Evaluation of financial incentives as a quality improvement strategy in the public hospital context : clinician attitudes, design variables, and economic costs

In 2008, a three-year pilot ‘pay for performance’ (P4P) program, known as ‘Clinical Practice Improvement Payment’ (CPIP) was introduced into Queensland Health (QHealth). QHealth is a large public health sector provider of acute, community, and public health services in Queensland, Australia. The organisation has recently embarked on a significant reform agenda including a review of existing funding arrangements (Duckett et al., 2008). Partly in response to this reform agenda, a casemix funding model has been implemented to reconnect health care funding with outcomes. CPIP was conceptualised as a performance-based scheme that rewarded quality with financial incentives. This is the first time such a scheme has been implemented into the public health sector in Australia with a focus on rewarding quality, and it is unique in that it has a large state-wide focus and includes 15 Districts. CPIP initially targeted five acute and community clinical areas including Mental Health, Discharge Medication, Emergency Department, Chronic Obstructive Pulmonary Disease, and Stroke. The CPIP scheme was designed around key concepts including the identification of clinical indicators that met the set criteria of: high disease burden, a well defined single diagnostic group or intervention, significant variations in clinical outcomes and/or practices, a good evidence, and clinician control and support (Ward, Daniels, Walker & Duckett, 2007). This evaluative research targeted Phase One of implementation of the CPIP scheme from January 2008 to March 2009. A formative evaluation utilising a mixed methodology and complementarity analysis was undertaken. The research involved three research questions and aimed to determine the knowledge, understanding, and attitudes of clinicians; identify improvements to the design, administration, and monitoring of CPIP; and determine the financial and economic costs of the scheme. Three key studies were undertaken to ascertain responses to the key research questions. Firstly, a survey of clinicians was undertaken to examine levels of knowledge and understanding and their attitudes to the scheme. Secondly, the study sought to apply Statistical Process Control (SPC) to the process indicators to assess if this enhanced the scheme and a third study examined a simple economic cost analysis. The CPIP Survey of clinicians elicited 192 clinician respondents. Over 70% of these respondents were supportive of the continuation of the CPIP scheme. This finding was also supported by the results of a quantitative altitude survey that identified positive attitudes in 6 of the 7 domains-including impact, awareness and understanding and clinical relevance, all being scored positive across the combined respondent group. SPC as a trending tool may play an important role in the early identification of indicator weakness for the CPIP scheme. This evaluative research study supports a previously identified need in the literature for a phased introduction of Pay for Performance (P4P) type programs. It further highlights the value of undertaking a formal risk assessment of clinician, management, and systemic levels of literacy and competency with measurement and monitoring of quality prior to a phased implementation. This phasing can then be guided by a P4P Design Variable Matrix which provides a selection of program design options such as indicator target and payment mechanisms. It became evident that a clear process is required to standardise how clinical indicators evolve over time and direct movement towards more rigorous ‘pay for performance’ targets and the development of an optimal funding model. Use of this matrix will enable the scheme to mature and build the literacy and competency of clinicians and the organisation as implementation progresses. Furthermore, the research identified that CPIP created a spotlight on clinical indicators and incentive payments of over five million from a potential ten million was secured across the five clinical areas in the first 15 months of the scheme. This indicates that quality was rewarded in the new QHealth funding model, and despite issues being identified with the payment mechanism, funding was distributed. The economic model used identified a relative low cost of reporting (under $8,000) as opposed to funds secured of over $300,000 for mental health as an example. Movement to a full cost effectiveness study of CPIP is supported. Overall the introduction of the CPIP scheme into QHealth has been a positive and effective strategy for engaging clinicians in quality and has been the catalyst for the identification and monitoring of valuable clinical process indicators. This research has highlighted that clinicians are supportive of the scheme in general; however, there are some significant risks that include the functioning of the CPIP payment mechanism. Given clinician support for the use of a pay–for-performance methodology in QHealth, the CPIP scheme has the potential to be a powerful addition to a multi-faceted suite of quality improvement initiatives within QHealth.

