The following list of research and evaluation projects carried out in 2014 includes a mix of short-term projects completed in one calendar year and longer term projects lasting, in some cases, for two or three years.
2014 projects
2014 research projects
- Evaluation of the HWA Expanded Scopes of Practice Program
- Evaluation of the National Quality Dementia Care Initiative (Alzheimer’s Australia)
- Evaluation of the Southern Suburbs Community Sector Capacity Building Project
- Indigenous Multi-Disciplinary Health Research Coalition
- Kiama Youth Mental Health National Broadband Network
- Literature Review and Needs and Feasibility Assessment of Services for People with Younger Onset Dementia
- NFC price per procedure for paediatric liver transplantation
- Nurse Practitioners in NSW Gaining Momentum
- RDF Health Needs Indices Review
- A Systematic Literature Review on Question Prompt Lists and Shared Decision Making in Health Care
- WA State-wide Rehabilitation Service – Peer Review of Service Delivery Model
Background
The HWA-ESOP program is part of a work plan implementing the National Health Workforce Innovation and Reform Strategic Framework for Action 2011-2015. It was instigated to address known areas of workforce shortage in the Australian health system by expanding the scopes of practice of nurses and allied health professionals. Innovative models of care delivery have been developed by State and Territory health authorities. These models have the potential to improve patient outcomes, reduce waiting times and ease pressure in areas of high demand, such as Emergency Departments (EDs), by equipping health professionals with skills and experience to extend their existing roles. In total, 26 organisations have received funding under the HWA-ESOP program to implement and evaluate models of expanded scope of practice. They constitute four sub-projects: Advanced Practice in Endoscopy Nursing; Physiotherapists in the Emergency Department; Nurses in the Emergency Department; and Extending the Role of Paramedics.
What we did
As national evaluator of the program, the role of the Centre for Health Service Development (CHSD) was to assist sites with planning and carrying out their evaluation activities; to monitor evaluation outcomes; and to collect, organise and synthesise evaluation data from the program as a whole, to inform future policy and practice. CHSD systematically evaluated these models and assessed whether they were suitable for wider (national) roll-out and the conditions under which they were most likely to succeed.
A set of Key Performance Indicators was collected for each sub-project in addition to a range of evaluation information to address national evaluation requirements. In combination this data and information ensured the evaluation reported on the key domains of inquiry for HWA: workforce capacity; effectiveness including the impact and experience for consumers and service providers as well as safety and quality outcomes; economic measures including cost and efficiency; workforce productivity; sustainability and the generalisability or scalability of the implemented models.
The downloadable Evaluation Framework (pdf) was developed in consultation with sub-project Clinical Advisors, Project Advisory Groups and implementation sites. The evaluation framework was designed to measure impact from the perspective of consumers, providers and the system by investigating six broad evaluation questions:
- Program/project delivery: What did you do?
- Program/project impact: How did it go?
- Sustainability: Can you keep it going?
- Capacity building: What has been learnt?
- Generalisability: Are your lessons useful for someone else?
- Dissemination: Who did you tell?
To support the collection of data to inform the evaluation, a downloadable Compendium of Data Requirements and Evaluation Tools (pdf) was developed which detailed the data required and specified how this information was collected and recorded.
More information is available from Health Workforce Australia's (archived) Expanded Scopes of Practice Program Website.
Download the final evaluation report
- Download the National Synthesis (pdf)
- Download the Advanced Practice in Endoscopy Nursing Sub-Project Final Report (pdf)
- Download the Physiotherapists in the Emergency Department Sub-Project Final Report (pdf)
- Download the Nurses in the Emergency Department Sub-Project Final Report (pdf)
- Download the Extending the Role of Paramedics Sub-Project Final Report (pdf)
Related journal articles
- Masso M and Thompson C (2016) Attributes of innovations and approaches to scalability – lessons from a national program to extend the scope of practice of health professionals. Journal of Multidisciplinary Healthcare, 9: 401-410.
- Bird S, Thompson C, Williams KE (2016) Primary contact physiotherapy services reduce waiting and treatment times for patients presenting with musculoskeletal conditions in Australian emergency departments: an observational study. Journal of Physiotherapy, 62 (4): 209–214.
