Ministry of Health Library

Health Improvement and Innovation Digest

Issue 173 - 30 August 2018

Welcome to the fortnightly Health Improvement and Innovation Digest (formerly the HIIRC digest). The Digest has links to key evidence of interest, with access to new content arranged by topic.

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Have you heard about Grey Matter?

We'd like to introduce you to another newsletter that the Ministry of Health Library prepares.  The Grey Matter newsletter provides monthly access to a selection of recent NGO, Think Tank, and International Government reports related to health. Information is arranged by topic, allowing readers to quickly find their areas of interest.  If you'd like to subscribe to Grey Matter, email library@moh.govt.nz.

Article access

For articles that aren't open access, contact your DHB library, or organisational or local library for assistance in accessing the full text. If your organisation has a subscription, you may be able to use the icon under full text links in PubMed to access the full article.

Quality Improvement (New Zealand)

An audit of regular medication compliance prior to presentation for elective surgery
Patients presenting for elective surgery frequently omit one or more regular medications. There is evidence that withholding some medication classes may lead to harm in the peri-operative period. The aim of this study, published in the New Zealand Medical Journal, was to quantify medication non-compliance in an adult, elective surgical population and identify the reasons for this non-compliance

Quality Improvement (International)

The state of health services partnering with consumers: evidence from an online survey of Australian health services
Involving consumers in producing health services is mandated in many countries. Evidence indicates consumer partnerships lead to improved service design, quality and innovation. The authors of this study, published in BMC Health Services Research, conducted an online survey of Australian hospitals and day services. Questions covered consumer partnering in service planning, management and evaluation plus patient care design and inclusion of consumers from minority groups.

Hospital Productivity (International)

Hospital ambulatory medicine: A leading strategy for Internal Medicine in Europe
Published in the European Journal of Internal Medicine, this study’s aim was to describe the official position and approach of the Working Group on Professional Issues and Quality of Care of the European Federation of Internal Medicine (EFIM), for encouraging internists to lead a thorough reengineering of hospital operational procedures by the implementation of innovative hospital ambulatory care strategies. Among these, the authors include outpatient and ambulatory care strategies, quick diagnostic units, hospital-at-home, observation units and daycare hospitals.

A systematic review of trials evaluating success factors of interventions with computerised clinical decision support
Computerised clinical decision support (CDS) can potentially better inform decisions, and it can help with the management of information overload. The objective of this systematic review, published in Implementation Science, was to examine which factors make CDS strategies more effective on a number of outcomes, including adherence to recommended practice, patient outcome measures, economic measures, provider or patient satisfaction, and medical decision quality.

Shorter Waits for Cancer Treatment (International)

Reducing Wait Time for Lung Cancer Diagnosis and Treatment: Impact of a Multidisciplinary, Centralized Referral Program 
A multidisciplinary, centralized referral program was established at the authors’ institution in 2014 to reduce delays in lung cancer diagnosis and treatment following diagnostic imaging observed with the traditional, primary care provider-led referral process. The main objectives of this retrospective cohort study, published in the Canadian Association of Radiologists Journal, were to determine if referral to a Thoracic Triage Panel (TTP): 1) expedites lung cancer diagnosis and treatment initiation; and 2) leads to more appropriate specialist consultation.

Direct access cancer testing in primary care: a systematic review of use and clinical outcomes
Direct access (DA) testing allows GPs to refer patients for investigation without consulting a specialist. The aim is to reduce waiting time for investigations and unnecessary appointments, enabling treatment to begin without delay. Published in the British Journal of General Practice, this systematic review assessed the effectiveness of GP DA testing in adults. The aim was to establish the proportion of patients diagnosed with cancer and other diseases through DA testing, time to diagnosis, and suitability of DA investigations.

Shorter Stays In Emergency Departments (New Zealand)

Time to CT head in adult patients with suspected traumatic brain injury: Association with the 'Shorter Stays in Emergency Departments' health target in Aotearoa New Zealand
A national health target for length of stay in emergency departments (ED) was introduced in 2009 to reduce crowding and improve quality of care. This study, published in Injury, aimed to determine whether the target was associated with changes in time to CT and appropriateness of CT imaging, as markers of care quality for suspected acute traumatic brain injury (TBI).

Shorter stays in Emergency Departments (International)

Interventions to improve patient flow in emergency departments: an umbrella review  
Patient flow and crowding are two major issues in ED service improvement. A substantial amount of literature exists on the interventions to improve patient flow and crowding, making it difficult for policymakers, managers and clinicians to be familiar with all the available literature and identify which interventions are supported by the evidence. This umbrella review, published in the Emergency Medicine Journal, provides a comprehensive analysis of the evidence from existing quantitative systematic reviews on the interventions that improve patient flow in EDs.

