scholarly journals Protocol for a mixed methods realist evaluation of regional District Health Board groupings in New Zealand

BMJ Open ◽  
2019 ◽  
Vol 9 (3) ◽  
pp. e030076
Author(s):  
Tim Stokes ◽  
Carol Atmore ◽  
Erin Penno ◽  
Lauralie Richard ◽  
Emma Wyeth ◽  
...  
Keyword(s):  
Mixed Methods ◽  
New Zealand ◽  
Health Outcomes ◽  
Health Equity ◽  
Service Integration ◽  
Realist Evaluation ◽  
Health Board ◽  
Programme Theory ◽  
District Health ◽  
The Impact

IntroductionAchieving effective integration of healthcare across primary, secondary and tertiary care is a key goal of the New Zealand (NZ) Health Strategy. NZ’s regional District Health Board (DHB) groupings are fundamental to delivering integration, bringing the country’s 20 DHBs together into four groups to collaboratively plan, fund and deliver health services within their defined geographical regions. This research aims to examine how, for whom and in what circumstances the regional DHB groupings work to improve health service integration, healthcare quality, health outcomes and health equity, particularly for Māori and Pacific peoples.Methods and analysisThis research uses a mixed methods realist evaluation design. It comprises three linked studies: (1) formulating initial programme theory (IPT) through developing programme logic models to describe regional DHB working; (2) empirically testing IPT through both a qualitative process evaluation of regional DHB working using a case study design; and (3) a quantitative analysis of the impact that DHB regional groupings may have on service integration, health outcomes, health equity and costs. The findings of these three studies will allow refinement of the IPT and should lead to a programme theory which will explain how, for whom and in what circumstances regional DHB groupings improve service integration, health outcomes and health equity in NZ.Ethics and disseminationThe University of Otago Human Ethics Committee has approved this study. The embedding of a clinician researcher within a participating regional DHB grouping has facilitated research coproduction, the research has been jointly conceived and designed and will be jointly evaluated and disseminated by researchers and practitioners. Uptake of the research findings by other key groups including policymakers, Māori providers and communities and Pacific providers and communities will be supported through key strategic relationships and dissemination activities. Academic dissemination will occur through publication and conference presentations.

scholarly journals Geographical Variation in Dementia Mortality in Italy, New Zealand, and Chile: The Impact of Latitude, Vitamin D, and Air Pollution

2016 ◽  
Vol 42 (1-2) ◽  
pp. 31-41 ◽  
Author(s):  
Tom C. Russ ◽  
Laura Murianni ◽  
Gloria Icaza ◽  
Andrea Slachevsky ◽  
John M. Starr
Keyword(s):  
Vitamin D ◽  
New Zealand ◽  
Southern Hemisphere ◽  
Geographical Variation ◽  
Health Board ◽  
District Health ◽  
Men And Women ◽  
The North ◽  
Dementia Risk ◽  
The Impact

Background: Dementia risk is reported as being higher in the north compared to the south, which may be related to vitamin D deficiency. If this were the case, an opposite gradient of risk would be observed in the southern hemisphere, but this has not been investigated previously. Methods: We calculated standardised mortality ratios (SMRs) for deaths in 2012 where dementia (Alzheimer's disease, vascular or unspecified dementia) was recorded as the underlying cause for 20 regions in Italy, 20 District Health Board areas in New Zealand and 29 Health Service areas in Chile. Results: Dementia SMRs were higher in northern than central or southern Italy. The inverse pattern was seen in women in New Zealand, with rates higher on South Island than North Island. However, dementia risk was raised in eight regions in the north and centre of Chile in both men and women. Conclusions: Geographical variation plays a key role in dementia risk, but patterns vary in men and women. In the northern hemisphere, dementia mortality is higher in the north, but the pattern in the southern hemisphere is more complex.

scholarly journals Strategies and processes emergency department nurses consider important to safely manage during an influenza pandemic: A qualitative descriptive study

2021 ◽  
Author(s):  
◽  
Jessica Lockett
Keyword(s):  
Emergency Department ◽  
New Zealand ◽  
Healthcare System ◽  
Emergency Departments ◽  
Influenza Pandemic ◽  
Health Board ◽  
District Health ◽  
Emergency Department Nurses ◽  
Qualitative Descriptive ◽  
The Impact

