PCHSS Autumn Newsletter 2021
Welcome to the PCHSS’s autumn newsletter! As the days grow shorter and the nights get cooler, we reflect on the first quarter of another strange year. The COVID-19 pandemic continued to dominate the news with some countries progressing well with their vaccine rollouts and others suffering devastating new waves of infections. The challenges in managing the complexities of vaccinations and controlling new infections highlights the importance of building sustainable and resilient health systems. In this edition of our newsletter, we feature some of our investigators’ and system partners’ recent work on health system sustainability.
WHAT IS THE PCHSS?
The PCHSS is a $10.75M, five-year collaboration involving 17 lead investigators, 20 expert advisors, and over 40 system implementation partners from around Australia. Our vision is that our research findings significantly influence the development of a more resilient health care system – one that is affordable, cost effective, and delivers improved health outcomes for all Australians.
Creating a value-based, integrated health systems for Australia (3 June, 1 – 5:30 pm (AEST))
- This event will be a discussion with PCHSS researchers, system partners, and health consumers. Presentations and discussions will unpack the challenges to and opportunities for developing and implementing a value-based health system, rather than the current volume driven system. During this webinar, we will examine how integrated care can contribute to better value care. We will draw on examples from successfully implemented integrated care programs and discuss how to determine which health services should be scaled up (and which could be scaled down).
For more details and to register, please see our Eventbrite page. This is a free event.
Shaping a sustainable health system through collaboration (June (TBA))
- We will also be hosting the final webinar in our 2020-2021 Health System Sustainability series. The webinar, ‘Shaping a sustainable health system through collaboration’ will include a panel discussion with researchers and health consumers on the future of health systems.
The event be held in late June. Registration will be open shortly on our website.
PCHSS 2020-2021 webinar series
PCHSS hosted three more webinars in its 2020-2021 Health System Sustainability series. If you missed any of our webinars, you can watch them on our YouTube channel. Follow us on Twitter @PCHSS_AIHI for notifications of upcoming events and registration links.
Can new payment models for healthcare providers support the provision of value-based healthcare?; moderated by Associate Professor Yvonne Zurynski (PCHSS and Macquarie University). 27 April 2021.
- Professor Tony Scott presented new evidence on how creating the right financial incentives can increase value-based, rather than volume driven, healthcare. He discussed what the evidence suggests about reforming private payment methods in Australia. Following the presentation, he was joined by Dr Michael Wright (Royal Australasian College of Physicians and the University of Sydney) and Mr James Downie (Independent Hospital Pricing Authority) for a panel discussion. The full webinar and responses to the Q&A are available on our website.
Improving health system performance from planning to evaluating implemented health services; moderated by Professor Henry Cutler (Macquarie University).30 March 2021
- Professor Jon Karnon (a health economist with the PCHSS and Flinders University) discussed the “Embedded Economist” program, which links economists with healthcare managers to co-design health services for Primary Health Networks and Local Health Networks. Associate Professor Yvonne Zurynski (PCHSS and Macquarie University) explained the importance of evaluations performed along-side of implementation of health service improvement programs or new models of care to support program sustainability. Watch the video and read the responses to the Q&A on our website.
Not yet business as usual: How are alternative models of care changing the health system and healthcare?; moderated by Professor Len Gray (PCHSS and The University of Queensland). 23 February 2021
Professor Rachelle Buchbinder, AO (PCHSS, Monash University and Cabrini Institute) shared her research on alternate models of care, such as early supported discharge from hospital and hospital-in-the-home. Dr Tracey Tay (NSW Agency for Clinical Innovation) spoke about the NSW Health Virtual Care Initiatives that have been ongoing and further enhanced through the Virtual Care Accelerator in response to the COVID-19 pandemic.