The effect of vertical split-flow patient management on emergency department throughput and efficiency 
To address emergency department overcrowding operational research seeks to identify efficient processes to optimize flow of patients through the emergency department. Vertical flow refers to the concept of utilizing and assigning patients virtual beds rather than to an actual physical space within the emergency department to care of low acuity patients. The aim of this study, published in the American Journal of Emergency Medicine, was to evaluate the impact of vertical flow upon emergency department efficiency and patient satisfaction.

Improving Patient Flow from the Emergency Department Utilizing a Standardized Electronic Nursing Handoff Process
Published in the Journal of Nursing Administration, the goal of this project was to decrease handoff delays from the emergency department (ED) as measured by ready to move (RTM)-to-occupied time. ED boarding compromises the quality, safety, and experience of patient care. Lack of standardized and transparent handoff communication contributes to boarding time. This process improvement initiative implemented a standardized electronic situation, background, assessment, and recommendation (eSBAR) format-based nursing handoff process from the ED to a medical unit.

Is patient flow more efficient in Urgent Care Collaborations? 
Emergency Departments and out-of-hours General Practitioner services collaborate increasingly in Urgent Care Collaborations (UCCs) by sharing one combined entrance and joint triage. The aim of this study, published in the European Journal of Emergency Medicine, was to examine the difference between UCCs and providers who operate separately with respect to the efficiency of patient flow.

Cardiovascular Disease and Diabetes (New Zealand)

Consensus Statement of Standards for Interventional Cardiovascular Nursing Practice   
The Interventional Nurses Council (INC) developed a definition and scope of practice for interventional cardiac nursing (ICN's) in 2013. The INC executive committee established a working party of seven representatives from Australia and New Zealand. The working party finalised the standards on 14 July 2017, following endorsement from the CSANZ, INC, Heart Rhythm Council, CSANZ Quality Standards Committee and the Australian College of Critical Care Nurses (ACCCN). The resulting document, published in Heart, Lung & Circulation, provides clinical practice and education standards for interventional cardiac nursing practice.

Primary Health Care (New Zealand)

Core components of the rural nurse specialist role in New Zealand
As the number of GPs declines, the rural nurse specialist (RNS) role has emerged. The RNS is a registered nurse with advanced nursing skills that enable independent, autonomous practice within rural areas. The health needs of each rural community are specific to that area and the RNS role has been developed according to local healthcare needs. The purpose of this research, published in Rural & Remote Health, was to provide a description of the RNS role in New Zealand.

Ethnic disparities in community antibacterial dispensing in New Zealand, 2015   
There are significant ethnic disparities in the incidence of various infectious diseases in New Zealand. Antimicrobial stewardship interventions which ignore these disparities may have negative effects on the health of some ethnic groups. The authors of this study, published in the New Zealand Medical Journal, aimed to determine the relationship between ethnicity and community antimicrobial dispensing in New Zealand, to inform the development of antimicrobial stewardship interventions in New Zealand.

Primary Mental Health (International)

Interventions to Increase Depression Treatment Initiation in Primary Care Patients: a Systematic Review
Nearly 50% of depressed primary care patients referred to mental health services do not initiate mental health treatment. The most promising interventions for increasing depression treatment initiation in primary care settings remain unclear. The aim of this systematic review, published in the Journal of General Internal Medicine, was to identify interventions designed to increase depression treatment initiation and grade these for strength of evidence.

E-Health interventions for anxiety and depression in children and adolescents with long-term physical conditions
The objective of this systematic review, published in the Cochrane Database of Systematic Reviews, was to assess the effectiveness of e-health interventions in comparison with attention placebos, psychological placebos, treatment as usual, waiting-list controls, or non-psychological treatments for treating anxiety and depression in children and adolescents with long-term physical conditions.

Systems levers for commissioning primary mental healthcare: a rapid review
Primary Health Networks (PHNs) are a new institution for health systems management in the Australian healthcare system. PHNs will play a key role in mental health reform through planning and commissioning primary mental health services at a regional level, specifically adopting a stepped care approach. Selected PHNs are also trialling a healthcare homes approach. Little is known about the systems levers that could be applied by PHNs to achieve these aims. For this study, published in the Australian Journal of Primary Health, the authors conducted a rapid review of academic and grey literature published between 2006 and 2016, to describe the use of systems levers in commissioning primary care services.
 

