Effectiveness of the Koorliny Moort out-of-hospital health care program for Aboriginal and Torres Strait Islander children in Western Australia.

OBJECTIVES: To determine whether the Koorliny Moort program could reduce emergency department presentations, hospital admissions and length of stay, and improve attendance at out-of-hospital appointments for Aboriginal and Torres Strait Islander children in Western Australia. DESIGN: Children were enrolled in the program from 1 August 2012. Each child acted as their own control. Evaluation data were collected from 1 August 2010 to 31 July 2014. Occasions of service and person-time in days were compared for each child before and after referral to the program. SETTING AND PARTICIPANTS: Aboriginal children aged 0-16 years residing in three WA regions (Kimberley, Pilbara, Perth metropolitan) who were referred to the Koorliny Moort program. INTERVENTIONS: Partnerships with primary care providers; nurse-led care coordination; and outreach care by paediatricians, nurses and social workers closer to the home of the child. MAIN OUTCOME MEASURES: Emergency department presentations; hospital admissions; length of hospital stay; non-attended appointments. RESULTS: A total of 942 children were referred to the program. There were significant decreases after referral to the program in the incidence of emergency department presentations (incident rate ratio [IRR], 0.47; 95% CI, 0.43-0.53; P < 0.001), of hospitalisation (IRR, 0.70; 95% CI, 0.62-0.79; P < 0.001), and of non-attended appointments (IRR, 0.83; 95% CI, 0.74-0.94; P < 0.001), as well as in the mean length of hospital stay (IRR, 0.23; 95% CI, 0.21-0.25; P < 0.001). CONCLUSIONS: Health-seeking behaviour and health outcomes for Aboriginal children can be improved by engaging Aboriginal families in their health care, providing effective communication between health service providers, and delivering a coordinated program of Aboriginal service provider-led care.

Effect of socioeconomic disadvantage, remoteness and Indigenous status on hospital usage for Western Australian preterm infants under 12†months of age: a population-based data linkage study.

OBJECTIVES: Our primary objective was to determine the incidence of hospital admission and emergency department presentation in Indigenous and non-Indigenous preterm infants aged postdischarge from birth admission to 11 months in Western Australia. Secondary objectives were to assess incidence in the poorest infants from remote areas and to determine the primary causes of hospital usage in preterm infants. DESIGN: Prospective population-based linked data set. SETTING AND PARTICIPANTS: All preterm babies born in Western Australia during 2010 and 2011. MAIN OUTCOME MEASURES: All-cause hospitalisations and emergency department presentations. RESULTS: There were 6.9% (4211/61 254) preterm infants, 13.1% (433/3311) Indigenous preterm infants and 6.5% (3778/57 943) non-Indigenous preterm infants born in Western Australia. Indigenous preterm infants had a higher incidence of hospital admission (adjusted incident rate ratio (aIRR) 1.24, 95% CI 1.08 to 1.42) and emergency department presentation (aIRR 1.71, 95% CI 1.44 to 2.02) compared with non-Indigenous preterm infants. The most disadvantaged preterm infants (7.8/1000 person days) had a greater incidence of emergency presentation compared with the most advantaged infants (3.1/1000 person days) (aIRR 1.61, 95% CI 1.30 to 2.00). The most remote preterm infants (7.8/1000 person days) had a greater incidence of emergency presentation compared with the least remote preterm infants (3.0/1000 person days; aIRR 1.82, 95% CI 1.49 to 2.22). CONCLUSIONS: In Western Australia, preterm infants have high hospital usage in their first year of life. Infants living in disadvantaged areas, remote area infants and Indigenous infants are at increased risk. Our data highlight the need for improved postdischarge care for preterm infants.

Home oxygen therapy for infants and young children with acute bronchiolitis and other lower respiratory tract infections: the HiTHOx program.

BACKGROUND: Acute lower respiratory tract infection (LRTI) including bronchiolitis, is one of the leading causes of pediatric hospital admissions worldwide. Recent studies have demonstrated that some children with acute bronchiolitis can be successfully managed using home oxygen therapy. AIM: To report the impact of a Hospital in The Home Oxygen therapy program (HiTHOx) for selected infants and young children with acute bronchiolitis and other LRTI. FINDINGS: The HiTHOx program appears to be a safe model of care for carefully selected infants and young children with acute bronchiolitis and LRTI that reduces the hospital length of stay. CONCLUSIONS: The HiTHOx program provides an alternative model of care for infants and young children with acute LRTI. Implementation of models of care similar to that of the HiTHOx program in other pediatric health services may have the potential to create additional bed capacity, at the time of year when it is most needed.

Care coordination for children with complex care needs significantly reduces hospital utilization.

PURPOSE: The purpose was to evaluate an ambulatory care coordination program for children with complex care needs. DESIGN AND METHODS: A pre- and postcohort evaluation design was implemented to analyze the impact on hospital utilization. RESULTS: Results included a decrease in emergency department presentations (15%, p < .001), hospital admissions (9%, p < .019), and hospital bed days (43%, p < .001). Economic analysis indicated a cost savings of $A 1.9 million per annum. PRACTICE IMPLICATIONS: Hospital utilization is significantly reduced for children with complex care needs through 24/7 care coordination.

Development of a clinical practice guideline for testing nasogastric tube placement.

PURPOSE: A Perth metropolitan hospital group standardized changes to nasogastric tube placement, including removal of the "whoosh test" and litmus paper, and introduction of pH testing. DESIGN AND METHODS: Two audits were conducted: bedside data collection at a pediatric hospital and a point-prevalence audit across seven hospitals. RESULTS: Aspirate was obtained for 97% of all tests and pH was < or = 5.5 for 84%, validating the practice changes. However, patients on continuous feeds and/or receiving acid-inhibiting medications had multiple pH testing fails. PRACTICE IMPLICATIONS: Nasogastric tube placement continues to present a challenge for those high-risk patients on continuous feeds and/or receiving acid-inhibiting medications.