Design and development of automatic visual inspection system for PCB manufacturing

Inspection of solder joints has been a critical process in the electronic manufacturing industry to reduce manufacturing cost, improve yield, and ensure product quality and reliability. This paper proposes two inspection modules for an automatic solder joint classification system. The “front-end” inspection system includes illumination normalisation, localisation and segmentation. The “back-end” inspection involves the classification of solder joints using the Log Gabor filter and classifier fusion. Five different levels of solder quality with respect to the amount of solder paste have been defined. The Log Gabor filter has been demonstrated to achieve high recognition rates and is resistant to misalignment. This proposed system does not need any special illumination system, and the images are acquired by an ordinary digital camera. This system could contribute to the development of automated non-contact, non-destructive and low cost solder joint quality inspection systems.

Physical activity and nutrition program for seniors (PANS) : protocol of a randomized controlled trial

Background Along with reduced levels of physical activity, older Australian's mean energy consumption has increased. Now over 60% of older Australians are considered overweight or obese. This study aims to confirm if a low-cost, accessible physical activity and nutrition program can improve levels of physical activity and diet of insufficiently active 60-70 year-olds. Methods/Design This 12-month home-based randomised controlled trial (RCT) will consist of a nutrition and physical activity intervention for insufficiently active people aged 60 to 70 years from low to medium socio-economic areas. Six-hundred participants will be recruited from the Australian Federal Electoral Role and randomly assigned to the intervention (n = 300) and control (n = 300) groups. The study is based on the Social Cognitive Theory and Precede-Proceed Model, incorporating voluntary cooperation and self-efficacy. The intervention includes a specially designed booklet that provides participants with information and encourages dietary and physical activity goal setting. The booklet will be supported by an exercise chart, calendar, bi-monthly newsletters, resistance bands and pedometers, along with phone and email contact. Data will be collected over three time points: pre-intervention, immediately post-intervention and 6-months post-study. Discussion This trial will provide valuable information for community-based strategies to improve older adults' physical activity and dietary intake. The project will provide guidelines for appropriate sample recruitment, and the development, implementation and evaluation of a minimal intervention program, as well as information on minimising barriers to participation in similar programs.

The Aboriginal voice and the left-leaning 'Australia' (Baz Luhrmann, 2008)

Arguing that Baz Luhrmann's "Australia" (2008) is a big-budget, non-independent film espousing a left-leaning political ideology in its non-racist representations of Aborigines on film, this paper suggests the addition of a 'fourth formation' to the 1984 Moore and Muecke model is warranted. According to their theorising, racist "first formation" films promote policies of assimilation whereas "second formation" films avoid overt political statements in favour of more acceptable multicultural liberalism. Moore and Muecke's seemingly ultimate "third formation films", however, blatantly foreground the director's leftist political dogma in a necessarily low budget, independent production. "Australia", on the other hand, is an advance on the third formation because its feminised Aboriginal voice is safely backed by a colossal production budget and indicates a transformation in public perceptions of Aboriginal issues. Furthermore, this paper argues that the use of low-cost post-production techniques such as voice-over narration by racially appropriate individuals and the use of diegetic song in Australia work to ensure the positive reception of the left-leaning message regarding the Stolen Generations. With these devices Luhrmann effectively counters the claims of right-wing denialists such as Andrew Bolt and Keith Windschuttle.

Seismic capacity of building constructed in slip formed load bearing wall panels

Constructing buildings using slip formed load bearing wall panels is becoming increasingly popular in Sri Lanka due to several advantages; low cost, environmental friendliness and rapid construction technique. These wall panels are already successfully implemented in many low rise buildings. However, the seismic capacities of these buildings have not been properly studied. Few seismic activities reported in Sri Lanka have not caused severe structural damage, but predictions can not be made as to whether this will continue to be the case in the future. This highlights the need to study the seismic capacity of buildings constructed in slip formed load bearing wall panels. This paper presents a study of the seismic capacity of the existing medium rise building.

