Anthony, MY, Goodall, SR, Papouli, M & Levene, MI 1992, 'Measurement of plasma volume in neonates.', Archives of Disease in Childhood, vol. 67, no. 1 Spec No, pp. 36-40.
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There is no reliable and safe method for measuring plasma volume in ill newborn infants. We describe an adaptation of the dye dilution technique using indocyanine green as the plasma label, which can be used in the sickest and smallest of infants with the minimum of disturbance. To avoid the need to take large volumes of blood from the infant, samples were diluted 1:1 with distilled water and pooled adult sera was used to construct the dye dilution standard curves. Eighteen preterm and fullterm infants were studied on 30 occasions. The measured plasma volume ranged between 21.4 and 106 ml/kg. Paired measurements were performed within 30-90 minutes of each other in seven infants. In five infants estimations of plasma volume were made shortly before and 30 minutes after the infusion of a known quantity of plasma. In eight out of 12 infants who had two measurements made there was close agreement between the second measured volume and the first measured volume, taking into account how much plasma had been given to or taken from the infant between the two measurements. The error ranged from 0.2 to 5.2 ml and the plasma recovery error ranged from -2.9% to +4.7%. In the remaining four infants the errors ranged from 2.1 to 9.5 ml and -14.2% to +8.8%. Errors in the measurement of plasma volume may arise as the result of sampling too early before full mixing of the dye has occurred, and there is a potential error in the measurement due to the distribution of albumin in the extracellular space in sick infants resulting in an overestimation of the plasma volume. Proposals for reducing sources of errors are discussed.
HALL, J & HAAS, M 1992, 'THE RATIONING OF HEALTH-CARE - SHOULD OREGON BE TRANSPORTED TO AUSTRALIA', AUSTRALIAN JOURNAL OF PUBLIC HEALTH, vol. 16, no. 4, pp. 435-440.
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The Oregon Plan is an ambitious attempt to address the widespread problem in the United States of a growing number of individuals who are without private health insurance and are not eligible for federal assistance programs. Its aim is to provide univers
HALL, J, GERARD, K, SALKELD, G & RICHARDSON, J 1992, 'A COST UTILITY ANALYSIS OF MAMMOGRAPHY SCREENING IN AUSTRALIA', SOCIAL SCIENCE & MEDICINE, vol. 34, no. 9, pp. 993-1004.
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Cost utility analysis is the preferred method of analysis when quality of life instead is an important outcome of the project being appraised. However, there are several methodological issues to be resolved in implementing cost utility analysis, including whether to use generalised measures or direct disease specific outcome assessment, the choice of measurement technique, and the combination of different health states. Screening for breast cancer meets this criterion as mammographic screening has been shown to reduce mortality; and it is said that earlier treatment frequently results in less radical surgery so that women are offered the additional benefit of improved quality of life. Australia, like many other countries, has been debating whether to introduce a national mammographic screening programme. This paper presents the results of a cost utility analysis of breast cancer screening using an approach to measuring outcome, Healthy Year Equivalents, developed within this study to resolve these problems. Descriptions of breast cancer quality of life were developed from surveys of women with breast cancer, health professionals and the published literature. The time trade off technique was then used to derive values for breast cancer treatment outcomes in a survey of women in Sydney, Australia. Respondents included women with breast cancer and women who had not had breast cancer. Testing of (i) the effect of prognosis on the value attached to a health scenario; and (ii) whether the value attached to a health scenario remains constant over time has been reported. The estimate of the net costs of screening are reported. The costs of breast cancer screening include the screening programme itself, the further investigations and the subsequent treatment of breast cancer cases. Breast cancer is treated in the absence of screening, many commentators claim earlier treatment is costly but there is little evidence. Therefore we have investigated current patterns...
MOONEY, G, HALL, J, DONALDSON, C & GERARD, K 1992, 'REWEIGHING HEAT - RESPONSE', JOURNAL OF HEALTH ECONOMICS, vol. 11, no. 2, pp. 199-205.
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Cameron, S, Kenny, P, Scott, T & King, M CHERE 1992, Evaluation of obstetric early discharge - reasons for non-participation, CHERE Discussion Paper No 11, Sydney.
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An Early Discharge Program (EDP) for medically uncomplicated obstetrics patients operates from three hospitals in Sydney's western suburbs, Westmead Hospital, a large teaching hospital, and Auburn and Blacktown, which are smaller district hospitals. The patients are discharged home between 6 and 48 hours after delivery and visited in the home by midwives for up to 7 days after birth. This program is funded under the Medicare Incentive Package, one of the objectives of which is to facilitate the development of less costly alternatives to acute hospital care. An economic analysis and evaluation of the EDP was carried out at the same time as this study, to examine the net economic value of resources released due to the EDP. As a considerable proportion of obstetric patients who are eligible for this program decline to take it up, this study investigated the reasons these women had for choosing to remain longer in hospital, rather than going home early with domiciliary midwifery support. On the day before discharge, the patients were asked to complete a self administered questionnaire, giving their reasons for refusing the EDP, an assessment of the costs incurred by their stay in hospital to themselves and their visitors, and their satisfaction with the post natal care received. This study showed an apparent lack of awareness and information about the EDP among the patients, particularly those with non-English speaking backgrounds. It also showed that a substantial proportion of the women had no help at all with housework and child care and would have used EDP if more home help was available. One outstanding characteristic which distinguished EDP participants and non-participants was parity. A higher proportion of women who chose not to take early discharge were first time mothers. This reflected their lack of confidence, experience and information about baby care and possibly their low expectations of postnatal health. In order to increase participation rates in EDP...
