News

Winter is in full swing in the southern hemisphere, but the research from the NHMRC Partnership Centre for Health System Sustainability (PCHSS) is running hot! We reflect on the latest research findings and recommendations made by PCHSS investigators and partners, and on our recent events and achievements.

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.

AWARDS AND RECOGNITION

Professor Rachelle Buchbinder AO has been awarded the 2023 Australian Rheumatology Association Distinguished Service Medal. This award recognises exceptional service to the Australian rheumatology community in areas such as research, education, advocacy, policy, clinical service, and leadership. Congratulations Rachelle!

NEW PUBLICATIONS

Since our last newsletter, PCHSS investigators have published more than 40 papers, abstracts, reports, and other research works. These, and our other papers, are available on the Our Publications page on our website.

Here are some notable recent examples of our publications:

• This research examined the effect of electronic medication management (eMM) systems on error rates in a paediatric referral hospital. eMM implementation showed no improvement in error rates in the short-term; however, error rates following a year significantly declined, indicating the long-term benefits of this intervention. (Westbrook JI, Li L, Raban MZ, Mumford V, Badgery-Parker T, Gates P, Fitzpatrick E, Merchant A, Woods A, Baysari M, McCullagh C, Day R, Gazarian M, Dickinson M, Seaman K, Dalla-Pozza L, Ambler G, Barclay P, Gardo A, O’Brien T, Barbaric D, White L. Short- and long-term effects of an electronic medication management system on paediatric prescribing errors. NPJ Digital Medicine).
• Vitamin D testing in children attending primary care has increased 30-fold over 15 years, but the odds of detecting a low vitamin D level has stayed the same, so more testing does not mean a better detection rate. Worryingly, when vitamin D deficiency was detected (25OHD <30nmol/L), only 3.9% of children were followed up and re-tested, but testing was repeated in 19.2% when the initial test was normal. These practices are at odds with the Global Consensus Recommendations for the prevention and management of nutritional rickets, which recommends Vitamin D supplementation rather than testing. (Zurynski Y, Munns C, Sezgin G, Imai C, Georgiou A. Vitamin D testing in children and adolescents in Victoria, Australia: are testing practices in line with global recommendations? Archives of Disease in Childhood).
• Which services for primary and secondary prevention of cardiovascular disease are used in primary care? This systematic review showed that lifestyle recommendations for cardiovascular disease prevention were largely underused. The review also found a lack of adherence to published clinical guidelines and suggests that further investigation is needed to understand the overuse and underuse of interventions. (Byambasuren O, Hattingh L, Jones M, Obuccina M, Craig L, Clark J, Hoffmann T, Glasziou P, Cardona M. Two decades of overuse and underuse of interventions for primary and secondary prevention of cardiovascular diseases: a systematic review. Current Problems in Cardiology).

  

• This survey of over 1000 Australians examined associations between care navigation, engagement with health providers, and having a chronic health condition. People living with chronic conditions were more likely to have low engagement and struggle with navigating the system to manage their care. Upskilling is needed for healthcare providers and health consumers. (Zurynski Y, Ellis LA, Pomare C, Meulenbroeks I, Gillespie J, Root J, Ansell J, Holt J, Wells L, Braithwaite J. Engagement with healthcare providers and healthcare system navigation among Australians with chronic conditions: a descriptive survey study. BMJ Open).
  
• A new process model has been proposed that can better link process mining and decision analytics to help inform the management of healthcare resources. The approach was evaluated with decision modelling and health economics experts, with particular focus on how the outputs can be used for decision-making. (Leemans SJJ, Partington A, Karnon J, Wynn MT. Process mining for healthcare decision analytics with micro-costing estimations. Artificial Intelligence in Medicine).
• Our survey of over 1000 health consumers examined preferences for telephone, video, and in-person consultations to gain a better understanding of the use of telehealth services in Australia. Telephone was found to be the most common telehealth modality, with consumers preferring this over in-person consultations for scenarios where the consumer needed a prescription or received test results. (Snoswell CL, Haydon HM, Kelly JT, Thomas EE, Caffery LJ, Smith AC. How do consumers prefer their care delivered: in-person, telephone or videoconference? Journal of Telemedicine and Telecare).
  
• Decision analytics and tools can help direct care to those most likely to benefit from that care. This scoping review examined the methods and objectives used in decision analytic modelling studies of back, neck, knee, or shoulder imaging modalities. Across 18 studies, the results showed that methodological issues related to poor reporting and measures of effectiveness did not incorporate changes in quantity and/or quality of life. Future investment in health technologies and their effectiveness should implement validated outcome measures. (Docking S, Gao L, Ademi Z, Bonello C, Buchbinder R. Use of decision-analytic modelling to assess the cost-effectiveness of diagnostic imaging of the spine, shoulder, and knee: a scoping review. Applied Health Economics and Health Policy).

MEDIA ENGAGEMENTS

Since our last newsletter, there have been more than 30 popular press stories covering PCHSS research.