<p>The influenza virus is responsible for significant morbidity and mortality worldwide each year, with influenza pandemics occurring every 10 to 50 years and responsible for millions of deaths and substantial economic impact. Increasing globalisation through travel and trade means New Zealand is vulnerable to the risks of pandemic influenza, placing a strain on the healthcare system, putting lives at risk and posing a significant cost to the country. Emergency Departments are at the frontline of New Zealand’s healthcare system and are a crucial component in the response to an influenza pandemic, however little research has been done on the impact such an event would have on the nursing staff who work in this area and the care they provide to influenza patients.  This study aims to explore what New Zealand Emergency Department nurses perceive as the biggest challenges to nursing care and staff safety during an influenza pandemic, in order to provide information on how to ensure the engagement of these nurses at the frontline of the pandemic response. With a lack of evidence-based research available, a qualitative descriptive design was used to allow an exploration of the first-hand perspectives of Emergency Department nurses, gaining meaningful insights into a phenomena which has been little explored.  Sixteen nurses from two Emergency Departments participated in face-to-face interviews conducted using semi-structured questions. Raw data was transcribed, and an inductive approach was taken to data analysis, guided by the principles of both content and thematic analysis.  The findings demonstrate that Emergency Department nurses work in an environment that poses risk to patient and staff safety every day, and an understanding of these safety problems is provided in the theme ‘the everyday reality for Emergency Department nurses’. Working within this context shapes the fears that Emergency Department nurses hold about what could happen if an influenza pandemic were to affect New Zealand in the future, and are summarised within the theme ‘fears for a pandemic’. The final theme, ‘strategy and planning for pandemics’ provides insight into how Emergency Department nurses feel these issues could be managed within future pandemic planning at Emergency Department, District Health Board and government level.  This thesis identifies both existing and potential future safety concerns in relation to the management of influenza in New Zealand Emergency Departments, affecting the safety of patients and staff. It also provides specific multi-level and multi-agency recommendations for future pandemic plans that could help to mitigate the significant risks highlighted by those who work within the system every day.</p>

scholarly journals Saving 20 000 Days and Beyond: a realist evaluation of two quality improvement campaigns to manage hospital demand in a New Zealand District Health Board

2019 ◽  
Vol 8 (4) ◽  
pp. e000374 ◽  
Author(s):  
Lesley Middleton ◽  
Diana Dowdle ◽  
Luis Villa ◽  
Jonathon Gray ◽  
Jacqueline Cumming
Keyword(s):  
Quality Improvement ◽  
New Zealand ◽  
Realist Evaluation ◽  
System Level ◽  
Phase Iii ◽  
Health Board ◽  
Team Leaders ◽  
Collaborative Teams ◽  
District Health ◽  
Collaborative Team

BackgroundThe current paper reports on a realist evaluation of two consecutive quality improvement campaigns based on the Institute for Healthcare Improvement’s Breakthrough Series. The campaigns were implemented by a District Health Board to manage hospital demand in South Auckland, New Zealand. A realist evaluation design was adopted to investigate what worked in the two campaigns and under what conditions.MethodsA mixed-methods approach was used, involving three phases of data collection. During the first phase, a review of campaign materials and relevant literature, as well as key informant interviews were undertaken to generate an initial logic model of how the campaign was expected to achieve its objective. In phase II, the model was tested against the experiences of participants in the first campaign via a questionnaire to all campaign participants, interviews with campaign sponsors and collaborative team leaders and a review of collaborative team dashboards. In phase III, the refined model was tested further against the experiences of participants in the second campaign through interviews with collaborative team leaders, case studies of four collaborative teams and a review of the overall system-level dashboard.ResultsThe evaluation identified four key mechanisms through which the campaigns’ outcomes were achieved. These were characterised as ‘an organisational preparedness to change’, ‘enlisting the early adopters’, ‘strong collaborative teams’ and ‘learning from measurement’. Contextual factors that both enabled and constrained the operation of these mechanisms were also identified.ConclusionsBy focusing on the explication of a theory of how the campaigns achieved their outcomes and under what circumstances, the realist evaluation reported in this paper provides some instructive lessons for future evaluations of quality improvement initiatives.

scholarly journals Strategies and processes emergency department nurses consider important to safely manage during an influenza pandemic: A qualitative descriptive study

2021 ◽  
Author(s):  
◽  
Jessica Lockett
Keyword(s):  
Emergency Department ◽  
New Zealand ◽  
Healthcare System ◽  
Emergency Departments ◽  
Influenza Pandemic ◽  
Health Board ◽  
District Health ◽  
Emergency Department Nurses ◽  
Qualitative Descriptive ◽  
The Impact

