Strategic Health Research Program

1
Strategic HealthResearch Program

• Briefing Session 2
• Health Systems Research Topics
• 18 October 2007

2
Kaurna Introduction

• We would like to acknowledge this land that we
  meet on today is the traditional Lands for the
  Kaurna people and that we respect their spiritual
  relationship with their country. We also
  acknowledge the Kaurna people as the custodians
  of the greater Adelaide region and that their
  cultural and heritage beliefs are still as
  important to the living Kaurna people today.

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Overview

• Part 1 Overview of Program

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Introduction

• Second funding round of SHRP.
• SHRP represents a paradigm shift from research
  funded under broad priority areas to a program
  where researchers are invited to respond to
  specific topics and questions (a targeted
  approach similar to commissioned research)

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Two main SHRP Strategies

• Two major strategies
• 1. User Driven research against priorities,
  topics and questions identified by the
  Department
• (applicants should consider SHRP as seed
  funding for topics which also have national
  relevance).
• 2. Leveraging research against Departmental
  priorities which provides more scope for
  researcher flexibility (not part of this call
  for research).

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Why this approach?

• We need to adopt strategies where there is
  focussed use of limited resources through a
  greater level of specificity within the
  prioritisation process. (Many good ideas but not
  everything can be funded)
• The universities approach the Dept for research
  topics. SHRP provides opportunities for
  university researchers to obtain funding under
  topics of mutual interest, but initially
  identified by the Dept.

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Collaboration

• Greater emphasis on research collaborations in
  three ways
• On the research undertakings themselves
• ie research team collaborations
• - Collaborations with policy makers/practiti
  oners
• Theme groups

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Why research collaboration?

• These collaborations aim to
• Co-produce research with policy/practitioners
  (research)
• Build SA research strength and capacity
• Help to position SA researchers competitively
  nationally
• Build stronger multidisciplinary responses to
  complex research topics

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SHRP HSR Priorities

• Priorities - revised to take account of the
  recent SA Health Care Plan and new directions for
  SA Health.
• Revision process was undertaken with selected
  end users of research (policy and decision
  makers) across the health system.
• As with the previous SHRP round, the priority
  setting process has been designed to generate
  research which has the capacity to be applied
  across the health system in a range of settings.
• Linkage and exchange underpins this process for
  better translation of research into policy and
  practice.

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SHRP HSR Priorities

• Themes for 2007
• Demand Management
• Public/Private Health Service Collaboration and
  Demand Management
• Public/Private Health service and Health
  insurance
• Understanding and managing community
  expectations
• Effective and responsive mainstream services for
  Aboriginal people.

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Cross cutting issues/approaches

• SHRP designed to address the priorities from the
  perspective of
• Achieving health equity health systems equity
  marginalised groups
• Health Economics
• Workforce capacity

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Structure of SHRP

• One research stream (2007)
• New Research primary research to address longer
  term HSR priorities.
• Research topics are prioritised according to
  regional priorities. These are outlined in
  guidelines.

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SHRP does not fund

• Dental/Medical research
• Basic research
• Projects which do not address the SHRP 2007-2008
  Research Topics and Questions or do not align
  with the intent of the guidelines.
• Applications which exceed the stipulated funding
  levels under each research stream.
• Bio-technology research

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SHRP does not fund

• Retrospective funding of research projects.
• Capital items (e.g. computers, equipment).
• Projects requiring ongoing funding from the
  Department of Health, top ups to existing
  research etc.
• Attendance at seminars or conferences, unless
  integral to the research transfer strategy.

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What kind of research do we want

• Collaborative research with multi d teams of
  researchers and policy or practitioners (may
  mean new collaborations)
• Teams which address the research topic/s
  comprehensively with an applied focus
• Projects that directly address the topic and
  questions (some questions may need refinement but
  the original intention must be maintained)
• Timely research (start on time and finish on
  time)

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We Will

• Promote collaborations to avoid competing
  proposals and duplication of topics
• Researchers must show a willingness at the
  beginning of the process to talk to each other to
  discuss topics and how to collaborate
• SHRP team first who will put you in touch with
  relevant Departmental staff.
• Coordination will occur at this stage as well.

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Aboriginal Research

• Research team consist of 1 Aboriginal CI, if
  possible
• Community or key Stakeholder participation
• High level of collaboration but relevant to the
  topic
• Builds capacity
• Consistent with NHMRC Aboriginal Research
  Guidelines
• Deals with health equity
• Consistency with the Iga Warta Agreement
• Non Aboriginal researchers must be willing to be
  open to cultural perspective of Aboriginal peers

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Funding Levels

• Research Synthesis up to 120Kpa (GST Exc), for
  projects 6-12 months duration
• New Research up to 150Kpa (GST Exc), for
  projects up to 3 years duration
• These are the maximum funding levels for each
  stream. Applicants seeking maximum amounts must
  be able to justify clearly why funding is needed.
  
