Louise K. Wiles’s research while affiliated with Macquarie University and other places

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Publications (13)


The process for developing and ratifying CareTrack Aged evidence-based care indicators following Hibbert et al. (2022) [18]
The quality of care delivered to residents in long-term care in Australia: an indicator-based review of resident records (CareTrack Aged study)
  • Article
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January 2024

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74 Reads

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2 Citations

BMC Medicine

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Background This study estimated the prevalence of evidence-based care received by a population-based sample of Australian residents in long-term care (LTC) aged ≥ 65 years in 2021, measured by adherence to clinical practice guideline (CPG) recommendations. Methods Sixteen conditions/processes of care amendable to estimating evidence-based care at a population level were identified from prevalence data and CPGs. Candidate recommendations (n = 5609) were extracted from 139 CPGs which were converted to indicators. National experts in each condition rated the indicators via the RAND-UCLA Delphi process. For the 16 conditions, 236 evidence-based care indicators were ratified. A multi-stage sampling of LTC facilities and residents was undertaken. Trained aged-care nurses then undertook manual structured record reviews of care delivered between 1 March and 31 May 2021 (our record review period) to assess adherence with the indicators. Results Care received by 294 residents with 27,585 care encounters in 25 LTC facilities was evaluated. Residents received care for one to thirteen separate clinical conditions/processes of care (median = 10, mean = 9.7). Adherence to evidence-based care indicators was estimated at 53.2% (95% CI: 48.6, 57.7) ranging from a high of 81.3% (95% CI: 75.6, 86.3) for Bladder and Bowel to a low of 12.2% (95% CI: 1.6, 36.8) for Depression. Six conditions (skin integrity, end-of-life care, infection, sleep, medication, and depression) had less than 50% adherence with indicators. Conclusions This is the first study of adherence to evidence-based care for people in LTC using multiple conditions and a standardised method. Vulnerable older people are not receiving evidence-based care for many physical problems, nor care to support their mental health nor for end-of-life care. The six conditions in which adherence with indicators was less than 50% could be the focus of improvement efforts.

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Improving patient safety governance and systems through learning from successes and failures: qualitative surveys and interviews with international experts

October 2023

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233 Reads

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7 Citations

International Journal for Quality in Health Care

Patient harm is a leading cause of global disease burden with considerable morbidity, mortality, and economic impacts for individuals, families, and wider society. Large bodies of evidence exist for strategies to improve safety and reduce harm. However, it is not clear which patient safety issues are being addressed globally, and which factors are the most (or least) important contributors to patient safety improvements. We aimed to explore the perspectives of international patient safety experts to identify: (1) the nature and range of patient safety issues being addressed, and (2) aspects of patient safety governance and systems that are perceived to provide value (or not) in improving patient outcomes. English-speaking Fellows and Experts of the International Society for Quality in Healthcare participated in a web-based survey and in-depth semistructured interview, discussing their experience in implementing interventions to improve patient safety. Data collection focused on understanding the elements of patient safety governance that influence outcomes. Demographic survey data were analysed descriptively. Qualitative data were coded, analysed thematically (inductive approach), and mapped deductively to the System-Theoretic Accident Model and Processes framework. Findings are presented as themes and a patient safety governance model. The study was approved by the University of South Australia Human Research Ethics Committee. Twenty-seven experts (59% female) participated. Most hailed from Africa (n = 6, 22%), Australasia, and the Middle East (n = 5, 19% each). The majority were employed in hospital settings (n = 23, 85%), and reported blended experience across healthcare improvement (89%), accreditation (76%), organizational operations (64%), and policy (60%). The number and range of patient safety issues within our sample varied widely with 14 topics being addressed. Thematically, 532 textual segments were grouped into 90 codes (n = 44 barriers, n = 46 facilitators) and used to identify and arrange key patient safety governance actors and factors as a ‘system’ within the System-Theoretic Accident Model and Processes framework. Four themes for improved patient safety governance were identified: (1) ‘safety culture’ in healthcare organizations, (2) ‘policies and procedures’ to investigate, implement, and demonstrate impact from patient safety initiatives, (3) ‘supporting staff’ to upskill and share learnings, and (4) ‘patient engagement, experiences, and expectations’. For sustainable patient safety governance, experts highlighted the importance of safety culture in healthcare organizations, national patient safety policies and regulatory standards, continuing education for staff, and meaningful patient engagement approaches. Our proposed ‘patient safety governance model’ provides policymakers and researchers with a framework to develop data-driven patient safety policy.