<p>The influenza virus is responsible for significant morbidity and mortality worldwide each year, with influenza pandemics occurring every 10 to 50 years and responsible for millions of deaths and substantial economic impact. Increasing globalisation through travel and trade means New Zealand is vulnerable to the risks of pandemic influenza, placing a strain on the healthcare system, putting lives at risk and posing a significant cost to the country. Emergency Departments are at the frontline of New Zealand’s healthcare system and are a crucial component in the response to an influenza pandemic, however little research has been done on the impact such an event would have on the nursing staff who work in this area and the care they provide to influenza patients.  This study aims to explore what New Zealand Emergency Department nurses perceive as the biggest challenges to nursing care and staff safety during an influenza pandemic, in order to provide information on how to ensure the engagement of these nurses at the frontline of the pandemic response. With a lack of evidence-based research available, a qualitative descriptive design was used to allow an exploration of the first-hand perspectives of Emergency Department nurses, gaining meaningful insights into a phenomena which has been little explored.  Sixteen nurses from two Emergency Departments participated in face-to-face interviews conducted using semi-structured questions. Raw data was transcribed, and an inductive approach was taken to data analysis, guided by the principles of both content and thematic analysis.  The findings demonstrate that Emergency Department nurses work in an environment that poses risk to patient and staff safety every day, and an understanding of these safety problems is provided in the theme ‘the everyday reality for Emergency Department nurses’. Working within this context shapes the fears that Emergency Department nurses hold about what could happen if an influenza pandemic were to affect New Zealand in the future, and are summarised within the theme ‘fears for a pandemic’. The final theme, ‘strategy and planning for pandemics’ provides insight into how Emergency Department nurses feel these issues could be managed within future pandemic planning at Emergency Department, District Health Board and government level.  This thesis identifies both existing and potential future safety concerns in relation to the management of influenza in New Zealand Emergency Departments, affecting the safety of patients and staff. It also provides specific multi-level and multi-agency recommendations for future pandemic plans that could help to mitigate the significant risks highlighted by those who work within the system every day.</p>

Registered nurse prescribing: A descriptive survey of prescribing practices in a single district health board in Aotearoa New Zealand

2020 ◽  
Vol 36 (3) ◽  
pp. 61-72
Author(s):  
Melinda McGinty ◽  
◽  
Betty Poot ◽  
Jane Clarke ◽  
◽  
...  
Keyword(s):  
Primary Care ◽  
New Zealand ◽  
Registered Nurse ◽  
Health Conditions ◽  
Health Board ◽  
Prescribing Practices ◽  
District Health ◽  
Survey Tool ◽  
Aotearoa New Zealand ◽  
Descriptive Survey

The expansion of prescribing rights in Aotearoa New Zealand has enabled registered nurse prescribers (RN prescribers) working in primary care and specialty teams, to enhance nursing care, by prescribing medicines to their patient population. This widening of prescribing rights was to improve the population’s access to medicines and health care; however, little is known about the medications prescribed by RN prescribers. This paper reports on a descriptive survey of self-reported RN prescribers prescribing in a single district health board. The survey tool used was a Microsoft Excel spreadsheet to record nurse’s area of practice, patient demographic details, health conditions seen, and medicines prescribed and deprescribed. Simple data descriptions and tabulations were used to report the data. Eleven RN prescribers consented to take part in the survey and these nurses worked in speciality areas of cardiology, respiratory, diabetes, and primary care. Findings from the survey demonstrated that RN prescribers prescribe medicines within their area of practice and within the limits of the list of medicines for RN prescribers. Those working in primary care saw a wider range of health conditions and therefore prescribed a broader range of medications. This survey revealed that the list of medications available for RN prescribers needs to be updated regularly to align with the release of evidence-based medications on the New Zealand Pharmaceutical Schedule. It is also a useful record for both educational and clinical settings of the types of medications prescribed by RN prescribers.

scholarly journals Modeling the Costs of Hospital-Acquired Infections in New Zealand

2003 ◽  
Vol 24 (3) ◽  
pp. 214-223 ◽  
Author(s):  
Nicholas Graves ◽  
Tanya M. Nicholls ◽  
Arthur J. Morris
Keyword(s):  
New Zealand ◽  
Economic Cost ◽  
Cost Effective ◽  
Sensitivity Analyses ◽  
Primary Data ◽  
Health Board ◽  
District Health ◽  
Hospital Acquired Infections ◽  
Input Variables ◽  
Hospital Acquired

AbstractObjective:To model the economic costs of hospital-acquired infections (HAIs) in New Zealand, by type of HAI.Design:Monte Carlo simulation model.Setting:Auckland District Health Board Hospitals (DHBH), the largest publicly funded hospital group in New Zealand supplying secondary and tertiary services. Costs are also estimated for predicted HAIs in admissions to all hospitals in New Zealand.Patients:All adults admitted to general medical and general surgical services.Method:Data on the number of cases of HAI were combined with data on the estimated prolongation of hospital stay due to HAI to produce an estimate of the number of bed days attributable to HAI. A cost per bed day value was applied to provide an estimate of the economic cost. Costs were estimated for predicted infections of the urinary tract, surgical wounds, the lower and upper respiratory tracts, the bloodstream, and other sites, and for cases of multiple sites of infection. Sensitivity analyses were undertaken for input variables.Results:The estimated costs of predicted HAIs in medical and surgical admissions to Auckland DHBH were $10.12 (US $4.56) million and $8.64 (US $3.90) million, respectively. They were $51.35 (US $23.16) million and $85.26 (US $38.47) million, respectively, for medical and surgical admissions to all hospitals in New Zealand.Conclusions:The method used produces results that are less precise than those of a specifically designed study using primary data collection, but has been applied at a lower cost. The estimated cost of HAIs is substantial, but only a proportion of infections can be avoided. Further work is required to identify the most cost-effective strategies for the prevention of HAI.

