On 6 May 2019, the PCHSS hosted its annual Investigator Meeting at Macquarie University. Over 50 people, including academic researchers, healthcare system-based leads and funding partners, met to discuss the progress made by the PCHSS research and the future of health system sustainability.
Professor Jeffrey Braithwaite opened the workshop with an overview of the structure and objectives of the Partnership Centre. He explained how our research in the three main Research Themes of Using Analytics, Technology and Shared data, Reducing Waste and Low Value Care and Promoting Better Value for the Health Dollar is designed to produce major impacts on health system sustainability.
Central Research and Coordination Activities
Associate Professor Yvonne Zurynski summarised the research and capacity building activities of the Centre Coordination Team, including progress on three systematic reviews (e.g. Built to last?), a survey of health consumer sentiment undertaken in collaboration with the Consumers Health Forum of Australia, the development of a framework to assess impacts of MRFF funding, and an educational workshop on systematic reviews of the grey literature. In addition, the Partnership Centre Coordinator, Ms Jo Holt, gave a summary of the Centre’s administrative activities.
Dr Trent Yeend outlined the progress of his project with the Independent Hospital Pricing Authority which aims to realise the value of administrative data collections about the Australian hospital system. After receiving multiple ethics permissions to use the data, extensive data cleaning and preparation, Trent will now focus on analysis. The resulting robust evidence base on costs, financing, efficiency, and safety and quality will support evaluation, system planning and policy.
Lead investigators for each of the nine Research Streams (three under each Research Theme) presented their achievements for 2018-2019 and their plans for future research. Associate Professor Zurynski facilitated the discussions that ensued after presentations under each theme.
Professor Johanna Westbrook reported on exciting research that uses shared health information to improve evidence-based use of pathology reports in general practice. In partnership with Primary Health Networks, the team is co-designing and evaluating interventions to enhance quality and evidence-based use of pathology. To improve medication management and outcomes for people residing in aged cared facilities, the researchers are collaborating with residential aged care providers to implement electronic medications data systems that include for example, social norm feedback and electronic decision support tools for high risk medications. Examples of publications on these topics include: Nudging hospitals towards evidence-based decision support for medication management (Westbrook and Baysari, 2019) and Antidementia medication use by aged care facility residents with dementia (Lind et al., 2019).
Professor Enrico Coiera’s team works on the usability and impact of predictive analytics for clinical decision support. The protocol for a systematic review of the use of electronic dashboards in hospitals is available online at PROSPERO (Tufanaru et al. 2018). The team has also started a case study of global trigger tools (which are designed to detect and create alerts about adverse medical events) with two NSW hospitals. Their research into next generation decision support tools will examine how artificial intelligence (AI) could potentially improve patient treatment or the prognosis for specific diseases, such as motor neuron disease and melanoma. Examples of publications include: On algorithms, machines, and medicine (Coiera 2019) and The fate of medicine in the time of AI (Coiera 2018)
Professor Len Gray described his team’s work on telehealth. They are currently finalising a unique report on the “State of Play” in Australian telehealth, which used Medicare Benefits Schedule (MBS) data to determine the usage of telehealth services in different settings. Another report applies economic analyses and a scoping review to determine if the use of telehealth reduces short-term costs to the health system. These two eagerly awaited reports should be available later this year.
Dr Denise O’Connor presented work on alternative and potentially cost-saving models of care. Their systematic review about alternative models of care included over 550 systematic reviews (Alternative service models for delivery of healthcare services in high-income countries: a scoping review of systematic reviews (Protocol). The team has conducted detailed consultation with stakeholders responsible for delivering care and health consumers using Delphi surveys before convening a stakeholder workshop and webinar to prioritise alternative delivery models for further testing through trials. These top priorities were then presented to an advisory panel, which identified the two most promising models to further investigate.
