Over 50 research and evaluation projects were undertaken in 2017. These included a mix of short-term projects completed in one calendar year and longer-term projects extending in part throughout 2017. The following list provides a summary of each project’s activities and achievements.
2017 research projects
- After-hours primary care presentations in the St George Hospital and the Sutherland Hospital Emergency Departments
- Caring for Community: Investigating the contribution of Aboriginal organisations to community wellbeing
- Culturally and Linguistically Diverse Carers Support Project
- Evaluation of the national Severe Behaviour Response Team (SBRT) program
- Evidence check of Specialist Dementia Care Units
- Health outcomes analytics project
- Implementing the Australian Paediatric Rehabilitation Outcomes Registry
- Integrated Care Review (CCNSW)
- Preventing unintentional injury to Aboriginal children and young people in NSW
- Research into services and needs for people experiencing complicated grief (Phase 1)
- ReThink Respite
- ReThink Respite Online
- Review of Activity Based Funding data
- Review of costing data – Phase 1
- Social marketing research to prevent unintentional injury to Aboriginal children
- Statistical analysis of national subcutaneous insulin chart pilot data in subacute care
- Study into alternative aged care assessment, classification system and funding models
- Unwarranted clinical variation in rehabilitation
Central Eastern Sydney Primary Health Network
Duration: January – June 2017
Emergency department presentations in Australia are increasing annually. Potential primary care presentations are non-urgent presentations which can be dealt with by a general practitioner or other primary care provider rather than requiring the specialist services of an emergency department. Emergency departments are the most expensive of all after-hours primary care pathways and getting ‘the right care in the right place at the right time’ is a national health priority. A grant was received from the Central Eastern Sydney Primary Health Network to determine the level of primary care presentations in the after-hours period in the St George Hospital and the Sutherland Hospital Emergency Departments.
What we did
The study was a quantitative cross-sectional study, involving a retrospective audit of medical records. The existing code frame to determine a primary care appropriate presentation developed by Bezzina et al. (2005) and Siminski et al. (2008) was expanded on and tested on nearly 20,000 emergency department presentations. The final code frame was then applied to five years of emergency department data (over 601,000 presentations) at the St George Hospital and The Sutherland Hospital. Using this definition we found that 28% of all presentations in these hospitals were found to be potential primary care appropriate presentations, and that 19% of all presentations occurred in the after-hours period.
We then compiled a population profile of these patients and determined that the demographic profiles of potential primary care patients in the after-hours periods were different to the population demographics for the Local Government Areas within the hospital catchment areas. Our list of recommendations, along with this demographic information, will enable the Central Eastern Sydney Primary Health Network to develop and implement specifically targeted interventions to these population groups.
Project team: Heike Schütze and Kathy Eagar
University of Wollongong and National Indigenous Research and Knowledges Network
Duration: November 2014 – December 2017
This research examined the vital role of Indigenous community-controlled services and organisations in the health and wellbeing of contemporary Indigenous Australians. The overall aim was to build an evidence base around the contribution of Aboriginal Community Controlled Health Organisations (ACCHOs) to the social health and wellbeing of Aboriginal people. A key outcome of the project was to develop a model of how an effective, sustainable ACCHO can contribute to transforming lives and regions. The study involved an exploratory mixed methods case study of one Illawarra organisation, the Illawarra Koori Men’s Support Group (IKMSG). It aimed: firstly, to describe the operation of this community-controlled organisation and ascertain how it is sustained over time; and secondly, to examine the impact of the group’s activities on the health and wellbeing of the local Aboriginal community.
What we did
This collaborative research project built on work funded in 2014 by a UOW Global Challenges strategic grant. We commenced by hosting a workshop which identified the need for an ongoing program of collaborative and community-based participatory research between University researchers and Aboriginal community organisations around the theme of ‘Caring for Community’. Drawing on existing data sources we compiled baseline data and produced a snapshot report overviewing the demographics, socioeconomic status and health profile of the local Aboriginal population; we identified strengths of the community, notably the numerous ACCHOs.
In 2015, with further funding from the University of Wollongong’s Global Challenge Program and the National Indigenous Research and Knowledges Network (NIRAKN) we undertook a pilot study of the IKMSG using mixed methods to document and assess the impact of the group’s programs, networks and partnerships. Qualitative data was collected from 21 face-to-face or phone interviews with local stakeholders and three focus groups with IKMSG participants. Quantitative data was collected through an online survey of 21 regional stakeholders.
