Objectives: To describe the statewide projections of acute inpatient activity in New South Wales.Methods: Data on acute inpatient activity in NSW for the period 1998-1999 to 2003-04 were derived from the Admitted Patient Data Collection. Regression analysis was used to project trends in utilisation and length of stay by age group, clinical specialty groups and stay type (day-only and overnight). The projected separation rates and length of stay were subject to clinical review. Projected separation rates (by age group, clinical speciality and stay type) were applied to NSW population projections to derive the projected number of separations. Bed-days were calculated by applying projected overnight average length of stay.

A review of projection methodologies used to project sub-acute inpatient activity in various international health care jurisdictions was undertaken as part of a project to develop subacute inpatient activity projections for the state with the largest population in Australia. The literature search identified nearly 200 articles and found three main groups of projection methodologies: projections with a focus on subacute care; projections with a focus on acute care, but which often included subacute activity in the overall projections; and projections of specific diseases/conditions influencing the demand for subacute care.In terms of the examples in the literature specifically regarding subacute care, the most common method of estimating current or future need was the use of normative benchmark ratios of beds to population. This was mainly to provide a policy basis to encourage development of subacute services, but also because of convenience.In the literature regarding acute activity projection methodologies, many incorporated subacute activity in the overall activity measures of the acute hospital unit. The most common method of acute care activity projection was use of current or trended utilisation rates applied to population projections. It appears that a significant amount of planning and demand projection being undertaken internationally on subacute care takes place within acute care methodologies.In regard to the potential use of specific diseases/ conditions that drive demand for subacute care, such as stroke or cancer, it is suggested that the best use of these disease-specific projections is in reality testing the results of other modelling. What is known about the topic? With ageing of the population, subacute care is growing as an important area requiring specific planning methods to estimate current and future demand. However, internationally there is no consensus about the definition of subacute care or which projection method is more appropriate. What does this paper add?The literature review shows there are several methods being used internationally for estimating and projecting subacute care. Both demographic and non-demographic influences, a focus on patient activity rather than beds and scenario modelling were identified as important aspects. What are the implications for practitioners? Practitioners can choose from several different methods for estimating future demand for subacute care, depending on the degree of complexity required.

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We describe the development of a method for estimating and modelling future demand for suband non-acute inpatient activity across New South Wales, Australia to 2016. A time series linear regression equation was used, which is consistent with projection models found in the literature.Results of the modelling indicated an increase in rehabilitation, palliative care and maintenance episodes and bed-days. Projections for other categories of care are problematic due to smaller levels of activity and data quality issues. This project indicated a need for ongoing monitoring of type-changing by facilities and management of data quality. Local planners will need to consider a range of factors when considering the applicability activity projections at a local level, particularly THE ACUTE INPATIENT projection tool used by the NSW Health Department, aIM2005, incorporates subacute activity in its modelling, applying the same methodology for acute and subacute activity. 1 This methodology had not been validated for subacute care, which was seen as a key missing element within the planning process. Health service planners, particularly in rural regions, had requested assistance to develop a more consistent and systematic approach to sub-and non-acute care given the disparate nature of this activity.In late 2005, the New South Wales Health Department initiated a project requiring development of a methodology for estimating and modelling future demand for sub-and non-acute inpatient activity across NSW to 2016. 2 The objective of the project was to provide NSW with a well researched and credible projection methodology that can be used to model future demand (and potentially supply) of sub-and non-acute inpatient services. The methodology included consideration of factors that influence overall demand for these services and also the variation in demand across NSW, including: ■ Population demographic effects such as growth and ageing to 2016;

3921 adults randomly selected from across Great Britain were interviewed. Subjects were asked to assess a selection of 10 out of 200 vignettes. Each vignette contained four elements: a category of individual; access to some or all of the health record; specified purpose; and level of patient identifier. Subjects were asked to say how happy they would be to allow access to their health record in the circumstances described.The public were generally happy to provide access to health information. For almost a third of vignettes, subjects said that they would be very happy to allow access to their health information. 9.1% of subjects said that they would be very happy to allow access within all of the vignettes that they were asked to assess. There was however, a significant minority of responses (11.6%) to vignettes where subjects said that they would be very unhappy to allow access. In addition 2.1% of individuals said that they were very unhappy with all of the vignettes presented to them. Individuals from higher social groups, older people and males were more likely to be happy with access to their health information. The individual requesting information was the most important factor determining permission to access health information. Subjects were happier to release anonymised rather than personally identifiable data. Content of the information to be released did not seem to be that important, even when the health record contained sensitive information. With the exception of teaching students, the use of the information wasn't an important determinant of consent.Despite a level of support for use of health information in most circumstances, this doesn't mean that patients don't want to be asked for consent, nor that the views of the small minority can be ignored. The ethical and policy implications of these findings will be discussed.