CareTrack Australia
Project members - Macquarie University
Professor Jeffrey Braithwaite - Professor and Director
Professor Johanna Westbrook - Professor and Director
Professor Enrico Coiera - Professor and Director
Associate Professor Peter Hibbert - Program Director
Project main description
CareTrack Australia is part of a National Health & Medical Research Council (NHMRC) program grant that examined the appropriateness of the care provided in Australia, for 22 common conditions. Previous studies have demonstrated that patients receive evidence-based care for common conditions approximately half of the time [1], and that there is considerable variation in the care that is provided. In order to improve the situation, we need to understand who is getting what healthcare from whom, and how and why, from the perspectives of both participants and healthcare providers.
The Chief Investigators are Professor Bill Runciman and Professors Jeffrey Braithwaite, Johanna Westbrook, Enrico Coiera and Professor Ric Day.
Results summary
The CareTrack Australia study showed that adults in Australian received appropriate care in 57% of consultations. Results were published in the Medical Journal of Australia.
Runciman WB, Hunt TD, Hannaford NA, Hibbert PD, Westbrook JI, Coiera E, Day RO, Hindmarsh DM, McGlynn EA, Braithwaite J. CareTrack: Assessing the appropriateness of healthcare delivery in Australia. Medical Journal of Australia. 2012; 197(2):100-5.
Publications
Braithwaite J, Hibbert P, Jaffe A, White L, Cowell C, Harris M, Runciman W, Hallahan AR, Wheaton G, Williams H, Murphy E, Molloy C, Wiles L, 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. The quality of health care for children in Australia. Journal of the American Medical Association. 2018; 319(11):1113-24.
Braithwaite J. Less than two in three treatments for common childhood ills meet guidelines. The Lighthouse. 2018 April 9.
Ramanathan SA, Hibbert P, Maher C, Day RO, Hindmarsh DM, Hooper TD, Hannaford A, Runciman WB. CareTrack: toward appropriate care for low back pain. Spine. 2017; 42(13):E802-E9.
Hibbert PD, Hallahan AR, Muething S, E, Lachman P, Hooper TD, Wiles LK, Jaffe A, White L, Wheaton GR, Runciman WB, Dalton S, Williams HM, Braithwaite J. CareTrack Kids–Part 3 Adverse events in children’s healthcare in Australia: Study protocol for a retrospective medical record review. BMJ Open. 2015; Published Online First: 8 April 2015(5:e007750).
Hooper TD, Hibbert PD, Mealing N, Wiles L, Jaffe A, White L, Cowell CT, Harris MF, Runciman WB, Goldstein S, Hallahan AR, Wakefield JG, Murphy E, Lau A, Wheaton GR, Williams HM, Hughes C, Braithwaite J. CareTrack Kids–Part 2 Assessing the appropriateness of the healthcare delivered to Australian children: A study protocol for a retrospective medical record review. BMJ Open. 2015; Published Online First: 8 April 2015(5:e00774).
Wiles LK, Hooper TD, Hibbert PD, White L, Mealing N, Jaffe A, Cowell CT, Harris MF, Runciman WB, Goldstein S, Hallahan AR, Wakefield JG, Murphy E, Lau A, Wheaton GR, Williams HM, Hughes C, Braithwaite J. CareTrack Kids–Part 1 Assessing the appropriateness of healthcare delivered to Australian children: A study protocol for clinical indicator development. BMJ Open. 2015; Published Online First: 8 April 2015(5:e007748).
Runciman WB, Hunt TD, Hannaford NA, Hibbert PD, Westbrook JI, Coiera E, Day RO, Hindmarsh DM, McGlynn EA, Braithwaite J. CareTrack: Assessing the appropriateness of healthcare delivery in Australia. Medical Journal of Australia. 2012; 197(2):100-5.
Runciman WB, Coiera E, Day RO, Hannaford NA, Hibbert PD, Hunt TD, Westbrook JI, Braithwaite J. Towards the delivery of appropriate healthcare in Australia. Medical Journal of Australia. 2012; 197(2):78-81.
Hunt T, Ramanathan SA, Hannaford NA, Hibbert PD, Braithwaite J, Coiera E, Day RO, Westbrook JI, Runciman WB. CareTrack Australia: Assessing the appropriateness of adult healthcare: Protocol for a retrospective medical record review. BMJ Open. 2012; 2(1):e000665.
Project sponsors
NHMRC Program Grant ID: 1054146
Project background in detail
Aims
The aims of the study were:
- To determine the percentage of healthcare encounters at which Australians receive evidence based care for selected common conditions.
- To examine the drivers of healthcare practice from the perspectives of participants and healthcare providers.
- To demonstrate the feasibility of applying the CareTrack Australia methodology to 1000 participants.
Ethics
Ethical approvals have been received from the Hunter New England Human Research Ethic Committee (HREC), University of New South Wales HREC, SA Health HREC, ACT Health HREC, TAS Health HREC, Southern Adelaide Health Service/Flinders University HREC and the Royal Australian College of General Practitioners.
The Commonwealth Government has granted CareTrack statutory immunity under Part VC of the Health Insurance Act (1973), protecting the identities of providers and patients.