scholarly journals Understanding and evaluating new models of Child and Adolescent Mental Health Services in South-East England: a study protocol for an observational mixed-methods study

BMJ Open ◽  
2018 ◽  
Vol 8 (12) ◽  
pp. e024230 ◽  
Author(s):  
Stephen Rocks ◽  
Melissa Stepney ◽  
Margaret Glogowska ◽  
Mina Fazel ◽  
Apostolos Tsiachristas
Keyword(s):  
Mental Health ◽  
Mixed Methods ◽  
Mental Health Services ◽  
Health Services ◽  
Health Outcomes ◽  
Adolescent Mental Health ◽  
Child And Adolescent ◽  
Resource Utilisation ◽  
South East England ◽  
The Impact

IntroductionIncreased demand for Child and Adolescent Mental Health Services (CAMHS), alongside concerns that services should be better commissioned to meet the needs of the most vulnerable, has contributed to a requirement to transform services to improve accessibility, quality of care and health outcomes. Following the submission of government-mandated transformation plans for CAMHS, services in England are changing in how, where and by whom they are delivered. This protocol describes the research methods to be applied to understand CAMHS transformations and evaluate the impact on the use of mental health services, patient care, satisfaction, health outcomes and health resource utilisation costs.Methods and analysisA mixed-methods approach will be taken in an observational retrospective study of CAMHS provided by a large National Health Service (NHS) mental health trust in South-East England (Oxford Health NHS Foundation Trust). Quantitative research will include descriptive analysis of routinely collected data, with difference-in-differences analysis supplemented with propensity score matching performed to assess the impact of CAMHS transformations from 2015 onwards. An economic evaluation will be conducted from a healthcare perspective to provide commissioners with indications of value for money. Qualitative research will include observations of services and interviews with key stakeholders including CAMHS staff, service users and guardians, to help identify mechanisms leading to changes in service delivery, as well as barriers and enabling factors in this phase of transformation.Ethics and disseminationThis project has been registered with NHS Oxford Health Foundation Trust as a service evaluation. Informed consent will be sought from all stakeholders partaking in interviews according to good clinical practice. A local data sharing protocol will govern the transfer of quantitative data. Study findings will be published in professional journals for NHS managers and peer-reviewed scientific journals. They will be discussed in seminars targeting CAMHS providers, managers and commissioners and presented at scientific conferences.

scholarly journals Community Governance and Civil Society: An Examination of the Purpose, Intent and Structure of Residents' Groups in New Zealand

2021 ◽  
Author(s):  
◽  
Jarrod Coburn
Keyword(s):  
New Zealand ◽  
News Media ◽  
Local Community ◽  
Political Activity ◽  
Health Board ◽  
District Health ◽  
Community Governance ◽  
Set Up ◽  
Civil Defence ◽  
Charitable Activities

<p>Residents’ groups have been in existence in New Zealand for almost 150 years yet very little is known about them. The collection of residents’, ratepayers’ and progressive associations, community councils, neighbourhood committees and the like make up a part of the community governance sector that numbers over a thousand-strong. These groups are featured prominently in our news media, are active in local government affairs and expend many thousands of volunteer hours every year in their work in communities… but what exactly is that work? From the literature we see these groups can be a source of local community knowledge (Kass et al., 2009), a platform for political activity (Deegan, 2002), critical of government (Fullerton, 2005) or help maintain government transparency and accountability (Mcclymont and O'Hare, 2008). They are sometimes part of the establishment too (Wai, 2008) and are often heard promoting the interests of local people (Slater, 2004). Residents’ groups can be set up to represent the interests of a specific demographic group (Seng, 2007) or focus on protecting or promoting a sense of place (Kushner and Siegel, 2003) or physical environment (Savova, 2009). Some groups undertake charitable activities (Turkstra, 2008) or even act in a negative manner that can impact on the community (Horton, 1996). This research examines 582 New Zealand organisations to derive a set of purposes that residents’ groups perform and ascertains how their purposes differ between geo-social and political locality and over three distinct eras of community development. The thesis also examines the relationship between residents’ groups and councillors, council officers, district health board members and civil defence and seeks to uncover if the level of engagement (if any) has an affect on their overall raison d’etre. The research concludes with a typology of New Zealand residents’ groups along with the key purposes of each type.</p>

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