This biennial award recognises health services research that has had a significant impact through translation into health policy, management, or clinical practice.   

 

2018 WINNERS

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

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.

Dr Elizabeth Lynch“Assessing and managing rehabilitation needs of people with stroke in Australia”

Read Elizabeth's blog - Assessing and managing rehabilitation needs of people with stroke in Australia 

 

 

 

Catherine Joyce on behalf of Anthony Scott

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)

 

2016 WINNERS

A/Prof Ian Scott and his team with their work   - “Maximising value of healthcare”.

Dr Ian Scott collecting his award

Dr Ian Scott collecting his award

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.

 

RUNNERS UP:

Prof William Parsonage and his team for “The Statewide Accelerated Chest Pain Risk Evaluation (ACRE) Project”

Dr Will Parsonage

Dr Will Parsonage

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/ Prof Terri Jackson

A/ Prof Terri Jackson

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.

 

Dr Elizabeth Lynch

Dr Elizabeth Lynch is an experienced stroke rehabilitation physiotherapist. She has been awarded state and national awards for her work implementing evidence-based practices in stroke rehabilitation settings.

Liz completed her PhD in 2015, which used mixed methods to explore and improve how rehabilitation needs are assessed after stroke. She was awarded an NHMRC Early Career Research Fellowship (commenced 2018) and she is currently investigating how to effectively implement the 2017 Stroke Clinical Guidelines and how partnerships with patients can be incorporated into implementation projects.  Liz is based at the Adelaide Nursing School, University of Adelaide and is affiliated with the NHMRC Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery.

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“Assessing and managing rehabilitation needs of people with stroke in Australia”

This program of research investigated the implementation of the nationally recommended Assessment for Rehabilitation Tool that was disseminated in 2012. The Assessment for Rehabilitation Tool is a patient-centred, evidence-based decision-making tool that can help determine whether a person has rehabilitation needs and how these can best be managed. A cluster-randomised trial was conducted at 10 hospitals in South Australia and New South Wales, comparing the effectiveness of education-only to a multifaceted intervention. Data were collected from all participating sites about how the Assessment Tool was being used, and factors affecting its use. This work highlighted that judgements were being made about a person’s rehabilitation potential based primarily on whether services were available to meet a person’s needs – people whose needs fell outside the scope of the usual services (e.g. people with severe stroke, people with reduced alertness) often did not have rehabilitation needs identified and were not referred to a rehabilitation service, despite evidence that this cohort can improve independence and quality of life with rehabilitation.

Elizabeth has:

• Presented the findings to consumer, clinical and research audiences.

• Acted in a consultancy role with Australia’s peak stroke body, the Stroke Foundation, to advise on wording of the National Stroke Audit. This has enabled the collection of information about how rehabilitation needs are being identified and managed, and objective reasons why rehabilitation is not indicated or why rehabilitation is not accessed.

• Provided advice and mentoring to clinicians in three states of Australia regarding how to implement the Assessment for Rehabilitation Tool, so clinicians are empowered and confident to conduct patient-centred, evidence-based assessments, and refer to rehabilitation according to patients’ rehabilitation needs.

• Contributed to the updating the Australian Stroke Clinical Guidelines and was nominated to lead the section regarding assessment of rehabilitation needs. The Stroke Clinical Guidelines now explicitly recommend use of the Assessment for Rehabilitation Tool, and recommend that every person with rehabilitation needs be referred to a rehabilitation service. The impact of the new Stroke Clinical Guidelines has yet to be evaluated.

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Professor Anthony Scott

Anthony Scott leads the Health Economics Research Program at the Melbourne Institute of Applied Economic and Social Research at the University of Melbourne. He has a PhD in Economics from the University of Aberdeen. He is an Associate Editor of Journal of Health Economics, Health Economics, and Social Science and Medicine, President of the Australian Health Economics Society, and a member of the Board of the International Health Economics Association. He is a Fellow of the Academy of the Social Sciences in Australia. He has been an ARC Future Fellow and NHMRC Principal Research Fellow. Tony’s research interests focus on the behaviour of physicians, health workforce, incentives and performance, primary care, and hospitals. He has consulted and provided advice to the World Bank, Independent Hospital Pricing Authority, Productivity Commission, Medibank Private, and Commonwealth and State Departments of Health. He leads the Medicine in Australia: Balancing Employment and Life (MABEL) panel survey of 10,000 physicians, and is a Research Lead Investigator on the NHMRC Partnerships Centre on Health System Sustainability.   

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Medicine in Australia: Balancing Employment and Life (MABEL)

Medicine in Australia: Balancing Employment and Life (MABEL) is Australia’s national panel survey of 10,000 doctors. Now running for over 11 annual Waves, MABEL is designed to improve access to health care by influencing the geographic distribution of doctors, and understanding workforce participation, doctor’s career choices, and working patterns.   The latest Wave 11 included new questions on doctor’s health and wellbeing and use of electronic shared records and video consultations.  MABEL survey data are also linked to MBS and PBS data.