• Applications exceeding these levels will be
  automatically rejected.

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Application Process Key Dates

• SHRP has a 3 stage application process
• Registration intention to submit an EOI for the
  SHRP 07-08 funding round
• Due Date 22 October
• Expression of Interest used to outline
  methodology and scope of research. 4 weeks
  allocated.
• Due Date 5 November
• Full Application those successful at EOI stage
  will be invited to submit a full application. 9
  weeks allocated.
• Due Date 21 January 2007
• All research must start within 6 weeks of
  notification prioritisation will take place in
  some areas and funded later

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Assessment Process

• Applicants must address all headings in the
  application forms and selection criteria
• Assessment through a panel (with relevant mix of
  expertise), and full proposals peer reviewed,
  plus DH policy input
• While peer review comments will be important,
  final decisions made by Department

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2006-2007 Data

• Registrations of Interest 55
• Expressions of Interest 25
• Invitations to submit Full App. 11
• Submissions received 10
• Projects funded 7

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Guidelines

• Two sets of Guidelines have been produced for the
  07-08 funding round.
• Represent the separation of SASP general health
  topics and Health Systems Research topics.
• All key information is included in the
  Guidelines. Interested applicants must read and
  familiarise themselves with all components of the
  Guidelines.
• Further clarification (if needed) may be obtained
  from the SHRP team if Guidelines are unclear.

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Website

• Website contains
• Guidelines (and all documents)
• Application Forms
• Selection criteria
• Indicative timelines
• Relevant resources and DH policy documents
• http//www.health.sa.gov.au/shrp

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Contact Details

• Website http//www.health.sa.gov.au/shrp
• Email shrp_at_health.sa.gov.au
• Phone [phone] 6431

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Research Topics

• Part 2 Research Topics

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Main Factors Driving an Unsustainable Health
System

• Ageing population
• Increasing prevalence of Chronic Diseases
• Increasing community expectations about access to
  health care
• Workforce shortages
• Technological improvements
• Cost of care increasing at a faster rate than
  SAs revenue base

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Essential Background Info for HSR

• SA Health Care Plan 2007 2016
• GP Plus Health Care Strategy
• Clinical Networks
• Health Workforce Strategy
• Health Economics Collaborative

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Demand Management

• The Department of Health developing new and
  alternative strategies to reduce the demand on
  the public hospital system.
• Underpinning this work is the implementation of
  chronic disease management strategies and
  self-management strategies which over time should
  impact on the demand for hospital inpatient beds,
  and emergency department demand.
• However longer term care needs of people with
  chronic complex conditions will require ongoing
  care responses beyond those currently provided.
• The health sector along with aged care and non
  government services, including agencies such as
  (but not limited to) RDNS and Domiciliary Care,
  will have a role in longer term care provision.

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Demand Management

• Topic 1 What is creating high demand in the
  health system?
• The Department is unable to demonstrate that
  existing hospital demand strategies represent
  savings or reduce bed demand to the health
  system. Currently specific demand management
  strategies, in their own right, appear to be
  reducing bed demand, but beds keep filling
  despite these strategies.
• Research Questions
• What are the key factors creating this
  demand/need in the health system?
• What are the variables at play that are either
  not known, or not understood, which are
  contributing to this bed filling phenomenon?
• What could be done to address the bed filling
  phenomenon?
• Research Approach
• This is a prospective study which will require a
  multidisciplinary approach and include a health
  economics analysis. It may also require access to
  Department of Health administrative data sets,
  hospital data sets, as well as collection of
  primary data. Applicants will be required to
  discuss the proposed study with data custodians
  to ensure that secondary data will be made
  available for the study.

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Demand Management

• Topic 2 What are the longer term care needs and
  how can they be met?
• Post-discharge care packages are usually short
  term, but patient care needs tend to be longer
  term and complex. This is particularly so for the
  frail aged, when family carer supports may be
  fewer and, for example, their ability to manage
  complex medication regimes is limited. These
  population groups need ongoing care, including
  ongoing medication supervision which is currently
  limited to 7 10 days.

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Demand Management

• Research Questions
• What can the health system do to meet these
  longer term care needs? What workforce capacity
  does the health system require to respond to
  these needs?
• Are there other care options that could address
  these particular complex care needs? How safe are
  they? Do they contribute to improving treatment
  outcomes and quality of life? How cost effective
  are they?
• What is the role of the aged care and non
  government sector in the provision of longer term
  care and what is required to build capacity in
  these areas?
• Research Approach
• This is a prospective study which will require a
  multidisciplinary approach.

