Kathy Heathcote - Academia.edu (original) (raw)

Papers by Kathy Heathcote

Focus on Health Professional Education A Multi-Professional Journal, Jun 28, 2024

Research Square (Research Square), Aug 6, 2021

Background: Survival rates following major trauma are increasing. Understanding the longitudinal ... more Background: Survival rates following major trauma are increasing. Understanding the longitudinal outcomes of major trauma can promote successful recovery. A novel, hospital-led telephone follow-up program was implemented by a multidisciplinary clinical trauma service team at a Level I trauma centre. This evaluation was conducted to examine what factors promoted or impeded the program's implementation. Methods: A prospective mixed methods process evaluation was conducted alongside the implementation of the follow up program. Quantitative and qualitative data were collected across the evaluation domains: reach, dose, delity, context and sustainability and clinical data of program participants (patients); semi-structured interviews with staff delivering the program and patients and caregivers who had participated in the program and direct observations (by researchers) of the program delivery and data Descriptive statistics and thematic analysis were applied to quantitative and qualitative data respectively. Results: 274 major trauma patients (ISS ≥ 12) were eligible for follow up. A response rate of over 75% was achieved at both follow-up timepoints, with nurses responsible for the majority of calls. Limited time and competing clinical demands were identi ed as barriers to the timely completion of the calls, although over 75% of calls were completed within the designated timeframe. Staff and patients valued the pre-existing trauma service/patient relationship, and this facilitated program implementation. Clinicians were motivated to evaluate their patient's recovery, whilst patients felt 'cared for' and 'not forgotten' post-hospital discharge. Teamwork and leadership were highly valued by the clinical staff throughout the implementation period as ongoing source of motivation and support. Although primarily designed as a data collection activity, staff spontaneously developed the program to incorporate clinical follow up processes by providing guidance, advice and referrals to patients who indicated ongoing issues such as pain or emotional problems. Conclusion: Telephone follow up within a clinical trauma service team is feasible, accepted by staff and valued by patients and families. Despite time constraints, the successful implementation of this program is reliant on existing clinical/patient relationships, staff teamwork and leadership support. Background: Traumatic Injury is a signi cant global healthcare issue, accounting for 4.4 million deaths annually, or 9% of the global mortality [1]. Within Australia, injury related deaths amount to 13,000 per year, or 8.5% of all deaths nationally [2]. Whilst mortality rates remain high, advances in trauma systems such as specialised prehospital care and tertiary trauma centres have assisted in reducing both out of hospital and in-hospital trauma related mortality by up to 25% [3, 4]. This has led to increased rates of trauma survival which is evident from reports of increased hospitalisations rates in the decade up to 2018 [2]. As more people survive major trauma and are discharged back into the community, their ability to re-integrate into society is of paramount importance. Hence, trauma outcome research has become increasingly focused on long term community-based outcomes. Research shows that survivors of major trauma often experience physical and psychological sequela that adversely affects many aspects of their everyday life [5]. Understanding long term outcomes such as return to work, functional and psychological outcomes can promote a successful recovery and inform and guide the development of trauma health care policy, at both local and national levels. Evaluating the longitudinal impact of major trauma is challenging due to the heterogeneous nature and severity of injuries. For these reasons, standard quality of life (QoL) measurements such as the EQ-5D-5L [6] and WHO Disability Assessment Schedule (WHODAS) 2.0 [7] are often used to compare psychosocial outcomes across different populations and can also facilitate economic evaluations of healthcare interventions. Follow-up rates of trauma patients after hospital discharge are variable, and reportedly range from 31% up to 79% [8-11]. Within Australia, the Victorian State Trauma Outcomes Registry and Monitoring (VSTORM) program [12] has been successfully following up trauma patients at 6, 12 and 24 months after injury since 2001. This program is funded by the Transport Accident Commission Health Research and operated from Monash University. The program's data has informed service provision and development and aims to reduce mortality and morbidity from major trauma [13]. To date, the follow up of major trauma patients has been observational in design and primarily conducted for research purposes. However, a followup program that is implemented by a clinical multidisciplinary team who cared for the trauma patient during their admission is unique. More importantly, a follow up program designed and led by clinicians can provide unique insight to the patients' circumstances and enable research and evaluation of a wide range of factors that promote or impede their recovery.

