Terri Jackson

University of Melbourne | MSD · Melbourne School of Population Health

Background: The Council of Australian Governments has focused the attention of health service managers and state health departments on a list of hospital-acquired complications (HACs) proposed as the basis of funding adjustments for poor quality of hospital inpatient care. These were devised for the Australian Commission on Safety and Quality in H...

Background: Patients with CKD are at increased risk of potentially preventable hospital acquired complications (HACs). Understanding the economic consequences of preventable HACs, may define the scope and investment of initiatives aimed at prevention. Methods: Adult patients hospitalized from April, 2003 to March, 2008 in Alberta, Canada compris...

Background: and objectives Patients with CKD are at risk of hospital-acquired complications (HACs). We sought to determine the association of preventable HACs with mortality, length of stay (LOS), and readmission. Design, setting, participants, & measurements: All adults hospitalized from April of 2003 to March of 2008 in Alberta were characteri...

Background and objectives: Unintended injuries or complications in hospitalized patients are common, potentially preventable, and associated with adverse consequences, including greater mortality and health care costs. Patients with CKD may be at higher risk of hospital-acquired complications (HACs). Design, setting, participants, & measurements:...

Hospital-based clinicians have little information about the outcomes of their care, much less how those outcomes compare with those of their peers. A variety of care quality indicators have been developed, but comparisons tend to be hospitalwide, and often irrelevant to the practice and patient group of many hospital clinicians. Moreover, informati...

Background: In undertaking a major revision to the Australian Refined Diagnosis Related Group (ARDRG) classification, we set out to contrast Australia's approach to using data on additional (not principal) diagnoses with major international approaches in splitting base or Adjacent Diagnosis Related Groups (ADRGs). Methods: Comparative policy ana...

Background In-patients with diabetes have longer length of stays (LOS). Understanding patterns of in-hospital complications between patients with diabetes and others may reveal measures to improve patient welfare and minimise LOS.Objective Evaluate the rates and types of hospital acquired conditions amongst patients with and without diabetes and as...

Routinely coded hospital data ('administrative data') have been criticised as invalid and unreliable, without due regard for how Australian data differ from those of other healthcare systems. The skills and education of coders,degree of professional coding supervision, and the existence and rigour of coding audits all strengthen Australian routine...

Background Colorectal cancer (CRC) is common, and early diagnosis improves outcome. Overseas studies have suggested that low socio-economic status (SES) is related to advanced cancer stage at presentation and reduced survival. The situation in Australia is unclear. This study examines the effect of demographic and SES on CRC stage at presentation a...

Objective: Adverse drug events (ADEs) during hospital admissions are a widespread problem associated with adverse patient outcomes. The 'external cause' codes in the International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) provide opportunities for identifying the incidence of ADEs acquired during hos...

Hospitals are data-rich but information-poor. To develop a 'continuous-learning health care system' we need to harness our myriad information sources so that every patient encounter becomes the basis for new evidence of what works.

Incremental costs of hospital-acquired complications in Alberta, Canada T Jackson1,2*, A Fong3, M Liu3, K Murray4, L Walz3, C Houston3, K Walker3, S Dean3 From 27th Patient Classification Systems International (PCSI) Working Conference Montreal, Canada. 19-22 October 2011 Background Hospital-acquired diagnoses (HAD) not only lengthen inpatients’...

Our objective was to estimate the cost of inpatient malnutrition conditional upon admitting diagnosis and recorded nutritional treatment. We analysed an anonymised administrative data set for inpatients treated in hospitals in Victoria, Australia 2003–2004. The data set included patient-level cost, clinical markers, demographic and episode variable...

To examine differences between Queensland and Victorian coding of hospital-acquired conditions and suggest ways to improve the usefulness of these data in the monitoring of patient safety events. Secondary analysis of admitted patient episode data collected in Queensland and Victoria. Comparison of depth of coding, and patterns in the coding of ten...

Adverse event or complication rates are increasingly advocated as measures of hospital quality and performance. Objective of this study is to analyse patient-complexity adjusted adverse events rates to compare the performance of hospitals in Victoria, Australia. We use a unique hospital dataset that routinely records adverse events which arise duri...

To estimate the relative inpatient costs of hospital-acquired conditions. Patient level costs were estimated using computerized costing systems that log individual utilization of inpatient services and apply sophisticated cost estimates from the hospital's general ledger. Occurrence of hospital-acquired conditions was identified using an Australian...