CHF Summit 2021: Shifting Gears (18-19 March 2021)
- Imagine it’s 2031 – what role should consumers play in the health system? How will we get there? On 18-19 March 2021, the Consumers Health Forum of Australia (CHF) hosted a virtual summit entitled “Shifting Gears”. As part of the summit, PCHSS investigators Professor Braithwaite and Associate Professor Zurynski co-led a workshop on the crucial role of consumers in creating sustainable healthcare systems with a panel of leading consumer advocates and researchers. A summary of the discussion is available on the Croakey website.
Since our summer newsletter, PCHSS investigators published over 45 papers, abstracts, reports, and other research works that arose from Partnership Centre funding or were related to health system sustainability. These and all our papers are available on the Our Publications page on our website. Notable recent examples of our publications include:
- Adherence to guideline-recommended HbA1c testing frequency and better outcomes in patients with type 2 diabetes: a 5-year retrospective cohort study in Australian general practice. Imai C, Li L, Hardie R, Georgiou A. BMJ Quality & Safety (Published online first February 4, 2021). This research revealed that only 50% of patients were tested on the schedule recommended by the guidelines. This is problematic since patients who were not tested on time were more likely to develop complications, such as chronic kidney disease. A multifaceted approach that includes patients’ and clinicians’ perspectives and local population characteristics is needed to improve guidelines adherence.
- Impact of COVID-19 pandemic on utilisation of healthcare services: a systematic review. Moynihan R, Sanders S, Michaleff ZA, Scott AM, Clark J, To EJ, Jones M, Kitchener E, Fox M, Johansson M, Lang E, Duggan A, Scott I, Albarqouni L. BMJ Open. 2021 Mar 16;11(3):e045343. This paper found that during the COVID-19 pandemic, treatment for serious illness continued, but treatment for lower severity or lower-risk illness was reduced through either patient action (e.g., patients did not seek care) or health services action (e.g., cessation of elective surgeries). The pandemic created a natural experiment which can help inform strategies to reduce overtreatment and increase the use of alternative models of care when appropriate.
- Prioritising models of healthcare service delivery for a more sustainable health system: a Delphi study of Australian health policy, clinical practice and management, academic and consumer stakeholders. Putrik P, Jessup R, Buchbinder R, Glasziou P, Karnon J, O’Connor DA. Australian Health Review. 2021 Mar 18. doi: 10.1071/AH20160. This paper described a method for reaching consensus on which alternative models of care are the highest priority for implementation or for further research. The paper provides a list of healthcare delivery services which decision makers should consider (e.g., co-location of services in residential aged care facilities) when seeking to optimise health services.
- Embedding an economist in regional and rural health services to add value and reduce waste by improving local-level decision-making: protocol for the ‘embedded Economist’ program and evaluation. Searles A, Piper D, Jorm C, Reeves P, Gleeson M, Karnon J, Goodwin N, Lawson K, Iedema R, Gray J. BMC Health Services Research. 2021;21(1):201. The ‘embedded Economist’ is an innovative new program designed to improve health services commissioning. As with any new program, its efficacy needs to be evaluated. This protocol outlines the method for conducting the evaluation.
- Learning health systems: a review of key topic areas and bibliometric trends. Pomare C, Mahmoud Z, Vedovi A, Ellis LA, Knaggs G, Smith CL, Zurynski Y, Braithwaite J. Learning Health Systems. 2021:e10265. Learning health systems (LHS) are designed to translate data (from all sources including patients and research) to create new knowledge which directly informs patient care. This is meant to be a continuous cycle of improvement. This paper identified key trends in the literature on LHSs, including that the majority of the publications originate in the US, are not empirical studies, and focus on specific areas (e.g., oncology) instead of whole systems. There is also a disproportionate focus on IT systems, which suggests that more research is needed on organisational and human factors.
Since our last newsletter, there have been more than 15 popular press stories covering PHCSS research.
