This biennial award recognises health services research that has had a significant impact through translation into health policy, management, or clinical practice.
In 2018 we received seven very worthy nominations that that highlight the amazing real-world impact of health services research. The submissions covered a broad range of impacts and after the judges' votes had been cast, we had a tie between two very different pieces of HSR.
Dr Elizabeth Lynch and colleagues for a program of research around the implementation of the nationally recommended Assessment for Rehabilitation Tool. As part of a RCT, she identified that rehab needs were being made based primarily on the services available. Elizabeth’s subsequent engagement with stakeholders focused on supporting clinicians to use the tool to identify unmet needs, including a lead role in updating the stroke clinical guidelines with respect to the assessment of rehab needs.
Read Elizabeth's blog - Assessing and managing rehabilitation needs of people with stroke in Australia
Professor Tony Scott and his team involved in the development and maintenance of the Medicine in Australia: Balancing Employment and Life (MABEL) survey which is Australia's national panel survey of 10,000 doctors that has been running for over 10 annual Waves. The specific application of the project that was cited in the submission was the use of MABEL data to develop the Modified Monash Model (MMM), a new geographic classification scheme to allocate funding to medical workforce programs in rural areas. The MMM was first used by the Department of Health in 2015, and is now applied to over 15 workforce programs that allocate over $1bn to support access to medical care rural areas in Australia.
Prof Anthony Scott - Medicine in Australia: Balancing Employment and Life (MABEL).
Read Anthony's blog - Influencing policy through research: Medicine in Australia: Balancing Employment and Life (MABEL)
A/Prof Ian Scott and his team with their work - “Maximising value of healthcare”.
A/Prof Ian Scott has been the lead clinician and investigator for several major programs aimed at maximising value of healthcare that have attracted national and international interest. These include:
Ian was lead clinician in collaboration producing systematic review of evidence for 4-hour rule targets indicating all targets were arbitrary. Subsequent investigation of datasets from 59 Australian hospitals which found that adjusted in-hospital mortality for emergency admissions falls as 4-hour NEAT compliance rates rise to a nadir of 83%, with no further increase thereafter. This was an international first in presenting an evidence-based target of around 80% which Queensland Health adopted, with other jurisdictions considering similar moves, and researchers in the UK and New Zealand aiming to replicate in their jurisdictions.
Design and implementation of an integrated end of life care (EoL) program which incorporates advanced care planning (ACP) for patients with limited prognosis and which involves all hospitals, RACFs and general practices in Metro South (MS) Hospital and Health Service (HHS). More than 2600 patients have completed ACP in the last 2 years, and our methodology has been adopted by another 12 HHS and several other primary health networks. This work has been recognised by Queensland Health Minister at a recent COAG meeting.
Publication of a sentinel paper in Australian Health Review in 2015 which articulated 10 clinician-led strategies for maximising value in healthcare, with particular focus on hospital care, which featured prominently in a Productivity Commission report later that year and presented to health departments, professional colleges and the Australian Medical Association. Research has investigated cognitive biases in clinician decision-making that predispose to low value care (accepted for publication in MJA) that has informed Queensland Clinical Senate, the Royal Australasian College of Physicians EVOLVE program and the NPS Medicine Wise Choosing Wisely campaign.
Inappropriate polypharmacy is a major cause of avoidable hospitalisations and Ian established the Australian Deprescribing Network in 2014 and was lead author of a sentinel article on the deprescribing process in JAMA Internal Medicine in 2015, which has been cited 104 times and adopted by various guideline groups in Australia, UK and New Zealand.
Emergency care of patients with suspected or definite acute coronary syndromes is a leading cause of ED presentations. As lead methodologist, Ian co-authored the recently released 2016 National Heart Foundation/Cardiac Society of Australia and New Zealand Guidelines for Acute Coronary Syndromes which comprise the first Australian guidelines satisfying all Institute of Medicine standards.
Acknowledgements: Key collaborators: Prof Adam Elshaug, Prof Elizabeth Reymond, Assoc Professor Michelle Foster, Prof David Le Couteur, Prof Sarah Hilmer, Prof Derek Chew, Associate Professor Ruth Hubbard, Dr Clair Sullivan, Ms Kristen Anderson, Mr Chris Freeman.
Prof William Parsonage and his team for “The Statewide Accelerated Chest Pain Risk Evaluation (ACRE) Project”
The Accelerated Chest Pain Risk Evaluation (ACRE) Project is a structured program of clinical redesign which has rapidly translated research into clinical practice. The project aimed to improve the assessment patients presenting to emergency departments (EDs) with chest pain and to evaluate the health service outcomes of the change in practice. The project was based on high-quality clinical evidence from locally-derived, widely cited research published in 2012 (The ADAPT trial).A pilot study at a single site in Queensland was undertaken in 2013 followed by state-wide implementation in all eligible hospitals over a 2-year period from 2014 to 2016.
Pooled data from 12 months pre-implementation and up to 16 months post-implementation has demonstrated significantly decreased ED length of stay, hospital admission rates to inpatient units and total hospital length of stay. For all patients presenting with possible cardiac chest pain median total hospital LOS fell from 1210mins to 806mins (404mins 95% CI 370-437mins). Hospital admissions fell from 70.4% to 57.3% (-13.1% 95% CI 12.3 - 13.9%). From May 2014 to the end of April 2016 51,042 patients have presented to the ED’s across the 18 sites with possible cardiac chest pain. Of these, 12,138 (24%) have been managed on the ADAPT-ADP.
This research has resulted in substantial released capacity with economic impact evaluation suggesting savings of more than $7.5 million per year across the state.
Adj A/Prof Prof Terri Jackson for her project on – “Using information on hospital acquired diagnoses to improve hospital care"
A program of applied health services research in collaboration with National and State agencies to understand how routine data can be used in clinical oversight and funding. This work has informed Australian policy development, including:
National agreements to use pricing signals to motivate quality improvement, and to collect additional data elements in the hospital minimum dataset to identify condition-onset for hospital-acquired diagnoses.
Demonstrations of alternative ways of using activity-based pricing mechanisms to improve quality and safety of hospital care.
Estimates of State-specific and national incremental costs of harmful hospital-acquired diagnoses.
Development of data algorithms to group hospital-acquired diagnoses for use in quality improvement (CHADx and CHADx+), and to identify coding errors in condition onset flagging.
Reporting of CHADx rates in the annual Australian Hospital Statistics.
Testing the use of routine data to report nationally-mandated sentinel events.
Applied studies with clinical colleagues of the risks and outcomes of hospital-acquired diagnoses in various patient subpopulations, including elective surgical patients, cancer patients, cardiac surgery patients, inpatients older than 65, spinal injury patients, patients with pre-existing diabetes and kidney failure, and neonates.
Studies to investigate methods of using data on multiple emergency department presentations to predict delayed or missed diagnoses, using linked data to identify readmissions attributable to a hospital-acquired diagnosis in a previous admission, and data mining techniques to measure the extent to which hospital-acquired diagnoses are associated with the patient’s reason for admission.