L'évolution rapide des nouvelles technologies de la santé, pour lesquelles on dispose de preuves limitées, mais prometteuses, soulève un défi de taille, celui de dispenser des soins qui répondent aux besoins de santé de la population et optimisent l'issue des patients, qui démontrent une utilisation efficace des ressources en santé et qui respecten...

The rapid development of new health technologies for which there is limited, but promising, evidence has resulted in a daunting challenge - to provide care that meets population health needs and optimizes patient outcomes, demonstrates an efficient use of healthcare resources, and upholds basic principles of equity, access, and choice. In this pape...

The incidence and cost of complications occurring in older and younger inpatients were compared. Secondary analysis of hospital-recorded diagnosis and costs for multiday-stay inpatients in 68 public hospitals in two Australian states. A complication is defined as a hospital-acquired diagnosis that required additional treatment. The Australian Class...

To model the effect of excluding payment for eight hospital-acquired conditions (HACs) on hospital payments in Victoria, Australia. Retrospective ecological study using the Victorian Admitted Episodes Dataset. The analysis involved all acute inpatient admissions to Victorian public and private hospitals between 1 July 2007 and 30 June 2008. Each ad...

To quantify the frequency of, and the costs and payments associated with, admissions for treatment of injuries and illnesses that are consequences of care. Routinely-coded 2005/06 public hospital inpatient data from Victoria, Australia (1.25 million admissions) and corresponding patient-level cost data (1.04 million admissions). Payments reflected...

We compare adverse event rates for surgical inpatients across 36 public hospitals in the state of Victoria, Australia, conditioning on differences in patient complexity across hospitals. We estimate separate models for elective and emergency patients which stay at least one night in hospitals, using fixed effects complementary log-log models to est...

Analysis of patient-level diagnostic and cost data from an administrative database. To describe complications and cost differentials for hospitalized patients with traumatic spinal cord injury (T-SCI) and nontraumatic spinal cord injury (NT-SCI). Numerous studies have reported costs for T-SCI, but few have involved NT-SCI. All patients with SCI adm...

Instructions for data cleaning algorithm 20090304. This document includes additional information for use of the data cleaning algorithm.

Validation algorithm for 'Present on Admission' (POA) flagging written for SAS™ processing. This SAS™ program evaluates 40 diagnosis fields in routinely coded hospital data to identify those validly flagged as hospital-acquired ('C' in the data used here). Codes refer to the International Statistical Classification of Diseases and Related Health Pr...

Abstract Background The use of routine hospital data for understanding patterns of adverse outcomes has been limited in the past by the fact that pre-existing and post-admission conditions have been indistinguishable. The use of a 'Present on Admission' (or POA) indicator to distinguish pre-existing or co-morbid conditions from those arising during...

To develop a tool to allow Australian hospitals to monitor the range of hospital-acquired diagnoses coded in routine data in support of quality improvement efforts. Secondary analysis of abstracted inpatient records for all episodes in acute care hospitals in Victoria for the financial year 2005-06 (n=2.032 million) to develop a classification syst...

This paper describes the limitations of using the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-IO-AM) to characterise patient harm in hospitals. Limitations were identified during a project to use diagnoses flagged by Victorian coders as hospital-acquired to devise a...

Identifying the cost of hospital outputs, particularly acute inpatients measured by Diagnosis Related Groups (DRGs), is an important component of casemix implementation. Measuring the relative costliness of specific DRGs is useful for a wide range of policy and planning applications. Estimating the relative use of resources per DRG can be done thro...

Collections of routine, or 'administrative', hospital data have many applications in health care and are now recognised as valuable sources of information. In recent decades, administrative data have been seen primarily as funding and billing tools to assist with the reimbursement of hospitals for services provided; this purpose remains the primary...

Casemix-based inpatient prospective payment systems allocate payments for acute care based on what is done within an episode of care without regard for the outcome. To date, they have provided little incentive to improve quality. The Centers for Medicare & Medicaid Services have recently excluded 8 avoidable complications from their payment system....

To describe Iran's hospital activity with Australian Refined Diagnosis Related Groups (AR-DRGs). A total of 445,324 separations was grouped into discreet DRG classes using AR-DRGs. L(3)H(3); IQR and 10th-95th percentile were used to exclude outlier cases. Reduction in variance (R(2)) and coefficient of variation (CV) were applied to measure model f...

Abortion policy is still contentious in many parts of the world, and periodically it emerges to dominate health policy debates. This paper examines one such debate in Australia centering on research findings by a New Zealand research group, Fergusson, Horwood & Ridder, published in early 2006. The debate highlighted the difficulty for researchers w...

