BACKGROUND & AIM:Familial hypercholesterolaemia (FH) is a genetic condition that causes high plasma levels of low-density lipoprotein cholesterol, significantly increasing the risk of premature atherosclerotic cardiovascular disease. FH remains underdiagnosed and undertreated, despite the existence of high-level evidence and clinical practice guidelines. Both under-prescribing and non-adherence to medications have been identified as contributing factors. The aim of this study was to identify the barriers and facilitators or potential solutions to the implementation of improved FH management in Australia, focussed on primary care integration, paediatric management, and treatment adherence. METHOD:Three (3) 2-hour virtual focus groups were conducted as part of the 2022 Australasian FH Summit (29 October 2022). A purposive cross-section of key stakeholder groups was sought at the Summit. The focus groups were co-facilitated by an implementation scientist and a clinician, audio recorded, transcribed, and notes were taken by the facilitators. Transcripts were analysed inductively and deductively according to a template analysis using NVivo. RESULTS:There was a total of 27 workshop attendees across the three groups (n=6-14 each). We identified 27 barriers and 28 facilitators on the topics of integration of care with general practice (nine barriers and eight facilitators), paediatric management (eight barriers and eight facilitators), and treatment adherence (10 barriers and 12 facilitators), categorised according to whether they were patient-related, provider-related, or system-related. Common barriers across the priority areas included a lack of knowledge and skills in FH and urgency of treatment, patient fears of actual or perceived side effects from medications and clinician confidence in prescribing, and costs to patients and limited funding for coordinated models of care. Common facilitators included engaging patients in self-management and in advocacy, developing pathways for care for different risk profiles and ensuring coordination of care between primary and tertiary care settings, and improving communication between clinicians. CONCLUSIONS:These findings provide a foundation for the development of empirically-based implementation strategies tailored to the Australian healthcare context and highlight the importance of multi-level approaches to improving FH detection and management. Future work that is focussed on mapping strategies to these barriers and facilitators using implementation frameworks is needed to develop a national implementation plan for the integration of new guidance on the care of FH.

Artificial intelligence (AI) and data science are reshaping how healthcare systems detect risks, generate insights and organise improvement. This paper asks whether these developments have changed healthcare improvement enough, conceptually and practically, or whether they have primarily provided faster tools to monitor and detect, with longstanding challenges remaining endemic. The argument advanced is that AI and data science have altered the means of improvement more than the actuality of improvement. Four propositions are developed. First, healthcare improvement has begun to shift from periodic measurement to continuous sensing, but continuous sensing does not automatically produce continuous improvement. Second, the field has moved from descriptive analytics and dashboards towards probabilistic prediction and generative decision support, but prediction is not prevention. Third, the unit of improvement has started to move from isolated projects towards learning health systems, yet learning systems are not built by software and data science alone. Fourth, the risks introduced by AI, including bias, opacity, automation errors, hallucination, deskilling and misaligned incentives, have pushed governance, and the values and biases encoded in AI, to the centre of improvement work. To succeed, we will need to continuously educate the workforce, build better-trained AI models, generate a databank of generalisable exemplar projects, ensure we embrace exchange of expertise, collaboration and sharing rather than competition and underpin progress with transparency, rigorous evaluation and well-crafted research. Governance and ethical oversight need considerable attention as they remain underdeveloped. The paper concludes that AI’s greatest contribution may be to strengthen the feedback loops through which health systems learn, but that outcomes will still depend on implementation capability, organisational learning, workflow design and accountability.