Here is a small sampling of news stories from the past few months:
- Telehealth is here to stay as patients phone their GPs in droves (Georgiou A, The Lighthouse, 6 January 2021)
- Fears of ‘borderline unethical’ advertising after 75% of older Australians found to be taking supplements (Glasziou P, The Guardian, 1 February)
- Data dearth (Coeira E, Cosmos, 12 February 2021)
- Feds extend MBS items for telehealth until June 30 (Gray L, PulseIT, 15 March)
- Charting Australia’s healthcare journey into the age of artificial intelligence (Coiera E, Australian Healthcare & Hospitals Association Newsletter, 25 March)
- Shifting Gears Summit: a user’s manual in ten parts (Braithwaite J, Croakey, 31 March)
- Aged care facilities and data management (Westbrook J, ABC News Health Report (radio interview with Norman Swan, 12 April))
New leveraged funding and awards
PCHSS’ researchers won over AU$16 million in new funding in the past quarter. Below is a brief description of the new projects:
- Often referred to as ‘Australia’s National Cancer’, Australia has among the highest rates of melanoma (cancer of the skin cells) in the world. Through joint funding by the Skin Cancer Institute, the National Skin Cancer Centre, and Macquarie University, Professor Braithwaite and colleagues received money to establish a Collaboration to Improve Clinical Practice and Research Outcomes in Melanoma and Other Skin Cancers. (Braithwaite J, Rapport F, Wilkinson D, Mann G, Gust A and Smith A)
- Professor Braithwaite and colleagues also received a $15 million NHMRC grant on the future of genomic medicine in Australia. (Preparing Australia for Genomic Medicine: A proposal by the Australian Genomics Health Alliance 2.0. North K, Boughtwood T, Braithwaite J, Brown A, Christodoulou J, Dunwoodie S, Gaff C, Gecz J, Hofmann O, Kowal E, MacArthur D, Gaughran J, Meldrum C, Murray S, Newson A, Nowak K, Scott H, Spurdle A, Stark Z, Ward R)
- Accessing care for children with complex medical conditions who live in rural and remote Australia causes major disruptions to them and their families. Travel time, missed work and school, and high costs for accommodation and food are just some of the challenges. A new grant from NSWHealth Translational Research Grant Scheme to Associate Professor Yvonne Zurynski and colleagues aims to upscale the RuralKidsGPS program, an integrated model of technology-enabled care based on the SCHN Kids Guided Personalised Service (KidsGPS). Find out more about this research on NSWHealth’s website. (RuralKidsGPS– Delivering equitable care to children in rural NSW. Lingam R, Dickins E, Zurynski Y, O’Meara M, Preddy J, Crum M, Woolfenden S, Fletcher J, Epp J, Kerrigan A, Hodgson S, Hu N)
- Approximately 30% of all healthcare is of little- to no-value to the patient. Unfortunately, this level of wasteful care has stayed constant for decades. To begin to address this problem requires new strategies to change old behaviours. PCHSS’ Associate Professor Denise O’Connor and colleagues received a Victorian Healthcare Recovery Initiative Grant to address the issue of unnecessary colonoscopies (e.g., when used to screen for bowel cancer or when repeated more often that recommended by guidelines). (Measuring, providing regular feedback and co-designing quality improvement strategies to reduce low-value colonoscopy. O’Connor DA, Hiscock H, Audehm R, Hensher M, Hutchinson A, Liew D, O’Loughlin A, Thursky K)
Lastly, congratulations to PCHSS’ Telehealth researchers. PCHSS’ Telehealth stream researchers received a Commendation for Service Excellence Award at the 2020 University of Queensland Faculty of Medicine Excellence Awards. Dr Snoswell obtained a Women’s Research Assistance Program (WRAP) grant jointly funded by Advance Queensland and The University of Queensland to support her research work while she is away on maternity leave.
If you would like to partner with a stream of health system sustainability research, or you have an interest in any of the above areas of research, please contact us.
The Partnership Centre Team on behalf of:
Chief Investigator Professor Jeffrey Braithwaite
Founding Director, Australian Institute of Health Innovation, Macquarie University