Disability and Rehabilitation, Jun 22, 2018

Objective: To synthesize evidence of the effectiveness of socio-ecological resilience rehabilitat... more Objective: To synthesize evidence of the effectiveness of socio-ecological resilience rehabilitation programs on returning to work (RTW), self-efficacy, and stress mitigation following traumatic physical injuries. Methods: PubMed, Scopus, Proquest, Cinahl, Web of Science, Clinical Trials Database, and the Cochrane Central Register of Controlled Trials databases were searched. Methodological quality was assessed using the PEDro tool. Study selection: Randomized interventions aimed at promoting resilience. Data extraction: Twenty one studies were reviewed (11,904 participants). Data from 19 studies of high methodological quality were pooled using a random-effects meta-analysis. Mean differences for continuous outcomes and risk ratios for binary outcomes were calculated. Data synthesis: Resilience rehabilitation programs significantly increased the likelihood of ever RTW (OR 2.09, 95% CI 0.99-4.44, p ¼ 0.05), decreased the number of days taken to return to work (mean difference-7.80, 95% CI-13.16 to-2.45, p 0.001), and increased total self-efficacy scores (mean difference 5.19, 95% CI 3.12-7.26, p < 0.001). Subgroup analyses found that favorable return to work outcomes resulted from programs involving workplace support (p < 0.001) and for people with musculoskeletal or orthopedic injuries (p ¼ 0.02). Conclusions: Compared to rehabilitation programs providing standard care following injuries, programs aimed at developing resilience could improve reemployment outcomes and self-efficacy. ä IMPLICATIONS FOR REHABILITATION Individual resilience may be an important factor promoting functional recovery after traumatic injury. Resilience rehabilitation programs are effective in enabling patients' return to work and increasing their self efficacy. In particular, programs involving the workplace are important components for enabling optimal work participation outcomes.

Background Injury mortality rates have declined in many countries largely because of the developm... more Background Injury mortality rates have declined in many countries largely because of the development of sophisticated Trauma and injury prevention systems and improved patient care. However the morbidity following severe traumatic physical injury is increasingly recognized as an important public health matter. Little is known about injury recovery patterns and associated causes once patients are discharged home to their communities. Here, prevention activities are targeted at the secondary and tertiary levels in community settings, aiming to reduce or eliminate impairment and disability, minimize suffering and pain, and maximize quality of life for irremediable conditions. Studies show that factors in patients’ socio-ecological environments contribute to poor outcomes. Socioeconomic disadvantage, blue collar jobs, and low levels of family, social and community support frequently appear as significant covariates in inception cohort studies of trauma patients. The socio-ecological model is a well-recognized framework for activating prevention strategies. For trauma patients their ‘eco-system’ incorporates resilient and healthy caregivers and families, supportive social networks and community and rehabilitation services. It also encompasses a neighborhood, defined by economic, social and physical properties that provide access to resources, enabling trauma recovery. Variations in individuals’ resilience and in their resilient resources might explain why some people experience better outcomes compared to others, after suffering the same type of adversity. Resilience is rapidly becoming a factor of interest in trauma rehabilitation. It is a positive, protective quality, amenable to interventions, and bolstered by social and environmental factors. Resilience promotion, in rehabilitation could potentially, support people and families exposed to severe trauma. The over-arching aim of this thesis is to develop a program of research that investigated ‘resilience’ as part of the trauma patients’ socio-ecological system. Firstly, resilience at the community level was examined by synthesizing the research evidence of the effectiveness of socio-ecological resilience rehabilitation programs on the outcomes of people sustaining traumatic physical injuries. Secondly, a form of ‘neighborhood’ resilience characterized by the physical, social and economic aspects of patient’s neighborhoods were analysed in relation to rurality and short-term patient outcomes. And finally, resilience was examined in a cohort of primary informal caregivers of patients sustaining severe traumatic musculoskeletal injuries Methods A systematic review was conducted to identify the effectiveness of multifaceted community socio-ecological rehabilitation programs aimed at fostering resilience. Twenty-one studies were retrieved and reviewed (11,904 participants). The results of 19 randomised intervention studies of moderate to high methodological quality were then pooled using a random-effects meta-analysis. Mean differences for continuous outcomes and risk ratios for outcomes including return to work (RTW), self efficacy and stress reduction were calculated. To examine the influence of factors characterizing neighborhood resilience on trauma patients’ outcomes, data were accessed from the Gold Coast University Hospital Trauma Registry. A cross-sectional study design was employed, and geocoding methods enabled the creation of two area-level explanatory variables describing relative Socioeconomic Disadvantage, and remoteness from services. These variables were linked to individual patients represented on the Trauma Registry, along with data items including age, injury severity, anatomical region, discharge disposition, number of comorbidities, injury mechanism, postcode of injury occurrence, and the first provider of care. From this study sample, the association of these two neighborhood indices with inpatient outcomes was analysed using a retrospective cohort design. Outcome variables were acute length of stay days (ALSD) and inpatient mortality. Step-wise multivariable negative binomial regression and proportional hazards regression analyses were conducted, adjusting for age, injury severity, mechanism and comorbidity and sites of injury. Finally, a prospective cohort study was designed to examine resilience in primary, informal caregivers of severe musculoskeletal trauma patients. Patient and caregiver dyads were recruited, shortly after the injury event and followed up three months later. Resilience was measured, using the Connor Davidson resilience scale (CD-RISC 10). Primary outcomes were caregiver burden and quality of life measured respectively, using the Caregiver Strain Index and the Short Form Version 12 (SF-12) Health Survey. Results Resilience based community rehabilitation: Resilience rehabilitation programs significantly increased the likelihood of RTW (OR 2.09 95% CI 0.99-4.44 p=0.05), decreased the time taken to RTW (Mean difference…

