OUR Group Projects A Longitudinal Study of In-Patient Insurance Classification in Western Australia Using Linked Hospital Morbidity Data This new OUR Group study will examine longitudinal trends in in-patient insurance classification in Western Australia from 1980 to 2001, based on hospital morbidity data pertaining to all short-stay hospitals in the State linked at the level of the individual patient, to achieve the following: Overall Aim: To identify any significant trends in the use of private health insurance by in-patients over time and, in particular, to measure the extent to which switching or payment classification and use of the private and public sector hospitals occurs in individual patients. Specific objectives (as stated by HBF Health Funds Inc): (i) To describe the trends from 1980 to 2001, year by year, in in-patient payment classification in Western Australia by hospital type (private vs public teaching vs public non-teaching hospitals; and metropolitan vs country hospitals) and broad diagnostic and clinical categories (obstetric vs surgery vs medical vs paediatric cases; and elective vs emergency cases).
(ii) To measure the proportions of patients in different categories defined in (i) who change their payment classification and hospital type and what are the directions of these changes.
(iii) To determine if there are distinct behavioural patterns in the switching of payment classification and hospital type (such as the use of private insurance and private hospital facilities for obstetrics and elective surgery, while using public hospital facilities for other conditions in the same patient); and to measure the extent and describe the trends in each behavioural pattern. Additional specific objectives (as recommended by the UWA Centre for Health Services Research): (iv) To determine if there is evidence of specific ‘cut-points’ in the trends in in-patient classification described and measured in (i) and (ii), which are correlated in time with the introduction of significant changes in national policy affecting private health insurance; changes in private health insurance premiums and benefits; and changes in the local environment for health care delivery such as the opening of new hospitals or facilities.
(v) To carefully distinguish between changes in payment classification occurring in the course of serial, overlapping and nested inter-hospital transfers during the same episode of hospitalization and changes occurring between two entirely separate episodes of hospitalization; and to describe separately the trends in payment classification changes occurring in the course of inter-hospital transfer.
The WA Record Linkage Project: Population-Based Studies of Health System Utilisation and Outcomes
The studies undertaken by OUR Group researchers in this project, will measure rates of utilisation and outcomes of health care for selected conditions and procedures, according to locational and social disadvantage, and possession of private health cover. Risk adjustments will be made for age, sex, Aboriginality, co-morbidity and then, in the second phase of the study, severity of illness. Measures of utilisatsion will be calculated from 1994 - 1996 and 1997 - 1999 linked data and include admission and procedure rates, average length of stay and cumulative length of stay. Longitudinal outcome measures will include case fatality rates with 1, 3 and 5 years of index admission and cumulative readmission risk within 30 days and 1 year of separation. SQSCP StudiesWestern Australian Safety and Quality of Surgical Care Project (SQSCP) Established in 1996 as a unique quality assurance activity in Australia, this project has been established as a model to evaluate the outcomes of various surgical procedures (including circumcision, hysterectomies, hernias, ovarian cancer, breast cancer, prostate cancer, endoluminal stent grafting, abdominal aortic aneurysm) and where indicated, to recommend changes to improve the quality of surgical care in Western Australia. This project involves collaboration with the WA Branch of the Royal Australasian College of Surgeons, UWA School of Population Health and the Health Department of Western Australia. The project utilises the WA Data Linkage system to assess the outcomes of surgical care delivered to the whole population. The Project will mobilise the collaborative potential of surgeons, public health researchers and health service administrators, and will utilise the previously untapped potential of existing information resources by using the WA Data Linkage System to assess the outcomes of surgical care delivered to the whole population. Western Australian Audit of Surgical Mortality The Western Australian Audit of Surgical Mortality (WAASM) is a project within the SQSCP. Details are on the WAASM website.
Endophthalmitis in Western Australia
Cataract surgery is today the most commonly performed surgical procedure in Western Australian (WA) hospitals, with around 12,000 cataract operations performed each year. Such a large number of operations highlight the importance of efforts to reduce serious complications. The aim of this study, undertaken by members of the SQSCP team, is to determine the incidence, risk factors and most effective method of chemoprophylaxis (preventative antimicrobial treatments) during cataract surgery to reduce the risk of post-operative endophthalmitis. The study will be carried out in two stages. The first stage of the project involves the use of the WA Linked Data System to estimate: - the procedure rate of cataract surgery and the subsequent risk of post-operative endophthalmitis in WA using a total population patient series, and
- the associations among surgical technique, comorbidity, demographic characteristics and the occurrence of endophthalmitis using the hospital separation data.
The second stage of the project will include a nested case-control cohort study to: - estimate the relative risk of endophthalmitis according to different operative techniques and secular trends over time;
- assess the effectiveness of the different methods of chemoprophylaxis; and
- provide an economic review of the cost-effectiveness of different methods of treatment and of chemoprophylaxis.
A secondary study following on from this began in 2004: Western Australian Study into Complications after Cataract SurgeryAdverse events following cataract surgery in Western Australia: a population study using record linkage. The WA Study Into Complications after Cataract Surgery builds upon earlier work by the SQSCP team into endophthalmitis (a serious internal infection of the eye) complicating cataract surgery, by extending the research into the other major sight-threatening complications of cataract surgery— - retinal detachment;
- retained lens fragment;
- corneal decompensation;
- wound rupture, and
- problems with the positioning of the plastic lens often inserted to restore vision after cataract removal.
This study is unique in that it will utilise the WA Data Linkage System to examine these major complications from the perspective of the entire WA population who have had this surgery. Western Australian Gestational Breast Cancer Project This study, a joint project between the Centre for Health Services Research SQSCP and UWA School of Surgery & Pathology, concentrates on establishing the incidence, management and outcomes of breast cancer and pregnancy in women diagnosed with breast cancer. It looks at two groups of women, those diagnosed with breast cancer who subsequently conceive, and those diagnosed with gestational breast cancers. Further work is being undertaken which will examine imaging, pathology and psycho-social issues of women diagnosed with gestational breast cancer. One of our aims for the future is to set up a database for all young women diagnosed with breast cancer in WA, for future audit and research purposes. Breast Cancer: Surgery and Survival trends 1982-2000This aim of this SQSCP project was to investigate long-term survival outcomes of women diagnosised with breast cancer in WA from 1982-2000. The survival outcomes were compared for women who underwent conservative breast cancer surgery compared to women who underwent mastectomies over the same calendar period.
Breast cancer and the oestrogen receptor
This SQSCP study aims to determine the relationship between survival and disease recurrence rates of breast cancer with the level of oestrogen receptors expressed in the primary tumour.
The Development of the Zenith Endoluminal Stent Graft Research Database: Evaluation of the Outcomes and Device Durability
The aim of this project, a part of the SQSCP, was to establish the Zenith Endoluminal Stent Graft Research Database (Zenith Endoluminal Research Database), to provide high quality information for quality assurance, audit, assessment of device performance, and research of surgical outcomes and resulting complications of the endoluminal procedure. The design and construction of the database involved a multi-disciplinary team including vascular surgeons, radiologists, public health researchers and a computer programmer. Combined unit data was obtained from 18 endovascular centres in Western Australia, South Australia, Victoria and New Zealand, which use the Zenith endoluminal graft. Data was collected on 317 patients who were treated by endoluminal repair in the combined units since the beginning of the Zenith Endoluminal Program in 1993 to 1998. Patient data includes detailed clinical information, radiological data, x-ray films and stent design plans, and device information. Follow-up information will be collected for each patient on an ongoing basis for a period of 10 years. | 
