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CareTrack: assessing the appropriateness of health care delivery in Australia

Med J Aust 2012; 197 (2): 100-105. || doi: 10.5694/mja12.10510

Summary

Objective: To determine the percentage of health care encounters at which a sample of adult Australians received appropriate care (ie, care in line with evidence-based or consensus-based guidelines).

Design, setting and participants: Computer-assisted telephone interviews and retrospective review of the medical records (for 2009–2010) of a sample of at least 1000 Australian adults to measure compliance with 522 expert consensus indicators representing appropriate care for 22 common conditions. Participants were selected from households in areas of South Australia and New South Wales chosen to be representative of the socioeconomic profile of Australians. Health care encounters occurred in health care practices and hospitals with general practitioners, specialists, physiotherapists, chiropractors, psychologists and counsellors.

Main outcome measure: Percentage of health care encounters at which the sample received appropriate care.

Results: From 15 292 households contacted by telephone, 7649 individuals agreed to participate, 3567 consented, 2638 proved eligible, and 1154 were included after gaining the consent of their health care providers. The adult Australians in this sample received appropriate care at 57% (95% CI, 54%–60%) of 35 573 eligible health care encounters. Compliance with indicators of appropriate care at condition level ranged from 13% (95% CI, 1%–43%) for alcohol dependence to 90% (95% CI, 85%–93%) for coronary artery disease. For health care providers with more than 300 eligible encounters each, overall compliance ranged from 32% to 86%.

Conclusions: Although there were pockets of excellence and some aspects of care were well managed across health care providers, the consistent delivery of appropriate care needs improvement, and gaps in care should be addressed. There is a need for national agreement on clinical standards and better structuring of medical records to facilitate the delivery of more appropriate care.

  • William B Runciman1,2
  • Tamara D Hunt1
  • Natalie A Hannaford1,2
  • Peter D Hibbert3
  • Johanna I Westbrook3
  • Enrico W Coiera3
  • Richard O Day4
  • Diane M Hindmarsh3
  • Elizabeth A McGlynn5
  • Jeffrey Braithwaite3,2

  • 1 University of South Australia, Adelaide, SA.
  • 2 Australian Patient Safety Foundation, Adelaide, SA.
  • 3 Australian Institute of Health Innovation, University of New South Wales, Sydney, NSW.
  • 4 St Vincent’s Clinical School and School of Medical Sciences, University of New South Wales, Sydney, NSW.
  • 5 Kaiser Permanente, Pasadena, Calif, USA.

Correspondence: bill.runciman@apsf.net.au

Acknowledgements: 

We thank the participants, health care providers and expert reviewers who generously gave of their time. We also thank the surveyors: Laura Mudge, Heather Andrews, Sally Gregurke, Sally Whitaker, Paula Abrego, Kathy Mitchell and Toni McCallum Pardey; expert colleagues: Shanthi Ramanathan, Martin Basedow, Tim Schultz, Sharyn Lymer, Ling Li, Adam Dunn, Julie Halbert, Helena Williams, and Kaye Dolman; and the database tool designers and data collectors, Intersect and the Hunter Valley Research Foundation, for their contributions. This study was funded by a National Health and Medical Research Council program grant (no. 568612).

Competing interests:

No relevant disclosures.

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