Project team: Cristina Thompson, Kate Williams, Darcy Morris, Luise Lago, Karen Quinsey, Conrad Kobel, Patrea Andersen, Simon Eckermann, Rob Gordon, Malcolm Masso
Duration: October 2010 - December 2014
Background
This project consisted of an evaluation of the National Quality Dementia Care Initiative (NQDCI), which was launched in September 2010 in Sydney at the inaugural Quality Dementia Care Summit. The Initiative provided $3 million to facilitate consumers’ engagement and generate their perspectives on dementia research priorities and processes, as well as fund a series of rapid knowledge translation projects. The aim was to address priority dementia care areas of service provision and support as identified by consumers. The Initiative aimed to strengthen the relationships within the federation of State and Territory associations of Alzheimer’s Australia, as well as with external stakeholders such as the Dementia Collaborative Research Centres, the National Partnership Centre for Dealing with Cognitive and Related Functional Decline in Older People, service providers and the Department of Health.
What we did
Our role as national evaluators was to capture both formative and summative evaluation findings. Through ongoing interaction with members of the Consumer Directed Research Network (established through the Initiative); the project teams implementing knowledge translation interventions and our work with representatives of Alzheimer’s Australia we provided early feedback and results to inform the continuing development and improvement of the program. The summative evaluation was finalised in 2014 and addressed the extent to which the National Quality Dementia Care Initiative was implemented as intended and the desired results achieved.
In summary, eight major knowledge translation projects were completed in 2013/2014 implementing evidence across a range of care settings addressing priorities that were identified by consumers. These projects were required to have a national impact, or have outcomes that had the potential to be generalisable on a national scale. The final evaluation report of the NQDCI, focusing predominantly on the activities and outcomes of the knowledge translation projects, was submitted in December 2014. It was found that the Initiative effectively demonstrated the application of consumer involvement in dementia research and knowledge translation. The most successful components were the knowledge translation projects and the establishment and sustained operation of the Consumer Dementia Research Network. The success of the projects showed that implementation obstacles could be addressed, including overcoming inter-jurisdictional boundaries and inter-sectoral barriers, and engaging diverse professional groups in collaborative quality improvement initiatives. The Consumer Dementia Research Network has worked alongside researchers and service providers to identify priorities and improve processes for collaboration and involvement of consumers in research and research translation. The NQDCI predominantly generated indirect gains for consumers, tangible and useful benefits for service providers and showed the broader aged care sector that consumers have the capacity to drive effective knowledge translation in collaboration with researchers and care providers.
More information about the NQDCI is available from the Dementia Australia website.
One of the knowledge translation projects, Start2Talk, established a portal for information about dementia and advance care planning, designed from the consumer point of view to be relevant and usable by people with dementia, family carers and healthcare professionals.
Download the evaluation reports
The following reports are available to download:
Wollongong City Council
Duration: August 2012 - July 2014
Background
In 2011 Wollongong City Council obtained a three year funding grant from the NSW Government through Community Services, Department of Human Services, to develop and implement the Strengthening Communities - Community Builders Project. A Capacity Building Program was developed and implemented with two established community organisations in the Illawarra region. These were the Coomaditchie Community Hub operated by the Coomaditchie United Aboriginal Corporation and the Warrawong Community Kitchen/Lunch operated by the Warrawong Residents Forum Inc. The Capacity Building Program consisted of a series of activities implemented at each site by external consultants between July 2012 and June 2014. CHSD was commissioned by the Council in August 2012 to conduct the evaluation at the two sites.
What we did
A formative evaluation, encompassing process as well as outcomes elements, was conducted to provide a framework for developing an understanding of the process of change and for finding out how was the Program was implemented at each site, the extent to which the Program produced worthwhile results in the short, medium and long term, the enablers and barriers to participation in and impact of the Program at each site, and extent to which the Program contributed to the sustainability of the two organisations.
The first stage of the project involved a targeted literature review and development of an evaluation framework. Qualitative and quantitative data were collected and analysed including program data, 24 qualitative semi-structured interviews with stakeholders and key staff, on-site visits, and quantitative service data to describe client service activities and use.
The evaluation found that the Capacity Building Program was successfully implemented at each of the sites over a two year period. It brought together Council staff, external consultants, staff, management committee members, and volunteers at both sites around a Program designed to enhance the capacity of the organisations to deliver much needed services to their disadvantaged clients. The Program focused attention on the underpinnings of strong and effective organisations – good governance, vision, goals and objectives aligned with organisational capacity, the use of knowledge to inform service delivery, and the need to adopt innovative ways of addressing future uncertainties. The Program resulted in a number of outputs: revised policy and procedures manuals for both of the projects; Capacity Building Action Plans for each of the projects; a People Assets Mapping Project Report.
