CareTrack: assessing the appropriateness of health care delivery in Australia.
OBJECTIVE
To determine the percentage of health care encounters at which a sample of adult Australians received appropriate care (ie, care in line with evidence-based or consensus-based guidelines).


METHODS
Computer-assisted telephone interviews and retrospective review of the medical records (for 2009-2010) of a sample of at least 1000 Australian adults to measure compliance with 522 expert consensus indicators representing appropriate care for 22 common conditions. Participants were selected from households in areas of South Australia and New South Wales chosen to be representative of the socioeconomic profile of Australians. Health care encounters occurred in health care practices and hospitals with general practitioners, specialists, physiotherapists, chiropractors, psychologists and counsellors.


METHODS
Percentage of health care encounters at which the sample received appropriate care.


RESULTS
From 15 292 households contacted by telephone, 7649 individuals agreed to participate, 3567 consented, 2638 proved eligible, and 1154 were included after gaining the consent of their health care providers. The adult Australians in this sample received appropriate care at 57% (95% CI, 54%-60%) of 35 573 eligible health care encounters. Compliance with indicators of appropriate care at condition level ranged from 13% (95% CI, 1%-43%) for alcohol dependence to 90% (95% CI, 85%-93%) for coronary artery disease. For health care providers with more than 300 eligible encounters each, overall compliance ranged from 32% to 86%.


CONCLUSIONS
Although there were pockets of excellence and some aspects of care were well managed across health care providers, the consistent delivery of appropriate care needs improvement, and gaps in care should be addressed. There is a need for national agreement on clinical standards and better structuring of medical records to facilitate the delivery of more appropriate care.
University of South Australia, Adelaide, SA. bill.runciman@apsf.net.au
William B
WB
Runciman
Tamara D
TD
Hunt
Natalie A
NA
Hannaford
Peter D
PD
Hibbert
Johanna I
JI
Westbrook
Enrico W
EW
Coiera
Richard O
RO
Day
Diane M
DM
Hindmarsh
Elizabeth A
EA
McGlynn
Jeffrey
J
Braithwaite
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003695:Delivery of Health Care / Q000592:standards*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D009517:New South Wales; D017410:Practice Guidelines as Topic; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies; D013021:South Australia