Professor Thomas Marwick
Hospital admission and readmission for chronic cardiovascular disease
In 2016-17, there were >11 million hospital admissions in Australia, 6.6 million in public and 4.4 million in private hospitals. People aged 65 and over accounted for 42% of all hospitalizations, and between 2012-13 and 2016-17, the number of hospitalizations rose by an average of 4.3% each year for public hospitals and 3.6% each year for private hospitals. Hospital admission is a major contributor to the health budget, and it's growing.
A readmission is defined as occurring when a patient has been discharged from hospital and is admitted again within a certain time interval. Readmissions are deemed "avoidable" when they are clinically related to the index admission, and have the potential to be avoided through improved clinical management and/or appropriate discharge planning in the index admission. Reducing avoidable hospital readmissions supports better outcomes, improves patient safety and leads to greater health system efficiency.
Heart failure is among the most common chronic diseases, and a major cause of readmission.
Efforts to control health care expenditure and improve quality in Affordable Care Act (USA) involved reduction of US-Medicare payments to hospitals with readmission rates that exceeded the expected from their case-mix. There are many social drivers of readmission, so this was quite unfair to urban hospitals serving poor areas. However, it motivated hospitals engage with healthcare in the community (in many cases, for the first time), and it has been effective in reducing readmission.
In Australia, readmission is accepted as a quality metric, but mainly for surgical procedures rather than chronic disease. We have been leaders in developing nurse-led disease management programs, including for heart failure. However, these are expensive, and we have not been effective at funding these programs, with consequent geographic variation.
This presentation will describe the studies undertaken in this field at Menzies Institute for Medical Research over the last 5 years. They have shown the possibility of better risk-prediction for readmission and how they may enable more efficient investment in disease management programs, including the adoption of new technologies for home monitoring and home care.
Tom Marwick completed training in medicine and cardiology in Australia, before undertaking an Imaging Fellowship at Cleveland Clinic, a PhD at the University of Louvain, Belgium and a Masters in Public Health at Harvard.
He is Director of Baker Heart and Diabetes Institute, and has divided his career mostly between Australia (formerly at the Menzies Institute for Medical Research and Professor of Medicine and Head of Cardiovascular Imaging Research Centre, UQ) and the USA (former Head of Cardiovascular Imaging at Cleveland Clinic).
His main contribution has been in clinical research and research training, and has supervised about 30 research higher degree students - mainly clinical - including 22 completed PhDs. He was one of the initiators of stress echocardiography, and has made contributions to the prognostic evidence underlying cardiovascular imaging.
His main current research interests relate to the detection of early cardiovascular disease and cost-effective application of cardiac imaging techniques for treatment selection and monitoring. He has published over 650 papers, reviews, chapters and editorials, and is an Associate Editor at JACC and Deputy Editor at JACC-Cardiovascular Imaging.
Professor Marwick has been the recipient of more than fifty significant research grants and several awards, including the Simon Dack Award from the American College of Cardiology, 2009 and the RT Hall Prize (2006) and Kempson Maddox Lecture (2011) of the Cardiac Society of Australia and New Zealand.
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