The Program has achieved many of its short and medium term outcomes, including those around improved knowledge and skills in good governance principles and processes; an improved understanding of current organisational situation; and the capacity for short and long term planning. Perhaps the most important outcome to emerge in the short and medium term was that the AHSRI 2014 ANNUAL REPORT I 27 project staff and management committees have become better informed about potential business collaborations and partnerships between local business leaders and the community organisations were established. The implementation of the Capacity Building Program was facilitated by a systematic approach to organisational capacity building as well as a creative approach to trying out various strategies in order to find those which had the best fit for each of the organisations. The most success was achieved when the consultants were willing to listen and respond flexibly to the needs of the organisations. One of the key strengths of these community based organisations is that they are flexible and willing to adapt to changes in the environment. The evaluation demonstrated this ability of the projects to incorporate new ideas and to give new ways of doing things a go.
University of Wollongong Global Challenges Program)
Duration: January 2014 - December 2014
Background
The overarching goal of this 12 month pilot project was to establish an Indigenous led research multi-disciplinary collaboration of UOW researchers and local Aboriginal community organisations, with the aim of developing a broad social health research agenda that addresses the social determinants of Indigenous health within a regional context. The project was intended to serve as a model for urban Aboriginal communities nationally and internationally. The main objectives were: to develop a baseline understanding of the Illawarra and Shoalhaven Aboriginal communities; to host an event that would bring together Aboriginal community stakeholders with the UOW research team; and to develop the capacity of the local Aboriginal community to engage in research.
What we did
The coalition brought together researchers from across three UOW faculties (Business, Science, Medicine and Health, and Social Sciences) and three research institutes (AHSRI, IHMRI and ESRI). Using existing data sources the group compiled baseline data and produced a report, ‘Illawarra Aboriginal Community Profile: a snapshot of an urban Aboriginal community’, providing an overview of the demographic, socioeconomic and health profile of the regional Aboriginal population and identifying some of the strengths of the community, notably the Aboriginal community controlled organisations.
The Global Challenge project was based on the premise that Aboriginal people are the experts in their own communities and know what questions should be asked and the appropriate protocols for conducting research. To help enhance the ability of the Aboriginal community to engage meaningfully in research a series of research training workshops were conducted by team members with staff of the Illawarra Aboriginal Medical Service. The team also developed a guideline, ‘Aboriginal Health Research and Evaluation: Understanding the Difference’, aimed at assisting University of Wollongong researchers to undertake ethical research with Aboriginal communities in the region.
In December 2014 AHSRI hosted a Community Research Forum to share the information compiled in the ‘Illawarra Aboriginal Community Profile’ report and to discuss the research priorities of the Illawarra Aboriginal community. Invitations were issued to Aboriginal community members from a range of local organisations and around 30 participants attended. Forum participants expressed a strong interest in developing a program of collaborative and community based participatory research between University researchers and community organisations around the theme of ‘Caring for Community’. There was a particular interest in documenting and evaluating the impact of local Aboriginal organisations. Further applications for funding have been made to further develop the research program in 2015.
Illawarra Shoalhaven Medicare Local
Duration: June 2012 - June 2014
Background
Illawarra Shoalhaven headspace (youth mental health service) received funding to trial the use of NBN-enabled technologies to deliver their services to young people living in Kiama. Parts of the Kiama LGA have been connected to the NBN. These services were to be provided via very high definition video conferencing screens located in a client’s house or at an accessible location such as Kiama High School, Library or Community Centre and connected to the NBN. The aim of the Trial was to improve access to headspace services without prejudicing quality. CHSD was contracted to evaluate the trial.
What we did
At the commencement of the evaluation, CHSD undertook a targeted literature and practice review of technology enabled mental health services and then developed a detailed evaluation methodology. Semi-structured interviews were conducted with headspace clinicians at three time points during the project, and other key stakeholders were also interviewed at two time points. Qualitative analysis of these interviews was combined with data from a number of other sources, including data on headspace client service use and client responses to an online survey. The delays in the roll-out of NBN services resulted in lower than expected usage of the service and as such the trial was extended into 2014.