The financial and human costs of hospital-acquired infections are increasingly recognised in many healthcare systems. This study seeks to quantify excess expenditures on hospital-acquired bacteraemia (HAB) in three Belgian general hospitals in 2003 and 2004. Patients with HAB were compared with patients in the same All Patient Refined Diagnosis Rel...

The aim of this study was to estimate the incidence of adverse events in acute surgical admissions for cardiac disease in admitted episodes in the year 2003-2004 and to estimate the cost of these complications to the Victorian health system. Cardiac surgery adverse events are among the most frequent and significant contributors to the morbidity, mo...

Australia is well placed to again lead the world in health technology assessment.

To investigate a method to identify and understand patterns of adverse events by utilising secondary data analysis; to identify the types of complications associated with elective surgery; to identify any specific "adverse event-prone" elective procedures; and to consider the implications of these patterns for hospital patient safety programs. Publ...

To determine the incidence of adverse events in patients admitted in the year 2003-04 to selected Victorian hospitals; to identify the main hospital-acquired diagnoses; and to estimate the cost of these complications to the Victorian and Australian health system. The patient-level costing dataset for major Victorian public hospitals, 1 July 2003-30...

This study examined the impact of cost outliers in term of hospital resources consumption, the financial impact of the outliers under the Belgium casemix-based system, and the validity of two "proxies" for costs: length of stay and charges. The cost of all hospital stays at three Belgian general hospitals were calculated for the year 2001. High res...

The objective of this study was to find factors that could explain high and low resource use outliers, by associating an explanatory analysis with a statistical analysis. High resource use outliers were selected according to the following rule: 75th percentile + 1.5* inter-quartile range. Low resource use outliers were selected according to: 25th p...

The objective of this research was to document the most common first-recorded adverse events of inpatient care for lung cancer in Victoria, Australia. The sample comprised record abstracts for 3642 admissions (overnight or longer) of adult patients with lung cancer, extracted from the Victorian Admitted Episodes Database for 2000-2001. The method i...

To compare two methods for identifying adverse events using routinely recorded hospital abstract data in all public and private hospitals in Victoria, Australia. Secondary analysis of data on all admissions in the period 1 July 2000-30 June 2001 (n = 1,645,992) to estimate the rates of adverse events using International Classification of Diseases 1...

To describe the health outcomes and public healthcare costs of a single screening for Chlamydia trachomatis in Australian women aged 15-34 years. A decision analytic model was used to determine the epidemiological estimates of prevalence and costs of C. trachomatis infection and its diagnosis, treatment and sequelae. We estimate that in any female...

Despite the mixed results of Brown and colleagues' review of the evidence for the use of performance indicators in health policy, this paper argues that they have an important place. Healthcare organizations cannot rely on altruism alone to motivate improved performance. Berwick, supporting the use of performance indicators in healthcare, argues "t...

The use of ultrasonography and computed tomography (CT) in the diagnosis of appendicitis in adult patients was compared. Systematic review and meta-analysis of current evidence in two clinical situations: unselected nonpregnant, adult patients with symptoms of appendicitis, and more selective use in only those patients who still have an equivocal d...

The effects of socioeconomic position on health have been largely ignored in clinical guidelines. Australia's National Health and Medical Research Council has produced a framework to ensure that they are taken into account.

This commentary takes up A. David Paltiel's invitation to reflect on how to promote the use of decision analysis and cost-effectiveness analysis in health. From the perspective of a health services researcher outside the U.S. system, I make 3 arguments. First, the unthinking use of the term rationing for all applications of cost-effectiveness analy...

Casemix-funding systems for hospital inpatient care require a set of resource weights which will not inadvertently distort patterns of patient care. Few health systems have very good sources of cost information, and specific studies to derive empirical cost relativities are themselves costly. This paper reports a 5 year program of research into the...

Hospital emergency services are one of the key drivers of hospital activity, yet there has been surprisingly little attention paid to appropriate funding models for single-payer systems, in which funders must be concerned with issues of access and financial viability of emergency departments. This article analyzes the dynamics of hospital emergency...

Unlabelled: When compared with thiopental and isoflurane, propofol and sevoflurane are associated with a faster return to wakefulness after anesthesia. Yet their wider usage in inpatient surgery has been restrained by concerns regarding their acquisition costs and by lack of studies demonstrating improved patient outcome. We randomly allocated 453...

Unlabelled: Newer anesthetics promise improved clinical outcomes, but usually come at a higher price per dose. Previous studies have found few economic benefits in the immediate postoperative period, but have hypothesized that earlier recovery may lead to lower costs for the whole episode of hospitalization. This study uses cost data for patients...

