Associations of a Preoperative Anemia and Suboptimal Iron Stores Screening and Management Clinic in Colorectal Surgery With Hospital Cost, Reimbursement, and Length of Stay: A Net Cost Analysis.

BACKGROUND: In 2016, a preoperative clinic was implemented to screen, evaluate, and manage anemia and suboptimal iron stores at a major tertiary care medical center in Western Australia. Few studies compare the costs and reimbursements associated with preoperative anemia and suboptimal iron stores management. The objective of our study was to conduct a net cost analysis associated with the implementation of this clinic. METHODS: We designed a retrospective cohort study involving elective colorectal surgical admissions over a 3-year period. The baseline year selected was the 2015-2016 financial year, with outcomes in the 2016-2017 and 2017-2018 year compared to baseline. The study perspective was the Western Australian Health System. Hospital costs were extracted from the health service clinical costing system, which captures costs at the admission level. The primary outcome was net cost, defined as gross cost minus reimbursement (or funding) received. RESULTS: Our 3-year study included 544 admissions for elective colorectal surgery. After the implementation of the preoperative clinic, 73.4% (n = 257) of admissions were screened for anemia and suboptimal iron stores, and 31.4% (n = 110) received intravenous iron. In our adjusted analysis, when comparing the final year (2017-2018) with baseline (2015-2016), the units of red blood cells transfused per admission decreased 53% (142 vs 303 units per 1000 discharges; P = .006), and mean hospital length of stay decreased 15% (7.7 vs 9.1 days; P = .008). When comparing the final year with baseline, rectal resection admissions were associated with a mean decrease in the net cost of Australian dollar (A$) 7619 (95% confidence interval, 4230-11,008; P < .001) between 2015-2016 and 2017-2018. For small and large bowel procedures, there was a mean decrease of A$6744 (95% confidence interval, 2430-11,057; P = .002). CONCLUSIONS: The implementation of a preoperative anemia and suboptimal iron stores screening and management clinic in elective colorectal surgery was associated with reductions in red cell transfusions, length of stay, and net costs.

Use of Checklists in Reviews of Health Economic Evaluations, 2010 to 2018.

OBJECTIVE: It is useful for reviewers of economic evaluations to assess quality in a manner that is consistent and comprehensive. Checklists can allow this, but there are concerns about their reliability and how they are used in practice. We aimed to describe how checklists have been used in systematic reviews of health economic evaluations. METHODS: Meta-review with snowball sampling. We compiled a list of checklists for health economic evaluations and searched for the checklists' use in systematic reviews from January 2010 to February 2018. We extracted data regarding checklists used, stated checklist function, subject area, number of reviewers, and issues expressed about checklists. RESULTS: We found 346 systematic reviews since 2010 that used checklists to assess economic evaluations. The most common checklist in use was developed in 1996 by Drummond and Jefferson, and the most common stated use of a checklist was quality assessment. Checklists and their use varied within subject areas; 223 reviews had more than one reviewer who used the checklist. CONCLUSIONS: Use of checklists is inconsistent. Eighteen individual checklists have been used since 2010, many of which have been used in ways different from those originally intended, often without justification. Different systematic reviews in the same subject areas would benefit from using one checklist exclusively, using checklists as intended, and having 2 reviewers complete the checklist. This would increase the likelihood that results are transparent and comparable over time.

Economic Evaluations of Pathology Tests, 2010-2015: A Scoping Review.

BACKGROUND: Concerns about pathology testing such as the value provided by new tests and the potential for inappropriate utilization have led to a greater need to assess costs and benefits. Economic evaluations are a formal method of analyzing costs and benefits, yet for pathology tests, questions remain about the scope and quality of the economic evidence. OBJECTIVE: To describe the extent and quality of published evidence provided by economic evaluations of pathology tests from 2010 to 2015. METHODS: Economic evaluations relating to pathology tests from 2010 to 2015 were reviewed. Eight databases were searched for published studies, and details recorded for the country, clinical focus, type of testing, and consideration of sensitivity, specificity, and false test results. The reporting quality of studies was assessed using the Consolidated Health Economic Evaluation Reporting Standards checklist and cost-effectiveness ratios were analyzed for publication bias. RESULTS: We found 356 economic evaluations of pathology tests, most of which regarded developed countries. The most common economic evaluations were cost-utility analyses and the most common clinical focus was infectious diseases. More than half of the studies considered sensitivity and specificity, but few studies considered the impact of false test results. The average Consolidated Health Economic Evaluation Reporting Standards checklist score was 17 out of 24. Cost-utility ratios were commonly less than $10,000/quality-adjusted life-year or more than $200,000/quality-adjusted life-year. CONCLUSIONS: The number of economic evaluations of pathology tests has increased in recent years, but the rate of increase has plateaued. Furthermore, the quality of studies in the past 5 years was highly variable, and there is some question of publication bias in reporting cost-effectiveness ratios.

