Lixin Ou | The University of New South Wales (original) (raw)

Papers by Lixin Ou

Research paper thumbnail of Trends in general practice services in two cohorts of Australian children between 2003–2004  and 2010–2011

The Medical Journal of Australia, 2013

Research paper thumbnail of Trends and Variations in the Rates of Hospital Complications, Failure-to-Rescue and 30-Day Mortality in Surgical Patients in New South Wales, Australia, 2002-2009

PLoS ONE, 2014

Background: Despite the increased acceptance of failure-to-rescue (FTR) as an important patient s... more Background: Despite the increased acceptance of failure-to-rescue (FTR) as an important patient safety indicator (defined as the percentage of deaths among surgical patients with treatable complications), there has not been any large epidemiological study reporting FTR in an Australian setting nor any evaluation on its suitability as a performance indicator.

Research paper thumbnail of The impact of implementing a rapid response system: A comparison of cardiopulmonary arrests and mortality among four teaching hospitals in Australia

Resuscitation, 2014

Aims: To compare clinical outcomes between a teaching hospital with a mature rapid response syste... more Aims: To compare clinical outcomes between a teaching hospital with a mature rapid response system (RRS), with three similar teaching hospitals without a RRS in Sydney, Australia. Methods: For the period 2002-2009, we compared a teaching hospital with a mature RRS, with three similar teaching hospitals without a RRS. Two non-RRS hospitals began implementing the system in 2009 and a third in January 2010. We compared the rates of in-hospital cardiopulmonary arrest (IHCA), IHCA-related mortality, overall hospital mortality and 1-year post discharge mortality after IHCA between the RRS hospital and the non-RRS hospitals based on three separate analyses: (1) pooled analysis during 2002-2008; (2) before-after difference between 2008 and 2009; (3) after implementation in 2009. Results: During the 2002-2008 period, the mature RRS hospital had a greater than 50% lower IHCA rate, a 40% lower IHCA-related mortality, and 6% lower overall hospital mortality. Compared to 2008, in their first year of RRS (2009) two hospitals achieved a 22% reduction in IHCA rate, a 22% reduction in IHCArelated mortality and an 11% reduction in overall hospital mortality. During the same time, the mature RRS hospital showed no significant change in those outcomes but, in 2009, it still achieved a crude 20% lower IHCA rate, and a 14% lower overall hospital mortality rate. There was no significant difference in 1-year post-discharge mortality for survivors of IHCA over the study period. Conclusions: Implementation of a RRS was associated with a significant reduction in IHCA, IHCA-related mortality and overall hospital mortality.

Research paper thumbnail of Cardiopulmonary arrest and mortality trends, and their association with rapid response system expansion

The Medical Journal of Australia, 2014

Research paper thumbnail of Geographic Variation of Failure-to-Rescue in Public Acute Hospitals in New South Wales, Australia

PLoS ONE, 2014

Despite the wide acceptance of Failure-to-Rescue (FTR) as a patient safety indicator (defined as ... more Despite the wide acceptance of Failure-to-Rescue (FTR) as a patient safety indicator (defined as the deaths among surgical patients with treatable complications), no study has explored the geographic variation of FTR in a large health jurisdiction. Our study aimed to explore the spatiotemporal variations of FTR rates across New South Wales (NSW), Australia. We conducted a population-based study using all admitted surgical patients in public acute hospitals during 2002-2009 in NSW, Australia. We developed a spatiotemporal Poisson model using Integrated Nested Laplace Approximation (INLA) methods in a Bayesian framework to obtain area-specific adjusted relative risk. Local Government Area (LGA) was chosen as the areal unit. LGA-aggregated covariates included age, gender, socio-economic and remoteness index scores, distance between patient residential postcode and the treating hospital, and a quadratic time trend. We studied 4,285,494 elective surgical admissions in 82 acute public hospitals over eight years in NSW. Around 14% of patients who developed at least one of the six FTR-related complications (58,590) died during hospitalization. Of 153 LGAs, patients who lived in 31 LGAs, accommodating 48% of NSW patients at risk, were exposed to an excessive adjusted FTR risk (10% to 50%) compared to the state-average. They were mostly located in state's centre and western Sydney. Thirty LGAs with a lower adjusted FTR risk (10% to 30%), accommodating 8% of patients at risk, were mostly found in the southern parts of NSW and Sydney east and south. There were significant spatiotemporal variations of FTR rates across NSW over an eight-year span. Areas identified with significantly high and low FTR risks provide potential opportunities for policy-makers, clinicians and researchers to learn from the success or failure of adopting the best care for surgical patients and build a self-learning organisation and health system.

