Dr Gillian Gorham has spent the last eight years at Menzies School of Health Research facilitating the development of the renal health program and now manages a multidisciplinary, cross organisational team. Her prior experience and responsibilities include the strategic leadership of renal service delivery in the NT and working with state and Australian governments to develop strategic documents. She also has extensive experience in service and program evaluation with a specific interest in the economics of health service delivery.

Gillian recently completed a PhD and her thesis involved analysing linked health data sets and developing cost models to undertake a comparative evaluation of the costs and benefits of dialysis service delivery models in urban, rural and remote settings. This included developing, in a co-design process with patients, clinicians and policy makers, a value for money framework for the assessment of the different dialysis models of care. Gillian has a keen interest in evaluating models of care to identify ways to improve service integration, health outcomes and the patient experience.

The renal health program has a strong focus on evidence translation and the implementation of research findings into policy and practice. A key project of the program is the development of a clinical decision support tool which consolidates clinical information from government and non-government health services. This unique and innovative IT platform will support the delivery of integrated care for people with complex chronic diseases.

https://www.menzies.edu.au/page/Our_People/Researchers/Gillian_Gorham/

Gorham, G., Howard, K., Cunningham, J. et al. Do remote dialysis services really cost more? An economic analysis of hospital and dialysis modality costs associated with dialysis services in urban, rural and remote settings. BMC Health Serv Res 21, 582 (2021). https://doi.org/10.1186/s12913-021-06612-z

Link

The study discussed in Gillian's paper explored the concept of ‘place’ in the cost of dialysis service delivery in the NT. The study stemmed from the mismatch between renal service demand and service availability resulting in large numbers of Aboriginal people from remote areas relocating to urban areas to access treatment.  The study analysed the uptake of dialysis treatments and subsequent downstream impacts by where patients received dialysis care. An economic analysis examined the incremental cost differences between dialysis services in urban, rural and remote locations when all costs (maintenance dialysis including infrastructure and hospital costs) were included.

Observed and modelled activity and costs demonstrated a strong association between dialysis service, dialysis attendance and downstream health service utilisation. The recurrent and establishment costs of remote services was higher than urban services. However, dialysis attendance was significantly lower and health service usage significantly higher for relocated people attending urban services. The inverse was true of patients attending rural and remote services. Mean total health service costs per person year was highest for urban services.

The findings of this analysis indicate that the health system is incurring significant downstream health care costs directly related to dialysis service configuration. These findings should be sufficient to give pause to further centralisation of dialysis services, particularly if urban service models are not able to meet other requirements for patient acceptability. Moreover, the costs presented are only partial cost impacts. The full impacts of relocation on the individual and community are yet to be quantified but there is little doubt that they are significant.

This study has important implications for renal service delivery in the NT and for jurisdictions where a significant number of dialysis patients are relocated for treatment. It quantifies for the first time in Australia, the overall costs of dialysis service delivery in different locations and presents findings on different rates of health service engagement in relation to where people originally resided.

Models of care influence a patient’s engagement with health services and this in turn has cost consequences. The quantitative and economic findings support a re-examination of service delivery models and a redesign of models to address the needs of the majority of participants attending the service. This study delivers evidence to support patients in their advocacy for patient-centred models of care.