Introduction:Learning communities need access to resources to support efforts in building and sustaining learning health systems. This experience report details our development and initial assessments of the Learning Health System (LHS) Toolkit, a menu of resources purpose-designed to support users to build more proactive, responsive, and equitable systems of care by developing, implementing and sustaining LHSs. Methods:Toolkit development began in 2022, and the current version was completed in 2025. To optimize knowledge translation, we structured our methods to align with the phases of the Knowledge to Action (KTA) Model, including (1) Knowledge Inquiry; (2) Synthesis and Creation; (3) Knowledge Selection; (4) Adapting Knowledge to Local Context; (5) Assessing Barriers and Facilitators to Knowledge Use; (6) Selecting, Tailoring, and Implementing the Intervention, and (7) Monitoring Knowledge Use. Results:Development of the web-based toolkit and vetting of its contents were achieved over several phases. Feedback from toolkit users was positive overall and was integral to its development and refinement. Users from 72 countries have accessed the toolkit, although most engagement has occurred in high-income countries, chiefly the US, UK, Türkiye, Australia, Canada, The Netherlands, and New Zealand. Conclusions:The toolkit is uniquely situated to support learning communities. It includes a dynamic design, is regularly updated, and is accessible free of cost. Additionally, unlike a literature search, the toolkit is developed with usability in mind and includes tools beyond peer-reviewed literature, curated by LHS experts. The next steps are to develop and action a dissemination plan based on implementation science principles to increase the reach and adoption of the toolkit.

Background Between 4% and 17% of hospital inpatients experience a patient safety incident. Many healthcare organizations undertake analysis and investigation of serious incidents to understand them and prevent future occurrences. Tools have been developed to assess investigation quality as a reflection of a health service's learning and improvement process. However, a broad-scale examination of the quality of investigation reports has not been conducted in Australia. This study aimed to assess the quality of a sample of Australian patient safety incident investigation reports.Methods A deductive, directed content analysis was conducted to assess the quality of 300 incident investigation reports from 56 Australian health services. Each report was assessed on the extent to which they met predefined quality criteria using the Dutch Health and Youth Care Inspectorate (IGZ) scoring instrument and the United Kingdom's Learning Response Review and Improvement Tool (LRRT).Results A detailed and complete description of events was present in just over half of the reports (57%). There was also variable application of systems approaches to incident causation in the reports. Generally, there was evidence that the people affected were engaged with, and the avoidance of blame and counterfactual reasoning was well executed, as was overall writing quality. Areas in need of improvement included identifying contributing factors beyond the staff and local hospital, the use of appropriate scientific literature and using observational insights to enhance understanding of work-as-done-in our sample only 4% used observation techniques to examine healthcare processes.Conclusion This study establishes that stronger foundational, evidence-based approaches to incident investigation are necessary. These approaches include using multiple data sources, like observations of real work, and inclusion of people with skills to apply a systems thinking-driven analytical process to effectively identify contributing factors beyond the individual to drive learning and continuous systemic improvement.

Type 1 diabetes imposes a significant burden through morbidity, mortality, and high health care costs while also generating additional health, economic, and social costs, ranging from mental health conditions to risk of financial hardship to social stigma. Many of these outcomes may also spill over to families and caregivers. The economic literature increasingly recognizes the importance of including broader societal impacts in economic evaluations, including some guidelines for assessment of health interventions. However, in practice, societal impacts are incorporated in a limited way in assessments of type 1 diabetes therapies, most commonly through certain productivity-related measures, with limited consideration of broader impacts. In this article, we review the wider impacts of type 1 diabetes and examine how recent evaluations of novel technologies apply different perspectives. We find that economic assessments inconsistently incorporate broader societal impacts, such as psychosocial effects, informal caregiving, and long-term economic consequences. Consideration of a broader range of societal impacts may provide a more comprehensive evidence base for evaluating type 1 diabetes treatments and technologies, including in decisions related to their development, distribution, and reimbursement.

Public perceptions of climate change impacts on health systems and the health workforce remain underexplored yet are vital for informing policy to improve system performance and resilience. This study examined Australians’ views on their health system’s performance and its resilience to the effects of climate change. This first-of-its-kind survey canvassed a nationally representative sample of adults (≥ 18 years) capturing views on climate change, climate-related impacts, health system performance, and system readiness. Descriptive and inferential analyses were conducted. Adults (n = 6030) from all Australian States and Territories participated; 72.6% agreed that Australia is feeling the effects of climate change. Over half (55.2%) believed fundamental changes were needed to improve the health system; 61.2% identified the need for more health professionals. Nearly 39% believed that climate change was not affecting the health system, 36.6% thought it was prepared for climate-related emergencies. Opinions on preparedness varied significantly by demographics and were moderated by level of concern about climate change, views of system performance, and belief that the system was already climate-affected (χ2(22) = 1894.43, p < 0.001). This national survey of Australians reveals limited public understanding of how climate change affects health systems and the health workforce, which may undermine public support for health system adaptation.