We established an Advisory Panel and developed a Memorandum of Understanding between the UOW researchers and the IKMSG which served as a model for research agreements between university researchers and ACCHOs.
The current project developed as a community-based participatory action research initiative with three main foci: research; community engagement; and communications and messaging.
A social network analysis has mapped the relationships between the key organisations which support Aboriginal health and wellbeing within the Illawarra. Qualitative data provide evidence for the importance of IKMSG programs for Aboriginal men and their families and its value within the local Aboriginal community.
The results of the pilot research study were presented at the Australian Institute of Aboriginal and Torres Strait Islander Studies National Conference in March 2017. The final research report and a community report were launched at a community event in December 2017.
Multicultural Communities Council Illawarra
Duration: July 2016 – April 2017
Informal carers of older people make a critical contribution to the health and wellbeing of Australian communities. Carers provide care and support to family or friends who are frail and elderly, experiencing chronic or terminal illness, have a disability or mental illness or have drug or alcohol issues. Because the caring role can be stressful and isolating, services have been developed to support carers. However, carers from culturally and linguistically diverse (CALD) communities are less likely than those from majority cultures to seek or use support services.
Multicultural Communities Council Illawarra (MCCI) engaged our team to conduct formative research and develop social marketing materials to promote the awareness and uptake of carer support services for carers of older people from Turkish and Vietnamese communities in the Illawarra region.
What we did
We conducted both a literature review and qualitative formative research to develop a greater understanding of Turkish and Vietnamese carers’ knowledge about and attitudes towards carer support services. Three focus groups and fifteen interviews were conducted as part of inclusive consumer consultations that involved 33 participants including carers, people who work with carers, family members of carers, or community members who are of an age that potentially require access to carer services. All groups and interviews were analysed using a thematic approach informed by a patient-centred conceptual framework of access to health care services. Our findings suggest strong commonalities were identified as relevant to many carers’ capacity to locate, identify and communicate with support services. We also identified substantial inter- and intra-cultural diversity between the Turkish and Vietnamese communities. In this, service seeking was made more complex by individual perceptions of need, tenuous conceptualisations of support requirements and varied beliefs about the value or benefit of services.
Findings from the formative research informed the development of a suite of social marketing materials including social media posts, radio scripts, posters and print advertisements. The materials will be utilised as part of the ‘Every Carer’ campaign which focuses on the need for all Turkish and Vietnamese carers to have access to advice, support and company. These materials will be disseminated by MCCI as part of their larger CALD Carers Support Strategy (funded by an Aged Care Services Improvement Grant, Department of Social Services). Final outputs including a scoping review, research report, social marketing plan and plain language resources were delivered to MCCI in April 2017.
Duration: December 2015 – September 2017
The Severe Behaviour Response Team (SBRT) is a national emergency response program for residential aged care facilities to better support residents experiencing very severe behaviours and psychological symptoms of dementia (BPSD). The SBRT considers the clinical factors that may underlie the behaviours as well as the care context – including staff skills and confidence as well as environmental design factors – that are known to impact on behaviour. In October 2016 HammondCare commenced national operations of the Dementia Behaviour Advisory Service that complements the SBRT and developed a national partnership called Dementia Support Australia (DSA).
What we did
The major data collection activities conducted during 2017 included telephone surveys of aged care facilities, national site visits, key stakeholder interviews and SBRT staff surveys. Telephone surveys of aged care homes were conducted during February – March 2017, designed to better understand the context in which the SBRT was operating, and to assist refinement of issues to be considered within the national site visits. A total of 46 care homes that had used SBRT services participated in the short survey, as well as another 53 care homes that had not used the service. During April – June 2017 the evaluation team conducted site visits to an additional 20 aged care homes that had used the SBRT. At each home between two and five semi-structured interviews were conducted involving managers, senior clinical and other care staff; evaluation team members were also provided with the opportunity to view the amenities at each aged care home. A total of 47 participants were interviewed; despite attempts at recruitment, it was not possible to interview SBRT clients or their family members. An online survey was developed to ascertain the perspectives of SBRT staff regarding the service, with 27 consultants responding to the survey. The final data collection activity for the evaluation was a series of targeted key stakeholder interviews conducted during June and July 2017. A total of 14 interviews were conducted with aged care sector, professional, consumer and policy representatives.
The evaluation also included the analysis of program data provided by the service. This included de-identified client data of 859 clients including risk assessment and general assessment data, as well as activities of SBRT staff in relation to those clients.
