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The following list of funded projects carried out in 2011 include time-limited projects, some taking place over weeks or months and other work, usually complex program evaluations that last for two or three years.

2011 research projects

Background

On 3 March 2010, Prime Minister Rudd released a proposal for reform of the Australian health system called "A National Health and Hospitals Network for Australia's Future". A key feature of this reform proposal was the national introduction of Activity Based Funding (ABF).

The CHSD produced a series of short papers on ABF. This education and information series was designed to explain some of the key issues surrounding the Rudd hospital reform plan in more detail. 

Our goal in writing these papers was to make a balanced and reasoned contribution to the complex debate about how Australia's health care system should be reformed. We aim to provide factual and clear information for all the various national interest groups that are contributing to the debate. The federal and state issues that are at stake are too important to be decided by only the loudest voices.

We acknowledge the funding support we received from the NSW Health Department for this educational series. However, the views expressed in this series are those of the CHSD authors, not those of the NSW Health Department.

The following papers (from 2010-11) can be downloaded below:

Download the ABF Information Series No. 1: What is activity-based funding? (pdf)

Download the ABF Information Series No. 2: The special case of smaller and regional hospitals (pdf)

Download the ABF Information Series No. 3: Lessons from the USA (pdf)

Download the ABF Information Series No. 4: The cost of public hospitals - which State or Territory is the most efficient? (pdf)

Download the ABF Information Series No. 5: Counting acute inpatient care (pdf)

Download the ABF Information Series No. 6: Subacute care (pdf)

Download the ABF Information Series No. 7: Research and training (pdf)

Download the ABF Information Series No. 8: Mental health (pdf)

Download the CHSD Response to Pricing Framework Document (pdf)

Download the NCCC Response to Pricing Framework Document (pdf)

Background

This was a literature review project undertaken by the CHSD to ‘Review the Capacity of the Paramedic to Identify the Low Risk Patient’, for the Ambulance Service of New South Wales (ASNSW). It covered the evidence on how paramedics identify low risk patients using risk identification/triage methodologies, where ‘low risk’ meant an ambulance would be required within 90 minutes of the call.

What we did

The initial step was to describe the ‘patient journey’ for a caller to the ASNSW in order to focus the literature search. A classification system, designed by the CHSD, based on hierarchies of evidence originally developed by other organisations, was used to assess the strength of the evidence in the literature. This resulted in a practical framework to present the results of the review: 

  • Understanding the risk identification/triage capacity of emergency department (ED) personnel  
  • Comparing the risk identification/triage capacity of paramedics  
  • Validation methods used with paramedic decision-making processes for low risk patients  
  • Alternative interventions/models of care for management of low risk patients  
  • Barriers and enablers to the acceptance of paramedic patient assessment decisions  

There was no current ‘standard’ for assessing patient risk, however the inter-rater reliability of the Australian Triage Scale (ATS), could be used to compare the ratings of paramedics to ratings by ED staff, or to other tools, using written scenarios, ‘real time’ categorisation, retrospective review and comparison with guidelines.

Most of the models/interventions in the literature were not supported by good quality research evidence, mostly because the relevant research had not been done. As a result, the recommendations of the project were for targeted research to answer the key questions identified during the project.

Download the final report

Thompson C, Masso M, Westera A, Morris and Eagar K (2011) Ambulance Service of NSW: Review the Capacity of the Paramedic to Identify the Low Risk Patient Final Report. Centre for Health Service Development, Australian Health Services Research Institute, University of Wollongong.

 

Background

In mid 2011, the Centre for Health Service Development undertook a targeted literature review project ‘Responding to Mental Health Frequent Callers’, for the Ambulance Service of New South Wales (ASNSW or the Service). The Service was seeking to enhance its response to mental health frequent callers and the purpose of this project was to identify and compare a number of current models of care in settings similar to that of the ASNSW and, where available, information was included as to the costs and benefits of evidence based practice.

The project assessed the strength of evidence of interventions that were identified within the scope of the targeted literature review and was conducted in the style of a rapid literature review within a short timeframe and clear limits. 

