MedicalResearch.com Interview with:
Professor Jeffrey Braithwaite, PhD
Dr. Braithwaite is founding director of the Australian Institute of Health Innovation at Macquarie University and Chief Investigator of the just-published CareTrack Kids Study the largest study of the quality of care to children ever undertaken.
MedicalResearch.com: What is the background for this study?
Response: While seeking to improve health outcomes for patients, there has been substantial investment in developing clinical practice guidelines, to support the delivery of evidence-based healthcare. Prior to the CareTrack Kids study, little was known about the level of adherence to clinical practice guidelines for the care of Australian children.
Our study examined care provided to children under 16 years of age treated for 17 important clinical conditions, such as asthma or fever, to assess adherence to these guidelines. We surveyed over 6500 medical records in four clinical settings (general practices; paediatricians offices; hospital emergency departments; and hospital inpatient wards) in South Australia, New South Wales and Queensland, and assessed visits during 2012 and 2013.
MedicalResearch.com: What are the main findings?
Response: We found that care was in line with clinical practice guidelines 60 percent of the time, overall.
There was substantial variation in adherence to guidelines by clinical condition: for example, there was 89 percent adherence for the management of autism, 58 per cent in the management of asthma, 54 per cent in the management of fever, to 44 per cent for tonsillitis.
Mental health conditions (ADHD, anxiety, autism, and depression) and head injuries received most care in line with guidelines, while tonsillitis, gastroesophageal reflux disease and upper respiratory tract infections received care least in line with guidelines.
MedicalResearch.com: What should readers take away from your report?
Response: Australia has an excellent healthcare system, by world standards. While guidelines should not be strictly followed in all circumstances, there would appear to be opportunities for further improvement to Australian healthcare provision for children.
There have only been three previous studies of this type, two in adults (one in the USA and one in Australia) and one in children (USA). All have shown roughly similar rates of adherence to clinical practice guidelines, suggesting that the system of healthcare may need to be modified, to increase provision of care in line with guidelines.
We suggest several system improvements based around advancing the design and implementation of electronic health records, to help clinicians provide care in line with guidelines, and to monitor and report adherence rates to clinicians in real-time. Such feedback can help to incrementally improve the system over time.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: Going forward, the care provided for each of the conditions studied needs to be looked at in detail to identify the practices most likely to benefit from interventions to improve adherence. We need to then prioritise these intervention targets, based on the likely costs and anticipated benefits of intervening. We also need an ongoing study of ways to improve the design and implementation of electronic health records,
MedicalResearch.com: Is there anything else you would like to add?
Response: We have no disclosures to report. This work was funded as part of an Australian National Health and Medical Research (NHMRC) partnership grant (APP1065898), with contributions from BUPA Health Foundation, the Sydney Children’s Hospital Network, New South Wales Kids and Families, Children’s Health Queensland and the South Australian Department of Health. The funders had no role in determining the course of the research, interpreting the findings, or the decision to publish.
Braithwaite J, Hibbert PD, Jaffe A, White L, Cowell CT, Harris MF, Runciman WB, Hallahan AR, Wheaton G, Williams HM, Murphy E, Molloy CJ, Wiles LK, Ramanathan S, Arnolda G, Ting HP, Hooper TD, Szabo N, Wakefield JG, Hughes CF, Schmiede A, Dalton C, Dalton S, Holt J, Donaldson L, Kelley E, Lilford R, Lachman P, Muething S. Quality of Health Care for Children in Australia, 2012-2013. JAMA. 2018;319(11):1113–1124. doi:10.1001/jama.2018.0162
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