The impact of first- and second-eye cataract surgery on motor vehicle crashes and associated costs.

Objective: to evaluate the association between first- and second-eye cataract surgery and motor vehicle crashes for older drivers and the associated costs to the community. Design: retrospective population-based cohort study. Subjects: a total of 2,849 drivers aged 60 years and older who had undergone both first- and second-eye cataract surgery were involved in 3,113 motor vehicle crashes as drivers during the study period. Methods: de-identified data were obtained using the Western Australian Data Linkage System from 1 January 2003 to 31 December 2015. Poisson regression analysis based on Generalised Estimating Equations was undertaken to compare the frequency of crashes in the year before first eye cataract surgery, between first and second eye surgery and 1 year after second eye surgery. Results: first eye cataract surgery was associated with a significant 61% reduction in crash frequency (P < 0.001) and second eye surgery was associated with a significant 23% reduction in crashes (P < 0.001), compared to the year before first eye cataract surgery after accounting for age, gender, marital status, accessibility, socio-economic status, driving exposure and comorbidities. The estimated cost savings from the reduction in crashes in the year after second eye cataract surgery compared to the year before first eye cataract surgery was $14.9 million. Conclusions: first- and second-eye cataract surgery were associated with a significant reduction in motor vehicle crashes, with first eye surgery having the greatest impact. These results provide encouragement for the timely provision of first- and second-eye cataract surgery for older drivers.

The collective impact of rare diseases in Western Australia: an estimate using a population-based cohort.

PURPOSE: It has been argued that rare diseases should be recognized as a public health priority. However, there is a shortage of epidemiological data describing the true burden of rare diseases. This study investigated hospital service use to provide a better understanding of the collective health and economic impacts of rare diseases. METHODS: Novel methodology was developed using a carefully constructed set of diagnostic codes, a selection of rare disease cohorts from hospital administrative data, and advanced data-linkage technologies. Outcomes included health-service use and hospital admission costs. RESULTS: In 2010, cohort members who were alive represented approximately 2.0% of the Western Australian population. The cohort accounted for 4.6% of people discharged from hospital and 9.9% of hospital discharges, and it had a greater average length of stay than the general population. The total cost of hospital discharges for the cohort represented 10.5% of 2010 state inpatient hospital costs. CONCLUSIONS: This population-based cohort study provides strong new evidence of a marked disparity between the proportion of the population with rare diseases and their combined health-system costs. The methodology will inform future rare-disease studies, and the evidence will guide government strategies for managing the service needs of people living with rare diseases.Genet Med advance online publication 22 September 2016.

Socio-demographic disparities in the uptake of prenatal screening and diagnosis in Western Australia.

INTRODUCTION: Since the early 1980s, prenatal screening using ultrasound and biochemical markers has been used to refine the risk of Down syndrome and other fetal anomalies prior to considering fetal karyotyping. The performance of prenatal screening is subject to ongoing monitoring in Western Australia. The collection of these data can also assist in the identification of any potential inequities of access to prenatal screening within the state-wide programme. METHODS: Prenatal screening data (2005-2006) were collected from accredited ultrasound and pathology laboratories in Western Australia. Screening data were linked to diagnostic and pregnancy outcome data. Performance characteristics of screening and uptake by socio-demographic characteristics were analysed. RESULTS: Complete screening data were collected for 35,142 of the estimated 38,081 women screened during 2005 and 2006. There were 59,999 births related to this screening period. The lowest uptake of screening was among women who were Aboriginal (14.9%), living in remote areas (38.0%), under the age of 25 (40.2%), in the lowest quintile of the SEIFA index (41.6%) and with three or more children (48.4%). Logistic regression analysis showed all socio-demographic factors to be strongly associated with screening behaviour, with adjustment for ethnicity, socio-economic status, age, parity and area of residence. DISCUSSION: Our results have important implications for the delivery of prenatal screening services in Western Australia. While the screening programme meets international and national performance standards, the disparities in screening uptake suggest inequity in access to services, particularly for Aboriginal, remote and socio-economically disadvantaged women.