Research paper thumbnail of Trends and Variations in the Rates of Hospital Complications, Failure-to-Rescue and 30-Day Mortality in Surgical Patients in New South Wales, Australia, 2002-2009

PLoS ONE, 2014

Background: Despite the increased acceptance of failure-to-rescue (FTR) as an important patient s... more Background: Despite the increased acceptance of failure-to-rescue (FTR) as an important patient safety indicator (defined as the percentage of deaths among surgical patients with treatable complications), there has not been any large epidemiological study reporting FTR in an Australian setting nor any evaluation on its suitability as a performance indicator.

Research paper thumbnail of Have the Health Gaps Between Indigenous and Non-Indigenous Australian Children Changed over Time? Results from an Australian National Representative Longitudinal Study

Maternal and Child Health Journal, 2012

The purpose of this study was to evaluate the changes of health gaps between Indigenous and non-I... more The purpose of this study was to evaluate the changes of health gaps between Indigenous and non-Indigenous children over time and to explore critical factors that contribute to the changes. We employed data consisting of two cohorts of Australian children: infant (0/1 year) and children (4/5 years) that are part of the Longitudinal Study of Australian Children. Health outcomes were measured by physical outcome index (POI) and parent-rated health during 2004, 2006 and 2008. We used first-order autoregressive modelling to examine the longitudinal relationship between the changes in health outcomes and possible contributing risk factors. The results showed that the trends of POIs between Indigenous and non-Indigenous children were closing, while the gap of parentrated health between the two populations persisted. We found that health outcomes (both POI and parent-rated health) at an earlier time point (t -1) were significant predictors of the outcomes at the later time point (t). Carer's depression status, socio-economic position and neighbourhood liveability had significant and consistent impacts on parent-rated health, but had only varying impacts on POIs between Indigenous and non-Indigenous children as well as between the birth cohorts at different time periods. Similarly, low birth weight, carer's binge drinking behaviour and other risk factors showed such varying impacts at a particular time period. The study implied that appropriate interventions accompanied by monitoring of health outcomes are necessary in order to decrease the health gaps between Indigenous and non-Indigenous children.

Research paper thumbnail of How Accurate Are the Different Predictive Models in Identifying Deteriorating Patients? The ViEWS May Not Be as Clear as We First Thought*

Critical Care Medicine, 2014

Research paper thumbnail of Health services utilisation disparities between English speaking and non-English speaking background Australian infants

BMC Public Health, 2010

Background: To examine the differences in health services utilisation and the associated risk fac... more Background: To examine the differences in health services utilisation and the associated risk factors between infants from non-English speaking background (NESB) and English speaking background (ESB) within Australia.

Research paper thumbnail of A systematic review of the impact of routine collection of patient reported outcome measures on patients, providers and health organisations in an oncologic setting

BMC Health Services Research, 2013

Despite growing interest and urges by leading experts for the routine collection of patient repor... more Despite growing interest and urges by leading experts for the routine collection of patient reported outcome (PRO) measures in all general care patients, and in particular cancer patients, there has not been an updated comprehensive review of the evidence regarding the impact of adopting such a strategy on patients, service providers and organisations in an oncologic setting.