An important outcome of the evaluation was the identification of organisational factors that contribute to the presence of BPSDs, including workforce factors, resourcing and access to local specialist services. The final report was submitted in October 2017 and highlighted the major achievements of the SBRT service as well identifying opportunities for future service delivery, research and policy development.
Project team: Anita Westera, Dave Fildes, Rob Gordon, Sonia Bird, Cathy Duncan, Peter Samsa and Pam Grootemaat
Department of Health
Duration: June – September 2017
The Commonwealth Department of Health is implementing Specialist Dementia Care Units (SDCUs) to meet the needs of elderly people experiencing very severe and extreme behavioural and psychological symptoms of dementia (BPSD). The intention is to establish at least one SDCU in each of the 31 Primary Health Networks across Australia. SDCUs are the planned ‘third tier’ in programs to assist aged care consumers experiencing BPSD, complementing the existing Dementia Behaviour Management Advisory Service (Tier 1) and Severe Behaviour Response Teams (Tier 2). CHSD was commissioned to review the evidence regarding the effective management and care of people with very severe and extreme BPSD to inform the implementation of SDCUs, with the Sax Institute acting as ‘broker’ for the review.
What we did
Searching the academic and grey literature resulted in the identification of 25 papers about 17 units in Australia and countries with comparable health systems. The papers reported on units catering to different populations of people with dementia and behavioural symptoms across a variety of settings, with little consistency in the findings.
The quality of the evidence was assessed using a framework developed by the National Health and Medical Research Council, which resulted in nine studies being identified as having the greatest potential to inform the development of SDCUs: one study categorised as best practice, two studies categorised as promising practice and six studies assessed as emerging practices.
Evidence of effectiveness in managing very severe or extreme BPSD was limited: four units demonstrated improvement in behavioural symptoms, but in three of these the results were based on a weak study design. The evidence for improvement in behavioural symptoms for the fourth unit was based on a good study design.
Synthesising the findings resulted in the identification of various common elements across the units studied, covering issues such as unit philosophy; physical environment; staff education; medical and allied health staffing; activity programs; assessment and care planning; and a multidisciplinary approach to care.
The Department of Health was impressed with the quality of the review and subsequently initiated a ‘policy dialogue’ with CHSD in October. This took the form of a teleconference, facilitated by the Sax Institute, to seek the advice of CHSD regarding the ongoing development of SDCUs, particularly in relation to program design, implementation and evaluation.
Project team: Malcolm Masso, Cathy Duncan, Pam Grootemaat, Lyn Phillipson, Peter Samsa, Dave Fildes, Rob Gordon
Epidemiological Consulting and the Hunter New England and Central Coast Primary Health Network (HNECC Limited)
Duration: May – July 2017
The Australian Health Outcomes Collaboration (AHOC) was sub-contracted by Epidemiological Consulting, who was engaged to provide expert advice and assistance in developing the health outcomes analytic capability of the organisation. The objective of the project was to improve the knowledge and capability of HNECC Limited staff to identify, collect, analyse and report on health outcome indicators.
What we did
The key components and deliverables completed as part of this project were:
- Facilitating a series of workshops to a selection of HNECC Limited staff on managing and measuring health outcomes.
- Assisting HNECC Limited staff, key program stakeholders and contracted service providers to:
- Review and identify relevant outcome and experience indicators specific to each program;
- Identify appropriate tools to measure these (e.g. PROMs); and
- Suggest potential methodologies for the collection and analysis of indicators.
- Assisting in the provision of a project report outlining the work undertaken and recommendations on how to best progress health outcomes analytics for these programs.
Project leader: Associate Professor Jan Sansoni
Children's Health Queensland Hospital and Health Service
Duration: January 2016 – December 2017
Paediatric rehabilitation aims to maximise the ability of the child to participate in activities at home, school and the community. Rehabilitation focuses on maximal restoration of function regardless of age but there are substantial differences between children and adults in the types of impairments of concern, development and maturation and, importantly, decision making abilities. Thus families and caregivers play a key role in paediatric rehabilitation.
While the AROC adult rehabilitation benchmarking initiative commenced in 2002 is well established, with close to 100% participation of all inpatient rehabilitation facilities in Australia and New Zealand, a paediatric equivalent was not available.