PRISMA flow chart
Risk of bias summary
The effectiveness of educational interventions at improving moderate intensity physical activity outcomes in socio-economically disadvantaged populations: random effects meta-analysis
The effectiveness of educational interventions at improving cancer screening outcomes in socio-economically disadvantaged populations: random effects meta-analysis
Do health education initiatives assist socioeconomically disadvantaged populations? A systematic review and meta-analyses

March 2023

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203 Reads

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11 Citations

BMC Public Health

Abstract Background Health education interventions are considered critical for the prevention and management of conditions of public health concern. Although the burden of these conditions is often greatest in socio-economically disadvantaged populations, the effectiveness of interventions that target these groups is unknown. We aimed to identify and synthesize evidence of the effectiveness of health-related educational interventions in adult disadvantaged populations. Methods We pre-registered the study on Open Science Framework https://osf.io/ek5yg/ . We searched Medline, Embase, Emcare, and the Cochrane Register from inception to 5/04/2022 to identify studies evaluating the effectiveness of health-related educational interventions delivered to adults in socio-economically disadvantaged populations. Our primary outcome was health related behaviour and our secondary outcome was a relevant biomarker. Two reviewers screened studies, extracted data and evaluated risk of bias. Our synthesis strategy involved random-effects meta-analyses and vote-counting. Results We identified 8618 unique records, 96 met our criteria for inclusion – involving more than 57,000 participants from 22 countries. All studies had high or unclear risk of bias. For our primary outcome of behaviour, meta-analyses found a standardised mean effect of education on physical activity of 0.05 (95% confidence interval (CI) = -0.09–0.19), (5 studies, n = 1330) and on cancer screening of 0.29 (95% CI = 0.05–0.52), (5 studies, n = 2388). Considerable statistical heterogeneity was present. Sixty-seven of 81 studies with behavioural outcomes had point estimates favouring the intervention (83% (95% CI = 73%-90%), p


Figure 1. PRISMA flow diagram.
Figure 2. Graphic summary of the key findings of this review.
Included guidelines and resources.
Best practice care for persistent pain in adults with spinal cord injuries: a systematic review and narrative synthesis of clinical practice guideline recommendations

July 2022

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228 Reads

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5 Citations

Purpose: To review clinical practice guidelines (CPGs) and recent literature to identify common recommendations guiding "best practice" pain care for adults with spinal cord injury (SCI). Methods: We searched four scientific databases and four guideline repositories from January 2010 to February 2022 for CPGs relating to the management of pain following SCI. We excluded guidelines that related to a single treatment modality, complementary medicines, specific disease processes, and guidelines that were not freely available. Results: We identified 1373 records from which 11 met all eligibility criteria. Seven were classified as "tier 1" and were used to generate 46 care components related to neuropathic pain management. We organised these into three themes: screening and assessment, principles of evaluation and management, and management recommendations; and seven subthemes: screening, assessment and diagnosis, addressing complex care needs, ongoing evaluation, management - interventional, management - pharmacological, and management - non-pharmacological. Four CPGs were classified as "tier 2" and were used to provide supporting evidence. We identified 12 recommendations related to the management of nociceptive pain. Conclusions: This synthesis of recommendations can guide consumers, clinicians, researchers, and policy makers to inform understanding and clinical implementation of evidence-based "best practice" management of pain in adults with SCI.Implications for rehabilitationPersistent pain is a frequent problem for individuals following spinal cord injury and its effective management is challenging for clinicians.High-quality clinical practice guidelines that are up-to-date and readily accessible have the potential to enhance care quality and outcomes.This synthesis of 58 key care recommendations can guide consumers, clinicians, researchers, and policy makers towards improving pain care for adults with spinal cord injuries.