Hospital practice, Mar 17, 2022

Magnolia Cardona: Twitter-@endoflifeAUS Transparency statements Declaration of funding There is n... more Magnolia Cardona: Twitter-@endoflifeAUS Transparency statements Declaration of funding There is no funding associated with this study. All authors undertook the project as part of their role within the health service or in an 'in-kind' capacity. Disclosure of any financial/other conflicts of interest The authors have no relevant conflicts of interest to disclose. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose. Data availability statement Data used in this analysis has been reported in tables and figures. Ethics precludes external sharing of raw data even if de-identified, but the corresponding author can be contacted for further queries on processed data.

Australian and New Zealand Journal of Psychiatry, Aug 1, 2006

Objectives: To estimate the incidence of mental disorders in a cohort of previously symptom-free ... more Objectives: To estimate the incidence of mental disorders in a cohort of previously symptom-free individuals who are representatives of a regional Australian population. To map changing patterns of diagnosis and comorbidity within the cohort over a 2 year period. Method: Two year follow-up of a community-based cohort drawn from a telephone screening of 9191 randomly selected adults. Subjects were administered a comprehensive face-to-face interview which included the Composite International Diagnostic Interview. A total of 1407 subjects were interviewed at baseline, and 968 subjects were reinterviewed (a 68.8% follow-up rate). Results: There was considerable change in disorder status over the study period, and analysis of the Composite International Diagnostic Interview scoring suggests that these changes reflected real changes in symptomatology. Of subjects interviewed at both baseline and follow-up, 638 were classified as disorder-free at their entry to the study. After 2 years, 98 of these met criteria for a mental disorder during the preceding 12 months. After adjusting for sampling and gender, the 12 month incidence of any mental disorder among subjects who had been disorder-free 2 years previously was 9.95 per hundred person-years at risk. At baseline, a further 330 subjects met ICD-10 criteria for a mental disorder during the previous 12 months. Two years later, 167 of these subjects (50.6%) were disorder-free, and 163 still met the criteria for a mental disorder, although there had often been considerable change in their diagnosis. Subjects with a mental disorder at the commencement of the study were significantly more likely than those without a disorder to have a positive diagnosis 2 years later (p &amp;amp;lt; 0.001). The number of diagnoses at baseline was a strong predictor of the number of diagnoses at follow-up (p &amp;amp;lt; 0.001), and each additional comorbid diagnosis at baseline also increased the probability of a persisting disorder at follow-up (p &amp;amp;lt; 0.001). Conclusions: Over a 2 year period, the majority of subjects with a mental disorder will become disorder-free, while a significant number of previously disorder-free individuals will develop a positive diagnosis. Health services need to be designed to meet this labile demand.