Informing policy for the Australian context - Costs, outcomes and cost savings of prenatal carrier screening for cystic fibrosis.

AIMS: To examine the costs, outcomes and cost savings of three models of prenatal cystic fibrosis (CF) carrier screening compared to no screening from a public health sector perspective. METHODS: A decision tree was generated to estimate costs and outcomes for each screening model for a hypothetical cohort of 38 000 pregnancies. Sensitivity analysis assessed the impact of model parameter variation. RESULTS: Under baseline assumptions, the initial annual cost to provide a prenatal CF carrier-screening programme is Au$5.32 million, Au$3.35 million and $2.93 million for one-step, two-step simultaneous and two-step sequential screening respectively. Annual costs are significantly lower for an established programme. No screening model provides a net saving over a lifetime horizon; however, the results were sensitive to variation in lifetime cost of care, screening test costs and number of pregnancies per carrier couple. CONCLUSIONS: Under some scenarios, prenatal CF carrier screening is cost saving to the health system; however, this is not conclusive and depends on several factors. Cost remains a potential barrier due to the substantial level of funding required in the short term. Feasibility and psychosocial, ethical and legal implications of screening need to be considered. Additionally, consultation is required with the Australian community on the acceptability and/or desire for prenatal CF carrier screening.

Possession of health insurance in Australia--how does it affect hospital use and outcomes?

OBJECTIVE: To assess the effect of possession of private health insurance on hospital use and outcomes in Western Australia. METHOD: Hospital morbidity records were extracted from the Western Australian (WA) Data Linkage System for all 22 major diagnostic categories (MDCs) for the period 1994-99, with follow-up to the end of 2000. Multivariate modelling techniques were used to estimate the effect of possession of private health insurance on hospital admission rates, average and total length of stay (LOS), cumulative incidence of admission at 30 days and one year, and case fatality at one year. RESULTS: Possession of private health insurance had significant effects on hospital use and outcomes, even after adjustments for age, sex, aboriginality, socioeconomic status, location and comorbidity. Non-insured patients tended to have a higher overall hospital admission rate but a lower admission rate for surgical episodes, and they generally had a longer LOS although this difference was only greater than a day in three MDCs. Case fatality was higher in non-insured patients, but there was no systematic trend with regard to readmission rates. CONCLUSIONS: The study found that for all MDCs, other than those where treatment was required on an emergency basis, patients with private health insurance had improved access to surgical procedures. Either non-insured patients were disadvantaged in their access to surgery or the higher intervention rate in privately insured patients represented supplier-/consumer-induced demand which may not always have been to the patient's advantage or both may have occurred.

High-cost users of hospital beds in Western Australia: a population-based record linkage study.

OBJECTIVE: To describe how high-cost users of inpatient care in Western Australia differ from other users in age, health problems and resource use. DESIGN AND DATA SOURCES: Secondary analysis of hospital data and linked mortality data from the WA Data Linkage System for 2002, with cost data from the National Hospital Cost Data Collection (2001-02 financial year). OUTCOME MEASURES: Comparison of high-cost users and other users of inpatient care in terms of age, health profile (major diagnostic category) and resource use (annualised costs, separations and bed days). RESULTS: Older high-cost users (> or = 65 years) were not more expensive to treat than younger high-cost users (at the patient level), but were costlier as a group overall because of their disproportionate representation (n = 8466; 55.9%). Chronic stable and unstable conditions were a key feature of high-cost users, and included end stage renal disease, angina, depression and secondary malignant neoplasms. High-cost users accounted for 38% of both inpatient costs and inpatient days, and 26% of inpatient separations. CONCLUSION: Ageing of the population is associated with an increase in the proportion of high-cost users of inpatient care. High costs appear to be needs-driven. Constraining high-cost inpatient use requires more focus on preventing the onset and progression of chronic disease, and reducing surgical complications and injuries in vulnerable groups.