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How can we change the traditional episodic care
approach of health professionals to one of a
continuum of care and a more population health
approach?

• Changing the traditional episodic care approach
  of health professionals to one of a continuum of
  care and a more population health approach is
  already being addressed to some extent in the
  current primary health care networks.
• However there are many instances where people who
  have less common but chronic conditions may miss
  out on appropriate and continuous care.
• Clients missing out on timely and appropriate
  care as they fall through the net of service
  funding, service inclusion criteria, and national
  health program priorities.

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Episodic to Continuum of Care

• Topic 1 Models of Care
• Currently there are brokerage models in place to
  provide non clinical home supports. Case
  management strategies could be improved in the
  health system and are known to provide quality
  care, but are expensive. Brokerage models of care
  are not adequate enough to provide the
  clinical/health care required, thus case
  management would appear, with adequate connection
  with brokered home care, to contribute to more
  continuous care.
• Research Questions
• How could these two models of care intersect/work
  together to meet both health and home care needs?
  
• How can case management be implemented
  successfully at a lesser cost than was shown in
  the coordinated care trials?
• Can the case be made to show that a reorientation
  of the health system over time to case managed
  care in the community is more cost effective than
  hospital care?
• Which models of care produce better health
  outcomes?
• Please note that this research is not about
  repeating coordinated care trials.

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Episodic to Continuum of Care

• Topic 2 Primary Health Care Strategies
• Primary health care strategies including
  prevention and early intervention are cited on
  the national health agenda as longer term
  strategies to reduce demand and cost on the
  health system.

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Episodic to Continuum of Care

• Research Questions
• Do these strategies reduce eventual demand on
  hospital care?
• What are the important medium term steps to
  reorient the health system to a more community
  based health care system, whilst putting in
  longer term primary health care prevention and
  early intervention strategies?
• Will community-based centres such as GP Plus
  reduce the costs in the health system?
• What kind of community centres and or services
  would most effectively respond to client needs
  inclusive of clinical and other care?

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Episodic to Continuum of Care

• A variation on the above topic
• Another approach on the above topic is to examine
  the issue of those people 55 years and over who
  are frequently admitted to hospital for problems
  that could be avoidable if they had the right
  mix, frequency, type and coordination of home
  care that often falls outside the current modes
  of in-home care currently provided in SA.
• This could include the development of a properly
  designed prospective controlled trial of this
  group using evidence based interventions to
  determine effectiveness and cost compared with
  this same group receiving hospital care and those
  receiving existing services.
• The trial would aim to address problems
  associated with unnecessary hospital admission,
  poor case management and the lack of services
  needed for people to successfully stay at home
  those who fall between the gaps in services.

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Episodic to Continuum of Care

• The trial would examine
• how complications can be avoided, for example,
  medication misadventure
• how to ensure timely care to avoid unnecessary
  suffering
• undue pressure on clients around the organisation
  of basic care needs such as food preparation
• adequate nutrition and social interaction
• management of their organisational needs such as
  attendance at appointments or
• alternatively designing a system of care that
  reduces the need for multiple care providers and
  multiple appointments for this group of people.
• The interventions would need to examine skill set
  competencies with regard to practitioners (for
  example, nurses to make clinical judgements about
  clients).

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Episodic to Continuum of Care

• Research Approach
• Prospective studies should be designed which
  require multidisciplinary approaches. There are
  many facets to these topic areas which
  potentially make the research studies quite
  large. Applicants should also consider using SHRP
  as seed funding with the view to applying for
  NHMRC Health Services Research Grants in 2008.

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Public/Private Health Service Collaboration

• Theme 3 Public/Private health service
  collaboration and demand management
• Public/Private health service collaboration has
  not been given a great deal of attention in South
  Australia. In Australia, approximately one third
  of hospital care is provided in private hospitals
  and mostly comprises elective surgery. Currently
  the growth in private sector beds is increasing.
  The private health sector, like the public
  sector, is operating at high capacity. The
  private sector, however, does not have to deal
  with inpatient variations such as winter illness
  that impact on public hospitals.

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Public/Private Health Service Collaboration

• Private hospitals can also backfill empty beds
  for emergency patients and then divert the rest
  to public hospitals. Providing emergency care
  services is the main domain of the public
  hospital system. Public hospitals also deal with
  more complicated health needs compared to many
  private hospitals, and thus private hospitals are
  better able to plan their services compared with
  the public sector.
• Research Questions
• To what extent do private hospitals reduce demand
  for services in public hospitals? (This will
  necessitate identification of activity that
  occurs in private hospitals that would not occur
  necessarily in public hospitals).
• Is there potential for private hospitals to
  further contribute to reducing public hospital
  demand?