What we did
The Paediatric Rehabilitation Data Set Working Group (a combined AROC and Australasian Rehabilitation Faculty of Rehabilitation Medicine group) first met in Christchurch in March 2010. Subsequent work included development of paediatric specific impairment codes and a draft dataset. In 2016 the Queensland Paediatric Rehabilitation Service (QPRS) at Lady Cilento Children’s Hospital was successful in obtaining funding to allow AROC in association with QPRS and continuing collaboration with senior clinicians from the specialist paediatric rehabilitation units in Australia and New Zealand, to undertake the development of a paediatric rehabilitation outcomes benchmarking initiative.
The project achievements include:
- Finalisation of an agreed national outcome dataset and data points for inpatients and day hospital paediatric rehabilitation services; the major outcome measure in the dataset is the weeFIM
- Extension of the current AROC database to include inpatient and day hospital paediatric rehabilitation outcome measures
- Development and implementation of systems (including training) to collect data in line with the agreed national dataset for specialist paediatric rehabilitation services
- Pilot implementation of the data collection by QPRS in August 2016, following training in the dataset and data collection system
- Provision of dataset training in November and December 2016 to all paediatric rehabilitation services in Australia and NZ wishing to join the initiative
- Commencement of data submission by paediatric rehabilitation services in 2017
- Development of the inaugural paediatric rehabilitation benchmarking report.
AROC would like to acknowledge the valuable contributions of all those involved in the project and looks forward to continuing collaboration with the participating services including provision of support to review and analyse paediatric rehabilitation outcome data.
Project leaders: Jacquelin Capell and Frances Simmonds
Cancer Council NSW
Duration: February – May 2017
Through consultations and discussions with local stakeholders and partners, the Cancer Council NSW (CCNSW) identified significant benefits that could be realised if health professionals, patients and carers were able to access the full suite of CCNSW information, support services and programs at the point of treatment. It was anticipated that improving the method of delivering these services and programs (including transport, home help, accommodation, information and support, web and tele-support services) would enhance patient outcomes. This resulted in a decision to commission CHSD to identify opportunities for new and improved ways of working with local health districts and other health service providers in the provision of clinical and ancillary cancer support services for people affected by cancer.
What we did
The review focused on three domains of service delivery (cancer information, psychological and emotional support, practical support). Building on earlier work undertaken by CHSD, we synthesised some of the literature conceptualising ‘access’ and developed six dimensions of access – appropriateness, availability, adequacy, affordability, acceptability and awareness – to provide a framework for the review.
Data were collected from several sources including documentary material provided by the CCNSW, academic and grey literature, consultations with internal and external stakeholders, and site visits to a regional cancer centre and the corporate office of CCNSW.
The review found that there are several strengths in the current approach, particularly in the way the CCNSW works with colleagues in cancer care centres. The current range of information and support services is highly valued and the reputation and credibility of the organisation is positively perceived. The volunteers recruited and trained by the CCNSW are seen as a particular asset in centres where they contribute.
Analysis of the various data sources generated a range of insights about current information and support services, groups to target to improve access, core relationships to sustain this access and the business processes that underpin effective program delivery. A range of findings for improving access were identified at the level of individual consumers, individual clinicians (particularly those working in hospital-based cancer centres), primary health care practitioners and health care organisations. These included opportunities for improving quality and strengthening visibility. These findings generated a set of principles and strategic options for future program delivery.
Project team: Malcolm Masso, Cristina Thompson
NSW Ministry of Health
Duration: June 2015 – March 2017
In March 2015, NSW Kids and Families put out an expression of interest for researchers to conduct research which either informs paediatric injury prevention or informs health service provision for paediatric injury. CHSD researchers received funding from NSW Kids and Families to carry out a project that addresses the issue of high rates of hospitalisation and deaths amongst Aboriginal children. The research involved the development of guidelines about how best to prevent unintentional injury to Aboriginal children and young people in NSW. The project sought to inform policy by highlighting areas of prevention where most benefit can occur, inform and guide injury prevention practice within community settings, and inform future research directions and intervention studies.
What we did
The research project began in July 2015 and was underpinned by broad consultation with community, policy makers, program providers and researchers, and drew together existing knowledge from literature about the extent and characteristics of injury to Aboriginal children and young people. A literature review was conducted with two main components looking at effective programs that target injury in indigenous children internationally, as well as a review of what is known about Aboriginal community attitudes towards injury prevention and perceptions of risk.