Accreditation has become a central strategy for regulating and improving quality in health systems worldwide. Evidence suggests accreditation can strengthen governance, standardise processes and build quality improvement capability, although effects on outcomes remain variable and context-dependent. This paper examines two leading Middle Eastern accreditation bodies: the Jordanian Health Care Accreditation Council (HCAC) and Egypt's General Authority for Healthcare Accreditation and Regulation (GAHAR). Both organisations are accredited by the International Society for Quality in Health Care External Evaluation Association (ISQua EEA), signalling alignment with international benchmarks while adapting standards to local contexts. We describe their origins, mandates, standards portfolios and system roles, and interpret their trajectories in light of recent global syntheses of the accreditation literature. We then outline HCAC's and GAHAR's key challenges and strategic opportunities over the next five years, including their evaluation and use of large language models, and the contributions they can make to patient and community engagement, equity, digital health, climate change, and organisational resilience. The experiences of HCAC and GAHAR offer lessons for similarly reforming health systems both in the Middle East, and other regions.

Objectives This study aimed to explore perceptions of the Paediatric Improvement Collaborative’s (PIC’s) Clinical Practice Guidelines (CPGs) among clinicians, with a focus on awareness, frequency of use, applicability and areas for improvement.Design, setting Cross-sectional online survey and semi-structured interviews.Participants Clinicians working in all Australian states and territories. Recruitment was via non-probability convenience sampling. Invitations to participate in the online survey were posted on national- and state-level paediatric organisations, networks and groups. Survey participants could express interest in taking part in a follow-up online interview.Results A total of 466 clinicians, including consultants/specialists (46.1%), specialists in training (residents/registrars: 20.4%), nurses (17.8%), allied health professionals (4.7%) and general practitioners (3.6%) participated in the survey. Findings indicated a high level of usage, with two-thirds of participants (63.9%) using the guidelines weekly. Most participants (91.8%) deemed the CPGs highly applicable to their practice settings, and over half (57.9%) had referred to more than 10 different PIC CPGs in the past month. Patterns of use reflected experience, seniority and scope of practice, with utilisation significantly higher among specialists in training, those working in emergency settings and those with less practising experience. Ten clinicians were interviewed to gain deeper insights, reinforcing that PIC CPGs serve multiple purposes, such as to check practice and for self-learning, for teaching more junior staff, and to reinforce treatment decisions with parents and patients. The guidelines were noted as being useful for all members of the multidisciplinary team in providing consistent language and uniform care. Key areas for improvement included enhancing accessibility in time-pressured environments, such as incorporating human factors-based navigation features and standardised layouts, and integrating additional tools and localised referral information.Conclusions PIC CPGs are viewed as a source of credible, evidence-based information that was valued across medical, nursing and allied health professionals.

We argue for and outline the design of a second Quality in Australian Health Care Study (QAHCS2), 30 years after the original landmark study. A narrative review of historical developments in Australian patient safety since the publication of QAHCS in 1995, supported by international comparisons and contemporary evidence, was undertaken. QAHCS demonstrated that 16.6% of hospital admissions were associated with patient harm (conceptualised as adverse events), establishing patient safety as a national priority. In the three decades since, extensive reforms and new techniques and technologies have reshaped care, governance and standards. However, we lack benchmarked, large-scale, epidemiologically rigorous data on patient harm in contemporary Australian healthcare. QAHCS2, incorporating advances in digital records, automated adverse event detection and inclusion of primary care, would provide unique, actionable insights for Australia. QAHCS2 aims to determine whether care is safer now than in 1995, to evaluate national safety metrics and to benchmark Australia internationally. Without such evidence, healthcare improvement risks continuing without a reliable compass.