When compared with thiopental and isoflurane, propofol and sevoflurane are associated with a faster return to wakefulness after anesthesia. Yet their wider usage in inpatient surgery has been restrained by concerns regarding their acquisition costs and by lack of studies demonstrating improved patient outcome. We randomly allocated 453 adult surgic...

Newer anesthetics promise improved clinical outcomes, but usually come at a higher price per dose. Previous studies have found few economic benefits in the immediate postoperative period, but have hypothesized that earlier recovery may lead to lower costs for the whole episode of hospitalization. This study uses cost data for patients enrolled in a...

Private health insurance subsidy is now estimated to cost $2.19 billion; government support for private health care includes a further $1.2 billion of Medicare benefits expenditure in hospitals. The subsidy cannot be justified on efficiency grounds, as, on the basis of available evidence and taking casemix into account, public hospitals are more ef...

OBJECTIVE: This paper presents a framework for evaluation of alternative sources of estimates of the costs of hospital inpatient care in Australia. It argues that the choice of costing methods depends on the decision–context and the sensitivity of the decision to estimation errors. METHOD: Five criteria are proposed for evaluation of sources of hos...

Objective: Rotavirus gastroenteritis causes substantial morbidity, including hospital admission, in young children. In the context of recent vaccine developments, this study aimed to estimate the cost-effectiveness of a rotavirus vaccination program in Australia. Method: Standard methods of health economic evaluation were used to assess the tota...

Collaborative research is important in that it recognises the input and skills of a range of players participating in and contributing to health care programs. These players include academic researchers, practitioners, policy makers and evaluators. Questions relating to research publication arise across the spectrum of health-related research activ...

Policy-makers have always found it problematic to formulate fair and consistent counting rules for public hospital outpatient activities. In the context of output-based funding, such rules have consequences which can affect patient care. This paper reviews the rationale for organising multidisciplinary clinics and reports on a series of focus group...

This paper proposes an episode of care payment system for patients with chronic illnesses, extending earlier published work on this model of ambulatory care (Duckett and Jackson 1993). The payment system relies on annual voluntary enrollment and some marginal broadening of Medicare coverage in exchange for patients' willingness to participate in an...

We concluded a prospective randomised study comparing conventional electrocautery transurethral resection of the prostate (TURP) to laser prostatectomy using a right-angled Nd:YAG beam reflector. Seventy-one patients were evaluable, 34 laser and 37 TURP. Fifty patients have completed 6 months of follow-up. Using standard post prostatectomy outcome...

This paper distinguishes three separate ways in which casemix measurement serves as a foundation for hospital and health system reform. At the hospital level, diagnosis related groups provide a means of describing kinds of acute inpatient care which in turn facilitates utilisation review activities essential to modern clinical and financial managem...

A cost-effectiveness study compared visual laser ablation of the prostate (VLAP) with transurethral resection (TURP). Achieving equivalent outcomes, VLAP was more expensive than TURP. The result was sensitive to various assumptions, suggesting that VLAP might prove to be the preferred technology. Problems inherent in economic evaluation of emerging...

Measurement of the ambulatory casemix of Australian hospitals is important as the next step beyond DRGs in better management of total hospital output. This paper describes and analyses two classification systems, Ambulatory Patient Groups (APGs) and Ambulatory Visit Groups (AVGs), designed by the Yale casemix development group for use in the United...

Australia's approach to the financing of health care, as in most industrialized nations, rests on an important but ever-changing dynamic between the public and private sectors. While publicly financed care dominates, the ready availability of private insurance provides a counterpoint that compels the government to be accountable for its policy acti...

This paper seeks to explore the interaction of social and behavioural sources of ill-health and to propose a model for analysing the contribution of each to specific health problems. A more sophisticated analysis of these causal factors will allow health promotion to tailor prevention strategies more appropriately to the level and type of intervent...

data available in the VAED, and several others could be replicated only partially. 'Serious harm' could not be identified other than by limiting analysis to deaths associated with (but not necessarily caused by) a SE. Coded records apparently under-reported cases of wrong patient/wrong surgery, suicide by an inpatient and maternal deaths, when comp...

This paper describes the limitations of using the International Statistical Classifi cation of Diseases and Related Health Problems, Tenth Revision, Australian Modifi cation (ICD-10-AM) to characterise patient harm in hospitals. Limitations were identifi ed during a project to use diagnoses fl agged by Victorian coders as hospital-acquired to devis...

University Microfilms order no. 9316016. Thesis (Ph. D.)--Brandeis University, The Florence Heller Graduate School for Advanced Social Welfare, 1990. Includes bibliographical references.