On 15 and 16 October, the NHMRC Partnership Centre for Health System Sustainability hosted researchers from the Centre’s ‘Reducing waste and low-value care’ research stream (2.2).
Associate Professor Yvonne Zurynski opened the meeting with an overview of the Centre’s recent activities. These include the recently completed Crowd-Wisdom survey at the International Hospital Federation’s World Hospital Conference (10-12 Oct 2018), the upcoming Consumer Sentiment Survey in conjunction with Consumer Health Forum, three comprehensive literature reviews that are underway, and projects to address the future of healthcare, such as the 60:30:10 Challenge and work with Research Australia on improving research translation in healthcare.
Professor Paul Glasziou from Bond University then talked about the importance of reducing over treatment, over diagnosis and pricing failures. He outlined several pieces of work on interventions to reduce these areas of waste, including reviews of cancer and non-cancer over diagnosis. He discussed the effects that these three areas have on individuals, the economy and the sustainability of the healthcare system and potential ways to improve these areas.
Professor Rachelle Buchbinder of Monash University and Cabrini Health discussed the progress in ‘Lower cost delivery of effective services’ research stream. Inefficiently delivered services (e.g. costly care settings, care fragmentation and the use of unnecessarily expensive providers) are a huge cost to the health care system. To identify and reduce these types of issues, the investigators conducted a scoping review of systematic reviews of alternative delivery arrangements across all healthcare settings and conditions. They are working with partners to identify other potential alternative means of service delivery of interest. Based on their research, they determined which alternative delivery models could be investigated further and conducted a Delphi study to achieve consensus on which interventions to pursue. Later in the meeting, Dr Polina Putrik provided an overview of the Delphi survey results and the webinar and meeting with stakeholders planned for 16 October.
In his presentation entitled, ‘Early Economic Evaluations to Inform the Design of Services’, Professor Jon Karnon from the University of Adelaide explained the two sub-streams that he and his collaborators are evaluating: Primary Health Networks and State health service providers, including local health networks/districts. Jon emphasised the importance of working with stakeholders and outlined the new iN-DEPtH (Evidence-informed, co-creation framework for the Design, Evaluation and Procurement of Health Services) Framework. This framework, which is currently under review in a prestigious journal, is designed to engage stakeholders in each stage of the implementation of health programs. Jon also outlined their work on 1) complex contexts (which is a model for examining decision making processes under different level of agreement and certainty), 2) using Donabedian models to look at different types of intervention (policy, clinical service) and how economic evaluation might help, as well as 3) examining the benefits of conducting local economic evaluations. Investigators and partners from this research stream also held a webinar on 17 October. Jon, Jade Hart (Victorian PHN Alliance and the Melbourne School of Population and Global Health at the University of Melbourne) and Kenneth Lo (The University of Adelaide and Macquarie University) presented a webinar entitled, ‘Designing Evidence-Informed and Cost-Effective Primary Health Services’, which was attended by over 90 people. The webinar can be downloaded from the PCHSS website, Designing Evidence-Informed and Cost-Effective Primary Health Services.
Next, Professor Catalin Tufanaru provided a fascinating overview of methods for reviewing non-peer-reviewed literature, also known as non-research or ‘grey’ literature. He provided definitions and good examples of what non-research evidence is (e.g. expert opinions, policy or position statements, perspectives, commentaries or working papers) and how to conduct systematic reviews of the non-research literature. The presentation included a list of suggested tools (e.g. Grey Matters) and resources for investigators undertaking these types of systematic reviews (e.g. Joanna Briggs Institute Reviewers Manual). This was the final presentation of the one-day meeting.