Here is a sample of news stories from the past few months:

• Telehealth has much to offer First Nations people. But technical glitches and a lack of rapport can get in the way (Snoswell C, Caffery L, The Conversation, 31 March 2023)
• GPs suggest a team approach to beat burnout (Braithwaite J, Hospital and Healthcare, 8 March 2023)
• Telehealth for climate change, the latest on IBM Watson, & hospital billing transparency (Coiera E, Stat News, 22 November 2022)
• Prostate cancer treatment ‘does not alter’ 15-year survival: major study (Glasziou P, Australian Doctor, 21 March 2023)
• Measure what matters: the importance of measuring climate impact, and the health sector’s environmental footprint to deliver value (Smith CL, Zurynski Y, Braithwaite J, AHHA News, 9 May 2023)
  
  
• International Women’s Day prompts calls for tech equity (Magrabi F, The Lighthouse, 6 March 2023)

NEW LEVERAGED FUNDING

PCHSS’ researchers won over $5,863,700 in new funding and contracts in the last two quarters. Examples of some of the new projects include:

• A $1.4 million NHMRC grant involving Professor Johanna Westbrook and Professor Leonard Gray that leverages informatics to optimise medication reviews and outcomes in residential aged care.
• A mixed methods evaluation of Type 1 Diabetes services in Far North Queensland by researchers at PCHSS’ Observatory on Health System Sustainability (Carrigan A, Zurynski Y, Braithwaite J). This project is funded by a JDRF Global Centre of Excellence in Diabetes Research Seeding Grant.
• An NHMRC Partnership Project that will use a mixed-methods study to examine how to improve the health system’s response when patients are harmed. Professor Jeffrey Braithwaite is an investigator on this grant.
• An examination into reducing hospital re-admission for high-risk cardiology patients involving PCHSS investigator Dr Centaine Snoswell. This grant is worth over $1.4 million.

PAST EVENTS

PCHSS Research Showcase

Future Proofing Healthcare: What evidence tells us about creating sustainable health systems

On 16 June 2023, researchers and other stakeholders gathered at Macquarie University for the PCHSS Research Showcase. The event was attended by over 60 individuals in-person and over 110 online from most states of Australia.

We were honoured to be joined by two special guests from NSW Health: Associate Professor Jean-Frédéric Levesque (Deputy Secretary, Clinical Innovation and Research; Chief Executive, Agency for Clinical Innovation) and Ms Deborah Willcox AM (Deputy Secretary, Health System Strategy and Patient Experience). It was great to hear about the initiatives that NSW Health is implementing to improve the sustainability and efficiency of the NSW health system.

Presentations from Research Stream 1 covered reducing medication administration errors and using shared data (Professor Johanna Westbrook), using big data and AI in clinical care including identification of frail patients at greater risk (Professor Shlomo Berkovsky on behalf of Professor Enrico Coiera), and the acceptance and ongoing potential of telehealth as a method of care delivery (Dr Liam Caffery on behalf of Professor Len Gray). Professor Paul Glasziou and Professor Rachelle Buchbinder (Research Stream 2) focused on reducing medical waste and low-value care within the health system.

Research Stream 3 highlighted health economics research, with Professor Tony Scott emphasising the need to focus on system architecture to inform sustainability, and Professor Jon Karnon emphasising the potential of his embedded evaluation program. Abby Mosedale (on behalf of Associate Professor Delia Hendrie) examined the realist evaluations their team is conducting in Western Australia. Professor Jeffrey Braithwaite and Professor Yvonne Zurynski from the Observatory on Health System Sustainability, joined by Ms Leanne Wells (former CEO, Consumers Health Forum of Australia), gave insights into learning health systems, care integration, and the need for consumer involvement in the health system and in health research.

The afternoon session involved an interactive health system simulation run by Professor Jeffrey Braithwaite. The health system simulations are designed for all participants to challenge themselves and move outside of their every-day roles and established ways of working, to demonstrate that healthcare is indeed an interconnected, dynamic, and adaptive system – and many parts of it need to work together.

It was fantastic to be joined by so many engaged and knowledgeable researchers, health consumers, clinicians, and decision-makers, and to be able to share all the hard work and incredible achievements of the PCHSS over the past six years.

Presentations from the showcase have also been covered in the media. Notable articles include:

• Technology is no silver bullet for delivering error-free healthcare (Westbrook J, Health Services Daily, 21 June 2023)
• Unnecessary imaging costing system millions (Buchbinder R, Glasziou P, Medical Republic, 23 June 2023)

For a detailed recap of the day, visit our website.

Recordings of the research showcase will be available shortly on our YouTube Channel, along with videos of other past events.

Follow us on Twitter @PCHSS_AIHI for notifications of upcoming events and registration links.

CONTACT

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.

Warm regards,

The Partnership Centre Team on behalf of:  Chief Investigator Professor Jeffrey Braithwaite

Founding Director, Australian Institute of Health Innovation,  Macquarie University