 

MABEL’s most notable impact to date 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.  MMM was proposed by MABEL Chief Investigators Emeritus Prof. John Humphreys (Monash University) and Dr. Matthew McGrail (The University of Queensland) as part of a submission to a Senate Enquiry.  This was based on a paper published using MABEL data to describe how GP workload varied by population size.  MMM was adopted and 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. The measure has continuing strong support from the rural health sector and from the Commonwealth Department of Health. In addition, MABEL data are regularly used by researchers and key medical workforce stakeholders, including medical colleges, to provide evidence and data on a range of current issues within the medical workforce, including evidence on policies to support access to medical care in rural areas.  De-identified MABEL data are provided to external researchers at minimal cost to maximise the use of the data. We have 260 external data users from across Australia, and receive 2-3 data requests per month.

 

Impact Summary

 

 

 

 

Funding acknowledgement. NHMRC (2008 to 2015), Department of Health (2018-19), The University of Melbourne (2017-18), Health Workforce Australia (2013), Medibank Private Better Health Foundation (2017), DHHS (2017-18), NSW Health (2017), Australian Digital Health Agency (2018-19).

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Dr Alison Pearce

Alison Pearce is a health economist interested in the various costs of cancer. Her research aims to use health services research and health economics to improve cancer care by providing relevant, reliable information for decision making. Currently based at the University of Sydney School of Public Health, Alison teaches introductory health economics and conducts research in the areas of oncology patient preferences and productivity loss. Alison’s original training was in occupational therapy, and she remains interested in rehabilitation research. She also has keen interests in early career researcher development, communicating research to the public, and the use of social media in academia.

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‘Productivity losses due to premature mortality from cancer in Brazil, Russia, India, China, and South Africa (BRICS): A population-based comparison’

ABSTRACT

Background: Over two-thirds of the world’s cancer deaths occur in economically developing countries; however, the societal costs of cancer have rarely been assessed in these settings. Our aim was to estimate the value of productivity lost in 2012 due to cancer-related premature mortality in the major developing economies of Brazil, the Russian Federation, India, China and South Africa (BRICS).

Methods: We applied an incidence-based method using the human capital approach. We used annual adult cancer deaths from GLOBOCAN2012 to estimate the years of productive life lost between cancer death and pensionable age in each country, valued using national and international data for wages, and workforce statistics. Sensitivity analyses examined various methodological assumptions.

Results: The total cost of lost productivity due to premature cancer mortality in the BRICS countries in 2012 was $46·3 billion, representing 0·33% of their combined gross domestic product. The largest total productivity loss was in China ($28 billion), while South Africa had the highest cost per cancer death ($101,000). Total productivity losses were greatest for lung cancer in Brazil, the Russian Federation and South Africa; liver cancer in China; and lip and oral cavity cancers in India.

Conclusion: Locally-tailored strategies are required to reduce the economic burden of cancer in developing economies. Focussing on tobacco control, vaccination programs and cancer screening, combined with access to adequate treatment, could yield significant gains for both public health and economic performance of the BRICS countries.

Highlights

(Acknowledgement – Alison’s research was funded by an Irish Health Research Board ‘Interdisciplinary Capacity Enhancement Award’ and by the COST Action CANWON for a ‘Short Term Scientific Mission’ to the WHO International Association for Research on Cancer)

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Dr Haitham Tuffaha

Dr Haitham Tuffaha is NHMRC and Senior Research Fellow in Health Economics at Griffith University, Australia. Haitham holds an MSc degree in Clinical Pharmacy (with Distinction) from Strathclyde University in Glasgow, an MBA degree from Wollongong University in NSW and a PhD in Health Economics from Griffith University. His research encompasses the economic evaluation of health care technologies with an interest in Value of Information analysis as a systematic approach to inform reimbursement decisions, optimise trial design and prioritise research funding.

After completing his PhD in 2016, Haitham has rapidly established a high-quality track record and built a reputation as a promising leader in his field of research. He has over 50 peer-reviewed journal articles, book chapters and technical reports. He has published in leading journals including The Lancet, Nature Genetics in Medicine, Value in Health, PharmacoEconomics and the Medical Journal of Australia. His research has influenced health policy and clinical practice nationally and internationally.

Haitham is the Chair of the Clinical Oncology Society of Australia’s (COSA)-Epidemiology Group, the Co-Chair of Australian Clinical Trials Alliance (ACTA)-Research Prioritisation Group and Secretary of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR)-Australian Chapter. He is an Editorial Board Member of PharmacoEconomics-Open and a regular reviewer for leading journals.

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JohnBrett

Jonathan is a staff specialist in clinical pharmacology, toxicology and addiction at St. Vincent’s Hospital and a post-graduate fellow in clinical toxicology at NSW Poison Information Centre . He completed a PhD at the Centre for Big Data Research in Health on the use of PBS dispensing claims to measure the quality use of medicines. He is a tutor on masters courses in toxicology and health data and sits on the Drug Utilisation Sub Committee of the PBAC. 

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Tim Badgery-Parker

Tim Badgery-Parker is completing his PhD in the Menzies Centre for Health Policy, The University of Sydney. His research focuses on measuring low value care, defined by Choosing Wisely, RACP EVOLVE, or similar recommendations, in the NSW public hospital system. Tim previously worked as a biostatistician in the Centre for Epidemiology and Evidence, NSW Ministry of Health, and then in the Cancer Epidemiology and Services Research Group and the Surgical Outcomes Research Centre in the Sydney School of Public Health.

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