The evaluation found that videoconferencing technology delivered over the NBN could complement the delivery of more traditional face to face headspace services. However, there also appears to be some reluctance amongst young people to utilise services via videoconferencing when there are realistic and viable choices available.
Clinicians who used the video conferencing technology reported that they could build a therapeutic relationship with clients using the technology with some important provisos. The best approach may be the use of a blended approach where there is a combination of face-to-face engagement and video conferencing when it was convenient for the client or their family. The situation of the young person and family should be the key factor in determining the type of contact that should be used.
Duration: July 2013 - February 2014
Background
The project included an international literature review and national consultation process to identify the needs and feasibility of services to support people with younger onset dementia. The majority of dementia support services are located in the aged care sector, which is not well placed to address the needs of people who are younger and who have different personal, family, social and vocational needs and aspirations. The CHSD approach included looking beyond the traditional dementia services and examined disability services, community organisations and businesses that employ volunteer services, to explore the capacity of these organisations to contribute to improved quality of life for people with dementia.
What we did
The international literature review was the largest ever undertaken for younger onset dementia and included over 300 journal articles, reports, presentations and websites. The needs and feasibility analysis included face to face consultations with over 200 people across most States and Territories. Importantly, this included a number of people with younger onset dementia and family carers whose insights highlighted the need for a significant re-framing of the way in which services are provided, as well as the nature and breadth of those supports and services. Consultations were also held with service providers, special interest and needs groups, peak body representatives, researchers and jurisdictional policy and program advisors. An online survey was also conducted to widen access to the consultation process. Findings suggested that service and policy development for people with younger onset dementia should be guided by the following: a focus on the individual; timely and accurate diagnosis; appropriate services; integrated care; continuity of care; service-specific issues such as the need for respite care and peer support; and good policy and program design.
View the journal article
Download the final reports and executive summaries
Download the Executive Summary - Younger Onset Dementia: A Literature Review (pdf)
Download the Executive Summary Final Report - Literature Review and Needs and Feasibility Assessment of Services for People with Younger Onset Dementia.
Duration: March 2013 - May 2014
Background
The Nationally Funded Centres Program for paediatric liver transplantation has sites at the Royal Children’s Hospital Brisbane, Queensland, The Royal Children’s Hospital Melbourne, Victoria and The Sydney Children’s Hospital Network (Westmead), New South Wales. A comprehensive assessment of the NFC Program for paediatric liver transplantation was undertaken during 2012 and 2013 by DLA Piper which made a number of recommendations. One of the recommendations was that the paediatric liver transplantations provided through the NFC Program be funded at a rate of $270,681 for each transplant.
CHSD was approached to undertake a review of this recommendation price per procedure on behalf of the National Funded Centres Reference Group.
What we did
The review has comprised three activities – a review of relevant documentation (including previous NFC submissions), a targeted stakeholder consultation process and the development of an expected cost profile based on the pathway description for PLT services.
The review of the documentation highlighted that different approaches have been adopted in development of the costing submission, but revealed that there was a generally consistent care pathway for the management of paediatric liver transplantation across the three sites. At the same time, the stakeholder consultation highlighted that there remains a great deal of variability between patients receiving a liver transplant in terms of their responses to care, which often drives differences in cost.
NSW Ministry of Health
Duration: June 2014 - December 2014
Background
This project involved working closely with the Nursing and Midwifery Office in the NSW Ministry of Health to facilitate the ongoing development of nurse practitioner positions in the NSW public health system. The structure of the project evolved over time and consisted of three stages: (1) A review of the literature, with a particular focus on the Australian literature since 2000; (2) A review of the scope of practice documents of nurse practitioners in NSW; and (3) Development of a compendium, which included descriptions of 12 nurse practitioners recognised as ‘exemplars’ of what is possible.
What we did
The literature review sought to answer the question ‘what do nurse practitioners look like?’ and identify Australian research regarding the factors influencing successful implementation. Literature searching included the peer-reviewed academic literature and the non-peer reviewed literature available on the web sites of government departments, professional organisations and universities. The three main sources for the review were 28 existing reviews of the literature; 68 papers reporting studies undertaken in Australia to evaluate nurse practitioners; and some conceptual papers that provided insights into the nurse practitioner role. The literature review was published by the Nursing and Midwifery Office on their website in November 2014 (‘Rapid review of the nurse practitioner literature: Nurse Practitioners in NSW Gaining Momentum’).