A spoofing detection method for civilian L1 GPS and the E1-B Galileo Safety of Life service

This paper describes an effective method for signal-authentication and spoofing detection for civilian GNSS receivers using the GPS L1 C/A and the Galileo E1-B Safety of Life service. The paper discusses various spoofing attack profiles and how the proposed method is able to detect these attacks. This method is relatively low-cost and can be suitable for numerous mass-market applications. This paper is the subject of a pending patent.

Utility of routine data sources for feedback on the quality of cancer care: an assessment based on clinical practice guidelines

Background Not all cancer patients receive state-of-the-art care and providing regular feedback to clinicians might reduce this problem. The purpose of this study was to assess the utility of various data sources in providing feedback on the quality of cancer care. Methods Published clinical practice guidelines were used to obtain a list of processes-of-care of interest to clinicians. These were assigned to one of four data categories according to their availability and the marginal cost of using them for feedback. Results Only 8 (3%) of 243 processes-of-care could be measured using population-based registry or administrative inpatient data (lowest cost). A further 119 (49%) could be measured using a core clinical registry, which contains information on important prognostic factors (e.g., clinical stage, physiological reserve, hormone-receptor status). Another 88 (36%) required an expanded clinical registry or medical record review; mainly because they concerned long-term management of disease progression (recurrences and metastases) and 28 (11.5%) required patient interview or audio-taping of consultations because they involved information sharing between clinician and patient. Conclusion The advantages of population-based cancer registries and administrative inpatient data are wide coverage and low cost. The disadvantage is that they currently contain information on only a few processes-of-care. In most jurisdictions, clinical cancer registries, which can be used to report on many more processes-of-care, do not cover smaller hospitals. If we are to provide feedback about all patients, not just those in larger academic hospitals with the most developed data systems, then we need to develop sustainable population-based data systems that capture information on prognostic factors at the time of initial diagnosis and information on management of disease progression.

Resource allocation and scheduling of multiple composite web services in cloud computing using cooperative coevolution genetic algorithm

In cloud computing, resource allocation and scheduling of multiple composite web services is an important and challenging problem. This is especially so in a hybrid cloud where there may be some low-cost resources available from private clouds and some high-cost resources from public clouds. Meeting this challenge involves two classical computational problems: one is assigning resources to each of the tasks in the composite web services; the other is scheduling the allocated resources when each resource may be used by multiple tasks at different points of time. In addition, Quality-of-Service (QoS) issues, such as execution time and running costs, must be considered in the resource allocation and scheduling problem. Here we present a Cooperative Coevolutionary Genetic Algorithm (CCGA) to solve the deadline-constrained resource allocation and scheduling problem for multiple composite web services. Experimental results show that our CCGA is both efficient and scalable.

Dinuclear Ru-Cu complexes : electronic characterisation and application to dye-sensitised solar cells

Dye-sensitised solar cells have emerged as an important developing technology for low-cost solar energy conversion and a crucial element of these is the dye, responsible for light harvesting and control of interfacial electron-transfer processes.[1] A number of examples of dye exist in the literature which link a ruthenium polypyridyl complex to another platinum group metal complex such as Ru (II), Os (II), Re (I) or Rh (III) via a bridging ligand.[2-6] These systems are often referred to as heterosupramolecular triads when adsorbed on the surface of TiO2 as the semiconductor becomes an active component in the system. A number of problems can arise with these types of sensitisers, for example if a flexible linker, e.g. bis-pyridylethane, is used to couple the two complexes it can be hard to control the orientation of the whole dye. This may lead to the resultant dye cation hole being closer to the surface than desired, and hence the long-lived charge-separated state is not achieved. In addition the size of these dyes may be much larger than that of a mononuclear complex and can lead to poor pore filling on the TiO2 and lower dye coverage, leading to a lower efficiency cell.[7] Despite these issues, efficient charge-separation has been achieved with polynuclear complexes and a long-lived state on the millisecond timescale has been observed for a trinuclear ruthenium complex.[8]

