School of Primary, Aboriginal and Rural Health Care

Collaborative Health Analysis and Statistical Modelling (CHASM)

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M706, 35 Stirling Highway, Crawley, WA 6009


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Gnd Floor, N Block
QEII Medical Centre
Caladenia Crescent (off Monash Avenue roundabout)
Nedlands, WA 6008

The research group CHASM (Collaborative Health Analysis and Statistical Modelling) uses the Western Australian Data Linkage System (WADLS) to analyse the health outcomes and drivers of demand for the provision of equitable and accessible healthcare. The unit uses observational data in determining patient outcomes, and coordinated clinical service planning across the Western Australian health system.

Background

CHASM is within the Faculty of Medicine and Dental Health Sciences at the University of WA. The research directly advises the WA North Metropolitan Health Service and the relevant Medicare Locals through the Executive Partnership Group sponsored by the North Metropolitan Governing Council to facilitate the development of shared planning frameworks.

CHASM is a collaboration between the UWA Schools of:

This collaboration also involves input from Edith Cowan University, the Centre for Genetic Epidemiology and Biostatistics (UWA), and the Epidemiology Branch of the WA Department of Health.

CHASM is funded until 2015 by the Department of Health WA to supply high level research and evaluation services to Public Health and Ambulatory Care in the North Metropolitan Health Service (PHAC NMHS).

Chronic disease

We have examined the longitudinal impact of chronic disease admissions on health service utilisation, and its interaction with age using 10 years of hospital admission data from 2002-2010 for type II diabetes, COPD and heart failure. We have been able to identify a novel identifiable marker of a dramatic sustainable change in hospital utilisation (days in hospital and emergency department presentations) by patients with these three most common chronic conditions.

Further we discovered that regardless of age, that this cardinal event is a significant turning point in future hospital utilisation and emergency department presentations. Paradoxically the Emergency department presentations are significantly higher in younger age groups than for older persons with all three conditions, and hospital stay is similar in ALL age groups. Using this cardinal event we have, with geographical information system (GIS) technology, been able to map the location of patients and inform clinical service planning for the health jurisdictions.

Emergency department demand

This is particularly important when analysing clinical service provision within and without emergency departments (ED) and the drivers of emergency department demand. Our analysis shows that the socio-demographic drivers of emergency department demand are significant: age, gender, distance to ED, population, socio-economic status, and Aboriginal and Torres Straight Islander (ATSI) status are all associated with ED demand. Socio-economic factors and the relative distance to an ED both more than halve the likelihood of a patient presenting to the emergency department.

For primary health care services we have developed a representative accessibility index based on; distance, population and full time equivalence, that shows a similar association with ED demand for specific types of presentations.

We have also investigated the emergency department non-urgent care services to standardise data collection and recording of services provided to help analyse the effectiveness with regard to health outcomes and emergency department demand.

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Dental services

State-wide services and population needs are also being examined by CHASM, in particular the provision of public dental services. CHASM was critical to the development of the Dental Health Services Functionality Assessment in 2010, and is currently advising both Dental Health Services and the Oral Health Centre of WA on the monitoring and provision of services. CHASM is also the lead agent in developing a linked database of public dental service provision which will become one of the WA Data Collections, as approved by the Director General in 2012. CHASM also directly assists the WA Oral Health Promotion Unit, which is leading the development of the National Oral Health Plan.

Commissioned reports

  1. Whyatt, D., Vickery, A., Emery, J.D., Popescu, A., Bolt, S., Kaye, J., Kendall, P., Santamaria, N., Francs, G.  Evaluation of the effectiveness of the North Metropolitan Area Health Service Chronic Disease Management Programs. School of Primary, Aboriginal and Rural Health Care, UWA, 2009. Funded by SHRAC grant Department of Health, Western Australia
  2. Slater H., Davies S., Kermode F., Vickery A., Schug S. Self-Training Educative Pain Sessions to provide earlier self-management advice to patients referred to a State Government Pain Medicine Unit. Curtin University, 2009. Funded by SHRAC grant Department of Health, Western Australia
  3. Hung J., Williamson J., Dickinson W., Chan K., Smith P., Vickery A., Thompson P. An extension of a prospective randomised controlled trial of remote physiological monitoring for chronic heart failure to a rural cohort. UWA Heart Research Unit, 2010. Funded by SHRAC grant Department of Health, Western Australia
  4. Whyatt, D., Tenneti, R., Kok, M.R., Bolt, S.E.,  Kemp, A., Firth, L., Murray, K., Turlach, B., Emery, J.D., Vickery, A. Confidential report into the impact of a principal diagnosis of chronic disease on demand for hospital services in Western Australia using longitudinal analysis and GIS mapping. University of Western Australia, 2012.
  5. Vickery, A., Whyatt, D. 2007, 'Through the Metropolitan Ambulatory Care Service - Emergency Department Asthma Education & Intervention Project', WA Department of Health.
  6. Whyatt, DR., Kok, M.R., General Practice Accessibility and Emergency Department Demand in North Metropolitan Perth. University of Western Australia, 2012.
  7. Whyatt, DR., Kok, M.R., Dental Health Services (Public and private accessibility and service provision). University of Western Australia, 2013.

Papers currently under preparation/submitted

  1. Whyatt DR, Tenneti R, Bolt SE, Kemp A, Firth A, Murray K, Turlach B, Emery JD, Vickery AW. The Ecological Fallacy of the Role of Age in Chronic Disease and Hospital Demand. Plos Medicine submitted.
  2. Whyatt DR, Yap M, Nanda-Paul S.  Uptake Of Public Dental Services Associated With Reduced Rates Of Hospitalisation For Dental Caries: An Ecological Study. Manuscript in preparation.
  3. Whyatt DR, Kok MR, Vickery AW. Emergency department demand is associated with increasing access to emergency departments and decreasing access to general practice. Manuscript in preparation.

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