Qualitative research involved semi-structured interviews with stakeholders, and focus group discussions with Aboriginal community members to explore attitudes to the prevention of injury in Aboriginal children and young people. A roundtable discussion was held in June 2016 which brought together a diverse group of participants, including Aboriginal community organisations, government and non-government organisations, injury practitioners and policy makers. The roundtable discussion included researcher presentations and brainstorming sessions to inform a set of draft guidelines for effective injury prevention approaches targeting injury among Aboriginal children and young people in NSW.
Guidelines were developed to provide a resource to assist organisations, communities and individuals to work together to prevent unintentional injury to Aboriginal children in NSW in a way that reflects the values, attitudes and priorities of Aboriginal people. The guidelines are intended to assist Aboriginal community controlled organisations that deliver services to Aboriginal children, non-government organisations that develop and implement child safety programs, researchers responsible for developing and evaluating interventions, and government policy makers responsible for setting policy agendas. The final guidelines, entitled ‘Active and Safe: Preventing unintentional injury to Aboriginal children and young people in NSW: Guidelines for Policy and Practice’, were submitted to the Ministry of Health in March 2017. The interim and final study results were presented at two conferences: the World Safety Conference in Helsinki, Finland, in September 2016, and the Australian Injury Prevention Conference in Ballarat, Victoria, in November 2017.
While the injury mortality rate for non-Aboriginal children in NSW has halved over the past 15 years, the rate for Aboriginal children has remained the same.
AHSRI project team: Kathleen Clapham and Keziah Bennett-Brook
Collaborators: Rebecca Ivers and Kate Hunter (The George Institute for Global Health)
Funder: Australian Government Department of Health
Duration: June 2016 – March 2017
The CHSD was commissioned by the Palliative Care Section, Australian Government Department of Health, to undertake research into services and needs for people experiencing complicated grief, arising from the death of a relative or meaningful individual in someone’s life.
Bereavement – the loss of a loved one through death – is a normal, common human experience. Although it is associated with a period of acute suffering, most people adapt to their loss over time. For a few people, however, bereavement can lead to extreme and persistent mental and physical ill health, making it an issue of concern for both clinical practice and preventative care (Stroebe et al., 2007).
This research was undertaken to support the Palliative Care Section in the provision of policy advice to Government on issues relating to complicated grief.
What we did
A methodology was developed to ensure the research captured multiple perspectives of the key stakeholders affected by the phenomenon of complicated grief. The research design was based on a mixed methods approach that supported triangulation of data through using multiple qualitative and quantitative data sources.
The following core components of the project were undertaken during 2016:
- Targeted review of the academic literature to answer a series of research questions.
- Semi-structured interviews with 18 key stakeholders recognised as having highly relevant expertise in the domain of complicated grief and/or related fields to explore a range of issues.
- Discussion groups, one with nine NSW-based bereavement counsellors and another with three researchers currently engaged in bereavement studies.
- Survey of a convenience sample of service providers to support a gap analysis of needs and current resources, services and structures for people experiencing complicated grief, map national complex bereavement services and identify workforce gaps.
- Secondary data analysis of several existing and accessible data sets to explore service demand and supply issues.
- Synthesis of data sources and findings through the production of a comprehensive project report.
In early 2017 a facilitated workshop with key experts was conducted to review the findings presented in the draft final report, discuss policy related issues and draft recommendations, as well as to identify practical steps to progress supported recommendations. The final report was submitted in March 2017.
A second phase of research was undertaken in 2018: Addressing the needs of people experiencing prolonged grief (Phase 2).
Project team: Cristina Thompson, Kate Williams, Malcolm Masso, Darcy Morris, Conrad Kobel, Cathy Duncan and Peter Samsa
Alzheimer’s Australia Dementia Research Foundation, Resthaven Inc. Dementia Research Award
Duration: January 2015 – January 2017
Provision of respite is consistently identified by carers of People Living with Dementia (PLD) as one of their critical unmet care needs, yet only a small proportion use available respite and other support programs. ReThink Respite was a community intervention which aimed to improve knowledge about, attitudes toward, and uptake of, respite services for PLD and their carers, in the Illawarra-Shoalhaven community. The intervention provided education sessions as well as informational and navigational resources for PLD and their carers, respite service providers, and those promoting access to respite services throughout the Illawarra and Shoalhaven. Individualised support for PLD and their carers was offered via ‘ReThink Respite Coaching’, a goal orientated program developed specifically for the project and delivered by health professionals in the participants’ homes.
