The following list of funded projects carried out in 2012 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.
2012 research projects
- Cancer Australia Evaluation: National Centre of Gynaecological Cancers
- Developing a National Assessment Framework for Aged Care
- Development of the stage one plan for the Medicare Locals After Hours Program
- Evaluation of the Stephanie Alexander Kitchen Garden National Program
- Islet transplantation costing study
- Research and evaluation of the National Health Call Centre Network
- Review of demand for cochlear implantations in NSW to 2021
- The effect of student placements on GP income
- The organisation of internal medicine services - literature review
CHSD was engaged in 2010 to complete a program evaluation of the National Centre of Gynaecological Cancers (NCGC), a ‘virtual centre’ of Cancer Australia (CA). CHSD previously completed a broader evaluation study of the Cancer Australia organisation and this informed the evaluation of the NCGC.
This evaluation focused on the totality of the NCGC ‘program’, organised under the Centre’s three over-arching objectives:
- Improving information and support for women with gynaecological cancers, their carers and partners;
- Supporting the workforce to deliver coordinated gynaecological cancer care; and
- Building the evidence base for gynaecological cancer care, including through research and clinical trials.
The evaluation assessed the impact and outcomes of the NCGC at the level of consumers, service providers and the wider cancer control system. In addition it reviewed the appropriateness, efficiency and effectiveness of the Centre in the context of government service delivery.
The final report concluded the NCGC is performing well, is addressing its key objectives, fulfilling its role and implementing its activities effectively. The report made 15 key recommendations to the CA Chief Executive Officer and NCGC Advisory Group. As a result of this evaluation, the organisation consolidated its role to improve gynaecological cancer outcomes for diverse groups of women, their carers and families. This includes reducing disparities within and between groups with the poorest health outcomes.
Download the final report
Thompson C, Quinsey K, Cuthbert E, Dawber J, Grootemat P and Eagar K (2010) Evaluation of the National Centre for Gynaecological Cancers: Final Report. Centre for Health Service Development, University of Wollongong.
Project team: Cristina Thompson, Karen Quinsey, Elizabeth Cuthbert, James Dawber, Pam Grootemat, Kathy Eagar
This project began in late 2011 with the aim being to develop a model for national Aged Care Assessment as part of the government response to the Productivity Commission’s report on Caring for Older Australians. The project continued into 2012 with the aim being to outline the components of a recommended national assessment system. The work in this project brought together the community care assessment work, carried out over a period of more than ten years within the CHSD, with the more recent work by AHOC for a different section of the same Department on standardising the tools used by aged care assessment teams as gatekeepers for residential care. View more information on the Screening & assessment Tools page.
What we did
We undertook an academic/clinical review of aged care assessment tools being used in Australia, and developed an assessment framework and tool as a recommended model for future use as a “front-end” for aged care services. It recommended a national system that included a data repository, a data sharing model, linkages to local systems, assessment role delineation for service providers and specialist assessment agencies and accredited assessors. It proposed a three level model of assessment Level 1 for people with low needs and need some basic services, Level 2 for people who have mild to moderate problems and require access to more than a couple of basic services, and Level 3 for people who have moderate to high problems and/ or complex needs and require a comprehensive assessment for access to packaged or residential care. The recommended assessment tool focused on Levels 1 and 2 and was designed to be built on for Level 3 assessments. A prototype software tool was developed and a usability study was undertaken by the UOW Activity Theory Usability Laboratory with a sample of experienced assessors.
Sansoni J, Samsa P, Owen A and Eagar K (2012) Overlaps between Initial Intake Assessments and ACAT Assessment and Suggested Modifications. Centre for Health Service Development, University of Wollongong.
The primary purpose of this project was to support the Illawarra Shoalhaven Medicare Local in its first phase of planning for after-hours primary care services. All Medicare Locals were required to complete a whole-of-region needs assessment and stage one plan prior to 18 May 2012 through wide-ranging consultation with their members.
Primary care is the part of Australia’s health system that people use most. It is the first – primary – point of health care delivered in, and to people living in their communities – outside of hospitals. The aim of the Australian Government’s reforms to after hours primary care is to provide all Australians, regardless of where they live, with accessible and effective after hours primary care services.
Australian Government, National Health Reform Medicare Locals - Guidelines for after hours primary care responsibilities until 30 June 2013.
An independent national evaluation of the Stephanie Alexander Kitchen Garden National Program, conducted by the Centre for Health Service Development (CHSD) and involving collaboration between members of the University of Wollongong’s Faculties of Health and Behavioural Sciences and Education, commenced in July 2011. The evaluation was commissioned by the Department of Health and Ageing (DoHA).