Research paper thumbnail of Discharge delay in acute care: reasons and determinants of delay in general ward patients

Australian Health Review, 2009

To identify the reasons and determinants of discharge delay in acute care patients, information a... more To identify the reasons and determinants of discharge delay in acute care patients, information associated with delayed discharge was extracted from the medical record of 1958 patients in a tertiary referral hospital in New South Wales. A logistic regression model was used to examine the association between demographic factors and reasons for discharge delay. Delayed discharge was most commonly associated with the patient's medical conditions, delayed health care or medical consultation, delayed diagnostic services and delayed allied health services. Elderly patients, those living alone and patients from a non-English-speaking background were more likely to Aust Health Rev 2009: 33(3): 513-521 have these reasons for delayed discharge.

Research paper thumbnail of Effective discharge planning - timely assignment of an estimated date of discharge

Australian Health Review, 2011

Objective. To examine the implementation of estimated date of discharge (EDD) for planned admissi... more Objective. To examine the implementation of estimated date of discharge (EDD) for planned admissions and admissions via the emergency department, to assess the variance between EDD and the actual date of discharge (ADD), and to explore the determinants of delayed discharge in a tertiary referral centre, Sydney, Australia.

Research paper thumbnail of Ethnic and Indigenous access to early childhood healthcare services in Australia: parents’ perceived unmet needs and related barriers

Australian and New Zealand Journal of Public Health, 2011

Ethnic and Indigenous access to early childhood healthcare services in Australia: parents' percei... more Ethnic and Indigenous access to early childhood healthcare services in Australia: parents' perceived unmet needs and related barriers Abstract Objective: To evaluate the parents' perceived unmet needs in early childhood healthcare services among Indigenous, non-English-speaking background (NESB) and English-speaking background (ESB) children and the related barriers. Method: Data was from the Longitudinal Study of Australian Children (LSAC). Rao-Scott chi-square was used to examine the level of parents' perceived unmet needs in three ethnic groups in early childhood healthcare services over a 12 month period. Survey logistic regression was used to assess the association between the groups of infants and the barriers to utilisation. Results: Ten per cent of Australian infants have at least one parents' perceived unmet need in early childhood healthcare services. NESB (15.3%) and Indigenous (15.1%) infants were more likely than ESB infants (9.9%, p<0.001) to have parents' perceived unmet needs in health care services. The barriers to service access include cost, transport problems, child care difficulties, service availability and family reasons. Parents of ESB infants were more likely to cite operating hours as the major barrier to accessing services. Conclusion: There were parents' perceived unmet needs in a number of health services for all Australian infants, but at different levels by Indigenous, NESB and ESB groups. The most common barrier to services utilisation related to cost or private health insurance, availability and accessibility of service provision and other socioeconomic issues. Implications: Policy attention and operational changes are required to improve equity in accessing early childhood services, as well as to improve the overall access to healthcare services for all Australian infants.

Research paper thumbnail of The comparison of health status and health services utilisation between Indigenous and non-Indigenous infants in Australia

Australian and New Zealand Journal of Public Health, 2010

Research paper thumbnail of Rate of venous thromboembolism among surgical patients in Australian hospitals: a multicentre retrospective cohort study

BMJ open, 2014

Despite the burden of venous thromboembolism (VTE) among surgical patients on health systems in A... more Despite the burden of venous thromboembolism (VTE) among surgical patients on health systems in Australia, data on VTE incidence and its variation within Australia are lacking. We aim to explore VTE and subsequent mortality rates, trends and variations across Australian acute public hospitals. A large retrospective cohort study using all elective surgical patients in 82 acute public hospitals during 2002-2009 in New South Wales, Australia. Patients underwent elective surgery within 2 days of admission, aged between 18 and 90 years, and who were not transferred to another acute care facility; 4 362 624 patients were included. VTE incidents were identified by secondary diagnostic codes. Poisson mixed models were used to derive adjusted incidence rates and rate ratios (IRR). 2/1000 patients developed postoperative VTE. VTE increased by 30% (IRR=1.30, CI 1.19 to 1.42) over the study period. Differences in the VTE rates, trends between hospital peer groups and between hospitals with the ...