Abstract Background The Quality Implementation Framework (QIF) is a widely used process model in implementation science (IS). Since its publication in 2012, the field of IS has expanded considerably, yet QIF has never undergone formal revision. Given recent advances and the complexity in implementation research and practice, this study examines whether QIF continues to capture the full scope of implementation quality and its challenges. Methods An umbrella review of reviews was conducted on literature published between 2012 and 2025. Eligible articles reported on the development, application, or update of implementation frameworks within healthcare or social science. Data were deductively mapped to the four phases and 14 steps of the original QIF and inductively mapped to identify knowledge not included in the original framework. Results A total of 15 reviews met the inclusion criteria. Most aligned with the core structure of QIF, supporting its continued relevance. However, several reviews highlighted the need to add a pre-implementation phase focusing on evidence appraisal, and a post-implementation phase addressing sustainability. Four cross-cutting domains (service user, intervention deliverer, context, and technology) were identified as critical factors throughout the implementation process. Conclusions An updated version of QIF is proposed, building on the original framework while introducing two new phases and four cross-cutting domains. This expanded model reflects recent developments in the literature and provides more comprehensive guidance to support implementation across complex real-world settings; it has important implications for implementation research and implementation practice. Registration PROSPERO registration number: CRD42023475994.

Asthma is a leading chronic respiratory condition in children, and primary care plays a pivotal role in its management. Evidence on primary care–based interventions for paediatric asthma remains fragmented. This rapid review synthesised global evidence on primary care interventions for paediatric asthma and their clinical, health service and implementation outcomes. Following Cochrane Rapid Review methodology and PRISMA guidelines, PubMed, Ovid EMBASE, and PsycINFO were searched for English-language studies published between January 2015 and February 2026 that reported interventions for children aged 4–18 years in primary care. Two reviewers independently screened studies, extracted data and appraised methodological quality using the Joanna Briggs Institute checklists. Narrative synthesis was conducted due to heterogeneity. Sixteen studies were included. Interventions were multifaceted and targeted asthma assessment, treatment and self-management. These included tailored education for children, families and healthcare providers (n = 9), guideline-based assessment and decision-support tools (n = 6), written asthma action plans (n = 5), digital health tools (n = 5), and pharmacy- or nurse-led reviews (n = 4). Use of standardised tools, such as the Asthma Control Test (ACT) and the Childhood Asthma Control Test (C-ACT), improved the identification of poorly controlled asthma and prompted treatment adjustments. Educational interventions consistently improved inhaler technique, asthma knowledge and quality of life, whereas digital health interventions demonstrated mixed effects on asthma control and treatment engagement. Written asthma action plans were generally implemented within multifaceted interventions, limiting the assessment of their independent effects. Several interventions were associated with reduced emergency department visits, hospitalisations and school absenteeism. Primary care–based paediatric asthma interventions are multifaceted and associated with improved asthma control, self-management and healthcare utilisation. These findings support integrating guideline-based assessment, education, and team-based care into routine primary care practice. However, further research is needed to clarify the independent effectiveness of digital support tools and written asthma action plans.

Introduction This project will establish a nationally consistent and ethically defensible approach to embed genomic testing in Australian primary care. Many non-genetic health professionals (eg, general practitioners (GPs) and other specialists) have limited experience with such testing. Current tests—both subsidised and consumer-paid—target a range of genes and conditions, making appropriate selection challenging. A structured implementation approach is therefore crucial. We will develop, test, refine and evaluate internationally relevant tools to support GPs and consumers in using genomics effectively.Methods and analysis Aims of the project are to (1) develop, implement and evaluate key supports for GPs offering tests through three interventions: primary health point-of-care resources, a practical guide to dealing with ethical issues affecting clinicians and established recommendations for a national approach for genetic counsellors to support GPs providing genetic testing; (2) develop and evaluate consumer resources and plan the implementation strategies; (3) evaluate real-world utilisation and equity of access to genetic testing in primary care using linked Medicare and population data.This project will focus on two genomic applications recently made available in Australia on the universal insurance scheme (Medicare): a reproductive genetic carrier screen (an example of the role of genetics in reproductive testing) and genetic testing for familial hypercholesterolaemia (an example of a condition-specific test). Both tests can be complex for GPs to understand and explain to consumers and have potential implications beyond the purpose of the test (eg, personal health implications for carriers and results are also relevant to genetic relatives). Developing a robust clinical pathway and process for these tests will prepare GPs for future more complex applications of clinical genomics. The study will take place from January 2024 to December 2026.Ethics and dissemination Ethical approval for this work has been received from the Macquarie University Human Research Ethics Committee (Ref: 520241849560183) and the Royal Children’s Hospital Research Ethics and Governance (HREC/112451). Findings will be disseminated via publications, conferences and engagement with primary care networks and policymakers.