Designing Clinical Indicators for Common Residential Aged Care Conditions and Processes of Care: The CareTrack Aged Development and Validation Study

April 2022

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62 Reads

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7 Citations

International Journal for Quality in Health Care

Background: People who live in aged care homes have high rates of illness and frailty. Providing evidence-based care to this population is vital to ensure the highest possible quality of life. This study (CareTrack Aged, CT Aged) aimed to develop a comprehensive set of clinical indicators for guideline-adherent, appropriate care of commonly managed conditions and processes of care in aged care. Methods: Indicators were formulated from recommendations found through systematic searches of Australian and international clinical practice guidelines (CPGs). Experts reviewed the indicators using a multi-round modified Delphi process to develop consensus on what constitutes appropriate care. Results: From 139 CPGs, 5,609 recommendations were used to draft 630 indicators. Clinical experts (n=41) reviewed the indicators over two rounds. A final set of 236 indicators resulted, mapped to 16 conditions and processes of care. The conditions and processes were admission assessment; bladder and bowel problems; cognitive impairment; depression; dysphagia and aspiration; end of life/palliative care; hearing and vision; infection; medication; mobility and falls; nutrition and hydration; oral and dental care; pain; restraint use; skin integrity; and sleep. Conclusions: The suite of CT Aged clinical indicators can be used for research, assessment of quality of care in individual facilities and across organisations to guide improvement, and to supplement regulation or accreditation of the aged care sector. They are a step forward for Australian and international aged care sectors, helping to improve transparency, so that the level of care delivered to aged care consumers can be rigorously monitored and continuously improved.


Consumer engagement in health care policy, research and services: A systematic review and meta-analysis of methods and effects

January 2022

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396 Reads

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62 Citations

To assess the effects of consumer engagement in health care policy, research and services. We updated a review published in 2006 and 2009 and revised the previous search strategies for key databases (The Cochrane Central Register of Controlled Trials; MEDLINE; EMBASE; PsycINFO; CINAHL; Web of Science) up to February 2020. Selection criteria included randomised controlled trials assessing consumer engagement in developing health care policy, research, or health services. The International Association for Public Participation, Spectrum of Public Participation was used to identify, describe, compare and analyse consumer engagement. Outcome measures were effects on people; effects on the policy/research/health care services; or process outcomes. We included 23 randomised controlled trials with a moderate or high risk of bias, involving 136,265 participants. Most consumer engagement strategies adopted a consultative approach during the development phase of interventions, targeted to health services. Based on four large cluster-randomised controlled trials, there is evidence that consumer engagement in the development and delivery of health services to enhance the care of pregnant women results in a reduction in neonatal, but not maternal, mortality. From other trials, there is evidence that involving consumers in developing patient information material results in material that is more relevant, readable and understandable for patients, and can improve knowledge. Mixed effects are reported of consumer-engagement on the development and/or implementation of health professional training. There is some evidence that using consumer interviewers instead of staff in satisfaction surveys can have a small influence on the results. There is some evidence that consumers may have a role in identifying a broader range of health care priorities that are complementary to those from professionals. There is some evidence that consumer engagement in monitoring and evaluating health services may impact perceptions of patient safety or quality of life. There is growing evidence from randomised controlled trials of the effects of consumer engagement on the relevance and positive outcomes of health policy, research and services. Health care consumers, providers, researchers and funders should continue to employ evidence-informed consumer engagement in their jurisdictions, with embedded evaluation. Systematic review registration: PROSPERO CRD42018102595.