What we did
The project evaluation comprised a pre/post survey of carers of PLD living in the Illawarra and Shoalhaven regions. The baseline survey was conducted with 84 carers in 2015 and the follow-up completed by 44 of the 52 carers who were still eligible in 2016. Results demonstrate there is still an unmet need for respite for PLD and their carers in the Illawarra and Shoalhaven regions. All participants continued to consider general practitioners, carer support groups and family and friends as major sources of information about respite. However, coaching participants increased the number of sources they used to find information about respite. This increase was largely due to using the ReThink Respite website and Directory of Services. Carers participating in the coaching had many positive improvements in knowledge, attitudes and intention to use respite. They also improved self-efficacy and personal gain during the intervention period. This was not the experience for non-coaching survey participants, some of whom showed signs of worsening during the period of the intervention. This demonstrates the benefits of one-on-one support to gain the confidence and skills needed to successfully navigate the aged care system.
The ReThink Respite project took part during a transition period of aged care reforms in Australia. This, and the progressive nature of dementia as a condition, will have impacted on participants in the study and may account for the negative trends found for respondents in the survey who did not participate in the coaching program.
Resources were distributed through a customised ReThink Respite website, which is a companion to the Dementia Illawarra website.
Investigating the efficacy of an online intervention aiming to increasing respite use amongst carers of people with dementia: Roles of motivational enhancement and professional delivery
Dementia Research Foundation
Duration: March 2016 - March 2017
Despite the established benefits of respite, many carers of people with dementia are reluctant to use or are unaware of services or strategies which may provide them respite from their caring role. The ReThink Respite Online Project aimed to address the barriers to respite use by developing an online education and support program for carers of people with dementia.
What we did
The online program was developed from the ReThink Respite project run in the Illawarra Shoalhaven region during 2016. Project resources included 10 education modules in an email format, online ‘coaching space’ (using the Adobe Connect platform), and a tailored website which featured an online discussion forum, ‘respite experiences’ videos, and various tools and resources for participants. All project resources were reviewed by current carers of people with dementia to confirm their relevance and suitability.
The project used an experimental design to compare the efficacy of two online interventions, which included a group receiving the education modules with online coaching sessions with a health professional; a group receiving the education modules with access to an online discussion forum with other carers; and a control group (i.e. receiving the education modules only).
In total, 43 participants enrolled in the program and were randomly allocated into two intervention groups. Results indicate increased use of respite use following completion of the program for groups. This finding was across various forms of respite including day centres, in-home services, residential respite, informal respite, respite strategies, and carer support groups.
However, despite the increased use of respite, the majority of carers reported a preference to receive more respite than they were currently receiving. Results showed the coaching group were more confident in organising respite services, but were more worried that using respite may lead to negative outcomes for the person with dementia. Together, these results suggest ongoing limitations with some respite services currently provided in Australia.
Australian Government Department of Health
Duration: June – July 2017
Since August 2011, the Australian Government has contributed to the funding of public hospital services using Activity Based Funding (ABF) where practicable in accordance with the National Health Reform Agreement. From 2014-2015 the ABF model was uncapped and allocated funding for growth in activity or complexity of services at the rate of a national efficient price. The funded growth between 2014-15 and 2015-16 had been significantly higher than the 4% that had been anticipated.
The Australian Government Department of Health was seeking to understand the drivers of these recent patterns in the increase in reported activity, in the context of the efficient growth arrangements under the National Health Reform Agreement. The review undertaken by AHSRI supplemented other analyses that had recently been undertaken by the Australian Government.
What we did
Previously completed investigations into the difference between the estimated and the actual levels of service delivery were provided to AHSRI in addition to four years of national health activity data. A high level review of the data was completed, with a focus on the potential effect of changes in classifications and coding standards on growth in activity. The issue was investigated separately for different care types – acute admitted, admitted mental health, non-admitted and subacute and non-acute.
The period of analysis included the very early years of national ABF during which time there were a number of changes to the classifications systems and ongoing development of the definitions and mechanisms for data collections across the care types. These changes were identified for each care type. Additionally, the different jurisdictions varied significantly in how well established their local activity based systems were at the commencement of national ABF and the amount of system development that was undertaken in the early period of the new system. The impact of these factors on the stability of the activity data and amount of change over the four years was found to vary across the different care types and between jurisdictions.
The short timeframe of this project was sufficient to enable a high level overview to be undertaken, while identifying areas where a more detailed analysis might be valuable.
NSW Ministry of Health
Duration: May – June 2017
The NSW Ministry of Health had identified some financial performance issues within one of their Local Health Districts, which had not been explained by their standard review processes and some initial investigations. Additional investigations were required to identify any trends or patterns of cost, staffing and activity, or to find unexplained changes in reporting that could explain the financial performance issues.