Australasian Journal on Ageing, Jul 5, 2011

Injury, 2022

INTRODUCTION In Australia, people living in rural areas, compared to major cities are at greater ... more INTRODUCTION In Australia, people living in rural areas, compared to major cities are at greater risk of poor health. There is much evidence of preventable disparities in trauma outcomes, however research quantifying geographic variations in injuries, pathways to specialised care and patient outcomes is scarce. AIMS (i) To analyse the Australia New Zealand Trauma Registry (ATR) data and report patterns of serious injuries according to rurality of the injury location ii) to examine the relationship between rurality and hospital mortality and iii) to compare ATR death rates with all deaths from similar causes, Australia-wide. METHOD A retrospective cohort study of patients in the ATR from 1st July 2015 to 30th June 2019 was conducted. Descriptive analyses of trauma variables according to rurality was performed. Logistic regression quantified the moderating effect of rurality on trauma variables and hospital mortality. Australian death data on similar injuries were sourced to quantify the additional mortality attributable to severe injury occurring outside Major Trauma Centres (MTCs). RESULTS Compared to major cities, rural patients were younger, more likely to have spinal cord injuries, and sustain traffic-related injuries that are 'off road'. Injuries occurring outside people's homes are more likely. Mortality risk was greater for patients sustaining severe traumatic brain injury (TBI) spinal cord injury (SCI) and head trauma in addition to intentional injuries. Compared to the ATR data, Australian population-wide trauma mortality rates showed diverging trends according to rurality. The ATR only captures 14.1% of all injury deaths occurring in major cities and, respectively, 6.3% and 3.2% of deaths in regional and remote areas. CONCLUSION Compared to major cities, injuries occurring in rural areas of Australia often involve different mechanisms and result in different types of severe injuries. Patients with neurotrauma and intentional injuries who survived to receive definitive care at a MTC were at higher risk of hospital death. To inform prevention strategies and reduce morbidity and mortality associated with rural trauma, improvements to data systems are required that involve data linkage and include information about patient care from pre-hospital providers, regional hospitals and major trauma centres.

Frequent hospital admission of older people with ectional survey with Conclusions: This study pro... more Frequent hospital admission of older people with ectional survey with Conclusions: This study provides a detailed description of older patients with multiple chronic conditions and a Longman et al. BMC Health Services Research 2012, 12:373

International Journal of Environmental Research and Public Health, 2020

Ambient fine particulate matter <2.5 µm (PM2.5) air pollution increases premature mortality gl... more Ambient fine particulate matter <2.5 µm (PM2.5) air pollution increases premature mortality globally. Some PM2.5 is natural, but anthropogenic PM2.5 is comparatively avoidable. We determined the impact of long-term exposures to the anthropogenic PM component on mortality in Australia. PM2.5-attributable deaths were calculated for all Australian Statistical Area 2 (SA2; n = 2310) regions. All-cause death rates from Australian mortality and population databases were combined with annual anthropogenic PM2.5 exposures for the years 2006–2016. Relative risk estimates were derived from the literature. Population-weighted average PM2.5 concentrations were estimated in each SA2 using a satellite and land use regression model for Australia. PM2.5-attributable mortality was calculated using a health-impact assessment methodology with life tables and all-cause death rates. The changes in life expectancy (LE) from birth, years of life lost (YLL), and economic cost of lost life years were cal...

The Journal of Rural Health, 2019

Purpose: Socioecological factors are understudied in relation to trauma patients' outcomes. This ... more Purpose: Socioecological factors are understudied in relation to trauma patients' outcomes. This study investigated the association of neighborhood socioeconomic disadvantage (SED) and remoteness of residence on acute length of hospital stay days (ALSD) and inpatient mortality. Methods: A retrospective cohort study was conducted on adults hospitalized for major trauma in a Level 1 trauma center in southeast Queensland from 2014 to 2017. Neighborhood SED and remoteness indices were linked to individual patient variables. Step-wise multivariable negative binomial regression and proportional hazards regression analyses were undertaken, adjusting for injury and patient factors. Outcomes were ALSD and inpatient mortality. Findings: We analyzed 1,025 patients. Statistically significant increased hazard of inpatient mortality was found for older age (HR 3.53, 95% CI: 1.77-7.11), injury severity (HR 5.27, 95% CI: 2.78-10.02), remoteness of injury location (HR 1.75, 95% CI: 1.06-2.09), and mechanisms related to intentional self-harm or assault (HR 2.72, 95% CI: 1.48-5.03,). Excess mortality risk was apparent for rural patients sustaining less severe injuries (HR 4.20, 95% CI: 1.35-13.10). Increased risk for longer ALSD was evident for older age (