Sequestration through forestry and agriculture

Current climate mitigation policies have not fully resolved contentious issues regarding the inclusion of carbon sequestration through changes in forestry and agricultural management practices. Terrestrial carbon sinks could be a low-cost mitigation option that fosters conservation and development, yet issues related to accurately documenting the amount of carbon sequestered undermine confidence that emission offsets through sequestration are equivalent to emission reductions. From an atmospheric perspective, net of CO2 removals through sequestration are equivalent to emission reductions over a given period of time. But carbon will not remain sequestered in biomass or soils indefinitely and investments in sequestration could stifle investments in reducing emissions from other sources. Many international climate agreements cap emissions from some countries or sectors but enable participation of uncapped countries or sectors for forestry and agricultural sequestration. This structure can prompt emission increases in parts of the uncapped entities that weaken the value of emission reductions earned through sequestration. This has been a minor issue under the Clean Development Mechanism of the Kyoto Protocol. Reduced emissions through deforestation and degradation is susceptible to the same problems. The purpose of this article is to review the science, politics, and policy that form the basis of arguments for and against the inclusion forestry and agricultural sequestration as a component of current and future international climate mitigation policies.

Use of precision time protocol to synchronize sampled value process buses

Transmission smart grids will use a digital platform for the automation of high voltage substations. The IEC 61850 series of standards, released in parts over the last ten years, provide a specification for substation communications networks and systems. These standards, along with IEEE Std 1588-2008 Precision Time Protocol version 2 (PTPv2) for precision timing, are recommended by the both IEC Smart Grid Strategy Group and the NIST Framework and Roadmap for Smart Grid Interoperability Standards for substation automation. IEC 61850, PTPv2 and Ethernet are three complementary protocol families that together define the future of sampled value digital process connections for smart substation automation. A time synchronisation system is required for a sampled value process bus, however the details are not defined in IEC 61850-9-2. PTPv2 provides the greatest accuracy of network based time transfer systems, with timing errors of less than 100 ns achievable. The suitability of PTPv2 to synchronise sampling in a digital process bus is evaluated, with preliminary results indicating that steady state performance of low cost clocks is an acceptable ±300 ns, but that corrections issued by grandmaster clocks can introduce significant transients. Extremely stable grandmaster oscillators are required to ensure any corrections are sufficiently small that time synchronising performance is not degraded.

An ultraviolet selective photodetector based on a nanocrystalline TiO2 photoelectrochemical cell

