Validation of de-identified record linkage to ascertain hospital admissions in a cohort study

Background Cohort studies can provide valuable evidence of cause and effect relationships but are subject to loss of participants over time, limiting the validity of findings. Computerised record linkage offers a passive and ongoing method of obtaining health outcomes from existing routinely collected data sources. However, the quality of record linkage is reliant upon the availability and accuracy of common identifying variables. We sought to develop and validate a method for linking a cohort study to a state-wide hospital admissions dataset with limited availability of unique identifying variables. Methods A sample of 2000 participants from a cohort study (n = 41 514) was linked to a state-wide hospitalisations dataset in Victoria, Australia using the national health insurance (Medicare) number and demographic data as identifying variables. Availability of the health insurance number was limited in both datasets; therefore linkage was undertaken both with and without use of this number and agreement tested between both algorithms. Sensitivity was calculated for a sub-sample of 101 participants with a hospital admission confirmed by medical record review. Results Of the 2000 study participants, 85% were found to have a record in the hospitalisations dataset when the national health insurance number and sex were used as linkage variables and 92% when demographic details only were used. When agreement between the two methods was tested the disagreement fraction was 9%, mainly due to "false positive" links when demographic details only were used. A final algorithm that used multiple combinations of identifying variables resulted in a match proportion of 87%. Sensitivity of this final linkage was 95%. Conclusions High quality record linkage of cohort data with a hospitalisations dataset that has limited identifiers can be achieved using combinations of a national health insurance number and demographic data as identifying variables.

A randomised controlled trial to prevent hospital readmissions and loss of functional ability in high risk older adults: a study protocol

Background Older people have higher rates of hospital admission than the general population and higher rates of readmission due to complications and falls. During hospitalisation, older people experience significant functional decline which impairs their future independence and quality of life. Acute hospital services comprise the largest section of health expenditure in Australia and prevention or delay of disease is known to produce more effective use of services. Current models of discharge planning and follow-up care, however, do not address the need to prevent deconditioning or functional decline. This paper describes the protocol of a randomised controlled trial which aims to evaluate innovative transitional care strategies to reduce unplanned readmissions and improve functional status, independence, and psycho-social well-being of community-based older people at risk of readmission. Methods/Design The study is a randomised controlled trial. Within 72 hours of hospital admission, a sample of older adults fitting the inclusion/exclusion criteria (aged 65 years and over, admitted with a medical diagnosis, able to walk independently for 3 meters, and at least one risk factor for readmission) are randomised into one of four groups: 1) the usual care control group, 2) the exercise and in-home/telephone follow-up intervention group, 3) the exercise only intervention group, or 4) the in-home/telephone follow-up only intervention group. The usual care control group receive usual discharge planning provided by the health service. In addition to usual care, the exercise and in-home/telephone follow-up intervention group receive an intervention consisting of a tailored exercise program, in-home visit and 24 week telephone follow-up by a gerontic nurse. The exercise only and in-home/telephone follow-up only intervention groups, in addition to usual care receive only the exercise or gerontic nurse components of the intervention respectively. Data collection is undertaken at baseline within 72 hours of hospital admission, 4 weeks following hospital discharge, 12 weeks following hospital discharge, and 24 weeks following hospital discharge. Outcome assessors are blinded to group allocation. Primary outcomes are emergency hospital readmissions and health service use, functional status, psychosocial well-being and cost effectiveness. Discussion The acute hospital sector comprises the largest component of health care system expenditure in developed countries, and older adults are the most frequent consumers. There are few trials to demonstrate effective models of transitional care to prevent emergency readmissions, loss of functional ability and independence in this population following an acute hospital admission. This study aims to address that gap and provide information for future health service planning which meets client needs and lowers the use of acute care services.

Analysing and improving a recruitment process : a teaching case for developing business process improvement capabilities

The demand for Business Process Management (BPM) is rapidly rising and with that, the need for capable BPM professionals is also rising. Yet, only a very few structured BPM training/ education programs are available, across universities and professional trainers globally. The ‘lack of appropriate teaching resources’ has been identified as a critical issue for BPM educators in prior studies. Case-based teaching can be an effective means of educating future BPM professionals. A main reason is that cases create an authentic learning environment where the complexities and challenges of the ‘real world’ can be presented in a narrative enabling the students to develop crucial skills such as problem solving, analysis and creativity-within-constraints, and to apply the tools and techniques within a richer and real (or proxy to real) context. However, so far well documented BPM teaching cases are scarce. This article aims to contribute to address this gap by providing a comprehensive teaching case and teaching notes that facilitates the education of selected process improvement phases, namely identification, modelling, analysis, and improvement. The article is divided into three main parts: (i) Introductory teaching notes, (ii) The case narrative, and (iii) Student activities from the case and teaching notes.