Download the final report

Thompson C, Grootemaat P, Morris D, Owen A and Eagar K (2011) Ambulance Service of NSW: Responding to Mental Health Frequent Callers Final Report. Centre for Health Service Development, Australian Health Services Research Institute, University of Wollongong.

Integrated Services Framework for Specialist Health Care for Older People and Service system model for the NSW Connecting Care program
NSW Department of Health - December 2011

Background

This project involved preparing documentation in support of standardising the approach taken to implementing a state-wide NSW health program. The Connecting Care Program is designed to improve the care of people with chronic conditions who are at high or very high risk of hospitalisation. It works with a range of providers to co-ordinate the care that is delivered to these people in the community. The aim is that people with chronic disease are less reliant on the acute hospital system. The Program provides support directly to people with chronic disease via coaching and other support services.

Background

The aim of the EBPRAC Program was to improve evidence-based clinical care for aged care residents, and to enable nationally consistent application of clinical practice in residential aged care.

Projects were required to demonstrate that they improved clinical care for residents, provided additional skills for clinical care staff and be transferable to other aged care homes.

The Department of Health and Ageing engaged a national evaluator, the Centre for Health Service Development at the University of Wollongong, to work with the successful consortia to develop performance indicators for monitoring the implementation of the projects and also to ensure systems were in place to collect appropriate data, which was used to evaluate the effectiveness of the program.

Download the final report

Download the Encouraging Best Practice in Residential Aged Care (EBPRAC) Final Report (pdf)

More information

Second round projects for EBPRAC

Eight projects each established a consortium which comprised a number of residential aged care homes, researchers and educators. Around 90 aged care homes across five states were involved.

Lead Organisation - Queensland University of Technology (Wound Management)

Aged care homes involved in the project are located in Queensland and New South Wales.

This project aims to implement sustainable evidence-based practice in wound management in demographically diverse aged care homes. It will focus on enabling staff from the participating homes to preserve skin integrity through the application of evidence based practice to assessment, prevention, and management of wounds.

Lead Organisation - North East Valley Division of General Practice (Palliative Care)

Aged care homes involved in the project are located in Victoria and South Australia.

This project aims to implement evidence-based use of medications, to manage symptoms in the end-of-life phase for residents in aged care homes. The project will result in a number of improvements including: improved assessment and monitoring of symptoms at the end of life; improved prescribing; appropriate and effective use of 'as required' (prn) medications for symptom management; improved collaboration between aged care home staff, general practitioners, specialist palliative care services and pharmacists in ensuring timely availability of medications for symptom management; and improved processes to support informed choice by residents and families at the time of prescribing and administration of medication and / or in advance.

Lead Organisation - Murrumbidgee General Practice Network (Palliative Care)

Aged care homes involved in the project are located in New South Wales, Victoria and South Australia.

This project aims to encourage best practice in palliative care in residential aged care homes with a focus on rural communities within NSW, South Australia and Victoria. Particular emphasis is placed on: a multidisciplinary, palliative approach provided in the resident's familiar surroundings if adequately skilled care is available thus reducing the need for transfer to an acute setting; and systematic development and implementation of advance care planning involving communication between the resident, family and doctor.

Lead Organisation - University of Queensland and Blue Care (Palliative Care)

Aged care homes involved in the project are located in Queensland, South Australia and Western Australia.

This project aims to implement a comprehensive evidence-based palliative approach in Residential Aged Care (CEBPARAC). This will be achieved through a range of strategies including: providing education to nursing and care staff at all levels working in aged care homes using existing training materials; establishing training and support link nurses in each aged care home; and promoting the use of existing GP on-line training modules to support GPs in providing a palliative approach to residents in their care.

The project will develop a tool kit comprising generic templates for policies, procedures, documentation, production of the case conferencing DVD and the link nurse self directed learning package.

Lead Organisation - Hammond Care (Behaviour Management)

Aged care homes involved in the project are located in New South Wales and Victoria.

