Build successful team in small centre Link content & methods expertise

1. Strategy Build successful team in small centre • Link content & methods expertise • Build collaborations; local policy leaders (3 grants) & clinicians • Build on foundation in chronic disease (Passey; 3 Cat 1 grants, 23 chronic disease pubs 5 years) and environmental epi (Morgan; 1Cat 1 grant 28 pubs 5 years) • Use strong maternity care experience and reputation (Barclay; 4 Cat 1 grants current 15pubs in 2010) Establish a unique niche for our group • position us nationally, internationally as rural research leaders • Canadian links; 1 NHMRC grant applications (the ARBI) & CIHR

2. Brief summary current ‘developmental’ program • Background: ED admissions are rising • Some evidence shows reduction in admission for people with chronic disease by more effective use of primary health care • We have identified 646 rural patients 65+ with chronic disease and a history of frequent admission • Pilot project nearly complete that will advance understanding of: the characteristics of a rural population of frequent 'admitters' the factors that influence their hospitalisation assessing the avoidability of their admissions develop instruments that can be used in a substantive study • Project rationale: timely and effective care for certain conditions, delivered in a primary care setting, might reduce avoidable hospitalisation

3. Understanding Frequent Hospitalisation of Older People with chronic conditions Research questions: • What are the individual, social, environmental, economic and health service provision and utilisation characteristics of older patients frequently admitted to hospital in the NCAHS area? • What do patients, carers, and professionals identify as the factors which lead to avoidable hospitalisation? And which of these factors might be modifiable in the short to medium term? • Are there gaps in primary care services or nonclinical care which contribute to admissions? • Can we develop a robust assessment tool to assess the avoidability of individual admissions? Collaborators: NCAHS ,Northern Rivers General Practice Network. Methods; mixed methods. Funding: NSW Institute for Rural Clinical Services and Teaching and UCRH – NC . Publications; 1 paper submitted, several in preparation. Future Research/Future Opportunities: An APHCRI CRE application in June 2011.

4. What we are doing? (locally led) Scoping Study Study Group n=646 Analysis of routine hospitalisation data Frequent Admissions Survey Readmitted Avoidable Readmissions Survey Admission assessed as avoidable Data Linkage Study Avoidable Readmission Qualitative Study

5. Frequent and/or avoidable hospital admission amongst older people with ACS chronic disease in rural Australia Goal ‘to improve the quality of life of rural people with chronic conditions through improved management in the community and consequent reduction in avoidable hospital admissions.  Aims are to: Understand ‘avoidability’ better in this patient group and contribute to limited literature in this area Test commonly accepted assumptions that some admissions in this patient group are actually avoidable  Identify factors that reduce frequent hospitalisatiosn including exploring the role of the Ambulance Service Understand more about effects of rurality on these issues. In preparation: An APHCRI CRE application due in June 2011.

6. UCRH APHCRI CRE APPLICATION

7. Health Improvement and Prevention Study (HIPS) Aim • To evaluate the impact of a general practice intervention for patients at high risk of vascular disease on change in behavioural and physiological risk factors Design • Cluster RCT in 30 general practices in 5 divisions of general practice • Screening for risk factors through a health check by GP • Referral to lifestyle intervention (individual and group) • Follow-up at 6 and 12 months • Qualitative and quantitative data collection – individual and practices Collaborators: UNSW- lead, Broken Hill UDRH. Funding: NHMRC. publications: 3 papers published, 3 under review, 10 more planned eg Passey M, Barnett L, Heading G, Amoroso C. The Detection and Management of Pre-diabetes in Rural and Remote General Practice: A study of current practices, capacity and feasibility. Sydney: NSW Department of Health, 2007.

8. Methods expertise tied to health service redesign • Earnest A, Beard J, Morgan G, Lincoln D, Summerhayes R, Donoghue D, Dunn T, Muscatello D, Mengersen K. (2010) Small area estimation of sparse disease counts using shared component models-application to birth defect registry data in New South Wales, Australia. Health & Place. accepted March 2010 • Beard, J.R., Tomaska, N., Earnest, A., Summerhayes, R., & Morgan, G. (2009). Influence of socioeconomic and cultural influences on rural health. Australian Journal of Rural Health, 17(1), 10–15 • Beard, J.R., Earnest, A., Morgan, G., Chan, H., Summerhayes, R., Dunn, T.M., Tomaska, N.A., & Ryan, L. (2008). Socioeconomic disadvantage and acute coronary events: A spatiotemporal analysis. Epidemiology 19:485-492 • Summerhayes, R., Willmore, A., Houlder, P., Morgan, G., Christen, P., Churches, T., & Beard, J. (2006). Automated geocoding of routinely collected health data in New South Wales. NSW Public Health Bulletin, 17(3-4), 34-38. • Lesley Barclay 42 publications in last 5 years; around 50% tied to rural, remote or health services improvement in maternity care

9. Selected chronic disease publications • Passey M, Fanaian M, Lyle D, Harris MF. Assessment and management of lifestyle risk factors in rural and urban general practices in Australia. Australian Journal of Primary Health 2010;16:81-86. • Fanaian M, Laws RA, Passey M, McKenzie S, Wan Q, Powell Davies G, Lyle D, Harris MF. Health improvement and prevention study (HIPS) - evaluation of an intervention to prevent vascular disease in general practice. BMC Family Practice, 2010;11:57 • McKenzie SH, Jayasinghe UW, Fanaian M, Passey M, Lyle D, Powell Davies G, Harris MF. Socio-demographic factors, behaviour and personality: associations with psychological distress. European Journal of Cardiovascular Prevention and Rehabilitation. Published on line February 2011. doi: 10.1177/1741826711399426 • Cooper J, Moore S, Palmer L, Reinhardt J, Roberts M, Solomon A, Passey M. A partnership approach to Indigenous primary health care and diabetes: a case study from regional New South Wales. Australian Journal of Rural Health, 2007; 15:67-70. • Schofield D, Shrestha R, Passey M, Earnest A, Fletcher S.Chronic disease and labour force participation among older Australians. Medical Journal of Australia, 2008; 189(8):447-450. • Pit S, Shrestha R, Schofield D, Passey M. Health problems preventing healthy ageing: retirement due to ill-health among Australian retirees aged 45 to 64 years. Health Policy, 2010; 94:175-181.

10. Related work in the Centre Health Improvement and Prevention Study (HIPS) [NHMRC] Understanding Frequent Hospitalisation of Older People (UFHOP) [IRCST] Long term economic impacts of disease on older workers to 2030 [ARC] Stop Smoking in its Tracks [Commonwealth DoHA] Career Link School Based Aboriginal Traineeship; in Community Pharmacy [Education] Development of a chronic heart failure resource for ATSI People [Heart Foundation] Exploring the knowledge and attitudes of AMS staff & antenatal clients regarding smoking & alcohol consumption in pregnancy [NT Department of Health] Ageing well & productively: pathways to healthy workforce participation & care giving & impact of medicines & health care [ARC]