Better Help for Smokers to Quit (New Zealand)

Reconceptualizing motivation for smoking cessation among people with rheumatoid arthritis as incentives and facilitators
Smokers with rheumatoid arthritis (RA) may have different motivations for, and barriers to, quitting. The focus of this study, published in Musculoskeletal Care, is to gain an understanding of the motivations of smokers and ex-smokers with RA, to help in the design and implementation of targeted smoking cessation interventions for people with RA that are not based solely on extrapolation from the general population or populations with other chronic illnesses.

Plain packaging: legislative differences in Australia, France, the UK, New Zealand and Norway, and options for strengthening regulations
By July 2018, five countries (Australia, France, the UK, New Zealand and Norway) had fully implemented plain (standardised) packaging. This study, published in Tobacco Control, used government documents to review the key legislative differences between these five countries to identify best practice measures and potential lacuna.

Increased Immunisation (International)

A review of the key factors to improve adult immunization coverage rates: What can the clinician do?
The interventions described in this article, published in Vaccine, have been reviewed by the United States Preventive Services Task Force. Recommended interventions fall into three categories: (1) Enhancing Patient Access to Vaccination; (2) Improving community/patient demand; and (3) Provider- and healthcare system-directed interventions.

Better Help for Smokers to Quit (New Zealand)

Estimating the effects of novel on-pack warnings on young adult smokers and susceptible non-smokers
On-pack tobacco warnings can deter smoking initiation and provide powerful cessation cues. However, these warnings typically feature graphic health images, which many young adults dismiss as irrelevant. For this research paper, published in Tobacco Control, the authors estimated responses to more diverse warnings and examined how these performed relative to each other.

Better Help for smokers to Quit (International)

Enhancing partner support to improve smoking cessation
While many cessation programmes are available to assist smokers in quitting, research suggests that support from individual partners, family members, or 'buddies' may encourage abstinence. The objective of this systematic review, published in the Cochrane Database of Systematic Reviews, was to determine if an intervention to enhance one‐to‐one partner support for smokers attempting to quit improves smoking cessation outcomes, compared with cessation interventions lacking a partner‐support component.

Childhood Obesity (International)

How to reduce parental provision of unhealthy foods to 3- to 8-year-old children in the home environment? A systematic review utilizing the Behaviour Change Wheel framework
The effectiveness of obesity prevention interventions to improve children's diet can be enhanced. Deconstructing past interventions can identify components with potential to change behaviour. Published in Obesity Reviews, this systematic review using the Behaviour Change Wheel aimed to examine the behaviour change content of interventions supporting parents of 3- to 8-year olds to reduce provision of unhealthy foods to children.

Antibiotic exposure in early life and childhood overweight and obesity: A systematic review and meta-analysis
Published in Diabetes, Obesity & Metabolism, this systematic review and meta-analysis of observational studies investigated the association between antibiotic exposure in infancy and risk of childhood overweight and obesity.

A description of health care system factors in the implementation of universal weight management services for children with overweight or obesity: case studies from Queensland and New South Wales, Australia
The purpose of this research, published in Implementation Science, was to compare and contrast the impact of system and organisational factors on the implementation of childhood obesity management services within two Australian States (New South Wales and Queensland) to comprehensively describe their influence on the achievement of the WHO recommendation.

Māori Innovation

"Outside the box but kinda in the box”: Evaluating with a rural Māori community
This Ministry of Health-funded, 3-year, Whānau Ora-focused and innovative model of care seeks to enhance the wellbeing of whānau who maintain Te Puke Marae’s ahi kā. Whakauae Research for Māori Health and Development is evaluating the project alongside the project partners. Using a kaupapa Māori approach to evaluation, this article, published in Evaluation Matters—He Take Tō Te Aromatawai, explores how Whakauae has contributed to project outcomes being achieved.

Key Ministry of Health Publications

Strategy to Prevent and Minimise Gambling Harm 2019/20 to 2021/22: Consultation document
The Ministry is seeking comments on its draft Strategy to Prevent and Minimise Gambling Harm. It includes proposed services and indicative costs of providing the strategy as well as proposed problem gambling levy rates necessary to recoup the costs of the strategy from the main gambling sector operators.

Second annual update on increasing transparency in New Zealand health care
This paper sets out the annual update required by the Ombudsman from the Ministry of Health (the Ministry) and the Health Quality & Safety Commission (the Commission) on the sector’s progress towards increasing transparency of health data in New Zealand by June 2021. Specifically this means selecting, developing and publicly reporting a range of quality of care measures (including outcomes data) across specialties.

The information available on or through this newsletter does not represent Ministry of Health policy. It is intended to provide general information to the health sector and the public, and is not intended to address specific circumstances of any particular individual or entity.