Research paper thumbnail of Trends in general practice services in two cohorts of Australian children between 2003–2004  and 2010–2011

The Medical Journal of Australia, 2013

Research paper thumbnail of Trends and Variations in the Rates of Hospital Complications, Failure-to-Rescue and 30-Day Mortality in Surgical Patients in New South Wales, Australia, 2002-2009

PLoS ONE, 2014

Background: Despite the increased acceptance of failure-to-rescue (FTR) as an important patient s... more Background: Despite the increased acceptance of failure-to-rescue (FTR) as an important patient safety indicator (defined as the percentage of deaths among surgical patients with treatable complications), there has not been any large epidemiological study reporting FTR in an Australian setting nor any evaluation on its suitability as a performance indicator.

Research paper thumbnail of The impact of implementing a rapid response system: A comparison of cardiopulmonary arrests and mortality among four teaching hospitals in Australia

Resuscitation, 2014

Aims: To compare clinical outcomes between a teaching hospital with a mature rapid response syste... more Aims: To compare clinical outcomes between a teaching hospital with a mature rapid response system (RRS), with three similar teaching hospitals without a RRS in Sydney, Australia. Methods: For the period 2002-2009, we compared a teaching hospital with a mature RRS, with three similar teaching hospitals without a RRS. Two non-RRS hospitals began implementing the system in 2009 and a third in January 2010. We compared the rates of in-hospital cardiopulmonary arrest (IHCA), IHCA-related mortality, overall hospital mortality and 1-year post discharge mortality after IHCA between the RRS hospital and the non-RRS hospitals based on three separate analyses: (1) pooled analysis during 2002-2008; (2) before-after difference between 2008 and 2009; (3) after implementation in 2009. Results: During the 2002-2008 period, the mature RRS hospital had a greater than 50% lower IHCA rate, a 40% lower IHCA-related mortality, and 6% lower overall hospital mortality. Compared to 2008, in their first year of RRS (2009) two hospitals achieved a 22% reduction in IHCA rate, a 22% reduction in IHCArelated mortality and an 11% reduction in overall hospital mortality. During the same time, the mature RRS hospital showed no significant change in those outcomes but, in 2009, it still achieved a crude 20% lower IHCA rate, and a 14% lower overall hospital mortality rate. There was no significant difference in 1-year post-discharge mortality for survivors of IHCA over the study period. Conclusions: Implementation of a RRS was associated with a significant reduction in IHCA, IHCA-related mortality and overall hospital mortality.

Research paper thumbnail of Cardiopulmonary arrest and mortality trends, and their association with rapid response system expansion

The Medical Journal of Australia, 2014

Research paper thumbnail of Geographic Variation of Failure-to-Rescue in Public Acute Hospitals in New South Wales, Australia

PLoS ONE, 2014

Despite the wide acceptance of Failure-to-Rescue (FTR) as a patient safety indicator (defined as ... more Despite the wide acceptance of Failure-to-Rescue (FTR) as a patient safety indicator (defined as the deaths among surgical patients with treatable complications), no study has explored the geographic variation of FTR in a large health jurisdiction. Our study aimed to explore the spatiotemporal variations of FTR rates across New South Wales (NSW), Australia. We conducted a population-based study using all admitted surgical patients in public acute hospitals during 2002-2009 in NSW, Australia. We developed a spatiotemporal Poisson model using Integrated Nested Laplace Approximation (INLA) methods in a Bayesian framework to obtain area-specific adjusted relative risk. Local Government Area (LGA) was chosen as the areal unit. LGA-aggregated covariates included age, gender, socio-economic and remoteness index scores, distance between patient residential postcode and the treating hospital, and a quadratic time trend. We studied 4,285,494 elective surgical admissions in 82 acute public hospitals over eight years in NSW. Around 14% of patients who developed at least one of the six FTR-related complications (58,590) died during hospitalization. Of 153 LGAs, patients who lived in 31 LGAs, accommodating 48% of NSW patients at risk, were exposed to an excessive adjusted FTR risk (10% to 50%) compared to the state-average. They were mostly located in state's centre and western Sydney. Thirty LGAs with a lower adjusted FTR risk (10% to 30%), accommodating 8% of patients at risk, were mostly found in the southern parts of NSW and Sydney east and south. There were significant spatiotemporal variations of FTR rates across NSW over an eight-year span. Areas identified with significantly high and low FTR risks provide potential opportunities for policy-makers, clinicians and researchers to learn from the success or failure of adopting the best care for surgical patients and build a self-learning organisation and health system.