Disability and Rehabilitation, 2019

Aims: This study investigated the association of resilience on caregiver burden and quality of li... more Aims: This study investigated the association of resilience on caregiver burden and quality of life in informal caregivers of patients with severe traumatic musculoskeletal injuries. Methods: A prospective cohort study of eligible caregivers and acutely injured trauma patients was conducted during 2018 in South East Queensland, with follow-up 3 months after patient discharge. Resilience was examined using the 10-item Connor Davidson Resilience Scale. The primary outcomes, caregiver burden and quality of life were measured respectively, using the Caregiver Strain Index and the Short Form Version 12 Health Survey. Results: Baseline measures were completed with fifty-three (77%) patient/carer dyads. Thirty-eight (28%) were available for follow up at 3 months. Significant reductions from baseline were found at follow up, for levels of resilience, mental health, physical exercise and community support. In multiple regression models, caregiver resilience at follow-up independently predicted lower caregiver burden (b ¼ À0.74, p ¼ 0.008) and higher levels of patient physical health and function (b ¼ À0.69, p ¼ 0.003). Conclusions: Upon commencing informal care, caregivers' resilience, mental health and support systems are adversely affected. Higher levels of caregiver resilience appear to be protective against caregiver burden and declines in patient physical function. Early evaluation of caregivers' resilience, their physical and mental health and socio-ecological networks could improve carer and patient health outcomes. ä IMPLICATIONS FOR REHABILITATION After 3 months of providing informal care to severely injured musculoskeletal trauma patients, there are apparent declines in their mental health, resilience, community support and physical activity levels. However, those with higher levels of resilience compared to lower levels could be protected against caregiver burden. Higher caregiver resilience could also prevent declines in patients' physical function. The rehabilitation of severe trauma patients should additionally include routine assessment and management of informal caregivers with the aim to prevent caregiver burden. Early clinical assessment of caregiver resilience using a valid resilience measurement tool could identify caregivers at risk of caregiver burden and flag vulnerable caregivers for ongoing support in the community. Early assessment of caregivers' physical and mental health and health related behaviours could flag the need for health promotion interventions aimed at supporting caregivers' physical and mental health.

Disability and rehabilitation, Jan 22, 2018

To synthesize evidence of the effectiveness of socio-ecological resilience rehabilitation program... more To synthesize evidence of the effectiveness of socio-ecological resilience rehabilitation programs on returning to work (RTW), self-efficacy, and stress mitigation following traumatic physical injuries. PubMed, Scopus, Proquest, Cinahl, Web of Science, Clinical Trials Database, and the Cochrane Central Register of Controlled Trials databases were searched. Methodological quality was assessed using the PEDro tool. Randomized interventions aimed at promoting resilience. Twenty one studies were reviewed (11,904 participants). Data from 19 studies of high methodological quality were pooled using a random-effects meta-analysis. Mean differences for continuous outcomes and risk ratios for binary outcomes were calculated. Resilience rehabilitation programs significantly increased the likelihood of ever RTW (OR 2.09, 95% CI 0.99-4.44, p = 0.05), decreased the number of days taken to return to work (mean difference -7.80, 95% CI -13.16 to -2.45, p ≤ 0.001), and increased total self-efficacy ...

