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Caplan First Name THE UNIVERSITY OF NEW SOUTH WALES Thesis/Dissertation Sheet Surname or Family name: Caplan First name: Gideon Other name/s: Avram Abbreviation for degree as given in the University calendar: MD School: Clinical School Prince of Wales Hospital Faculty: Medicine Title: Alternatives to standard in-hospital care Abstract 350 words maximum: (PLEASE TYPE) The accompanying published articles submitted for the degree of Doctor of Medicine by publication focus on the rigorous evaluation of health services. They present the results of three non-randomized controlled trials and four randomized controlled trials that I initiated, conceived the ideas for, designed the hypotheses, employed a variety of people to carry out the data collection, and usually analysed and wrote up myself. The papers examine various aspects of alternatives to standard in-hospital care, including providing Hospital in the Home: acute subacute or post-acute care at home and in residential aged care facilities; chronic care at home to prevent readmission; implementing Comprehensive Geriatric Assessment in the Emergency Department; and adding to the hospital workforce, using a team of volunteers to improve the care on the ward, thereby covering a large variety of older peoples’ contacts with the hospital system. These studies have had a demonstrable major impact on the delivery of health services across Australia, and the ideas have been taken up overseas. There has been direct transfer of services based on these trials to other hospitals through the Australian Commonwealth Department of Health’s National Demonstration Hospitals Program , as well as systemic roll out by the NSW Department of Health. These studies have advanced the field of health services research by demonstrating that improving the delivery of health services not only affects administrative outcomes by reducing length of stay and cost, but also has a measurable effect on health outcomes, such as reduced mortality and reduced complications, including delirium and wound infections, as well as increased patient satisfaction. Combining the two sets of data, health outcomes and economic evaluation, has assisted with more rapid dissemination. Declaration relating to disposition of project thesis/dissertation I hereby grant to the University of New South Wales or its agents the right to archive and to make available my thesis or dissertation in whole or in part in the University libraries in all forms of media, now or here after known, subject to the provisions of the Copyright Act 1968. I retain all property rights, such as patent rights. I also retain the right to use in future works (such as articles or books) all or part of this thesis or dissertation. I also authorise University Microfilms to use the 350 word abstract of my thesis in Dissertation Abstracts International (this is applicable to doctoral theses only). ………………………………………………… …………………………………….. ……….…………………….. Signature Witness Date The University recognises that there may be exceptional circumstances requiring restrictions on copying or conditions on use. Requests for restriction for a period of up to 2 years must be made in writing. Requests for a longer period of restriction may be considered in exceptional circumstances and require the approval of the Dean of Graduate Research. FOR OFFICE USE ONLY Date of completion of requirements for Award: THIS SHEET IS TO BE GLUED TO THE INSIDE FRONT COVER OF THE THESIS ORIGINALITY STATEMENT ‘I hereby declare that this submission is my own work and to the best of my knowledge it contains no materials previously published or written by another person, or substantial proportions of material which have been accepted for the award of any other degree or diploma at UNSW or any other educational institution, except where due acknowledgement is made in the thesis. Any contribution made to the research by others, with whom I have worked at UNSW or elsewhere, is explicitly acknowledged in the thesis. I also declare that the intellectual content of this thesis is the product of my own work, except to the extent that assistance from others in the project's design and conception or in style, presentation and linguistic expression is acknowledged.’ Signed …………………………………………….............. Date …………………………………………….............. MD THESIS Alternatives to standard in-hospital care A/Prof Gideon A Caplan Director, Post Acute Care Services Director, Geriatric Medicine Prince of Wales Hospital Randwick NSW 2031 Sydney, Australia COPYRIGHT STATEMENT ‘I hereby grant the University of New South Wales or its agents the right to archive and to make available my thesis or dissertation in whole or part in the University libraries in all forms of media, now or here after known, subject to the provisions of the Copyright Act 1968. I retain all proprietary rights, such as patent rights. I also retain the right to use in future works (such as articles or books) all or part of this thesis or dissertation. I also