Routine measurement of outcomes in Australia's public sector mental health services

OBJECTIVE: This paper describes the Australian experience to date with a national 'roll out' of routine outcome measurement in public sector mental health services. METHODS: Consultations were held with 123 stakeholders representing a range of roles. RESULTS: Australia has made an impressive start to nationally implementing routine outcome measurement in mental health services, although it still has a long way to go. All States/Territories have established data collection systems, although some are more streamlined than others. Significant numbers of clinicians and managers have been trained in the use of routine outcome measures, and thought is now being given to ongoing training strategies. Outcome measurement is now occurring 'on the ground'; all States/Territories will be reporting data for 2003-04, and a number have been doing so for several years. Having said this, there is considerable variability regarding data coverage, completeness and compliance. Some States/Territories have gone to considerable lengths to 'embed' outcome measurement in day-to-day practice. To date, reporting of outcome data has largely been limited to reports profiling individual consumers and/or aggregate reports that focus on compliance and data quality issues, although a few States/Territories have begun to turn their attention to producing aggregate reports of consumers by clinician, team or service. CONCLUSION: Routine outcome measurement is possible if it is supported by a co-ordinated, strategic approach and strong leadership, and there is commitment from clinicians and managers. The Australian experience can provide lessons for other countries.

Introduction of routine outcome measures: staff reactions and issues for consideration

The aim of this study was to explore clinician reactions to (i) the introduction of routine outcome measures and (ii) the utility of outcomes data in clinical practice. Focus group discussions (n = 34) were conducted with mental health staff (n = 324) at approximately 8 months post implementation of routine outcome measures. A semi-structured interview schedule was used to collect data on two key issues; reactions to the introduction of outcome measures and factors influencing the utility of outcomes data in clinical practice. Data from the discussion groups were analysed using content analysis to isolate emerging themes. While the majority of participants endorsed the collection and utilization of outcomes data, many raised questions about the merits of the initiative. Ambivalence, competing work demands, lack of support from senior medical staff, questionable evidence to support the use of outcome measures, and fear of how outcomes data might be used emerged as key issues. At 8 months post implementation a significant number of clinical staff remained ambivalent about the benefits of outcome measurement and had not engaged in the process. The shift to a service model driven by outcomes and case-mix data will take time and resources to achieve. Implications for nursing staff are discussed.

Routine physiotherapy does not induce cardiorespiratory training effect post-stroke

Background and Purpose. Cardiorespiratory fitness is increasingly being recognized as an impairment requiring physiotherapy intervention after stroke. The present study seeks to investigate if routine physiotherapy treatment is capable of inducing a cardiorespiratory training effect and if stroke patients attending physiotherapy who are unable to walk experience less cardiorespiratory stress during physiotherapy when compared to those who are able to walk. Method. A descriptive, observational study, with heart rate monitoring and video-recording of physiotherapy rehabilitation, was conducted. Thirty consecutive stroke patients from a geriatric and rehabilitation unit of a tertiary metropolitan hospital, admitted for rehabilitation, and requiring physiotherapy were included in the study. The main measures of the study were duration (time) and intensity (percentage of heart rate reserve) of standing and walking activities during physiotherapy rehabilitation for non-walking and walking stroke patients. Results. Stroke patients spent an average of 21 minutes participating in standing and walking activities that were capable of inducing a cardiorespiratory training effect. Stroke patients who were able to walk spent longer in these activities during physiotherapy rehabilitation than non-walking stroke patients (p < 0.05). An average intensity of 24% heart rate reserve (HRR) during standing and walking activities was insufficient to result in a cardiorespiratory training effect, with a maximum of 35% achieved for the stroke patients able to walk and 30% for those unable to walk. Conclusions. Routine physiotherapy rehabilitation had insufficient duration and intensity to result in a cardiorespiratory training effect in our group of stroke patients. Copyright © 2006 John Wiley & Sons, Ltd.

A contour plot approach that uses data accumulated during routine monitoring to obtain insights into lagoon behaviour

Regular monitoring of wastewater characteristics is undertaken on most wastewater treatment plants. The data acquired during this process are usually filed and forgotten. However, systematic analysis of these data can provide useful insights into plant behaviour. Conventional graphical techniques are inadequate to give a good overall picture of how wastewater characteristics vary, with time and along the lagoon system. An approach based on the use of contour plots was devised that largely overcomes this problem. Superimposition of contour plots for different parameters can be used to gain a qualitative understanding of the nature and strength of relationships between the parameters. This is illustrated in an analysis of monitoring data for lagoon 115 East at the Western Treatment Plant, near Melbourne, Australia. In this illustrative analysis, relationships between ammonia removal rates and parameters such as chlorophyll a level and temperature are explored using a contour plot superimposition approach. It is concluded that this approach can help improve our understanding, not only of lagoon systems, but of other wastewater treatment systems as well.

Design of complementary UWB printed monopole antennas using simple formulas

Simple design formulas for designing ultra wideband (UWB) antennas in the form of complementary planar monopoles are described and their validity is tested using full electromagnetic wave simulations and measurements. Assuming dielectric substrate with relative permittivity of 10.2, the designed antennas feature a small size of 13 mmtimes26 mm. They exhibit a 10 dB return loss bandwidth from 3 to more than 15 GHz accompanied by near omnidirectional characteristics and good radiation efficiency throughout this band