Professor Glasziou discussed research to identify the causes of waste in healthcare and why the level is growing. They have published the first in a series of papers examining overdiagnosis of cancers (Pathirana et al. 2019), showing that 41% of prostate cancers are over-diagnosed potentially resulting in treatment needless interventions and significant psychological impacts. They are using the same model to examine other cancers, such as thyroid and renal cancers, and have developed a new framework and method to identify non-cancer overdiagnosis (Bell et al. 2017). Their work also investigates overtreatment, which includes the provision of treatments that have no-value, are of low-value care, or may actually cause harm.
The researchers working with Professor Scott are focusing on how financial incentives might encourage value-based care. Their systematic review (Scott et al. 2018), which examined 60 schemes, revealed that there was only about a 50% chance that the scheme would increase value-based care. The research will use large administrative datasets to examine financial incentives in different sectors.
Professor Karnon spoke about the use of economic evaluation as a framework for assisting decision making when choices need to be made. They are working within two contexts: Primary Health Networks and Local Health Services. The researchers have developed a new systematic approach to support health agencies to commission services. The framework, known as in-DEPtH (Evidence-informed, co-creation framework for the Design, Evaluation and Procurement of health Services (Karnon and Lo 2019)), is being trialled by two PHN’s this year. The researchers have also partnered with a South Australian Local Health Network to do a comparative analysis of health systems data.
Professor Scott also presented on markets, competition and choice in healthcare. There are eight projects within this stream. Some examples of ongoing work are research into the determinants of specialists’ and GPs’ fees, drivers of competition between hospitals and competition in aged care facilities, and the impact of the NBN rollout on patient’s access to health care information.
Dr Hendrie and Professor Liz Geelhoed and their team are evaluating the Research Translational Projects (RTP) program run by the Department of Health, Western Australia. The RTP funding targets research with potential to bring efficiency gains and raise awareness of better models for resource while supporting swift research translation. The team is creating a framework to evaluate the success of RTP projects in four areas: research translation and diffusion; advancing knowledge; capacity building; economic benefits. The framework will inform targeting of RTP funding in future rounds.
There were two panel discussions at the meeting. The first panel, Sharing Wisdom and Engaging System Partners for Impact was chaired by Professor Christine Bennett. The panel members were Jean-Frederic Levesque, Darren Gibson, Len Gray, Helena Teede, Jo Root, George Leipnik, Teresa Anderson and Melina Georgousakis. Several central concepts arose from the hour-long discussion. There was consensus that healthcare improvement is a goal for all involved in the PCHSS and everyone is working hard to improve collaboration, co-design between academics and system-partners to ensure that there is strategic alignment of research and health system priorities. There was clear recognition of consumers’ vital roles in healthcare improvement and the work undertaken by CHF in collaboration with PCHSS was valuable. It was recognised that to create real change, there must be durable and sustainable partnerships because change is not an event, it is a process.
The second panel on Strategic Next Steps was chaired by Professor Braithwaite. Professors Peter Brooks and Lyn Gilbert and Mr Michael Walsh were the panel members. The panel touched on numerous aspects of healthcare system sustainability, including workforce training, consumer involvement, barriers to implementation and the need for partnerships (at all levels) to leverage the research findings, to translate research findings into real-world changes, and the importance of articulating the PCHSS vision of a sustainable health system.
Changes to the Partnership Centre Administration
At the meeting, the Centre bid a fond farewell to friend and valued colleague, Ms Joanna Holt, who retired from her position as AIHI Manager and Coordinator of the PCHSS. Jo was an important driving force in developing the NHMRC Partnership Centre proposal and getting the PCHSS up and running. Her considerable expertise, unfaltering enthusiasm and ongoing belief in the value of the PCHSS will be missed. We wish her well for her exciting retirement plans – there is no doubt that Jo will continue to be interested in the ongoing activities of the Centre. Ms Britt Granath will be taking over Jo Holt’s role as AIHI Institute Manager and Partnership Centre Coordinator.