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Public/Private Health Service and Health Insurance

• Theme 4 Public/Private health service and health
  insurance
• At present, privately insured patients can
  receive public health services as public
  patients. They are not required to declare their
  private health insurance status and health funds
  are not required to provide this information to
  hospitals.
• Within this context, research under this topic
  may explore how to develop collaborations with
  private health funds to ensure private care
  provided in the public sector is funded by the
  private sector.
• Research Question
• How can the private hospital sector assist the
  growing public hospital demand?

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Community Expectations

• Theme 5 Understanding and managing community
  expectations on health service provision
• Central to future changes in the health system,
  including care provision and job redesign, is
  community attitude and acceptance. The community
  should have a role in determining what kinds of
  services and the extent to which services can be
  provided to meet health care needs. In the past
  the South Australian Department of Health has
  undertaken health dollar debates involving
  communities. It is now time in the current
  context of increased pressures on health services
  to examine community attitudes to where health
  dollar resources should be directed. For
  example, should high cost procedures be provided
  to people with complex co-morbidities who are
  nearing the end of their lives?

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Community Expectations

• Research Questions
• How much does community expectation drive
  decisions in regard to health care provision?
• How can communities be best engaged in decisions
  around the investment of health resources, and
  what are the most effective methods in eliciting
  this information?
• What are community views about job redesign that
  may involve new roles or traditional care
  providers such as nurses undertaking new roles?
• What is the role and effectiveness of community
  pressure groups in determining where resources go
  and would they change their views in light of
  evidence to the contrary?

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Mainstream Services for Aboriginal People

• Theme 6 Providing effective and responsive
  mainstream services to Aboriginal people
• Health services in general respond well to the
  needs of mainstream populations, but where there
  are particular nuances related to culture,
  geographical location, or Aboriginal clan groups,
  care needs will differ. For example, inpatient
  and discharge care needs will differ across small
  numbers of people from diverse clan groups,
  making it quite difficult for a large health care
  organisation to respond specifically to these
  needs.
• Some Aboriginal people, particularly traditional
  from remote areas, may have no conception of
  certain diseases or may explain them in regard to
  their spiritual beliefs. Such interpretive
  differences may result in Aboriginal inpatients
  not understanding the nature of their illness, or
  the ongoing care they need.

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Mainstream Services for Aboriginal People

• Although care providers may be providing the
  relevant treatment protocols, the health system
  response to small numbers of people may not be
  adequate (for example, Aboriginal people from
  different clan groups or geographical locations).
• Aboriginal people may be quite vulnerable to the
  impacts of organisational culture particularly
  experiences of objectification that other
  recipients of care may be able deal with
  (although not necessarily regarded as
  acceptable). For example, this can include the
  way Aboriginal people are spoken to in public
  places in regard to sensitive matters, and
  attitudes towards traditional people as
  unclean. These experiences have resulted in
  Aboriginal people refusing to return for care,
  going elsewhere for care, or leaving hospital
  prematurely.

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Mainstream Services for Aboriginal People

• There is a lack of a systematic health system
  wide approach to responding to Aboriginal health
  needs.
• This study concerns the capacity of various parts
  of the health system to respond effectively to a
  significantly marginalised population group,
  (that is, Aboriginal people), and how the system
  as a whole could be enhanced to better meet the
  needs of Aboriginal people. This research must
  start by defining the nature and extent of
  Aboriginal health service usage as well as
  experience of services. This study is not about
  client satisfaction surveys or ongoing system
  wide monitoring. Rather, this study is intended
  to be an exemplar which could be translated into
  other health service settings.

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Mainstream Services for Aboriginal People

• Research Questions
• What are the reasons for admission and the length
  of stay for people from Aboriginal backgrounds?
• What is the cost of their care compared with
  people from non-Aboriginal backgrounds?
• What are the experiences of Aboriginal people
  admitted to mainstream health services vis-à-vis
  non-Aboriginal people?
• What are the readmission rates and why?
• What types of system responses (inpatient,
  transition and community) could be implemented to
  meet the care needs of a small number of
  Aboriginal patients across diverse clan or
  geographical groups?
• What is the potential cost of meeting these care
  needs?
• What effective health system responses could be
  implemented more widely across the health system?

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Mainstream Services for Aboriginal People

• Methodology Approach
• This research will require a multidisciplinary
  team of health systems researchers who have a
  good understanding of the strategies within the
  SA Health Care Plan, are sensitive to diverse
  cultural needs, and have a broad understanding of
  health care responses from hospital to community.
  
• The study will require access to various health
  data sets. The Chief Investigator will be
  required to check with data custodians to ensure
  that data will be made available for the study.