BACKGROUND:Virtual care has become an integral part of oncology services, following the COVID-19 pandemic. Its association with unplanned hospital service use, alongside sociodemographic and clinical factors, remains unclear. METHOD:A retrospective cohort study was conducted among 39,099 adults with confirmed cancer diagnoses who accessed outpatient oncology services in Queensland between January 1, 2018 and December 31, 2020 using linked administrative data on unplanned emergency department (ED) visits, hospitalizations, and cancer-related hospitalizations. Multivariable logistic regression examined associations between nonadmitted patient (NAP) virtual care and unplanned hospital service use. RESULTS:Among 39,099 patients accessing oncology services, 57.9% used at least one virtual care service. During one-year follow-up, 55.4% had an unplanned ED visit, 29.7% had an unplanned hospitalization, and 9.4% had an unplanned cancer-related hospitalization. Virtual care users had higher odds of unplanned ED visits (OR: 1.64; 95% CI: 1.50-1.79) and hospitalizations (OR: 1.20; 95% CI: 1.10-1.30), with no association for cancer-related admissions. Lower odds of unplanned service use were observed among females, individuals in the least disadvantaged areas, treated during lockdown, with poorly differentiated tumors, born outside Australia and with higher outpatient use. Presence of Charlson comorbidities, mental health conditions, and digestive or lung cancers (Vs breast cancer) were associated with higher odds of unplanned service use. Younger age and rural residence were linked to increased likelihood of unplanned ED visits but reduced likelihood of unplanned hospitalizations. Being on active treatment predicted unplanned hospitalizations only. CONCLUSIONS:The findings suggest an association between virtual care use and unplanned health service utilization among oncology patients. However, further research using more robust methodologies is needed to better understand this relationship and inform optimal integration of virtual care into routine oncology services.

IntroductionAsthma is the most common chronic respiratory condition among Australian children. However, adherence to clinical guidelines for paediatric asthma care in general practice (GP) settings requires attention—it is estimated to be below 60% in some contexts. The National Paediatric Applied Research Translation Initiative (N-PARTI) is a three-phased, co-designed research program aiming to optimise guideline-concordant paediatric care across three priority conditions, including asthma, Type 1 Diabetes (T1D), and antibiotic stewardship in Australian general practices. This protocol outlines Phase I of the N-PARTI asthma stream, focusing on developing an Implementation Bundle to support evidence-based asthma management in general practices.Methods and analysisUsing a mixed-method design, Phase I will employ a multi-method, co-design approach comprising three Aims: (i) to verify and refine a multicomponent asthma Implementation Bundle tailored for general practice through evidence synthesis, and co-design workshops, involving children with asthma and their parents and carers, alongside with key stakeholders; (ii) to map asthma-related clinical workflows across diverse general practice settings through interviews and observations, analysed using the Functional Resonance Analysis Method (FRAM) to capture variations in routine practice; and (iii) to explore contextual factors within Primary Health Networks (PHNs) through stakeholder interviews, informing the development of locally tailored implementation strategies. Qualitative data will be analysed using a reflexive thematic analysis approach informed by the Consolidated Framework for Implementation Research (CFIR). Outputs will include a refined, contextually adapted paediatric asthma Implementation Bundle and resources to support real-world simulation, testing and tailoring (Phase II), as well as the scale-up, embedding and evaluation of the implementation (Phase III).Ethics and disseminationThis research project has been approved by the Macquarie University Human Research Ethics Committee (Reference No. 520251855660911). Findings will be disseminated through peer-reviewed publications, conferences, stakeholder forums, and policy briefings. Co-designed outputs will also be shared with participating PHNs to inform wider implementation and scale-up efforts.