What Constitutes “Appropriate Care” for Low Back Pain?: Point-of-Care Clinical Indicators From Guideline Evidence and Experts (the STANDING Collaboration Project)

November 2021

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633 Reads

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16 Citations

Spine

Study design: Multiround wiki-based Delphi expert panel survey. Objective: To provide proof of concept for an alternative method for creating sets of nationally-agreed point-of-care clinical indicators, and obtain consensus among end-user groups on "appropriate care" for the assessment, diagnosis, acute, and ongoing care of people with low back pain (LBP). Summary of background data: The provision of inappropriate and low value care for LBP is a significant healthcare and societal burden. Vague clinical practice guideline (CPG) recommendations can be difficult to apply and measure in real world clinical practice, and a likely barrier to "appropriate care." Methods: Draft "appropriate care" clinical indicators for LBP were derived from CPG recommendations published between 2011 and 2017. Included CPGs were independently appraised by two reviewers using the Appraisal of Guidelines for Research and Evaluation instrument. Headed by a Clinical Champion, a 20-member Expert Panel reviewed and commented on the draft indicators over a three-round modified e-Delphi process using a collaborative online wiki. At the conclusion of each review round, the research team and the Clinical Champion synthesized and responded to experts' comments and incorporated feedback into the next iteration of the draft indicators. Results: From seven CPGs and six qualitative meta-syntheses, 299 recommendations and themes were used to draft 42 "appropriateness" indicators. In total, 17 experts reviewed these indicators over 18 months. A final set of 27 indicators comprising screening and diagnostic processes (n = 8), assessment (n = 3), acute (n = 5), and ongoing care (n = 9), and two which crossed the acute-ongoing care continuum. Most indicators were geared toward recommended care (n = 21, 78%), with the remainder focused on care to be avoided. Conclusion: These 27 LBP clinical indicators can be used by healthcare consumers, clinicians, researchers, policy makers/funders, and insurers to guide and monitor the provision of "appropriate care" for LBP.Level of Evidence: 4.


Focus group participation by state.
Asthma profile of participants (n = 37).
Child and caregiver experiences and perceptions of asthma self-management

September 2021

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166 Reads

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24 Citations

npj Primary Care Respiratory Medicine

Asthma is the most common chronic condition of childhood. Self-management is integral to good asthma control. This qualitative paper explores how children with asthma and their parents perceive asthma, their experience with asthma, and how they manage symptoms, preventions and medications within and outside the home. We undertook 15 focus groups with 41 school-aged (6–11 years) children with asthma and 38 parents. Parents and their children attended the same focus groups. We used thematic analysis to analyse the transcripts. Our findings show the impact asthma can have on children’s social and emotional wellbeing and highlight how reliant school-aged children are on their parents to effectively manage their asthma. Parents reported being unsure when their child’s symptoms warranted visiting their doctor or hospital. Schools were identified as a source of difficulty regarding asthma management; families reported that children may be self-conscious about their asthma and using their inhaler at school. School policies and teachers’ lack of asthma knowledge were reported to exacerbate children’s reluctance to use their inhaler at school. Our results have implications for the design and implementation of children’s self-management interventions for their asthma, particularly when they are at school and away from their parents.


Figure 1 PRISMA flow diagram for study selection. PRISMA, Preferred Reporting Items for Systematic Reviews and MetaAnalyses statement.
Results of the critical appraisal
Systematic review of the factors and the key indicators that identify doctors at risk of complaints, malpractice claims or impaired performance