Solar ultraviolet (UV) radiation causes a range of skin disorders as well as affecting vision and the immune system. It also inhibits development of plants and animals. UV radiation monitoring is used routinely in some locations in order to alert the population to harmful solar radiation levels. There is ongoing research to develop UV-selective-sensors [1–3]. A personal, inexpensive and simple UV-selective-sensor would be desirable to measure UV intensity exposure. A prototype of such a detector has been developed and evaluated in our laboratory. It comprises a sealed two-electrode photoelectrochemical cell (PEC) based on nanocrystalline TiO2. This abundant semiconducting oxide, which is innocuous and very sta-ble, is the subject of intense study at present due to its application in dye sensitized solar cells (DSSC) [4]. Since TiO2 has a wide band gap (EG = 3.0 eV for rutile and EG = 3.2 eV for anatase), it is inher-ently UV-selective, so that UV filters are not required. This further reduces the cost of the proposed photodetector in comparison with conventional silicon detectors. The PEC is a semiconductor–electrolyte device that generates a photovoltage when it is illuminated and a corresponding photocur-rent if the external circuit is closed. The device does not require external bias, and the short circuit current is generally a linear function of illumination intensity. This greatly simplifies the elec-trical circuit needed when using the PEC as a photodetector. DSSC technology, which is based on a PEC containing nanocrystalline TiO2 sensitized with a ruthenium dye, holds out the promise of solar cells that are significantly cheaper than traditional silicon solar cells. The UV-sensor proposed in this paper relies on the cre-ation of electron–hole pairs in the TiO2 by UV radiation, so that it would be even cheaper than a DSSC since no sensitizer dye is needed. Although TiO2 has been reported as a suitable material for UV sensing [3], to the best of our knowledge, the PEC configuration described in the present paper is a new approach. In the present study, a novel double-layer TiO2 structure has been investigated. Fabrication is based on a simple and inexpensive technique for nanostructured TiO2 deposition using microwave-activated chemical bath deposition (MW-CBD) that has been reported recently [5]. The highly transparent TiO2 (anatase) films obtained are densely packed, and they adhere very well to the transparent oxide (TCO) substrate [6]. These compact layers have been studied as contacting layers in double-layer TiO2 structures for DSSC since improvement of electron extraction at the TiO2–TCO interface is expected [7]. Here we compare devices incorporating a single mesoporous nanocrystalline TiO2 structure with devices based on a double structure in which a MW-CBD film is situated between the TCO and the mesoporous nanocrystalline TiO2 layer. Besides improving electron extraction, this film could also help to block recombination of electrons transferred to the TCO with oxidized species in the electrolyte, as has been reported in the case of DSSC for compact TiO2 films obtained by other deposition tech-niques [8,9]. The two types of UV-selective sensors were characterized in detail. The current voltage characteristics, spectral response, inten-sity dependence of short circuit current and response times were measured and analyzed in order to evaluate the potential of sealed mesoporous TiO2-based photoelectrochemical cells (PEC) as low cost personal UV-photodetectors.

Reactive image-based collision avoidance system for unmanned aircraft systems

Approximately 20 years have passed now since the NTSB issued its original recommendation to expedite development, certification and production of low-cost proximity warning and conflict detection systems for general aviation [1]. While some systems are in place (TCAS [2]), ¡¨see-and-avoid¡¨ remains the primary means of separation between light aircrafts sharing the national airspace. The requirement for a collision avoidance or sense-and-avoid capability onboard unmanned aircraft has been identified by leading government, industry and regulatory bodies as one of the most significant challenges facing the routine operation of unmanned aerial systems (UAS) in the national airspace system (NAS) [3, 4]. In this thesis, we propose and develop a novel image-based collision avoidance system to detect and avoid an upcoming conflict scenario (with an intruder) without first estimating or filtering range. The proposed collision avoidance system (CAS) uses relative bearing ƒÛ and angular-area subtended ƒê , estimated from an image, to form a test statistic AS C . This test statistic is used in a thresholding technique to decide if a conflict scenario is imminent. If deemed necessary, the system will command the aircraft to perform a manoeuvre based on ƒÛ and constrained by the CAS sensor field-of-view. Through the use of a simulation environment where the UAS is mathematically modelled and a flight controller developed, we show that using Monte Carlo simulations a probability of a Mid Air Collision (MAC) MAC RR or a Near Mid Air Collision (NMAC) RiskRatio can be estimated. We also show the performance gain this system has over a simplified version (bearings-only ƒÛ ). This performance gain is demonstrated in the form of a standard operating characteristic curve. Finally, it is shown that the proposed CAS performs at a level comparable to current manned aviations equivalent level of safety (ELOS) expectations for Class E airspace. In some cases, the CAS may be oversensitive in manoeuvring the owncraft when not necessary, but this constitutes a more conservative and therefore safer, flying procedures in most instances.