Objectives Over the last decade, a growing number of health interventions (eg, medical assistance in dying and mitochondrial donation) have become legalised or decriminalised globally. Newly legalised health interventions share characteristics that are distinct from other health interventions, making their implementation more challenging. They are often highly emotive, controversial and associated with strong opinions and ethical dilemmas, with some of them being high-stake and irreversible. This study aimed to identify, systematise and map the factors that affect the implementation of health interventions that have recently been legalised.Design A systematically conducted review.Data sources PubMed, Scopus, EMBASE and CINAHL were searched to identify studies published between 2014 and 2024.Eligibility criteria for selecting studies We included studies if they evaluated the implementation of health interventions that were newly legalised or newly decriminalised.Data extraction and synthesis Data were extracted and synthesised through descriptive analysis. Both deductive and inductive thematic analyses were applied to map the barriers, facilitators and implementing strategies that influence the implementation of newly legalised health interventions in healthcare settings.Results The search strategy yielded 1510 publications, of which 78 were included in this review. Findings showed that several newly legalised health interventions, including medical assistance in dying (n=56 studies); medical abortion (n=13); assisted human reproduction (n=3); psychedelic-assisted therapies (n=3); use of medical cannabis (n=2) and use of biosimilars (n=1) were addressed. The analysis identified a total of 880 diverse barriers, facilitators and strategies in five domains across system, organisational and individual levels: (1) patients/service users/consumers; (2) healthcare providers; (3) healthcare organisation; (4) legal processes and (5) system. These were further divided into 27 themes of barriers, 18 themes of facilitators and 17 themes of strategies.Conclusions Implementing newly legalised health interventions is complex. Our findings can support the development of an implementation plan for the spread and scaling of future health interventions, maximising the impact of interventions and making them accessible to more people and health organisations.

BackgroundOlder adult care systems face severe workforce shortages, rising demands, and high levels of stress and burnout, undermining the quality of care and organizational resilience. Support4Resilience (S4R, 2024-2028) aims to improve working conditions and mental well-being by equipping leaders with an evidence-based, organizational-level intervention. The project develops and evaluates a digital S4R Toolbox consisting of 3 tools: (1) mapping and identification (MAP); (2) reflection and education (IMPROVE); and (3) reorganization (REMOVE). ObjectiveThe project aims to strengthen resilience and mental well-being among health care workers and informal caregivers in older adult care across Europe and Australia through the development and implementation of the digital S4R Toolbox. Secondary objectives are identifying determinants of resilience and mental well-being across diverse contexts; exploring needs and perspectives that inform successful adaptation to changing working conditions and ethical challenges; designing the S4R Toolbox; evaluating its relevance, effectiveness, and cost-effectiveness across health care systems; advancing theory on the relationship among individual resilience, organizational resilience, and leadership; and producing research-based recommendations and interventions through the open-access S4R Resource Bank. MethodsS4R applies an exploratory, longitudinal, mixed-methods co-design approach across 4 phases. The input phase gathers evidence through literature reviews, context mapping, and qualitative and quantitative data collection in 7 countries. The co-design and prototype testing phase involves developing the S4R Toolbox and conducting pilot testing. The implementation, evaluation, and finalization phase includes a 1-year implementation period, followed by process, effectiveness, and cost-effectiveness evaluations and final refinement of the Toolbox. The output phase disseminates the results through the open-access S4R Resource Bank. ResultsThe project has achieved substantial early progress, including 5 literature reviews, completed and published context mapping, and comprehensive data collection involving health care workers, leaders, and informal caregivers in 7 countries. Toolbox development is well advanced, and pilot testing has been completed. ConclusionsS4R will deliver a research-based digital Toolbox that supports leaders in strengthening the resilience and mental well-being of health care workers and informal caregivers in older adult care. By integrating the perspectives and experiences of leaders, health care workers, and informal caregivers, identifying resilience factors, and developing theory-informed, cost-effective interventions, S4R will provide actionable resources through an open-access platform, contributing to more resilient older adult care systems. Trial RegistrationClinicalTrials.gov NCT07504042; https://clinicaltrials.gov/ct2/show/NCT07504042 International Registered Report Identifier (IRRID)DERR1-10.2196/73701