This project aims to introduce comprehensive, evidence-based intervention that will address the psycho-social and environmental determinants of behaviour through three integrated components: staff education and support; family education and support; and environmental design. The implementation will take place in a sample of homes that represent the experience of mainly smaller facilities that do not enjoy the support systems available to large homes or those in major metropolitan areas.

Lead Organisation - Monash University (Behaviour Management)

Aged care homes involved in the project are located in Victoria.

The aim of the project is to implement evidence-based practice in non-pharmacological behaviour assessment and management based on the creation of dementia friendly physical and social environments in rural and regional aged care homes.

Lead Organisation - University of Technology, Sydney (Behaviour Management)

Aged care homes involved in the project are located in New South Wales, Victoria and Queensland.

This project aims to skill residential aged care staff to respond to need-driven dementia-compromised behaviours in people with dementia by utilising evidence-based practice embedded in the philosophy, principles and practice of person-centred care.

Lead Organisation - PivotWest Ltd (Infection Control)

Aged care homes involved in the project are located in Victoria.

This project aims to implement sustainable evidence-based practice in demographically diverse aged care homes by translating evidence-based guidelines for infection control in aged care homes into current practice using the collaborative methodology.

 

EBPRAC Presentations by CHSD

Background

This project was completed in October 2011 and involved the development of the evaluation framework for Cancer Australia’s National Lung Cancer Program (NLCP). The NLCP is a new program of Cancer Australia that was funded for an initial four year period from 2009–2013, with a total budget allocation $6.83 million.

The NLCP has three core objectives to guide the projects that are funded:

  • Increase research to build the evidence around lung cancer
  • Increase support and guidance for health professionals
  • Improve data and reporting for lung cancer

What we did

Designing the methodology for the program evaluation had two key purposes; to assess progress against the program objectives, and to determine if the program is operating appropriately, effectively and efficiently.

The approach drew on the CHSD experience across previous evaluation-based projects and our own internal research and development work in understanding the complexities of the issues in choosing the right evaluation methods and frameworks. It emphasised that there are both summative and formative evaluation tasks. Summative evaluation ascertains whether and to what extent the program was implemented as intended and the desired/anticipated results achieved. Formative evaluation more commonly occurs throughout the life of the program as it uses the results of the evaluation to inform the ongoing development and improvement of the program. The report on the project covered a recommended framework tailored to the program’s participants and their activities. It emphasised the pre-conditions for establishing a sound evaluation as a basis for meeting the Departmental requirements of a ‘lapsing program’ evaluation, including clarifying the program logic and establishing reliable data sources.

Download the final report

Thompson C, Samsa P and Eagar K (2011) Cancer Australia National Lung Cancer Program: Evaluation Framework. Centre for Health Service Development, University of Wollongong

Background

Radiation treatment is one of the fundamental tools available in cancer treatment and one of the three cornerstones of multidisciplinary cancer care, along with chemotherapy and surgery.

The NSW Audit Office conducted a Performance Audit of NSW radiotherapy services in 2009 and recommended that NSW Health assess economies of scale to assist in considering the most cost effective machine configuration and the impact on access to services. The CHSD was commissioned to undertake a targeted literature review to assist NSW Health to respond to this issue.

There is limited academic literature relating to optimal machine configurations for radiotherapy services. The search strategy found the most useful literature focused on related aspects of utilisation.

NSW Health should be able to monitor developments in radiotherapy, particularly if they impact upon costs, machine capacity, workload and throughput considerations, workforce availability and geographic access. The search strategy was therefore focused particularly to look for references to economies of scale.

Determining the optimal machine configuration for centres must balance many competing factors and the quality of clinical outcomes is one of the most useful criteria on which to base judgements. There are diverse issues that impact upon radiotherapy services planning, and many are outside the scope of this literature review. Because of the scale and scope of the project, it did not address in detail the various models used to estimate the number of linear accelerators required for given populations and treatment rates.

