressure wound therapy (NPWT) has been shown to improve clinical outcomes for children with burns by accelerating wound re-epithelialisation. Its effects on healthcare costs, however, remain poorly understood. The aim of this study was to evaluate the cost-effectiveness of NPWT from a healthcare provider perspective using evidence from the...

Recently hospitalized older people are at risk of falls and face barriers to undertaking fall prevention strategies after they return home from hospital. The authors examined the effects of tailored education delivered by physiotherapists on the knowledge (capability) and the motivation of older people to engage in fall prevention after hospital di...

Objective Falls are a significant problem for many older patients after hospital discharge. The purpose of this study was to evaluate the fidelity and impact of a tailored patient fall prevention education programme from the perspective of the educators who delivered the programme. Design Qualitative sequential design. Setting Three rehabilitatio...

Objective: The aim of the study was to determine the incidence and associated risk factors for falls in older adults in the 12 months after elective, primary total knee replacement (TKR) surgery. Design: A prospective observational cohort of older adults undergoing TKR were followed. Baseline measurements included risk factors of history of fall...

Objective The longer-term effectiveness of silicone and pressure burn scar interventions was evaluated at 12-months postburn. Design Parallel group, randomised trial. Setting Hospital outpatient clinics, research centre. Participants Children referred for burn scar management following grafted or spontaneously healed acute burn injuries or scar...

Background The optimal strategy to support primary care practitioners (PCPs) to assess fibrosis severity in nonalcoholic fatty liver disease (NAFLD) and thereby make appropriate management decisions remains unclear. Aims We aimed to examine the feasibility of using a 2-step pathway that combined simple scores (NAFLD Fibrosis Score and Fibrosis-4 I...

Introduction Children with chronic wet cough regularly use the health system, experience considerable variability in care, have reduced quality of life (QoL), and, left untreated, poorer health outcomes. Despite this, little is known about the associated economic burden. This study aimed to quantify the cost of chronic wet cough among Australian ch...

Background Treatment and recovery times following injury can be lengthy, comprising multiple interactions with the hospital system for initial acute care, subsequent rehabilitation and possible re-presentation due to complications. Aims This article aims to promote the use of consistent terminology in injury data linkage studies, suggest important...

Background/objectives: We investigated the impact of ceasing routine falls risk assessment tool (FRAT) completion and instead used clinical reasoning to select fall mitigation strategies. Design: Two-group, multi-site cluster-randomized active-control non-inferiority trial. Setting: Hospital wards. Participants: Adult inpatients admitted to...

Introduction This double-blind, randomised controlled trial (RCT) aims to estimate the effect of a physiotherapist-led intervention with targeted strengthening compared with a physiotherapist-led intervention with standardised stretching, on hip-related quality of life (QOL) or perceived improvement at 6 months in people with femoroacetabular impin...

Introduction Using patient-reported outcome measures (PROMs) with children have been described as ‘giving a voice to the child’. Few studies have examined the routine use of these measures as potentially therapeutic interventions. This study aims to investigate: (1) the effectiveness of feedback using graphical displays of information from electron...

Background This systematic review evaluated the efficacy of autologous skin cell suspensions (ASCS) on the re-epithelialization of partial thickness burn injuries and skin graft donor site wounds. Methods Four databases (EMBASE, Google Scholar, MEDLINE, Web of Science), grey literature and select journal hand-searching identified studies from 1975...

Aims: People living with heart disease are at elevated risk of hospitalisation during the last years of their life. The aim of this study was to describe hospitalisation-related usage patterns, and associated cost burden, for patients living with heart disease in the last six years of their life. Methods and results: The study was an observation...

Negative pressure wound therapy has been used to promote wound healing in a variety of settings, including as an adjunct to silver‐impregnated dressings in the acute management of paediatric burns. Fluid aspirated by the negative pressure wound therapy system represents a potentially insightful research matrix for understanding the burn wound micro...