Preservice teachers teaching technology with robotics

This study investigates the value of a robotics-based school engagement experience for preservice teachers enrolled in a fourth year technology education curriculum unit and analyses their perceived abilities and confidence to design and implement engaging technology activities following this experience. Technology is a key learning area in Australian schools but research shows that most teachers find this subject challenging to teach. This could be attributed to teachers’ attitudes and their lack of knowledge, hence investigating preservice teachers’ involvement with technology may provide further insights. In this study, 30 preservice teachers used robotics to implement technology activities with 22 primary school students from a school in a low socio-economic area. Surveys were administered to ascertain the preservice teachers' perceptions of their school engagement experiences. The data gathered from the participants showed that they had gained confidence and knowledge from the experience and felt the engagement activity would assist them to develop and implement technology activities in their future classrooms.

Urban pre-service teachers’ conceptions of teaching in rural communities

Encouraging quality teaching staff to apply for and accept teaching placements in rural and remote locations is an ongoing concern internationally. The value of different support mechanisms provided for pre-service teachers attending a rural and remote practicum[1] are investigated through theories of place and the school-community nexus. Qualitative data regarding the experiences of the pre-service teachers were collected through interviews and case study notes. This project adds to our understanding of practicum in rural areas by employing a conceptual understanding of place to propose how the experiences of a four-week practicum may contribute to urban pre-service teachers’ conceptions of work and life in a rural community

Teaching Teachers for the Future (TTF) : building the ICT in education capacity of the next generation of teachers in Australia

The Teaching Teachers for the Future (TTF) project is a unique nationally significant project funded by the Australian Government through the Department of Employment, Education and Workplace Relations (DEEWR, Au$8.8 million) and the Information and Communication Technology Innovation Fund (ICTIF). This 2011-2012 project has ambitiously attempted to build the ICT education (ICTE) capacity of the next generation of Australian teachers through its focus on pre-service teachers, teacher educators and the new Australian Curriculum. This paper will provide an overview of the project including a description of its genesis in a changing educational and political landscape, its structure and operations, its grounding in contemporary theory, the research opportunities it has engendered and its tangible outcomes.

Impact of opening a new emergency department on healthcare service and patient outcomes : analyses based on linking ambulance, emergency and hospital databases

Background Emergency department (ED) crowding caused by access block is an increasing public health issue and has been associated with impaired healthcare delivery, negative patient outcomes and increased staff workload. Aim To investigate the impact of opening a new ED on patient and healthcare service outcomes. Methods A 24-month time series analysis was employed using deterministically linked data from the ambulance service and three ED and hospital admission databases in Queensland, Australia. Results Total volume of ED presentations increased 18%, while local population growth increased by 3%. Healthcare service and patient outcomes at the two pre-existing hospitals did not improve. These outcomes included ambulance offload time: (Hospital A PRE: 10 min, POST: 10 min, P < 0.001; Hospital B PRE: 10 min, POST: 15 min, P < 0.001); ED length of stay: (Hospital A PRE: 242 min, POST: 246 min, P < 0.001; Hospital B PRE: 182 min, POST: 210 min, P < 0.001); and access block: (Hospital A PRE: 41%, POST: 46%, P < 0.001; Hospital B PRE: 23%, POST: 40%, P < 0.001). Time series modelling indicated that the effect was worst at the hospital furthest away from the new ED. Conclusions An additional ED within the region saw an increase in the total volume of presentations at a rate far greater than local population growth, suggesting it either provided an unmet need or a shifting of activity from one sector to another. Future studies should examine patient decision making regarding reasons for presenting to a new or pre-existing ED. There is an inherent need to take a ‘whole of health service area’ approach to solve crowding issues.

Towards teaching in partnership : lessons still to be learned

This article seeks to analyse current dilemmas in responding to calls to narrow 'the gap' between academic and school culture in the area of preservice teacher preparation. It critiques traditional practices and current policies which focus on the narrowly vocational at the expense of the contextual. Further, it acknowledges the problems in the teaching of theory as it has been traditionally understood. Finally, it assesses the benefits for teachers and academics of forms of pedagogical partnership and the likelihood of progress in this area, and suggest that a number of fundamental changes need to be made in academic culture for genuine partnerships to become a reality.

Team teaching : working together to promote student learning

This book chapter examines the concept of team teaching from the perspective of the various stakeholders, in order to discuss the advantages and disadvantages of team teaching for students, to consider the positive and negative dimensions of collaborative teaching for teachers, and to review the implications for educational administration. In addition, attention will be paid to the issues associated with team teaching in the context of e-learning. The chapter concludes with a case study which discusses how the implementation of collaborative teaching within the library and information science discipline at an Australian university helped develop the authors’ understanding of socially constructed knowledge.

