Health care variation: time to act.

Geographic variation in health care use has been demonstrated in many countries over many years. Such variation can be warranted - in response to patient need or preference for care - or unwarranted. Unwarranted variation raises concerns about equity and appropriateness of care. Recent analyses of health care provision in the Australian atlas of healthcare variation show that when routinely available Australian data are mapped by residence of patient, there are wide variations in rates of use of diagnostic tests, dispensing of prescriptions for a range of indications, surgical procedures and hospital admission rates. Despite the wealth of studies demonstrating variation in care internationally, there is relatively little research that explores the best ways of responding to unwarranted variation. Recommendations for action in the Australian Atlas focus on some approaches that could be used in Australia.

Variation in coronary angiography rates in Australia: correlations with socio-demographic, health service and disease burden indices.

BACKGROUND: Variation in the provision of coronary angiography is associated with health care inefficiency and inequity. We explored geographic, socio-economic, health service and disease indicators associated with variation in angiography rates across Australia. METHODS: Australian census and National Health Survey data were used to determine socio-economic, health workforce and service indicators. Hospital separations and coronary deaths during 2011 were identified in the National Hospital Morbidity and Mortality databases. All 61 Medicare Locals responsible for primary care were included, and age- and sex-standardised rates of acute coronary syndrome (ACS) incidence, coronary angiography, revascularisation and mortality were tested for correlations, and adjusted by Bayesian regression. RESULTS: There were 3.7-fold and 2.3-fold differences between individual Medicare Locals in the lowest and highest ACS and coronary artery disease mortality rates respectively, whereas angiography rates varied 5.3-fold. ACS and death rates within Medicare Locals were correlated (partial correlation coefficient [CC], 0.52; P < 0.001). There was modest correlation between ACS and angiography rates (CC, 0.31; P = 0.018). The proportion of patients undergoing angiography who proceeded to revascularisation was inversely correlated with the total angiogram rate (CC, -0.71; P < 0.001). Socio-economic disadvantage and remoteness were correlated with disease burden, ACS incidence and mortality, but not with angiography rate. In the adjusted analysis, the strongest association with local angiography rates was with admissions to private hospitals (71 additional angiograms [95% CI, 47-93] for every 1000 admissions). CONCLUSION: Variation in rates of coronary angiography, not related to clinical need, occurs across Australia. A greater focus on clinical care standards and better distribution of health services will be required if these variations are to be attenuated.

Australian health policy makers' priorities for research synthesis: a survey.

OBJECTIVES: Health policy making is complex, but can be informed by evidence of what works, including systematic reviews. We aimed to inform the work of the Cochrane Effective Practice and Organisation of Care (EPOC) Group by identifying systematic review topics relevant to Australian health policy makers and exploring whether existing Cochrane reviews address these topics. METHODS: We interviewed 30 senior policy makers from State and Territory Government Departments of Health to identify topics considered important for systematic reviews within the scope of health services research, including professional, financial, organisational and regulatory interventions to improve professional practice and the organisation of services. We then looked for existing Cochrane reviews relevant to these topics. RESULTS: Eighty-five priority topics were identified by policy makers, including advanced practice roles, care for Indigenous Australians, care for chronic disease, coordinating across jurisdictions, admission avoidance, and eHealth. Sixty published Cochrane reviews address these issues, and 34 additional reviews are in progress. Thirty-four topics are yet to be addressed. CONCLUSIONS: This survey has identified questions for which Australian policy makers have indicated a need for systematic reviews. Further, it has confirmed that existing reviews do address issues of importance to policy makers, with the potential to inform policy processes.

Australian clinical practice guidelines--a national study.

OBJECTIVE: To identify the number of Australian clinical practice guidelines, and their key characteristics. DESIGN, SETTING AND PARTICIPANTS: Clinical practice guidelines that were produced or reviewed between 2003 and 2007 for use in Australia at a national or state level were identified by approaching health-related organisations and searching websites. Their characteristics were abstracted from the published guidelines and publicly accessible accompanying material. MAIN OUTCOME MEASURES: Number of clinical practice guidelines, key health areas, documentation of evidence search and appraisal processes, numbers and types of guideline producers and funders, presence of competing interest statements. RESULTS: 313 clinical practice guidelines were identified, of which 91 (29%) were evidence-documented, either in the guideline itself or in an accessible accompanying document. Over 80 guideline producers were identified. Federal or state government agencies produced or contributed funding to 53% of the guidelines (167/313); 28% of the guidelines supported by government agencies (46/167) were categorised as evidence-documented. A review date was specified in 52% of evidence-documented guidelines (47/91), but a third of these had passed the review date at the time of our study and no updated guidelines were found. Areas with a large burden of disease did not necessarily receive government support for guideline development. Most guidelines (246/313; 79%) made no mention of possible competing interests of members of the guideline development group. CONCLUSIONS: A more coordinated approach to identifying national priorities for developing and updating clinical practice guidelines may produce better returns on investment in Australian guidelines. In addition, more transparency in documenting the guideline development process, including details on competing interests, is needed.