Health care financing and public responses: use of private insurance in Western Australia during 1980-2001.

OBJECTIVES: The aim was to identify and explain trends and cut points in payment classification (privately insured or otherwise) for episodes of hospitalisation in Western Australia. METHODS: Hospital morbidity data from 1980 to 2001 were used to produce trend lines of the proportion of hospital separations in each payment category in each year in age and clinical subgroups. RESULTS: The most significant changes in payment classification over time were found in all groups between 1980 and 1984, corresponding to a period when free public hospital care in Australia was abolished (Sep 1981 to Feb 1984). The trend associated with this policy change rebounded significantly just before the introduction of Medicare in 1984. These observations were consistent over all age groups except in the oldest group (70+ years). This trend was more pronounced for the surgical subgroup compared with other broad clinical categories. More recently, a trend towards increasing public episodes was reversed from 2000 following introduction of incentives for private health cover and sanctions against deferred uptake in younger people. CONCLUSION: The public appeared to adopt a short-term crisis reaction to major policy change but then reversed towards past patterns of behaviour. The implications for policy makers include the need to understand the underlying culture of the population; to realise that attitudes become fixed as people age; and to recognise the difference in the effectiveness of incentive- and deterrent-based policies.

The use of end-quintile comparisons to identify under-servicing of the poor and over-servicing of the rich: a longitudinal study describing the effect of socioeconomic status on healthcare.

BACKGROUND: To demonstrate the use of end-quintile comparisons in assessing the effect of socio-economic status on hospital utilisation and outcomes in Western Australia. METHODS: Hospital morbidity records were extracted from the WA Data Linkage System for the period 1994-99, with follow-up to the end of 2000. Multivariate modelling was used to estimate the effect of socio-economic status on hospital admission rates, average and total length of stay (LOS), cumulative incidence of readmission at 30 days and one year, and case fatality at one year. RESULTS: The study demonstrated higher rate ratios of hospital admission in the more disadvantaged quintiles: rate ratios were 1.31 (95% CI 1.25-1.37) and 1.32 (1.26-1.38) in the first quintile (most disadvantaged) and the second quintile respectively, compared with the fifth quintile (most advantaged). There was a longer total LOS in the most disadvantaged quintile compared with quintile 5 (LOS ratio 1.24; 1.23-1.26). The risk of readmission at 30 days and one year and the risk of death at one year were also greater in those with greater disadvantage: the hazard ratios for quintiles 1:quintile 5 were 1.07 (1.05-1.09), 1.17 (1.16-1.18) and 1.10 (1.07-1.13) respectively. In contradiction to the trends towards higher hospital utilisation and poorer outcomes with increasing social disadvantage, in some MDC's the rate ratio of quintile 1:quintile 2 was less than 1, and quintile 4:quintile 5 was greater than 1. For all surgical admissions the most disadvantaged had a significantly lower admission rate than the second quintile. CONCLUSION: This study has shown that the disadvantaged within Western Australia are more intensive users of hospital services but their outcomes following hospitalisation are worse, consistent with their health status. Instances of overuse in the least disadvantaged and under use in the most disadvantaged have also been identified.

Health outcomes in people with type 2 diabetes. A record linkage study.

INTRODUCTION: This study pilots a method of measuring health outcomes in a general practice population of patients with type 2 diabetes. METHOD: The Diabetic Register of the Perth and Osborne Divisions of General Practice was linked to the Western Australian Health Services Research Linked Database. RESULTS: Of the 487 patients in the study, 332 (68%) had been admitted before their diagnosis of diabetes (40% with a diabetes related condition), and 56% were admitted postdiagnosis (55% with a diabetes related condition). The admission rate increased with age and duration of diabetes. DISCUSSION: The data show that a large proportion of diabetic patients suffer from serious comorbidity both pre- and post-diagnosis and demonstrate that their hospital admission rate is higher than that in the general population. CONCLUSION: The project demonstrates that linked hospital morbidity data can be used to monitor health outcomes in a general practice population of diabetic patients.