CareTrack Australia is part of a National Health & Medical Research Council (NHMRC) program grant that will examine the appropriateness of the care provided in Australia, for 22 common conditions. Previous studies have demonstrated that patients receive evidence-based care for common conditions approximately half of the time , and that there is considerable variation in the care that is provided. In order to improve the situation, we need to understand who is getting what healthcare from whom, and how and why, from the perspectives of both participants and healthcare providers.
The Chief Investigators are Professor Bill Runciman of the University of South Australia and Professors Jeffrey Braithwaite, Johanna Westbrook, Enrico Coiera and Ric Day of the University of New South Wales.
The aims of the study are:
Ethical approvals have been received so far from the Hunter New England Human Research Ethic Committee (HREC), University of New South Wales HREC, SA Health HREC, ACT Health HREC, TAS Health HREC, Southern Adelaide Health Service/Flinders University HREC and the Royal Australian College of General Practitioners.
The Commonwealth Government has granted CareTrack statutory immunity under Part VC of the Health Insurance Act (1973), protecting the identities of providers and patients.
(September 2010 – March 2011)
This involves the selection and ratification of clinical indicators for the care processes of 22 common conditions that are national health priority areas and account for the majority of the current burden of disease in Australia . The indicators are based on previous work conducted in America  and have been updated with recent, relevant and preferably Australian guidelines, that have been ratified by panels of Australian clinical experts. Tools required for collecting data, training surveyors and conducting health care interviews have also been developed.
(April 2011 – July 2011)
This involves recruiting a representative sample of the Australian population and obtaining a list of their healthcare conditions and providers. Participant information sheets will be forwarded to persons interested in participating and they are requested to provide consent to access their health and Medicare records.
(September 2010 – July 2011)
This involves contacting the relevant healthcare facilities or practices, providing information about CareTrack, recruiting, training and accrediting CareTrack surveyors, and gaining State-wide and site-specific ethics approvals.
(July 2011 – December 2011)
A two-year retrospective medical record audit, for the period inclusive of 2009 – 2010 will be conducted. CareTrack surveyors will assess the medical records for concordance with the clinical indicators, for each of the conditions that the participant has identified.
(January 2012 - March 2012)
Selected participants will be interviewed by a UNISA researcher. The semi-structured interviews will focus on selected modules of care relevant to that participant with discussion about their knowledge, attitudes and beliefs about their healthcare and its management, and about problems encountered.
(January 2012 – March 2012)
Selected, consenting healthcare providers will be interviewed by a researcher (on the telephone) blinded to the identity of the healthcare provider. The semi-structured interview will focus on one condition and will probe why the relevant modules of care were handled as they were.
(March 2012 – June 2012)
Results will be analysed and reports and manuscripts for publication will be prepared. De-identified results with recommendations for strategies to improve the appropriateness of care will be disseminated.
The Hunter Valley Research Foundation (HVRF) is a non-profit organization which was established in 1956. The Foundation is a leader in regional social, health and economic research and has a considerable history of experience in the collection of information using mail, face to face and telephone techniques.
The HVRF regularly conducts population based data collection for clients and for internal projects. The HVRF focus on rigorous data collection methodology is complemented by our own expertise in study design, data analysis and research writing. Our interviewers are regularly briefed on issues which affect the quality of collected data, including random sampling, potential bias and interviewing techniques to encourage participation. Our open door policy ensures that the client has unrestricted access to all HVRF staff.
The 22 conditions that will be examined are:
Evidence based care is the practice of medicine in which the physician finds, assesses, and implements methods of diagnosis and treatment on the basis of the best available current research, their clinical expertise, and the needs and preferences of the patient . The percentage of eligible healthcare encounters at which relevant care was received will be assessed by compliance or otherwise with indicators.
Participants - We have chosen to talk about “participants” rather than patients, clients, consumers or citizens.
Conditions - The term ‘conditions’ includes acute (eg. myocardial infarction) and chronic (eg. diabetes) conditions and clinical circumstances (eg. Surgical site infection). Indicators will be with respect to processes for prevention (eg. mammogram), monitoring (eg. blood pressure, lipids) or treatment (eg. aspirin, statins).
Healthcare providers (target) - The term “healthcare providers” embraces doctors, nurses, physiotherapists, occupational therapists and chiropractors.
Surveyor - A surveyor will be a person with appropriate clinical and audit experience who has been trained and accredited as a CareTrack Surveyor.
Recruitment - The study will recruit around 1,000 participants. Sample size calculations have shown that a minimum n= 57 per indicator (CI 10%, power 90%) will be required. This will be done by the Hunter Valley Research Foundation (HVRF) using their Computer-Aided Telephone Interviewing system. HVRF has a research team with extensive experience in this type of work.
Data scoring and analysis will follow a previously published method of McGlynn et al . Participants will be eligible for each of the conditions based on a combination of variables. Not all indicators will be ‘eligible’ on a particular healthcare encounter. For each of the indicators, the participant will either have received or not received the care. Each indicator will be scored at three levels – that of an individual participant, that of the episode, and that of the patient-healthcare provider dyad. The level at which an indicator will be scored affects the number of times a participant will be eligible for the specified process, the resulting number will be the denominator in the calculation of the aggregate score. Summary level results will be reported on the proportion of care that was in concordance with the indicators for each eligible module of care.
1. McGlynn EA, Asch SM, Adams J, Keesey J, Hicks J, DeCristofaro A, Kerr EA: The quality of health care delivered to adults in the United States. N Engl J Med 2003, 348(26):2635-2645.
2. National Health Priority Action Council: National Chronic Disease Strategy. Australian Government Department of Health and Ageing 2006, Canberra.
3. Mosby's Medical Dictionary, 8th edition. © 2009, Elsevier. http://medical-dictionary.thefreedictionary.com/Evidence-based+health+care. Accessed online February 2011.
Hunter Valley Research Foundation
Toll free 1800 355 534
Project Manager: Tamara Hunt
Phone: (08) 8302 1004