An architecture for enhanced assurance in e-health systems

Notwithstanding the obvious potential advantages of information and communications technology (ICT) in the enhanced provision of healthcare services, there are some concerns associated with integration of and access to electronic health records. A security violation in health records, such as an unauthorised disclosure or unauthorised alteration of an individual's health information, can significantly undermine both healthcare providers' and consumers' confidence and trust in e-health systems. A crisis in confidence in any national level e-health system could seriously degrade the realisation of the system's potential benefits. In response to the privacy and security requirements for the protection of health information, this research project investigated national and international e-health development activities to identify the necessary requirements for the creation of a trusted health information system architecture consistent with legislative and regulatory requirements and relevant health informatics standards. The research examined the appropriateness and sustainability of the current approaches for the protection of health information. It then proposed an architecture to facilitate the viable and sustainable enforcement of privacy and security in health information systems under the project title "Open and Trusted Health Information Systems (OTHIS)". OTHIS addresses necessary security controls to protect sensitive health information when such data is at rest, during processing and in transit with three separate and achievable security function-based concepts and modules: a) Health Informatics Application Security (HIAS); b) Health Informatics Access Control (HIAC); and c) Health Informatics Network Security (HINS). The outcome of this research is a roadmap for a viable and sustainable architecture for providing robust protection and security of health information including elucidations of three achievable security control subsystem requirements within the proposed architecture. The successful completion of two proof-of-concept prototypes demonstrated the comprehensibility, feasibility and practicality of the HIAC and HIAS models for the development and assessment of trusted health systems. Meanwhile, the OTHIS architecture has provided guidance for technical and security design appropriate to the development and implementation of trusted health information systems whilst simultaneously offering guidance for ongoing research projects. The socio-economic implications of this research can be summarised in the fact that this research embraces the need for low cost security strategies against economic realities by using open-source technologies for overall test implementation. This allows the proposed architecture to be publicly accessible, providing a platform for interoperability to meet real-world application security demands. On the whole, the OTHIS architecture sets a high level of security standard for the establishment and maintenance of both current and future health information systems. This thereby increases healthcare providers‘ and consumers‘ trust in the adoption of electronic health records to realise the associated benefits.

An evaluation of the sustainability of agreements reached through mediations conducted by the dispute resolution centres of the Department of Justice and Attorney General, Queensland between 1999 to 2003

