The following list of funded projects carried out in 2013 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.
2013 research projects
- Developing a classification for artificial limbs
- Evaluation of the Asthma Management Program
- Review and update of the NSW prosthesis relative value units
- Systematic literature review on options for integrating quality into healthcare pricing systems
- Validation & Field Trials of the National Assessment Framework for Aged Care
Duration: October 2012 - December 2013
EnableNSW is the government agency responsible for funding the provision of artificial limb services to eligible clients in NSW. Artificial limb services are provided to clients on behalf of EnableNSW by commercial limb manufacturers. EnableNSW is looking to implement a range of policy options, including funding reforms, to improve the effectiveness and efficiency with which artificial limb services are provided. The CHSD was commissioned in late 2012 by EnableNSW to undertake a project to contribute to this reform process.
What we did
One potential way to improve the efficiency of the current model is to develop a classification system that assigns services into resource homogeneous classes. This offers the potential advantage of streamlining payment arrangements by allowing manufacturers to be paid based on the number of services provided to clients in a particular class rather than being required to invoice for individual services. Under such a scenario, it is important to ensure that the classification system does not have any adverse impacts on either the funder or the provider and equally that the system does not introduce any unintended or perverse incentives.
In this context, the core objectives of the current project were to:
- Undertake a systematic analysis of existing EnableNSW cost and service use data to assess the potential to develop an artificial limb classification system;
- Based on the results of the above analysis, develop a classification system that accurately classifies the range of artificial limb services funded by EnableNSW;
- Test the impact of the classification, using a set of funding rules that could be applied in the payment of artificial limb services.
The project was undertaken in two stages. The first stage involved obtaining data from EnableNSW, developing a study dataset and conducting a range of exploratory analyses. The second stage involved applying recognised classification development principles to produce a recommended classification and an associated set of funding rules.
Download the final report
Gordon R, Navakatikyan M and Green J (2014) Developing a classification for artificial limbs: Final report. Centre for Health Service Development, Australian Health Services Research Institute, University of Wollongong.
In late 2009, the CHSD was selected to evaluate the Asthma Management Program (AMP) as well as to provide support and assistance to each of the funded initiatives within the Program. The use of evaluation frameworks helped to standardise and at least to ‘harmonise’ the data collected by the projects so they were more capable of learning by comparisons and building their own outcome measurement systems.
The overall purpose of the AMP evaluation was to assess progress in addressing the effectiveness, appropriateness and efficiency requirements of the Program, with the initial stage being formative with the emphasis on the implementation and progress of projects.
This is where CHSD made good use of a long track record in rural palliative care, care planning, rehabilitation, hospital avoidance programs and other aspects of chronic disease management. The use of data collection tools tailored to the projects’ aims helped them to plan their work programs around priority population groups.
The evaluation design phase in 2010 set up regular opportunities for the projects and the program managers to reflect on progress to date and identify potential improvements to projects, and to the Program as a whole, though a series of national workshops, an Evaluation Advisory Committee and regular contact with the Department of Health and Ageing. The final report of the evaluation was submitted in 2013.
NSW Ministry of Health
Duration: August 2013 - September 2013
The National Casemix and Classification Centre (NCCC) was engaged by the NSW Ministry of Health to develop Relative Value Units (RVUs) based on AR-DRG Version 6.x. RVUs are used in health service costing when there is insufficient patient utilisation data available to enable actual costs to be allocated to individual episodes. The last revision of prosthesis weights in 2005 did not include the use of NSW data. These NSW specific RVUs were to be applied for the costing of 2012/13 patient activity.
What we did
The costing data from 20 NSW hospitals were analysed. In these hospitals, costs had been allocated using prosthesis utilisation data and therefore should be reflective of actual costs. The data underwent a rigorous testing, and as a result, a number of costed episodes, and the entire dataset in the case of two hospitals, were discarded.
A set of RVUs were developed in Version 6.x AR-DRGs. The new RVUs were then included in detailed comparative analysis against the service weights which had previously been used to allocate prosthesis costs. In testing, the performance of the RVUs was greatly improved compared to the service weights, particularly in the areas of mental health and drug and alcohol treatment where the use of prostheses would be expected to be negligible.
The use of these RVUs in the costing of patient episodes for the 2012/13 year is expected to provide significant improvements in the quality and reliability of the costing data.
Australian Commission on Safety and Quality in Health Care
Duration: September 2012 – March 2013
This review is part of a larger work program being managed jointly by the Australian Commission on Safety and Quality in Health Care (the Commission) and the Independent Hospital Pricing Authority (IHPA). The purpose of this literature review is to review the evidence on existing mechanisms in operation which aim to integrate quality and safety into the pricing or funding arrangements for health care. We considered this relatively small project to be critical in the context of current national health reforms including the introduction of a national model of Activity Based Funding.
What we did
For this project, we applied a rapid but rigorous search strategy to identify literature related to integrating quality and safety into healthcare pricing or funding systems. The review considered a number of overarching models including best practice pricing, normative pricing, quality structures pricing and payment for performance.
The literature revealed that the key considerations in the implementation of such models were the creation of substantial and targeted incentives, the development of a meaningful impact evaluation model, and the inclusion of methodologies for risk adjustment.
Our key conclusions were that there is insufficient international evidence at present to support the ‘off the shelf’ adoption of any existing pricing model that incorporates financial incentives and/or sanctions for quality and safety; and that, overall, the strongest evidence on how to genuinely improve quality and safety exists for clinical quality registry and benchmarking systems which typically have no links to funding.
Download the final report
The project built on the earlier 'Development of a National Assessment Framework for Aged Care' project and focused on the adaptation of the recommended tool for use in the Commonwealth Government’s Aged Care Gateway which is intended to be the primary access point to aged care services as part of the Living Longer Living Better reform package. The tool was to be field trialled and used to inform the development of the Gateway and provide the Business Requirements and Specifications for the development of the Information Technology required for the assessment tool to be used in the Gateway. This also included development of competencies for assessors using the tool.
We worked with an application developer to build a version of the tool that could be delivered via a web-browser. We negotiated with relevant state government Agencies about their participation in the trial. Four states, SA, NSW, Tasmania and Victoria, agreed to participate and eventually seven assessment services in these states were involved. We liaised with these sites, developed training materials and trained 60 assessors in the use of the tool. The sites assessed approximately 1,600 people between mid-May and June 2013. The data collected about the applicants and the assessment process were analysed to better understand the range of clients and ways that the assessment process could be streamlined. We also asked assessors to provide feedback on each assessment carried out and conducted feedback sessions with them after the trial ended. Consumers were also asked to provide feedback on the assessment process after each assessment and were asked if they wished to provide feedback via a written survey.
Download the final report
Sansoni J, Samsa P, Duncan C, Westera A, Grootemaat P, Shadbolt B and Eagar K (2013) Final Project Report on the Validation and Field Trials of the Assessment Framework and Tool for Aged Care Project Plan. Centre for Health Service Development, Australian Health Services Research Institute, University of Wollongong.