With 178 primary schools across Australia participating at various stages of implementation, the Stephanie Alexander Kitchen Garden National Program teaches students from grades 3 to 6 how to grow, harvest, prepare and share fresh, seasonal food. The Program aims to encourage and reinforce healthy, lifelong eating habits.
Four years since the beginning of the Program’s rollout into schools, the evaluation team aimed to assess a variety of factors including changes to food preferences, lifestyle, behaviour, and gardening and cooking skills, to determine its positive reach. Broader implications for students’ academic performance in reference to Key Learning Areas were also considered, as were impacts on improving social inclusion and on understanding of effective health promotion practice in schools.
The objectives of the evaluation, and the methodologies to be applied, were outlined in a Project Plan developed at the commencement of the project, and subsequently approved by an Evaluation Reference Group (consisting of members of the evaluation team as well as external members). A national workshop was organised and held during September 2011. It was attended by 34 participants, including representatives of participating schools, DoHA, the Stephanie Alexander Kitchen Garden Foundation, and the evaluation team. The national workshop, and a series of web-based conferences held for those that could not attend the national workshop, represented the commencement of the evaluation.
The next step of the evaluation involved visits to 28 schools across Australia, which occurred in late 2011. Interviews were conducted with key school staff involved in the Program during these visits, and a number of other key evaluation data collection activities took place, namely the administration of student surveys, parent surveys and student food diaries.
During this period, additional data were collected and analysed, including schools’ mandatory three and nine month reports to the Stephanie Alexander Kitchen Garden Foundation. Also, relevant school level data on the Australian Curriculum, Assessment and Reporting Authority’s My School website were analysed, specifically the results from the National Assessment Program – Literacy and Numeracy (NAPLAN) and attendance rates.
The interim report was submitted January 2012. This was followed by a number of final evaluation data collection activities. Teacher and volunteer surveys were administered, a literature review written, and stakeholder interviews conducted with principals of demonstrations schools, key personnel within both the Stephanie Alexander Kitchen Garden Foundation and DoHA, as well as representatives of state and territory health and education departments. Additionally, an investment form was developed and completed by principals, which provided important costing information for the economic analysis component of the evaluation. The final report was submitted mid 2012.
The evaluation team was led by Professor Heather Yeatman (Faculty of Health and Behavioural Sciences), together with Senior Research Fellow Karen Quinsey (CHSD). Evaluation team members include Dr Deanne Condon-Paoloni (Health Sciences), Dr Wendy Nielsen (Education), Professor Simon Eckermann (Health Economics) and other participating CHSD personnel. The advantages of cross disciplinary research – in this case the combination of public health, nutrition and education expertise, with the range of disciplines of the CHSD staff – are evident in this evaluation.
For further information about this evaluation please contact the Centre for Health Service Development on (02) 4221 4411.
Download the final report
Nationally Funded Centres Reference Group
Duration: April - May 2012
In late 2010, the CHSD completed a costing project on behalf of the Juvenile Diabetes Research Foundation that formed part of a submission to the NFC Program to fund a National Islet Transplantation Service. The outcome of this project was a report that provided cost estimates of current islet transplantation services in Australia.
In December 2011, the Nationally Funded Centres Reference Group (NFCRG) established a working group to further consider the NFC submission. The working group commissioned this project to address specific costing issues.
What we did
CHSD was engaged to undertake the project and to complete supplementary costing on behalf of the NFCRG. The project built on the work undertaken in 2010 and involved completion of additional detailed costing of the islet transplantation process and the development of a costing methodology based on a ‘Staged Care Approach’ where three possible stages of a patient’s journey are separately costed and the development of separate costs for four different models of service delivery currently under consideration by the NFCRG.
A final aspect of the project was consideration of the potential to adopt an Activity Based Funding approach for the transplantation component of islet transplantation. The conclusion was drawn that, in our view, the only component that could be considered for an ABF approach is the inpatient episode during which the transplantation occurs. However, as the inpatient component of care represents less that 10% of the total cost of care for each transplant, it is questionable whether it would be sensible to implement a different funding arrangement for this episode of care.
Australian Healthcare and Hospital Association
Duration: September 2012
As one of the services the National Health Call Centre Network (NHCCN) provides, healthdirect is a 24-hour telephone health advice line staffed by Registered Nurses to provide expert health advice. AHSRI, in collaboration with the Deeble Institute, undertook a preliminary analysis of the healthdirect utilisation data through the lens of health need in order to determine which priority population sub-groups may be under utilising the services it provides.