August 2021

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182 Reads

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25 Citations

BMJ Open

Objective To identify the risk factors associated with complaints, malpractice claims and impaired performance in medical practitioners. Design Systematic review. Data sources Ovid-Medline, Ovid Embase, Scopus and Cochrane Central Register of Controlled Trials were searched from 2011 until March 2020. Reference lists and Google were also handsearched. Results Sixty-seven peer-reviewed papers and three grey literature publications from 2011 to March 2020 were reviewed by pairs of independent reviewers. Twenty-three key factors identified, which were categorised as demographic or workplace related. Gender, age, years spent in practice and greater number of patient lists were associated with higher risk of malpractice claim or complaint. Risk factors associated with physician impaired performance included substance abuse and burn-out. Conclusions It is likely that risk factors are interdependent with no single factor as a strong predictor of a doctor’s risk to the public. Risk factors for malpractice claim or complaint are likely to be country specific due to differences in governance structures, processes and funding. Risk factors for impaired performance are likely to be specialty specific due to differences in work culture and access to substances. New ways of supporting doctors might be developed, using risk factor data to reduce adverse events and patient harm. PROSPERO registration number PROSPERO registration number: CRD42020182045.


Southern Adelaide Local Health Network's 8 Step Problem Solving Process in their Continuous Improvement Framework
Components of high-performing hospitals [32] and ingredients necessary for a successful quality improvement program highlighted in red ovals [Adapted by permission from Springer Nature Customer Service Centre GmbH: Springer Nature, BMC Health Services Research. (High performing hospitals: a qualitative systematic review of associated factors and practical strategies for improvement. Taylor N, Clay-Williams R, Hogden E, Braithwaite J, Groene O.) COPYRIGHT 2015]
How to sustainably build capacity in quality improvement within a healthcare organisation: a deep-dive, focused qualitative analysis

June 2021

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435 Reads

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20 Citations

BMC Health Services Research

Background A key characteristic of healthcare systems that deliver high quality and cost performance in a sustainable way is a systematic approach to capacity and capability building for quality improvement. The aim of this research was to explore the factors that lead to successful implementation of a program of quality improvement projects and a capacity and capability building program that facilitates or support these. Methods Between July 2018 and February 2020, the Southern Adelaide Local Health Network (SALHN), a network of health services in Adelaide, South Australia, conducted three capability-oriented capacity building programs that incorporated 82 longstanding individual quality improvement projects. Qualitative analysis of data collected from interviews of 19 project participants and four SALHN Improvement Faculty members and ethnographic observations of seven project team meetings were conducted. Results We found four interacting components that lead to successful implementation of quality improvement projects and the overall program that facilitates or support these: an agreed and robust quality improvement methodology, a skilled faculty to assist improvement teams, active involvement of leadership and management, and a deep understanding that teams matter. A strong safety culture is not necessarily a pre-requisite for quality improvement gains to be made; indeed, undertaking quality improvement activities can contribute to an improved safety culture. For most project participants in the program, the time commitment for projects was significant and, at times, maintaining momentum was a challenge. Conclusions Healthcare systems that wish to deliver high quality and cost performance in a sustainable way should consider embedding the four identified components into their quality improvement capacity and capability building strategy.


Citations (12)


... However, the patients emphasized that, over time, the disclosure of adverse events could promote well-being for both patients and healthcare professionals. To further improve patient safety, healthcare professionals can approach and use patient knowledge more systematically [52]. Thus, the results of this study can also serve as a crucial reminder of patient involvement and knowledge to increase the patient safety culture. ...

Reference:

Patient safety culture through the lenses of surgical patients: a qualitative study
Improving patient safety governance and systems through learning from successes and failures: qualitative surveys and interviews with international experts

International Journal for Quality in Health Care

... No caso desta pesquisa, ela se inicia com o reconhecimento da epidemia de esporotricose no Brasil, que perdura por mais de duas décadas, e com a busca por estratégias eficazes de combate à doença. Dentre as diversas políticas públicas que podem ser adotadas, uma delas é a educação em saúde (Butala; Fyfe; Welburn, 2021; Karran et al., 2023;OMS, 2024). A partir dessa perspectiva, a pergunta que motivou este estudo foi: quais são as previsões legais no Brasil referentes à implementação de ações educativas em saúde no enfrentamento à epidemia de esporotricose? ...