Particulate air pollution and cardiorespiratory hospital admissions in a temperate Australian city: A case-crossover analysis

Although ambient air pollution exposure has been linked with poor health in many parts of the world, no previous study has investigated the effect on morbidity in the city of Adelaide, South Australia. To explore the association between particulate matter (PM) and hospitalisations, including respiratory and cardiovascular admissions in Adelaide, South Australia. Methods: For the study period September 2001 to October 2007, daily counts of all-cause, cardiovascular and respiratory hospital admissions were collected, as well as daily air quality data including concentrations of particulates, ozone and nitrogen dioxide. Visibility codes for presentweather conditions identified dayswhen airborne dust or smoke was observed. The associations between PM and hospitalisations were estimated using timestratified case-crossover analyses controlling for covariates including temperature, relative humidity, other pollutants, day of the week and public holidays. Mean PM10 concentrations were higher in the warm season, whereas PM2.5 concentrations were higher in the cool season. Hospital admissions were associated with PM10 in the cool season and with PM2.5 in both seasons. No significant effect of PM on all-age respiratory admissions was detected, however cardiovascular admissions were associated with both PM2.5 and PM10 in the cool season with the highest effects for PM2.5 (4.48%, 95% CI: 0.74%, 8.36% increase per 10 μg/m3 increase in PM2.5). These findings suggest that despite the city's relatively low levels of air pollution, PMconcentrations are associated with increases in morbidity in Adelaide. Further studies are needed to investigate the sources of PM which may be contributing to the higher cool season effects.

Knowing and teaching the indigenous other : teachers’ engagement with Aboriginal and Torres Strait Islander cultures

This is the first empirical study of teacher knowledge and classroom practice in Aboriginal and Torres Strait Islander education. It describes the construction of a survey instrument to measure non-Indigenous Australian teachers’ knowledge of Indigenous culture and place, frequency of everyday intercultural exchanges, and attempts to integrate Indigenous knowledge into classroom practice. Many teachers reported low levels of knowledge of Indigenous cultures, and limited encounters outside of school. While the cohort expressed dissatisfaction with pre-service training, exposure to pre- and in-service courses in Indigenous education correlated with higher levels of cultural knowledge and cultural engagement. Teachers with higher levels of cultural engagement were more likely to attempt to integrate Indigenous knowledges in curriculum and pedagogy.

The Australian curriculum : implications for teaching and assessment

Teachers will be aware of the raft of educational changes introduced recently and also of the associated challenges and opportunities that such educational reforms present. This PETAA Paper commences with an overview of the major educational changes and how they impinge on teachers’ classroom practice in the teaching of English and makes explicit the implications for policy support. This article aims to provide teachers with some insight into how they might respond in their teaching to develop their own assessment and pedagogic practices and in so doing support students to improve in their learning and to achieve higher standards. A group of teachers’ classroom practice, which has applicability to both Upper Primary and Middle School English teaching, is analysed to demonstrate how these teachers have pedagogically incorporated some of the ‘general capabilities’ and a cross-curriculum priority of ‘Aboriginal and Torres Strait Islander histories and cultures’ into their classroom practice.

Becoming professionals : partnerships reshaping preservice teachers’ transition to full-time teaching

While strengthened partnerships between University and Schools have been proposed in recent reviews of teacher education (House of Representative Standing Committee on Education and Vocational Training, 2007; Caldwell & Sutton, 2010; Donaldson, 2010), there is a need to understand the benefits and challenges for participants of these partnerships. The Teacher Education Centre of Excellence (TECE) in this study is a preservice teacher preparation partnership between a Queensland University, Queensland Department of Education, Training and Employment (DETE) and an Education Queensland school. It was established in response to a mandated reform within the Improving Teacher Quality National Partnership Agreement (Department of Education Employment and Workplace Relations, 2011). High-achieving Bachelor of Education preservice teachers apply to be part of the 18-month program in the third year of their four-year Education degree. These preservice teachers experience mentoring in partner schools in addition to course work designed and delivered by a DETE appointed Head of Mentoring and a university academic. On completion of the program, graduates will be appointed to South West Queensland rural and remote Education Queensland schools. This paper analyses participant perspectives from the first phase of this partnership in particular identifying the benefits and challenges experienced by the preservice teachers and the leaders of the program from the participating institutions. A sociocultural theoretical perspective (Wenger, 1998) informed the analysis examining how preservice teachers experience a sense of becoming a professional teacher within a specific employment context. Data from interviews with 6 pre-service teachers and 8 program leaders were analysed inductively through coding of interview records. Findings indicate the importance of strong relationships and opportunity for reciprocal learning through ongoing professional conversations as contexts for preservice teachers to develop an identity as an emerging professional. This research has significance for the ongoing development of this partnership as well as informing the principles for the design of future similar partnerships.