In 1990 the Dispute Resolution Centres Act, 1990 (Qld) (the Act) was passed by the Queensland Parliament. In the second reading speech for the Dispute Resolution Centres Bill on May 1990 the Hon Dean Wells stated that the proposed legislation would make mediation services available “in a non-coercive, voluntary forum where, with the help of trained mediators, the disputants will be assisted towards their own solutions to their disputes, thereby ensuring that the result is acceptable to the parties” (Hansard, 1990, 1718). It was recognised at that time that a method for resolving disputes was necessary for which “the conventional court system is not always equipped to provide lasting resolution” (Hansard, 1990, 1717). In particular, the lasting resolution of “disputes between people in continuing relationships” was seen as made possible through the new legislation; for example, “domestic disputes, disputes between employees, and neighbourhood disputes relating to such issues as overhanging tree branches, dividing fences, barking dogs, smoke, noise and other nuisances are occurring continually in the community” (Hansard, 1990, 1717). The key features of the proposed form of mediation in the Act were articulated as follows: “attendance of both parties at mediation sessions is voluntary; a party may withdraw at any time; mediation sessions will be conducted with as little formality and technicality as possible; the rules of evidence will not apply; any agreement reached is not enforceable in any court; although it could be made so if the parties chose to proceed that way; and the provisions of the Act do not affect any rights or remedies that a party to a dispute has apart from the Act” (Hansard, 1990, 1718). Since the introduction of the Act, the Alternative Dispute Resolution Branch of the Queensland Department of Justice and Attorney General has offered mediation services through, first the Community Justice Program (CJP), and then the Dispute Resolution Centres (DRCs) for a range of family, neighbourhood, workplace and community disputes. These services have mirrored those available through similar government agencies in other states such as the Community Justice Centres of NSW and the Victorian Dispute Resolution Centres. Since 1990, mediation has become one of the fastest growing forms of alternative dispute resolution (ADR). Sourdin has commented that "In addition to the growth in court-based and community-based dispute resolution schemes, ADR has been institutionalised and has grown within Australia and overseas” (2005, 14). In Australia, in particular, the development of ADR service provision “has been assisted by the creation and growth of professional organisations such as the Leading Edge Alternative Dispute Resolvers (LEADR), the Australian Commercial Dispute Centres (ACDC), Australian Disputes Resolution Association (ADRA), Conflict Resolution Network, and the Institute of Arbitrators and Mediators Australia (IAMA)” (Sourdin, 2005, 14). The increased emphasis on the use of ADR within education contexts (particularly secondary and tertiary contexts) has “also led to an increasing acceptance and understanding of (ADR) processes” (Sourdin, 2005, 14). Proponents of the mediation process, in particular, argue that much of its success derives from the inherent flexibility and creativity of the agreements reached through the mediation process and that it is a relatively low cost option in many cases (Menkel-Meadow, 1997, 417). It is also accepted that one of the main reasons for the success of mediation can be attributed to the high level of participation by the parties involved and thus creating a sense of ownership of, and commitment to, the terms of the agreement (Boulle, 2005, 65). These characteristics are associated with some of the core values of mediation, particularly as practised in community-based models as found at the DRCs. These core values include voluntary participation, party self-determination and party empowerment (Boulle, 2005, 65). For this reason mediation is argued as being an effective approach to resolving disputes, that creates a lasting resolution of the issues. Evaluation of the mediation process, particularly in the context of the growth of ADR, has been an important aspect of the development of the process (Sourdin, 2008). Writing in 2005 for example, Boulle, states that “although there is a constant refrain for more research into mediation practice, there has been a not insignificant amount of mediation measurement, both in Australia and overseas” (Boulle, 2005, 575). The positive claims of mediation have been supported to a significant degree by evaluations of the efficiency and effectiveness of the process. A common indicator of the effectiveness of mediation is the settlement rate achieved. High settlement rates for mediated disputes have been found for Australia (Altobelli, 2003) and internationally (Alexander, 2003). Boulle notes that mediation agreement rates claimed by service providers range from 55% to 92% (Boulle, 2005, 590). The annual reports for the Alternative Dispute Resolution Branch of the Queensland Department of Justice and Attorney-General considered prior to the commencement of this study indicated generally achievement of an approximate settlement figure of 86% by the Queensland Dispute Resolution Centres. More recently, the 2008-2009 annual report states that of the 2291 civil dispute mediated in 2007-2008, 86% reached an agreement. Further, of the 2693 civil disputes mediated in 2008-2009, 73% reached an agreement. These results are noted in the report as indicating “the effectiveness of mediation in resolving disputes” and as reflecting “the high level of agreement achieved for voluntary mediations” (Annual Report, 2008-2009, online). Whilst the settlement rates for the DRCs are strong, parties are rarely contacted for long term follow-up to assess whether agreements reached during mediation lasted to the satisfaction of each party. It has certainly been the case that the Dispute Resolution Centres of Queensland have not been resourced to conduct long-term follow-up assessments of mediation agreements. As Wade notes, "it is very difficult to compare "success" rates” and whilst “politicians want the comparison studies (they) usually do not want the delay and expense of accurate studies" (1998, 114). To date, therefore, it is fair to say that the efficiency of the mediation process has been evaluated but not necessarily its effectiveness. Rather, the practice at the Queensland DRCs has been to evaluate the quality of mediation service provision and of the practice of the mediation process. This has occurred, for example, through follow-up surveys of parties' satisfaction rates with the mediation service. In most other respects it is fair to say that the Centres have relied on the high settlement rates of the mediation process as a sign of the effectiveness of mediation (Annual Reports 1991 - 2010). Research of the mediation literature conducted for the purpose of this thesis has also indicated that there is little evaluative literature that provides an in-depth analysis and assessment of the longevity of mediated agreements. Instead evaluative studies of mediation tend to assess how mediation is conducted, or compare mediation with other conflict resolution options, or assess the agreement rate of mediations, including parties' levels of satisfaction with the service provision of the dispute resolution service provider (Boulle, 2005, Chapter 16).