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Abstract
Introduction In recent years in keeping with international best practice, clinical guidelines for common conditions have been developed, endorsed and disseminated by peak national and professional bodies. Yet evidence suggests that there remain considerable gaps between the care that is regarded as appropriate by such guidelines and the care received by patients. With an ageing population and increasing treatment options and expectations, healthcare is likely to become unaffordable unless more appropriate care is provided. This paper describes a study protocol that seeks to determine the percentage of healthcare encounters in which patients receive appropriate care for 22 common clinical conditions and the reasons why variations exist from the perspectives of both patients and providers.
Methods/design A random stratified sample of at least 1000 eligible participants will be recruited from a representative cross section of the adult Australian population. Participants' medical records from the years 2009 and 2010 will be audited to assess the appropriateness of the care received for 22 common clinical conditions by determining the percentage of healthcare encounters at which the care provided was concordant with a set of 522 indicators of care, developed for these conditions by a panel of 43 disease experts. The knowledge, attitudes and beliefs of participants and healthcare providers will be examined through interviews and questionnaires to understand the factors influencing variations in care.
Ethics and dissemination Primary ethics approvals were sought and obtained from the Hunter New England Local Health Network. The authors will submit the results of the study to a relevant journal as well as undertaking oral presentations to researchers, clinicians and policymakers.
This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.
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Footnotes
To cite: Hunt TD, Ramanathan SA, Hannaford NA, et al. CareTrack Australia: assessing the appropriateness of adult healthcare: protocol for a retrospective medical record review. BMJ Open 2012;2:e000665. doi:10.1136/bmjopen-2011-000665
Funding The study was supported by Australian National Health and Medical Research Council.
Competing interests None.
Patient consent A patient consent form was developed specifically for the study and is shown in appendix 4.
Ethics approval The study was approved by Hunter New England Local Health Network (HNE HREC Reference no: 09/12/16/5.09).
Contributors TDH, CareTrack project manager, was responsible for coordinating the project, developing and getting ethics approvals, liaising with the Hunter Valley Research Foundation (HVRF), preparing information packages and consent forms for participants and providers, managing the pilot study, indicator development, liaising with the database developers, training and accrediting surveyors, implementation of the marketing strategy and management of the budget. SAR was responsible for developing the scripts for the computer-assisted telephone interviews, for training and managing the interviewers, planning and managing the participant recruitment process, developing the sampling strategy and managing the HVRF components of the pilot study. NAH worked closely with TDH and SAR on all aspects of the project but was particularly involved in preparing information sheets, development of the surveyor training manual and indicator development and review. PDH was involved in coordinating interactions between CareTrack Australia and the other three NHMRC program grant studies, including budgeting. He also played a major role in the development and execution of the marketing strategy, developing methods for data acquisition, storage and analysis, and reviewing the sampling strategy. JB is the lead chief investigator of the overall program grant; he chairs program grant meetings and works across CareTrack and other studies in the research program. As a chief investigator of the program grant he was involved at a conceptual stage and then at monthly intervals in providing oversight and advice. He helped draft and edit the current manuscript. EC, ROD and JIW as chief investigators of the program grant were involved at a conceptual stage and then at monthly intervals in providing oversight and advice on aspects of the project as it evolved. ROD as a practicing clinician was involved in strategies for reviewer selection and indicator development as well as classification and structure of the indicators. JIW provided expertise and advice on methodology, particularly in terms of sampling and inter-rater reliability. WBR conceived of the project initially and wrote the relevant components of the research grant application. He worked closely with the other authors generating the information sheets and ethics applications and was involved in developing and executing strategies for making and monitoring progress in areas such as condition selection, indicator development and wording, CareTrack marketing, indicator classification and review and writing the manuscripts.
Provenance and peer review Not commissioned; internally peer reviewed.