Do health education initiatives assist socioeconomically disadvantaged populations? A systematic review and meta-analyses

BMC Public Health

... We report the methods and results of each stage separately and then integrate the findings. An overview of high-quality CPGs for the management of pain following SCI [21] was also incorporated into this final evaluative phase. ...

Best practice care for persistent pain in adults with spinal cord injuries: a systematic review and narrative synthesis of clinical practice guideline recommendations

... Delphi process will ensure a set of indicators that are comprehensive and valid. 39 In future studies, we plan to test the MHICare Tool within 'real-world' RAC settings to determine if the quality indicators are (1) feasible to administer and measure, (2) targeted, specific, acceptable and meaningful and (3) reliably measured. ...

Designing Clinical Indicators for Common Residential Aged Care Conditions and Processes of Care: The CareTrack Aged Development and Validation Study
  • Citing Article
  • April 2022

International Journal for Quality in Health Care

... In a review by Degeling et al. (2015), consumer engagement captured a variety of patient and family perspectives and led to investigation of acceptable approaches to produce evidence for policy making. Evidence suggests that promotion of patient engagement in healthcare supports the quality and clinical relevance of health systems research (Wiles et al. 2022). ...

Consumer engagement in health care policy, research and services: A systematic review and meta-analysis of methods and effects

... Most of these people will have a benign musculoskeletal cause to their LBP without specific or serious underlying pathology [3]. As such, LBP guidelines consistently recommend avoiding imaging and potentially harmful medicines such as opioids [4][5][6][7][8][9]. Despite this, over one-third of people in ED receive imaging [10], and opioids are administered at rates of up to 77% [11,12]. ...

What Constitutes “Appropriate Care” for Low Back Pain?: Point-of-Care Clinical Indicators From Guideline Evidence and Experts (the STANDING Collaboration Project)
  • Citing Article
  • November 2021

Spine

... Government policies and research highlight that parents and carers (hereafter referred to as 'caregivers') have a key role in communicating with the school about their child's medical needs and contributing to healthcare plans, monitoring their child's health, and liaising with professionals (Bowtell et al., 2018;Department for Education, 2015;Kelada et al., 2021). In multiple studies, educators and caregivers have reported poor communication between families, schools and health services (Barlow et al., 1998;Hinton & Kirk, 2015;McLoone et al., 2011). ...

Child and caregiver experiences and perceptions of asthma self-management

npj Primary Care Respiratory Medicine

... Conditions directly designed to address health-related problems (e.g., mental health or substance use and addiction) linked with the misconduct are rarely featured. At first glance, this may appear surprising given the broader understanding of tribunal penalty conditions as being rehabilitative and other research implicating health impairments with professional misconduct (Austin et al. 2021;Wang et al. 2024). However, it could reflect that some regulatory bodies have strong health assessment pathways, including mandated ones. ...

Systematic review of the factors and the key indicators that identify doctors at risk of complaints, malpractice claims or impaired performance

BMJ Open

... The second contextual factor relates to when neither the leader nor members are part of the facility management. The importance of management support is illustrated in one study reporting how QI activities were delayed because management did not approve it in good time [57], and conversely, how management approval for staff to attend training, strengthened the QI programme [23]. All the Mphatlalatsane hospitals were without direct management participation. ...

How to sustainably build capacity in quality improvement within a healthcare organisation: a deep-dive, focused qualitative analysis

BMC Health Services Research

... A patient with Barrett's esophagus develops anemia (low red blood cell count), then CBC with Diff can help determine the cause. The patient with Barrett's esophagus might has an infection (such as fever or leukocytosis), or to monitor blood counts after chemotherapy, then CBC with Diff can help monitor potential side effects [12]. ...

Assessing the appropriateness of the management of gastro-oesophageal reflux in Australian children: a population-based sample survey