The source of information for the analysis undertaken by AHSRI was the District and Network Return (DNR) which is a mandatory state-wide costing process involving costing data which is undertaken twice annually. The DNR process is governed by both NSW and national standard methodologies and supported by standard information systems and costing tools. This routine data collection includes patient or client level activity across all care streams (acute inpatient, sub and non-acute, mental health, emergency, non-admitted and primary and community care) as well as reporting streams for teaching, training and research and non-health related expenses.
What we did
An examination of three years of DNR data was undertaken using statistical techniques to identify changes in expense activity over that time that were not sufficiently explained by changes in activity which is measured using National Weighted Activity Units. The detailed expense analysis was limited to a review of general fund recurrent expenses and excluded non-operating costs as well as costs that are fully recovered.
The review focused on factors relating to the reported financial performance issues only for the Local Health District, with all care streams in-scope but targeting the non-Activity Based Funding stream given the results of the earlier analysis work that had been undertaken by the Ministry of Health.
A three year data period of DNR data was provided by the Ministry of Health for analysis, which included Inpatient, Non-Admitted Patient & Emergency department activity tables, FTE data by facility, expenses and revenue. A systematic top-down approach was used for the analysis, with areas of highest expense growth over the three years prioritised for investigation. Analysis at the subprogram level was found to be the most valuable as the major inconsistencies were identified at this data level.
NSW Ministry of Health
Duration: July 2016 – December 2017
In March 2015, CHSD responded to an expression of interest from the NSW Ministry of Health for research proposals which either inform paediatric injury prevention or inform health service provision for paediatric injury. Funding was received to undertake research to develop a set of guidelines for policy and practice for the prevention of unintentional injury to Aboriginal children and young people. The research involved a literature review, stakeholder interviews and focus group discussions and explored the knowledge, attitudes and perceptions of risk of injury to Aboriginal children from the perspectives of Aboriginal people. It resulted in a set of guidelines which identified key injury prevention messages from experts and identified Aboriginal community preferences including: flexibly delivered educational components, utilisation of social media, allowing children to explore and learn for themselves, and using positive strength based messaging. This research is being used to inform the social marketing campaign which is currently underway.
What we did
We drew from our existing collaboration with experts in the field of injury research (The George Institute for Global Health), non-government organisations with a focus on child injury prevention (Kidsafe NSW and the Sydney Children’s Hospitals Network) and the Aboriginal Community Controlled Health Sector. The project utilised social media to share safety messages, and develop e-learning experiences based on injury issues for children from birth to five years e.g. falls, burns, drowning, poisonings, and the promotion of home safety devices. Information was delivered via online platforms including Facebook and the Kidsafe website; the target group for the project were social media participants who are parents or carers of Aboriginal children under five years and are active Facebook users.
A targeted literature review was carried out to explore how social media can be used to promote child safety messages to an Aboriginal audience. The review provided an up-to-date state of knowledge of how social media is used for injury prevention and how Aboriginal people use social media. It identified current gaps in the literature about how social media can most effectively be used for child injury prevention and safety promotion.
The research involved the research team working closely with one Aboriginal organisation, Waminda – South Coast Women’s Health & Welfare Aboriginal Corporation, to identify a pilot site. The project employed action research methodologies that engaged the Aboriginal participants in the design, delivery and evaluation of the activities. Women who attended the Waminda’s weekly ‘Mums and Bubs’ group, were recruited as research participants. We engaged Kidsafe NSW to deliver two child safety training workshops, and worked with the women to develop culturally appropriate child safety messages within a closed Facebook group. The project used a process and impact evaluation with the development of a logic model and evaluation framework. We collected data through yarning sessions and online observation and a post-implementation focus group. The pilot group showed greater general awareness of child safety. The group also showed interest in sharing child safety content beyond the scope of study.
The study results were presented at the Australian Injury Prevention Conference in November 2017 and the final report was submitted to the NSW Ministry of Health in December 2017.
AHSRI research team: Kathleen Clapham, Keziah Bennett-Brook
George Institute for Global Health research team: Kate Hunter, Rebecca Ivers
Reference group and collaborations: Christine Erskine (CEO Kidsafe NSW), Karen Zwi (Sydney Children’s Hospital Network), Stephanie Blows (NSW Health)
Australian Commission on Safety and Quality in Health Care
Duration: January – June 2017
A subcutaneous insulin chart was being piloted nationally by the Australian Commission on Safety and Quality in Health Care. Concerns had been raised that some hospitals were failing to comply with prescribed diabetes treatment regimens for some insulin-dependent inpatients. A bedside chart had been designed to help avoid this issue and we were commissioned to analyse the data collected during the pilot implementation of this chart.