Cancer Forum, 2007

Cancer in Australia is largely a positive story. Despite increased incidence rates, which reflect... more Cancer in Australia is largely a positive story. Despite increased incidence rates, which reflect an ageing population, the corresponding falling age-adjusted death rates and better survival suggest a health system well-equipped for early detection and treatment of cancer. However, there are inequalities in cancer survival among people in rural, regional and remote areas of Australia and disparities in cancer treatment, particularly in respect to colorectal, lung and breast cancer, are probably partly responsible. Other factors closely aligned with cancer risk and poorer survival in regional and remote Australia include: greater levels of socio-economic disadvantage, limited access to specialist cancer treatment services and a greater proportion of Indigenous people who have their cancers diagnosed at more advanced stages and may receive poorer treatment. In the absence of more complete data, the survival pattern we see in remote parts of Australia probably represents the cancer experience of Indigenous Australians. Questions about the ways in which all of these factors collectively explain the survival picture in Australia will remain unanswered, unless we enrich our data sources, enhance cancer surveillance and work to better understand how the health system responds to the needs of different population subgroups, in particular our Indigenous people.

BMC Health Services Research, 2012

Background: The continued increase in hospital admissions is a significant and complex issue faci... more Background: The continued increase in hospital admissions is a significant and complex issue facing health services. There is little research exploring patient perspectives or examining individual admissions among patients with frequent admissions for chronic ambulatory care sensitive (ACS) conditions. This paper aims to describe characteristics of older, rural patients frequently admitted with ACS conditions and identify factors associated with their admissions from the patient perspective. Methods: Patients aged 65+ resident in North Coast NSW with three or more admissions for selected ACS chronic conditions within a 12 month period, were invited to participate in a postal survey and follow up telephone call. Survey and telephone data were linked to admission and health service program data. Descriptive statistics were generated for survey respondents; logistic regression models developed to compare characteristics of patients with 3 or with 4+ admissions; and comparisons made between survey respondents and non-respondents. Results: Survey respondents (n=102) had a mean age of 77.1 years (range 66-95 years), and a mean of 4.1 admissions within 12 months; 49% had at least three chronic conditions; the majority had low socioeconomic status; one in five (22%) reported some difficulty affording their medication; and 35% lived alone. The majority reported psychological distress with 31% having moderate or severe psychological distress. While all had a GP, only 38% reported having a written GP care plan. 22% of those who needed regular help with daily tasks did not have a close friend or relative who regularly cared for them. Factors independently associated with more frequent (n=4+) relative to less frequent (n=3) admissions included having congestive heart failure (p=0.003), higher social isolation scores (p=0.040) and higher Charlson Comorbidity Index scores (p=0.049). Most respondents (61%) felt there was nothing that could have avoided their most recent admission, although some potential avoidability of admission was described around medication and health behaviours. Respondents were younger and less sick than non-respondents. Conclusions: This study provides a detailed description of older patients with multiple chronic conditions and a history of frequent admission in rural Australia. Our results suggest that programs targeting medication use, health behaviours and social isolation may help reduce multiple hospital admissions for chronic disease.

BMC Health Services Research, 2011

Background: Frequent and potentially avoidable hospital admission amongst older patients with amb... more Background: Frequent and potentially avoidable hospital admission amongst older patients with ambulatory care sensitive (ACS) chronic conditions is a major topic for research internationally, driven by the imperative to understand and therefore reduce hospital admissions. Research to date has mostly focused on analysis of routine data using ACS as a proxy for 'potentially avoidable'. There has been less research on the antecedents of frequent and/or avoidable admission from the perspectives of patients or those offering community based care and support for these patients. This study aimed to explore community based service providers' perspectives on the factors contributing to admission among older patients with chronic disease and a history of frequent and potentially avoidable admission. Methods: 15 semi-structured interviews with community based providers of health care and other services, and an emergency department physician were conducted. Summary documents were produced and thematic analysis undertaken. Results: A range of complex barriers which limit or inhibit access to services were reported. We classified these as external and internal barriers. Important external barriers included: complexity of provision of services, patients' limited awareness of different services and their inexperience in accessing services, patients needing a higher level or longer length of service than they currently have access to, or an actual lack of available services, patient poverty, rurality, and transport. Important internal barriers included: fear (of change for example), a 'stoic' attitude to life, and for some, the difficulty of accepting their changed health status. Conclusions: The factors underlying frequent and/or potentially avoidable admission are numerous and complex. Identifying strategies to improve services or interventions for this group requires understanding patient, carer and service providers' perspectives. Improving accessibility of services is also complex, and includes consideration of patients' social, emotional and psychological ability and willingness to use services as well as those services being available and easily accessed.

Australian Journal of Rural Health, 2009

Hospital Practice, 2022