Research paper thumbnail of Trends and Variations in the Rates of Hospital Complications, Failure-to-Rescue and 30-Day Mortality in Surgical Patients in New South Wales, Australia, 2002-2009

PLoS ONE, 2014

Background: Despite the increased acceptance of failure-to-rescue (FTR) as an important patient s... more Background: Despite the increased acceptance of failure-to-rescue (FTR) as an important patient safety indicator (defined as the percentage of deaths among surgical patients with treatable complications), there has not been any large epidemiological study reporting FTR in an Australian setting nor any evaluation on its suitability as a performance indicator.

Research paper thumbnail of Have the Health Gaps Between Indigenous and Non-Indigenous Australian Children Changed over Time? Results from an Australian National Representative Longitudinal Study

Maternal and Child Health Journal, 2012

The purpose of this study was to evaluate the changes of health gaps between Indigenous and non-I... more The purpose of this study was to evaluate the changes of health gaps between Indigenous and non-Indigenous children over time and to explore critical factors that contribute to the changes. We employed data consisting of two cohorts of Australian children: infant (0/1 year) and children (4/5 years) that are part of the Longitudinal Study of Australian Children. Health outcomes were measured by physical outcome index (POI) and parent-rated health during 2004, 2006 and 2008. We used first-order autoregressive modelling to examine the longitudinal relationship between the changes in health outcomes and possible contributing risk factors. The results showed that the trends of POIs between Indigenous and non-Indigenous children were closing, while the gap of parentrated health between the two populations persisted. We found that health outcomes (both POI and parent-rated health) at an earlier time point (t -1) were significant predictors of the outcomes at the later time point (t). Carer's depression status, socio-economic position and neighbourhood liveability had significant and consistent impacts on parent-rated health, but had only varying impacts on POIs between Indigenous and non-Indigenous children as well as between the birth cohorts at different time periods. Similarly, low birth weight, carer's binge drinking behaviour and other risk factors showed such varying impacts at a particular time period. The study implied that appropriate interventions accompanied by monitoring of health outcomes are necessary in order to decrease the health gaps between Indigenous and non-Indigenous children.

Research paper thumbnail of How Accurate Are the Different Predictive Models in Identifying Deteriorating Patients? The ViEWS May Not Be as Clear as We First Thought*

Critical Care Medicine, 2014

Research paper thumbnail of Health services utilisation disparities between English speaking and non-English speaking background Australian infants

BMC Public Health, 2010

Background: To examine the differences in health services utilisation and the associated risk fac... more Background: To examine the differences in health services utilisation and the associated risk factors between infants from non-English speaking background (NESB) and English speaking background (ESB) within Australia.

Research paper thumbnail of A systematic review of the impact of routine collection of patient reported outcome measures on patients, providers and health organisations in an oncologic setting

BMC Health Services Research, 2013

Despite growing interest and urges by leading experts for the routine collection of patient repor... more Despite growing interest and urges by leading experts for the routine collection of patient reported outcome (PRO) measures in all general care patients, and in particular cancer patients, there has not been an updated comprehensive review of the evidence regarding the impact of adopting such a strategy on patients, service providers and organisations in an oncologic setting.