Project leader: Dr Conrad Kobel
Alternative Aged Care Assessment, Classification Systems and Funding Models
Australian Government Department of Health
Duration: September 2016 – February 2017
The residential aged care sector has experienced considerable change since the introduction of the Aged Care Funding Instrument (ACFI) in 2008. There were some concerns that the ACFI-based funding model has been unable to account for the shift in demography, and the increased frailty and medical complexity of residents. Over this time, the Department of Health has reported growth in residential aged care expenditure that regularly exceeds budget expectations. Changes to the ACFI funding system over time have been reactive, resulting in funding uncertainty for both government and providers.
In line with the recent efforts towards aged care funding reform, the Australian Government Department of Health commissioned AHSRI to undertake a review and develop options for an improved funding model for residential aged care.
What we did
The project involved a review of international models, consultation with government, provider and consumer stakeholder groups and analysis of trends in the ACFI assessment data. Based on these reviews, AHSRI presented five alternative funding system options and recommended one as the preferred option.
The recommended option is a blended model with fixed and variable payments. The variable daily payments are proposed to be based on a branching classification system that better accounts for the individual needs of aged care residents. This model also includes a number of options for resident assessments, which may be undertaken internally or by independent assessors, for the determination of the fixed payment amount, and for the allocation of a one-off adjustment payment when a new resident enters a facility.
The proposed model has the key benefit of recognising the drivers of cost in aged care with the payment levels to be informed by a resource utilisation study. This model will also be more aligned with consumer needs and care planning than the current system.
This work was completed in 2017 with the delivery of a formal report in February containing recommendations for ongoing development work. AHSRI was subsequently engaged by the Department of Health to undertake the Resource Utilisation and Classification Study and progress the recommendations of this report.
Information on residential aged care reform, including AHSRI's report, is available from the Australian Government Department of Health's website.
Project team: Jenny McNamee, Chris Poulos, Habibur Seraji, Conrad Kobel, Cathy Duncan, Anita Westera, Peter Samsa, Kathy Eagar
NSW Agency for Clinical Innovation (ACI)
Duration: March – June 2017
The objective of this research project was to explore clinical variation in service delivery and outcomes for people who participated in rehabilitation in NSW public rehabilitation services. Utilising analysis of AROC rehabilitation data, the goal was to determine the factors which contribute to unwarranted clinical variation (UCV) and thereby identify opportunities and recommend strategies at both facility level and system level for reducing UCV in rehabilitation services.
What we did
The first stage of the project focused on data analysis and interrogated the AROC database. This stage aimed to translate the Australian Commission on Safety and Quality in Health Care’s definition of unwarranted clinical variation into the inpatient rehabilitation context by considering a variety of measures on entry to, during and at exit from inpatient rehabilitation, and identifying variations between facilities. In determining the factors which contribute to unwarranted clinical variation we identified opportunities for improvement and made initial recommendations of strategies at both facility level and system level for potentially reducing unwarranted clinical variation among inpatient rehabilitation services. At the request of ACI this analysis focused on three types of impairments: stroke, fractured hip and reconditioning. The analysis compared each NSW public facility with at least 20 episodes of the impairment being considered against each other, against the total NSW public inpatient rehabilitation data, and against the Australian national data. The analysis described facilities that were performing well and those that were not, using national data as the benchmark against which facilities were compared.
The second stage of the project involved consultation with AROC member stroke rehabilitation services. Senior rehabilitation staff at a range of (AROC member) rehabilitation services were contacted to explore their perceptions about the mechanisms which may result in, or contribute to reduction of, unwarranted clinical variation in key indicators as identified by the AROC data.
A final report was completed which identified that variation in processes and outcomes clearly exist in the NSW public inpatient rehabilitation sector. Variation across the three specific impairment categories of stroke, fractured hip and reconditioning were identified and enumerated. Using casemix adjustment, the variation attributable to the mix of patients was controlled for, leaving the remaining variation likely to be caused by differences in health system performance. Factors that underpin the identified differences in health system performance were reported and recommendations provided.
Project team: Tara Alexander, Jacquelin Capell, Frances Simmonds