Cleland, S, Cameron, S, Kenny, P, King, M, Scott, A & Shiell, A CHERE 1992, Evaluation of obstetric early discharge - overview, CHERE Discussion Paper No 9, Sydney.
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This paper gives an overview of evaluations of obstetric early discharge schemes at three hospitals in Western Sydney Area Health Service. Satisfaction of early discharge and hospital clients with their postnatal care, the reasons given by eligible women who chose not to participate in the schemes, and cost-effectiveness analyses are presented. It was found that women choosing early discharge were more likely to be satisfied with their postnatal care than were women choosing institutional care. This result is dependent on sufficient support for the women in the home, absence of medical complications, and autonomy over the selection of the type of postnatal care received. Participation in the schemes could be increased through better communication of information and increased provision of help in the home. Both Blacktown and Westmead Early Discharge Schemes currently cost the health care system more than the value of the hospital resources which they release. The value of hospital resources released by the Auburn scheme exceeds its costs, but the difference is slight. All results are sensitive to assumptions made in the analyses. Improvements in cost-effectiveness are possible, but would not necessarily lead to reductions in hospital expenditure, as that would depend on the uses made of released resources. From the perspective of the wider community, all three schemes cost more than the value of resources which are released. At issue, therefore, is whether the increase in client choice which the early discharge schemes bring about is judged worth the additional cost.
Farnworth, M & Kenny, PM CHERE 1992, An economic evaluation of a fractured hip management program., CHERE Discussion Paper No 8, Sydney.
Haas, M & Hall, J CHERE 1992, The Oregon experience in the provision of universal health care, CHERE Discussion Paper No 4, Sydney.
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The Oregon Experiment is an attempt to provide universal access to health care while achieving budgetary caps on expenditure. The appeal of the experiment lies in its explicit approach to rationing health care within a framework of cost effectiveness analysis and its involvement of the community in priority setting. The purpose of this paper is to review the history, process and progress of the Oregon Plan in the context of resource allocation in health care generally and the specific problems of US health care. The relevance of the Oregon approach to Australia is considered. The problems of resource allocation in health care are not new, nor are they confined to Oregon. Section 1 of the paper discusses the general problems as these must be understood before considering the Oregon 'solution'. The particular problem in Oregon, as in the rest of the US, is the rising number of people not covered by health insurance and not eligible for government benefits. The essence of the Oregon approach is to provide universal access to health care but to limit the particular conditions and treatments which could be provided. Section 2 covers the history and development of this approach. The problems and criticisms of the Oregon approach are discussed in section 4. The implementation of the Plan does not live up to the rhetoric; in reality the implementation has been limited by the lack of data on both costs and benefits of health care interventions and the restricted extent of community consultation and involvement. Could or should the Oregon Experiment be tried in Australia? It is important to realise that the Oregon Plan provided access to health care to a significant group, but nonetheless a minority of Oregon citizens; the use of health care services by the majority of the Oregon population is not rationed by the Plan. The Oregon approach, therefore, is a response to the particular problems of Oregon, not Australia. The lesson that Australia could learn from Oreg...
Kenny, P, Cameron, S, King, M, Scott, A & Shiell, A CHERE 1992, Evaluation of obstetric early discharge - client satisfaction, CHERE Discussion Paper No 10, Sydney.
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A study of client satisfaction with postnatal care was conducted to ascertain the extent to which a program for the early discharge of obstetric patients meets its clients' needs. Women who were eligible for early discharge were surveyed at the end of their period of postnatal care. Satisfaction with care was compared for women choosing hospital and home postnatal care. While most of the women in both groups were satisfied with their postnatal care, those who chose early discharge with home postnatal care were more likely to give extremely positive responses to questions in all dimensions of postnatal care. The difference in satisfaction with the quality of postnatal care between the two groups of women was most apparent for the process of care and less so for the outcome of care. The study results indicate that the early discharge program provides a valuable option for the care of women in the postnatal period.
Scott, A, Cameron, S, Kenny, P, King, M & Shiell, A CHERE 1992, Evaluation of obstetric early discharge - economic evaluation, CHERE Discussion Paper No 12, Sydney.
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Obstetric early discharge provides an alternative to conventional, hospital based, postnatal care. Clients are discharged around two days earlier than usual and followed up at home by a midwife for up to seven days after delivery. Although previous evidence has shown that health status is at least equivalent in both alternatives, clients have an increased choice of their location of postnatal care. The primary objective of the economic evaluation is to estimate the net economic value of resources released due to the early discharge scheme in operation at three hospitals in Western Sydney. At current levels of activity the early discharge schemes at Blacktown and Westmead Hospitals use more hospital resources than they release. The Auburn early discharge scheme is the only one which releases resources in excess of the cost of domiciliary midwifery care, but this result is extremely sensitive to changes in key assumptions used in the analysis. Strategies which may improve the cost-effectiveness of each early discharge scheme are examined. The results also show that the burden of care has shifted to the community for all three schemes. When client and community related resource use is included in the results all three schemes consume more resources than they release. The ability of all three schemes to release resources may be eroded if lengths of conventional postnatal stay continue to fall in the future. This may also affect health outcomes if women are sent home early without midwifery support. Further research should be carried out on the effects on maternal and infant health status, not only of the declining trend in length of stay, but also of the number of postnatal visits received by each early discharge client. The study results indicate that even if early discharge schemes release resources greater than the cost of domiciliary midwifery care, it does not guarantee reductions in hospital expenditure. This depends on the alternative use to which th...