Working in close collaboration with the nurse practitioner coordinator in each local health district, scope of practice documents were obtained from nurse practitioners from across the state. Document review identified several areas where the scope of practice documents could be improved.
Discussions with the Nursing and Midwifery Office resulted in 12 suggestions for nurse practitioner models to be included in a compendium of exemplars of nurse practitioner practice. The models described in the compendium included seven nurse practitioners working in rural locations, four in metropolitan locations, and one in a remote location. Compilation of the descriptions for inclusion in the compendium was based on interviews with nurse practitioners, interviews with clinicians and managers familiar with their work, and some observation of their work. The case studies resulted in rich descriptions of the nurse practitioner role.
Download the final report
Related journal article
Project team: Malcolm Masso and Cristina Thompson
NSW Ministry of Health
Duration: October 2013 - February 2014
Background
The NSW Ministry of Health engaged Health Policy Analysis (as part of a consortium including the Centre for Health Service Development at the University of Wollongong) to assist in the development of health needs indices (HNIs) for acute care, rehabilitation and extended care, emergency department care, outpatient and primary and community care. These indices are used in the NSW Health Resource Distribution Formula to determine the relative need of local health districts, over and above the influence of the age and sex composition of the resident populations.
What we did
The objectives of the project were to produce new estimates for the acute care and rehabilitation and extended care HNIs, and to develop new HNIs for emergency departments, outpatient services, primary care and community-based services. The project involved an extensive literature review, collation of data from a broad range of sources, extensive modelling and consultation on the results of the modelling. Through the project, the need indices for acute care were updated, and new methods were developed for addressing the treatment of private sector activity and private patient revenue. A new approach to the need index for maternity services was developed. The need index for rehabilitation and extended care services was updated. New need indices were developed for emergency department services, outpatient services, and community health.
Australian Commission on Safety and Quality in Health Care
April – September 2014
Background
This project involved a systematic literature review concerning the use of Question Prompt Lists (QPLs) to facilitate communication, patient question asking, information gathering and information provision to patients by health care professionals during health care consultations. QPLs may be prepared lists of questions relevant to the health condition prepared by research teams but they also include patient generated question prompt lists.
What we did
A systematic search was undertaken to identify relevant literature concerning QPLs including academic databases, Google-based and snowball searching. Forty-two relevant studies reporting 50 interventions were identified. There was evidence that a QPL endorsed by the physician increased total question asking. Using a QPL also increased question asking concerning specific content areas (e.g. prognosis). There was some evidence that physicians provided more information during these consultations. There were no consistent findings concerning effects on patient knowledge recall, anxiety and satisfaction or consultation time. Some interventions that increased question asking had longer consultation times.
There is evidence that an appropriate QPL, endorsed by the physician and provided immediately before the consultation, may increase patient question asking and lead to more information being provided by the physician.
These findings lend support to QPL use in routine practice. Further trials might address the research issues identified including an assessment of the optimal length of a QPL and QPL adaptation for cultural and special needs groups.
Related publications
Fiona Stanley Hospital
Duration: February – March 2014
Background
Opening in 2014, Fiona Stanley Hospital, Perth is a 783-bed, $2 billion public hospital that will rank among the best in Australia and will include the 140- bed State-wide rehabilitation service. Under the State-wide service model, it will provide tertiary rehabilitation services for acquired brain injury, spinal injury, stroke and chronic neurological conditions, amputee, complex trauma and complex multi-diagnostic patients. In preparation for opening in 2014 the team commissioning the State-wide Rehabilitation Service sought an expert peer review of the service delivery model they had developed. The recently opened Fiona Stanley Hospital in Perth, Western Australia.
What we did
CHSD staff in association with AROC put together a team of experts in rehabilitation, including medical, nursing and allied health representatives. This team undertook a desk-top review of the specialty service plans (amputee, neurology, acquired brain injury, spinal, trauma and multispecialty rehabilitation) developed in preparation for the opening of the hospital. A site visit was also undertaken by a senior rehabilitation physician. The final report provided to the Fiona Stanley team covered issues such as did the speciality plans represent contemporary best practice. Areas such as clinical outcomes, operational performance, innovation, workforce and environment were covered.