authorise University Microfilms to use the 350 word abstract of my thesis in Dissertation Abstract International (this is applicable to doctoral theses only). I have either used no substantial portions of copyright material in my thesis or I have obtained permission to use copyright material; where permission has not been granted I have applied/will apply for a partial restriction of the digital copy of my thesis or dissertation.' Signed ……………………………………………........................... Date ……………………………………………........................... AUTHENTICITY STATEMENT ‘I certify that the Library deposit digital copy is a direct equivalent of the final officially approved version of my thesis. No emendation of content has occurred and if there are any minor variations in formatting, they are the result of the conversion to digital format.’ Signed ……………………………………………........................... Date ……………………………………………........................... Table of Contents Page 1) Introduction 4 2) Publications 1. Caplan GA Lord SR Ward JA. The benefits of exercise in postmenopausal 55 women. Australian Journal of Public Health 1993; 17 (1): 23-26. 2. Lord SR Caplan GA Ward JA. Balance, reaction time, and muscle strength in 59 nonexercising older women: A pilot study. Archives of Physical Medicine and Rehabilitation 1993; 74 (8): 837-840. 3. Caplan GA Colagiuri R Lord SR Colagiuri S Ward JA. Exercise in older 62 people with type II diabetes maintains bone density despite weight loss. Australian Journal on Ageing 1995; 14 (2): 71-75. 4. Lord SR Caplan GA Colagiuri R Colagiuri S Ward JA. Sensori-motor 67 function in older persons with diabetes. Diabetic Medicine 1993; 10: 614-618. 5. Caplan GA Scane A Francis RM. Pathogenesis of vertebral crush fractures in 72 women. Journal of the Royal Society of Medicine 1994; 87: 200-202. 6. Caplan GA Brown A. Post acute care: can hospitals do better with less? 75 Australian Health Review 1997; 20: 43-54. 7. Brennan NJ Caplan GA. Attitudes to osteoporosis among elderly female 87 orthopaedic patients. Osteoporosis International 1999; 9: 139-143. 8. Lim K Wren B Jepson N Roy S Caplan GA. Hormone replacement therapy 92 and its effects on left ventricular wall thickness. American Journal of Cardiology 1999; 83: 1132-4. 9. Boxall A-m, Sayers A, Caplan GA. A cohort study of 7 day a week 95 physiotherapy on an acute orthopaedic ward. Journal of Orthopaedic Nursing 2004; 8: 96-102. 10. Henderson EJ, Caplan GA. Home sweet home? Community care for older 102 people in Australia. Journal of the American Medical Directors Association, 2008; 9(2): 88-94. 11. Caplan GA, Meller A. Home care for dying people. (Editorial) Journal of the 109 American Medical Directors Association, (in press) 12. Brown A Caplan G. A post-acute respiratory outreach service. Australian 111 Journal of Advanced Nursing 1997; 14: 5-11. 13. Boxall A-m Barclay L Caplan GA. Managing chronic obstructive pulmonary 118 disease in the community: a randomised controlled trial of home based pulmonary rehabilitation for elderly, housebound patients. Journal of Cardiopulmonary Rehabilitation 2005; 25: 378-385. 14. Caplan GA Brown A Crowe PJ Yap S-J Noble S. Reengineering the elective 126 surgical service of a tertiary hospital: a historical controlled trial. Medical Journal of Australia 1998; 169: 247-251. 15. Caplan GA Board N Paten A Tazelaar-Molinia J Crowe PJ Yap S-J Brown A. 131 The cost to the community of decreasing lengths of stay. Australian and New Zealand Journal of Surgery 1999; 69: 433-7. 16. Board N Caplan G. Implications of decreasing surgical length of stay, 136 Australian Health Review 2000; 23(2): 71-85. 17. Board N Caplan GA. Use of pathology services in re-engineered clinical 151 pathways. Journal of Quality in Clinical Practice 2000; 20: 24-9. 18. Henderson A, Caplan GA, Daniel A. Patient satisfaction: the Australian patient 157 1 perspective. Australian Health Review 2004; 27: 73-83. 19. Caplan GA Ward JA Brennan N Board N Coconis J Brown A. Hospital in the 167 Home: a randomised controlled trial. Medical Journal of Australia 1999; 170: 156-160. 20. Board N Brennan N Caplan GA. A randomised controlled trial of the costs of 172 hospital as compared with hospital in the home for acute medical patients. Australian and New Zealand Journal of Public Health 2000; 24(3):305-311. 21. Caplan GA, Coconis J, Woods J. Effect of Hospital in the Home treatment on 179 physical and cognitive function: a randomised controlled trial. Journal of Gerontology: Medical Sciences 2005; 60: 1035-1038. 22. Caplan GA, Coconis J, Sayers A, Board N. A randomised controlled trial of 183 Rehabilitation of Elderly and Care at Home Or Usual Treatment (The REACH OUT Trial). Age and Ageing 2006; 35: 60-65. 23. Caplan GA. Hospital in the home: a concept under question. (editorial). 191 Medical Journal of Australia 2006;184: 599-600. 24. Caplan GA. Does Hospital in the Home treatment prevent delirium? Aging 193 Health 2008; 4(1): 69-74. 25. Caplan GA, Meller A, Chan S, Squires B, Willett W.
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