Research Themes and
Content Area
Each year the Centre undertakes about ten to fifteen
research and development projects from a variety of
funding sources: Commonwealth Health and Veterans; States/Territories;
local health and community care authorities; private
health insurers; non-government and not for profit organisations;
and the National Health and Medical Research Council
(State Commonwealth Research Issues Forum funding program).
This diversity of funding sources means we are not dependent
on any one partnership or funder. It allows a level
of independence that is helpful to the health system,
and at the same time, it requires considerable collaboration
and multiple partnerships at all levels.
Over time, the research undertaken by the CHSD has
consolidated into six integrated themes driven by our
commitment to combine realism with rigour:
These research themes are shaped by the national, State/Territory
and local health system environments, their strengths
and weaknesses and the immediate research opportunities
they generate. As a research unit, we are one of the
few to benefit from Australia's Federal and State divisions
of responsibilities, differing regional priorities,
and multiplicity of programs, because, for us, the design
of the system creates ample opportunity for research
on themes of coordination and integration.
Our work is designed to build lasting structures that
are priority, and not project, driven. For example,
our development pathway shows how we can use concepts
from inpatient casemix (ie, resource homogenous patient
classes that are also clinically sensible) to focus
on allocation issues in other sectors such as rehabilitation
and palliative care and to focus on care across settings
and in the community.
Our themes interact with the priorities of our industry
partners, and our goal is to undertake thematic research
within a ‘priority-driven’ environment.
We make our own research opportunities, but not in circumstances
necessarily chosen by ourselves.
Another result of our thematic approach has been our
contributions to R&D in the community care sector,
where there is little experience with research or coherent
strategies for development. For example, we have developed
a suite of tools to examine ways that agreed client
need indicators (organised under domains of primary
care) can be reliably screened at the entry point. This
work has been conducted in three States and also helps
local planning and service delivery and decision-making.
Casemix classification across
settings
An understanding of the cause of variation in health
system activities and outcomes is essential to sound
management decision-making. Casemix classifications
play an important role in health finance, by allowing
us to examine the variation in costs of an episode of
care while controlling for variation among patients
or clients. In the hospital sector, the AR-DRG classification
has proved successful in differentiating between types
of acute care episodes with different average costs.
Outside this setting, there is still a need for better
classification systems, and the Centre has undertaken
various projects on sub-acute/non-acute hospital care
as well as community care.
Health and community care financing
There has been major reforms of health care financing
in many countries as governments and other funders seek
ways to improve the cost-effectiveness of their health
care systems. Australia has been no different, with
many States shifting to episode-based funding models
in different settings. The Centre has particular expertise
in developing funding models, supported by our experience
of evaluating different funding approaches such as funds
pooling. The Centre has advised State Governments and
Area Health Services on funding model design, and continues
to participate in the design and evaluation of projects
that test new funding approaches.
Care coordination
With Commonwealth and State governments sharing responsibilities
for health policy and finance, the integration and coordination
of services remains an important issue. These split
responsibilities can create various impediments to patients
accessing care, especially people with chronic conditions.
The Centre sees reforms to improve the coordination
of services as potentially have a large beneficial impact
on patients, and has been involved in various research
initiatives. The evaluation of the Illawarra Coordinated
Care Trial was a major piece of work for the Centre,
as was the evaluation of the Mental Health Integration
Projects in which the CHSD was the National Design Team
for the Commonwealth. Currently, our research in this
area is focusing on evaluating models of care to improve
the coordination of palliative care services.
Health service delivery and
organisation
Research in this theme is a natural extension of our
policy level work. Its results support and inform our
work at the policy level, while our policy work raises
issues of implementation that benefit from research
projects on (and for) health services. For the Centre,
a particular impetus has been the moves to improve the
Australia's health information. The development of minimum
data sets for various services, linked to the need to
improve the sharing of health information, has highlighted
the need for consistent data collection by services.
The Centre has responded to these challenges by helping
services develop common assessment forms that are reliable
and valid measures of clinical function. The Centre
has also undertaken various projects that provide agencies
with information about the use of services by residents
of different jurisdictions. Finally, the Centre is the
supplier of SNAPshot, software that supports the collection
of patient data on sub-acute/non-acute episodes of care.
Management decision-making
Related to our work on improving data collections is
research that aims to assist management decision making.
This work covers a number of areas, from providing guidelines
on the interpretation of health statistics (such as
small-areas statistics), to developing novel statistical
approaches to assist clinicians and managers with planning
and resource allocation decisions.
Health care outcomes
The primary aim of any health system is to provide
quality of patient care, and the performance of a health
system can only be systematically monitored by measuring
the outcomes of care. The CHSD has a commitment to improve
the measurement of the outcomes of health care as well
as measures of service activity. This commitment was
a key motivation behind the creation of the Australian
Health Outcomes Collaboration (AHOC). AHOC is part of
the Centre but is located with the Clinical Health Outcomes
Centre and the ACT Epidemiology Unit in Canberra. Its
role is to:
- disseminate information about health outcomes research,
- maintain a database of health outcomes projects
and instruments,
- provide advice on the selection of measures for
health outcomes assessment,
- provide health outcomes education and training,
- organise national and international conferences
and seminars on health outcomes and;
- distribute measures and instruments used in health
outcomes assessment.
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