What we did
The priority populations were those identified by the Australian Institute of Health and Welfare as groups with poorer health or more vulnerable to illness than the general population. It was assumed that, if the service was not available, some callers may have gone to their local emergency department (ED), while others may have gone to their General Practitioner (GP), contacted a local after-hours GP service or the ambulance service. Publicly available data from these other services were used to compare with utilisation of healthdirect by the priority sub-populations.
Some differences were found for various age and sex groups. For example, males and older people tended to under-utilise healthdirect. On the other hand young children and females aged between 20-39 years tended to utilise healthdirect more than other services. This showed that healthdirect has been effective in its objective to provide advice for infants and for 20-39 year old women. The analysis also found that Indigenous people may be under-utilising healthdirect when data on ED presentations was used as an indicator of health need. Indigenous people also have a higher burden of disease, which suggests that they have a greater need for health services such as healthdirect than non-Indigenous people.
NSW Ministry of Health
Duration: January - April 2012
Cochlear implantation is a rapidly growing field of medicine delivering substantial benefits to individuals and the economy. This has been reflected in a substantial growth in public funding for cochlear implantation in this new millennium.
This review was CHSD’s third exploring the supply and demand for cochlear implants in NSW. The report was commissioned by NSW Health to assist them in developing a measured response to the increasing demand for cochlear implantation in adults and children.
What we did
The review looked into various aspects of the supply and demand for cochlear implants: the impact on patient selection and demand arising from current evidence supporting cochlear implantation; the costs of paediatric and adult implantation; and current access, supply and capacity for growth.
As part of this process we consulted with key stakeholders and referred to the literature in relation to the evidence of the effectiveness of cochlear implants. We also undertook a costing of cochlear services provided in NSW and developed demand projections for cochlear services until 2021.
Most of the recommendations set out in our three reports have been adopted by NSW Health allowing public patients to share in the benefits available for those patients treated in the private sector.
The University of Wollongong’s Graduate School of Medicine (GSM) secured a ‘Rural Clinical School Funding Program Grant’ through the Commonwealth Department of Health and Ageing to compare the costs and impact of a long term integrated clinical placement for graduate medical students based in rural general practices with those in regional general practices. This research focused on one academic year. The GSM invited the CHSD to collaborate in the design and implementation of this research project. The costs were those related directly to the teaching program and its support. The analysis considered the impact on patient throughput during the sessions when the GSM student was working in the general practice. The project provided evidence of the impact and utility of senior medical students in communities with rural workforce shortages.
Illawarra Shoalhaven Local Health District
Duration: February - March 2012
The Director of the Division of Internal Medicine within the Illawarra Shoalhaven Local Health District requested a targeted literature review focused on the organisation of internal medicine services in acute hospitals.
This review of the literature sought to answer the question: what is known in the literature about the optimal way to organise, manage and deliver internal medicine services in the acute hospital setting? This work aimed to provide best practice evidence to inform future planning, quality improvement and change management initiatives within the organisation. The audience for the report included executive personnel and senior clinicians working within the organisation.
What we did
The literature review focused on evidence-based material and encompassed both the academic and practice literature, particularly literature published in the UK, Canada and New Zealand. Accepted academic search methods were used with almost 3000 titles/abstracts resulting in only 24 papers of potential relevance to the literature review. Selected professional websites were considered to identify relevant practice literature for example: the Royal College of Physicians of London.
The Medical Staff Capability Framework developed in Tasmania by Shannon et al* was used to structure our findings. Identifying high quality papers of relevance to the research question for this review was difficult. Studies often elicited mixed findings of questionable relevance to internal medicine in Australia. Many of the interventions covered in this review (e.g. clinical practice guidelines, clinical indicators) are a means to an end, with success or failure probably more dependent on how and why a particular intervention is implemented than the intervention itself. In conclusion, the optimal way to organise, manage and deliver internal medicine services in the acute hospital setting cannot be achieved through a simple remedy. It will be facilitated through an inclusive approach addressing all aspects of the capability framework provided by Shannon et al (2007). Success will rely on combining available evidence with expert opinion; working within each organisation's unique context, harnessing the good will of clinicians and accepting that change is likely to be incremental.
* Shannon EA, Brand BA, et al. (2007) Developing metrics for hospital medical workforce allocation. Australian Health Review 31(3): 411-421.