Research paper thumbnail of Discharge delay in acute care: reasons and determinants of delay in general ward patients

Australian Health Review, 2009

To identify the reasons and determinants of discharge delay in acute care patients, information a... more To identify the reasons and determinants of discharge delay in acute care patients, information associated with delayed discharge was extracted from the medical record of 1958 patients in a tertiary referral hospital in New South Wales. A logistic regression model was used to examine the association between demographic factors and reasons for discharge delay. Delayed discharge was most commonly associated with the patient's medical conditions, delayed health care or medical consultation, delayed diagnostic services and delayed allied health services. Elderly patients, those living alone and patients from a non-English-speaking background were more likely to Aust Health Rev 2009: 33(3): 513-521 have these reasons for delayed discharge.

Research paper thumbnail of Effective discharge planning - timely assignment of an estimated date of discharge

Australian Health Review, 2011

Objective. To examine the implementation of estimated date of discharge (EDD) for planned admissi... more Objective. To examine the implementation of estimated date of discharge (EDD) for planned admissions and admissions via the emergency department, to assess the variance between EDD and the actual date of discharge (ADD), and to explore the determinants of delayed discharge in a tertiary referral centre, Sydney, Australia.

Research paper thumbnail of Ethnic and Indigenous access to early childhood healthcare services in Australia: parents’ perceived unmet needs and related barriers

Australian and New Zealand Journal of Public Health, 2011

Ethnic and Indigenous access to early childhood healthcare services in Australia: parents' percei... more Ethnic and Indigenous access to early childhood healthcare services in Australia: parents' perceived unmet needs and related barriers Abstract Objective: To evaluate the parents' perceived unmet needs in early childhood healthcare services among Indigenous, non-English-speaking background (NESB) and English-speaking background (ESB) children and the related barriers. Method: Data was from the Longitudinal Study of Australian Children (LSAC). Rao-Scott chi-square was used to examine the level of parents' perceived unmet needs in three ethnic groups in early childhood healthcare services over a 12 month period. Survey logistic regression was used to assess the association between the groups of infants and the barriers to utilisation. Results: Ten per cent of Australian infants have at least one parents' perceived unmet need in early childhood healthcare services. NESB (15.3%) and Indigenous (15.1%) infants were more likely than ESB infants (9.9%, p<0.001) to have parents' perceived unmet needs in health care services. The barriers to service access include cost, transport problems, child care difficulties, service availability and family reasons. Parents of ESB infants were more likely to cite operating hours as the major barrier to accessing services. Conclusion: There were parents' perceived unmet needs in a number of health services for all Australian infants, but at different levels by Indigenous, NESB and ESB groups. The most common barrier to services utilisation related to cost or private health insurance, availability and accessibility of service provision and other socioeconomic issues. Implications: Policy attention and operational changes are required to improve equity in accessing early childhood services, as well as to improve the overall access to healthcare services for all Australian infants.

Research paper thumbnail of The comparison of health status and health services utilisation between Indigenous and non-Indigenous infants in Australia

Australian and New Zealand Journal of Public Health, 2010

Research paper thumbnail of Rate of venous thromboembolism among surgical patients in Australian hospitals: a multicentre retrospective cohort study

BMJ open, 2014

Despite the burden of venous thromboembolism (VTE) among surgical patients on health systems in A... more Despite the burden of venous thromboembolism (VTE) among surgical patients on health systems in Australia, data on VTE incidence and its variation within Australia are lacking. We aim to explore VTE and subsequent mortality rates, trends and variations across Australian acute public hospitals. A large retrospective cohort study using all elective surgical patients in 82 acute public hospitals during 2002-2009 in New South Wales, Australia. Patients underwent elective surgery within 2 days of admission, aged between 18 and 90 years, and who were not transferred to another acute care facility; 4 362 624 patients were included. VTE incidents were identified by secondary diagnostic codes. Poisson mixed models were used to derive adjusted incidence rates and rate ratios (IRR). 2/1000 patients developed postoperative VTE. VTE increased by 30% (IRR=1.30, CI 1.19 to 1.42) over the study period. Differences in the VTE rates, trends between hospital peer groups and between hospitals with the ...