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OBJECTIVE: To describe changes in palliative care characteristics, utilisation and outcomes in Victoria during a period of enhanced public health management and a prolonged lockdown due to coronavirus disease 2019. METHODS: A national retrospective cohort study with palliative care service setting comparisons in Victoria and other mainland states was conducted. RESULTS: Analysis of 48 non-Victorian services (n=53,428 patients) and 20 Victorian services (n=31,125 patients) showed that for community services, patient volume, average length of stay, functional dependency and the proportion of admissions in a deteriorating phase increased during the lockdown in Victoria, yet little changed in comparator states. Regarding inpatient services, the management of family/carer problems remained constant in comparator states, yet substantial fluctuations in outcomes in Victoria were observed. CONCLUSIONS: As health systems adapt to changing circumstances during the pandemic, the ability to upscale community services is critical. Addressing the implications of shifting inpatient care to the community needs attention. IMPLICATIONS FOR PUBLIC HEALTH: Our study highlights the need to ensure community care providers are adequately considered within public health management responses. 'Joined up' policy and implementation across care settings are essential, especially as major barriers to infection control and increased utilisation may be evident in the community during the coronavirus disease 2019 pandemic.

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The Illawarra Coordinated Care Trial was one of nine Australian trials undertaken to see whether different models of coordinated care could improve the health of people with multiple service needs within existing resources. This paper summarises the findings of an extensive local evaluation and discusses the impact of the trial on clients and service providers. It examines the main findings related to the principal trial hypothesis and points to lessons that might inform the next round of trials.

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OBJECTIVE: To investigate whether the Australian National Sub-acute and Non-acute Patient Casemix Classification (SNAP) and Functional Independence Measure and Functional Related Group (Version 2) (FIM-FRG2) casemix systems can be used to predict functional outcome, and reduce the variance of length of stay (LOS) of patients undergoing rehabilitation after strokes. DESIGN AND SETTING: The study comprised a retrospective analysis of the records of patients admitted to the Cedar Court Healthsouth Rehabilitation Hospital for rehabilitation after stroke. SUBJECTS: The sample included 547 patients (83.3% of those admitted with stroke during this period). Patient data were stratified for analysis into the five SNAP or nine FIM-FRG2 groups, on the basis of the admission FIM scores and age. MAIN OUTCOMES: The AN-SNAP classification accounted for a 30.7% reduction of the variance of LOS, and 44.2% of motor FIM, and the FIM-FRG2 accounts for 33.5% and 56.4% reduction respectively. Comparison of the Cedar Court with the national AN-SNAP data showed differences in the LOS and functional outcomes of older, severely disabled patients. Intensive rehabilitation in selected patients of this type appears to have positive effects, albeit with a slightly longer period of inpatient rehabilitation. CONCLUSIONS: Casemix classifications can be powerful management tools. Although FIM-FRG2 accounts for more reduction in variance than SNAP, division into nine groups meant that some contained few subjects. This paper supports the introduction of AN-SNAP as the standard casemix tool for rehabilitation in Australia, which will hopefully lead to rational, adequate funding of the rehabilitation phase of care.

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The Australian National Sub-Acute and Non-Acute Patient (AN-SNAP) Version 1 casemix classification was completed in 1997. AN-SNAP is designed for the classification of sub-acute and non-acute care provided in both inpatient and ambulatory settings and is intended to be useful for both funding and clinical management purposes. The National Sub-Acute and Non-Acute Casemix Classification study has produced the first version of a national classification of sub-acute and non-acute care. Ongoing refinement (leading to Version 2) will be possible through further analysis of the existing data set in combination with analysis of the results of a carefully planned and phased implementation.

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The costs of subacute care (palliative care, rehabilitation medicine, psychogeriatrics, and geriatric evaluation and management) and non-acute care (nursing home, convalescent and planned respite care) are not adequately described by existing casemix classifications. The predominant treatment goals in subacute care are enhancement of quality of life and/or improvement in functional status and, in non-acute care, maintenance of current health and functional status. A national classification system for this area has now been developed--the Australian National Sub-Acute and Non-Acute Patient Classification System (AN-SNAP). The AN-SNAP system, based on analysis of over 30,000 episodes of care, defines four case types of subacute care (palliative care, rehabilitation, psychogeriatric care, and geriatric evaluation and management and one case type of non-acute care (maintenance care), and classifies both overnight and ambulatory care. The AN-SNAP system reflects the goal of management--a change in functional status or improvement in quality of life--rather than the patient's diagnosis. It will complement the existing AN-DRG classification.

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This is the first study in Australia to test definitions of various types of 'episodes of care'. The definitions reported here are those used in the 1996 National Sub-Acute and Non-Acute Patient (SNAP) Casemix Classification Study. The study collected data on a total of 683 patients at 10 hospitals and 2 community health services providing a range of rehabilitation, aged care and community care services. The kappa statistic (kappa) was used to determine the significance of the level of agreement between raters. The value of kappa was 0.838 with a 95 per cent confidence interval of 0.801 to 0.975. The results of this study are encouraging and support the use of the five Case Types - Palliative Care, Rehabilitation, Psychogeriatric, Geriatric Evaluation and Management, and Maintenance Care. All five Case Types proved to have good interrater reliability, there was a good fit for most patients, and staff found the definitions easy to use.

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In 1994 the New South Wales Casemix Area Network initiated a study to develop a classification and funding model for sub-acute and non-acute care. Thirty-five rehabilitation, geriatric, psychogeriatric and palliative care services were recruited into the study throughout eight area health services. The aim of the first phase, summarised here, was to capture and analyse a sufficiently large quantity of data to select those variables most likely to predict resource utilisation, for subsequent use in a detailed costing study. It is known that acute care diagnosis related groups are not predictive of costs in sub-acute care. This phase of the project confirmed that, in New South Wales, the most predictive variables were case type, functional status measures, impairment type for rehabilitation, phase for palliative care and severity of symptoms for palliative care. The resultant Phase 1 casemix classification, which has built on recent United States experience and studies in other Australian States, has been termed the New South Wales Sub-Acute and Non-Acute Patient (SNAP) Version 1 classification.

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The Illawarra Area Health Service has been experimenting with use of computerised nursing care plans. Microcomputer software has been successfully tested in several wards and the intention is to move to implementation which will probably involve porting the software to the area-wide mainframe. The technology was recently extended to multidisciplinary care planning using the managed care/critical pathways approach. This paper describes the development process and some of the initial results.

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