Who comes when the world goes Code Blue? A novel method of exploring job advertisements for COVID-19 in health care.

AIM: To explore the health workforce responses to COVID-19. DESIGN: Analysis of job advertisements. METHODS: We collected advertisements for healthcare jobs which were caused by and in response to COVID-19 between 4 March-17 April 2020 for the United States, Canada, United Kingdom, Australia and New Zealand. We collected information on the date of the advertisement, position advertised and location. We categorized job positions into three categories: frontline, coordination and decision support. RESULTS: We found 952 job advertisements, 72% of which were from the United States. There was a lag period between reported COVID-19-confirmed cases and job advertisements by several weeks. Nurses were the most advertised position in every country. Frontline workers were substantially more demanded than coordination or decision-support roles. Job advertisements are a novel data source which leverages a readily available information about how workforces respond to a pandemic. The initial phases of the response emphasise the importance of frontline workers, especially nurses.

The growth of Australian public health graduates and courses, 2001-2018: implications for education and employment opportunities.

OBJECTIVES: To describe the numbers of degree completions, variety of available courses and demographics of students who study public health in Australia. METHODS: We utilised national completions data from universities between 2001 and 2018 and analysed data for students who had completed degrees labelled as public health at the bachelor's and master's by coursework level. RESULTS: There have been 21,000 master's by coursework public health graduates since 2001, and 15,770 public health bachelor's degrees. Nearly two-thirds of all students study in a 'broad' degree, such as a Bachelor of Health Science or Master of Public Health. There has been an increase in the proportion of overseas students and a decreasing proportion of Indigenous students over this time. CONCLUSIONS: Given the growth of graduates with public health degrees, there should be an increased focus on relevant job opportunities, as supply may be outpacing demand. Implications for public health: We note three potential issues with public health education and practice in Australia. Firstly, there may be an oversupply of graduates relative to opportunities. Secondly, there may be inconsistencies in the delivery of public health courses. Thirdly, curricula may need to be revised, owing to differences in student composition.

No Two Workforces Are the Same: A Systematic Review of Enumerations and Definitions of Public Health Workforces.

The delivery and coordination of public health functions is essential to national and global health, however, there are considerable problems in defining the people who work in public health, as well as estimating their number. Therefore, the aim of this systematic review was to identify and explore research which has defined and enumerated public health workforces. In particular, how were such workforces defined? Who was included in these workforces? And how did researchers make judgments about the size of a workforce? In this systematic review, we identified 82 publications which enumerated a public health workforce between 2000 and November 2018. Most workforce definitions were unique and study-specific and included workers based on their occupation or their place of work. Common occupations included public health nurses and physicians, epidemiologists, and community health workers. National workforces varied by size, with the United States and Switzerland having the largest public health workforces per-capita, although definitions used varied substantially. Normative assessments (e.g., assessments of ideal workforce size) were informed through opinion, benchmarks or "service-target" models. There are very few regular, consistent enumerations within countries, and fewer still which capture a substantial proportion of the public heath workforce. Assessing the size of the public health workforce is often overlooked and would be aided by fit-for-purpose data, alignment of occupations and functions to international standards, and transparency in normative methods.

Public health job advertisements in Australia and New Zealand: a changing landscape.

OBJECTIVE: To describe available public health jobs in Australia and New Zealand by comparing recent job advertisements. METHODS: We screened vacancies from 14 online job boards for public health jobs in late 2018. Data collected included information on job titles, sector, contract tenure, location and salary. We compared our findings with those of a job advertisements study from 2005. RESULTS: We found 333 public health job advertisements in Australia and New Zealand. Common roles included project officers, researchers and managers. Nearly 40% of jobs asked for a 'tertiary' degree, with an additional 20% requiring a PhD degree. A qualification in public health was considered essential in 13% of job advertisements. Median annual salary range was $95,000-$111,365. CONCLUSIONS: There is not one specific public health job. Instead, such jobs are diverse in role, sector, qualification level required and the salary they confer. Implications for public health: There is a demand for skilled workers to perform increasingly complex public health functions, but this may eventually be outpaced by graduate supply. Furthermore, while salaries are considerable, long-term positions are not, and this has implications for the sustainability of the public health workforce.