The literature review and recommendations are relevant to NSW locations funded under the Commonwealth Government ‘Health and Hospital Fund Regional Cancer Centre Initiative’ announced in April 2010. This included the funding of two bunker, single machine units in Tamworth and Nowra and a two linear accelerator unit in Gosford. A second linear accelerator has been funded for both Lismore and Port Macquarie and a third linear accelerator for Wollongong.

Multiple factors will influence decision-making for this service planning issue. This literature review provides another ingredient for the population planning ‘melting pot’.

The literature review pointed out how the literature will need to be supplemented by new and emerging evidence, advances in best practice, the advice of clinical and technical experts, patient preferences and how decisions always have to be taken in the context of available public funds.

Download the final report

Thompson C, Fildes D, Grootemaat P and Gordon R (2011) Optimal Machine Configurations in Radiotherapy: Findings of a Targeted Literature Review. Centre for Health Service Development, University of Wollongong.

 

Photo by Michael Anderson

Background

The NSW Audit Office review in 2009 also recommended that NSW Health assess options for increasing the capacity of radiotherapy facilities, which might include the feasibility and ‘value for money’ of extended hours operation. CHSD was commissioned to undertake a targeted literature review to assist NSW Health in responding to this issue.

The issues regarding the ‘extended hours’ were first considered by the Department in 1993 and a Business Process Improvement project was undertaken for radiotherapy services was completed in 2009. This demonstrated that improvements in efficiencies can be realised with existing infrastructure by improvements in operational processes and as part of planning a quality comprehensive cancer service.

There are many factors that influence the model of care and service delivery of radiotherapy, so the targeted literature review focused particularly on the feasibility and ‘value for money’ of extended hours operation. The options for increasing capacity of radiotherapy facilities fall broadly under three headings:

1. Increase the number of linear accelerator machines available

2. Work existing machines smarter

3. Work existing machines harder

Option three is the most relevant as NSW Health already has strategies underway for options one and two. Approximately 50% of the cost of running a radiotherapy service is attributable to staff and 30% to equipment and maintenance costs. The remaining 20% includes cost inputs relating to space, materials and departmental overheads.

Radiotherapy facilities, like most outpatient departments, have traditionally based appointment times around a 9.00 am to 5.00 pm, five day working week; however some facilities are introducing extended hours to more effectively manage patient workflow. To extend the working hours means that the existing pool of linear accelerators will need to be run for longer periods.

This option is reliant on an available and appropriately skilled workforce, so the availability of staff and appropriate skills mix will be the rate limiting factor for many localities seeking to increase productivity and or utilisation of equipment, through extended hours. If the demand for radiotherapy is increasing faster than the rate trained radiographers become available, then one of the main constraints to radiotherapy capacity is the number of radiographers available.

Determining the feasibility and ‘value for money’ of extended hours operations must balance many competing factors – finding a balance between optimum patient access and the available human and financial resources is the challenge.

Download the final report

Thompson C, Grootemaat P, Fildes D and Gordon R (2011) Increasing Capacity of Radiotherapy Facilities through Extending Working Hours: Findings of a Targeted Literature Review. Centre for Health Service Development, University of Wollongong.

Year One Report

The goal of the SS ICM project is to provide integrated case management across NSW Government and non-government human service agencies, with Local and Australian Government involvement to contribute to the well-being of families with multiple and/or complex needs who have exhausted other avenues of support. The project is small in scale (limited to 10 families within a small geographic area), is strategic in its aims, and managed within the NSW Government’s Regional Coordination Program.  Its first year focussed on refining the selection criteria and testing the abilities of the local service system, through the interagency model, to respond in a flexible and coherent way to the needs of the families. It represents an opportunity to make a wider and practical investment in changes to the efficiency of service delivery systems in the near future, via the SS ICM Steering Group and the NSW Government’s Justice and Human Services managers group.

The SS ICM Year One Report is available to download: 

Owen A and Samsa P (2011) Southern Suburbs Integrated Case Management Year One Report. Centre for Health Service Development, University of Wollongong.

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