Design and method
Stage 1: Tool development:
(September 2010 – March 2011)
This involves the selection and ratification of clinical indicators for the care processes of 22 common conditions that are national health priority areas and account for the majority of the current burden of disease in Australia [2]. The indicators are based on previous work conducted in America [1] and have been updated with recent, relevant and preferably Australian guidelines, that have been ratified by panels of Australian clinical experts. Tools required for collecting data, training surveyors and conducting health care interviews have also been developed.
Stage 2: Participant recruitment and consent
(April 2011 – July 2011)
This involves recruiting a representative sample of the Australian population and obtaining a list of their healthcare conditions and providers. Participant information sheets will be forwarded to persons interested in participating and they are requested to provide consent to access their health and Medicare records.
Stage 3: Surveyor recruitment and ethics approvals
(September 2010 – July 2011)
This involves contacting the relevant healthcare facilities or practices, providing information about CareTrack, recruiting, training and accrediting CareTrack surveyors, and gaining State-wide and site-specific ethics approvals.
Stage 4: Medical record review
(July 2011 – December 2011)
A two-year retrospective medical record audit, for the period inclusive of 2009 – 2010 will be conducted. CareTrack surveyors will assess the medical records for concordance with the clinical indicators, for each of the conditions that the participant has identified.
Stage 5: Participant interviews
(January 2012 - March 2012)
Selected participants will be interviewed by a UNISA researcher. The semi-structured interviews will focus on selected modules of care relevant to that participant with discussion about their knowledge, attitudes and beliefs about their healthcare and its management, and about problems encountered.
Stage 6: Healthcare provider interviews
(January 2012 – March 2012)
Selected, consenting healthcare providers will be interviewed by a researcher (on the telephone) blinded to the identity of the healthcare provider. The semi-structured interview will focus on one condition and will probe why the relevant modules of care were handled as they were.
Stage 7: Data analysis, reports, publications and recommendations
(March 2012 – June 2012)
Results will be analysed and reports and manuscripts for publication will be prepared. De-identified results with recommendations for strategies to improve the appropriateness of care will be disseminated.
Conditions
The 22 conditions examined were:
- Alcohol Dependence
- Antibiotic use
- Atrial Fibrillation (AF)
- Asthma
- Cerebrovascular Accident (CVA)
- Chronic Heart Failure
- Chronic Obstructive Pulmonary Disease (COPD)
- Community Acquired Pneumonia
- Coronary Artery Disease
- Depression
- Diabetes
- Dyspepsia
- Hyperlipidemia
- Hypertension
- Low Back Pain (LBP)
- Obesity
- Osteoarthritis
- Osteoporosis
- Panic Disorder
- Preventive Care
- Surgical Site Infection
- Venous -Thrombo Embolus (VTE)
Definitions
Evidence based care is the practice of medicine in which the physician finds, assesses, and implements methods of diagnosis and treatment on the basis of the best available current research, their clinical expertise, and the needs and preferences of the patient [3]. The percentage of eligible healthcare encounters at which relevant care was received will be assessed by compliance or otherwise with indicators.
Participants - We have chosen to talk about “participants” rather than patients, clients, consumers or citizens.
Conditions - The term ‘conditions’ includes acute (eg. myocardial infarction) and chronic (eg. diabetes) conditions and clinical circumstances (eg. Surgical site infection). Indicators will be with respect to processes for prevention (eg. mammogram), monitoring (eg. blood pressure, lipids) or treatment (eg. aspirin, statins).
Healthcare providers (target) - The term “healthcare providers” embraces doctors, nurses, physiotherapists, occupational therapists and chiropractors.
Surveyor - A surveyor will be a person with appropriate clinical and audit experience who has been trained and accredited as a CareTrack Surveyor.
Recruitment - The study will recruit around 1,000 participants. Sample size calculations have shown that a minimum n= 57 per indicator (CI 10%, power 90%) will be required. This will be done by the Hunter Valley Research Foundation (HVRF) using their Computer-Aided Telephone Interviewing system. HVRF has a research team with extensive experience in this type of work.
Data scoring and analysis will follow a previously published method of McGlynn et al [1]. Participants will be eligible for each of the conditions based on a combination of variables. Not all indicators will be ‘eligible’ on a particular healthcare encounter. For each of the indicators, the participant will either have received or not received the care. Each indicator will be scored at three levels – that of an individual participant, that of the episode, and that of the patient-healthcare provider dyad. The level at which an indicator will be scored affects the number of times a participant will be eligible for the specified process, the resulting number will be the denominator in the calculation of the aggregate score. Summary level results will be reported on the proportion of care that was in concordance with the indicators for each eligible module of care.
References
1. McGlynn EA, Asch SM, Adams J, Keesey J, Hicks J, DeCristofaro A, Kerr EA: The quality of health care delivered to adults in the United States. N Engl J Med 2003, 348(26):2635-2645.
2. National Health Priority Action Council: National Chronic Disease Strategy. Australian Government Department of Health and Ageing 2006, Canberra.
3. Mosby's Medical Dictionary, 8th edition. © 2009, Elsevier. http://medical-dictionary.thefreedictionary.com/Evidence-based+health+care. Accessed online February 2011.
Collaborative partners
The Hunter Valley Research Foundation (HVRF) - a non-profit organisation, specialising in regional social, health and economic research.
Related projects
Contact
Program Director: Peter Hibbert
Email: peter.hibbert@mq.edu.au
Phone: 0414 253 461
Project status
Completed
Centres related to this project
Content owner: Australian Institute of Health Innovation Last updated: 11 Mar 2024 4:12pm