2008 Pre-Conference Workshops

Morning

1. Health Outcomes: An Overview and an Introduction
Presenter: Jan Sansoni, Director, Australian Health Outcomes Collaboration; Centre for Health Service Development, University of Wollongong.
Target Audience: This workshop will suit those who are not so familiar with health outcomes evaluation. The workshop also provides a useful background to the workshops to be held in the afternoon.

The Health Outcomes Jigsaw
This section will provide a brief overview of both the Australian and international focus on health outcomes. Definitions and a health outcomes framework will be explored. The health outcomes focus will be discussed in relation to population health and health gain, quality improvement activities, best practice guideline development and benchmarking activities that may be undertaken by health and community care organisations. The consumer/client focus of health outcomes will be discussed.

Selecting Instruments and Measures: Some Practical Examples
Part of the workshop will be concerned with discussing measures used to assess health states and health related quality of life. The constructs of well being, quality of life and health related quality of life will be reviewed. Participants will be asked to complete some health related quality of life measures in order to discuss some of the practical and research issues that arise when using these instruments for patient/client based assessments. The typology of measures and indicators will be briefly examined as will the psychometric properties that apply to instruments (reliability, validity, responsiveness to change). The group will discuss issues that are relevant to the selection of measures and instruments used to ascertain health outcomes within the context of quality improvement and health service evaluation. Utility instruments used for cost utility analysis will be briefly discussed.

2. Economic Evaluation: Connecting Costs with Outcomes
Presenters: Associate Professor Rosalie Viney and Associate Professor Marion Haas, Centre for Health Economics Research and Evaluation (CHERE), University of Technology, Sydney.

Economics is concerned with allocating scarce resources between competing wants/needs. It focuses on choices; specifically how to allocate resources to different possible alternative uses.

Economic evaluation is the comparative analysis of alternative courses of action in terms of both their costs and their consequences. It is an aid to decision making, and can be used to assist in answering a range of questions at different levels of the health system.

This workshop will provide an introduction to the rationale for and principles of economic evaluation. It will address the concepts of opportunity cost and scarcity; discuss why health and health economics are 'different'; explore what is in the health economists' tool kit; and outline the basic steps in undertaking an economic evaluation of a health intervention.

The workshop aims to de-mystify the language of health economics and provide participants with the skills to critically analyse health economics research.

3. The Application of HRQOL Assessments in Clinical Research and Practice
Presenters: Prof Neil Aaronson, Head, Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute and Professor, Department of Clinical Psychology, The University of Amsterdam.
Target Audience: The workshop will be relatively basic and thus participants are not required to have advanced background or skills in psychometrics or statistics.

Over the past several decades major strides have been made in developing brief, standardized and psychometrically robust questionnaires for assessing the health-related quality of life (HRQL) and other related patient-reported outcomes (PRO’s) in chronic disease populations. PRO assessments have come to play an increasingly prominent role in clinical research, and such measures are now included in many phase II and phase III clinical trials. More recently, PRO assessment has been advocated as a means of monitoring the physical and psychosocial functioning and symptom experience of patients in daily clinical practice, with the goal of improving patient care and outcomes for individual patients. This workshop will provide an overview of a range of theoretical, methodological and practical issues involved in assessing PRO’s in clinical research and practice. Specific issues to be address include: (1) the need for developing and applying better conceptual models of PRO’s; (2) the need for and legitimacy of employing proxy PRO measures in selective research settings; (3) avoiding the “best bet” trap in selecting among available PRO instruments; (4) the search for meaning in interpreting scores generated by PRO measures (e.g., missing data, multiple outcomes, and statistical vs. clinical significance); (6) the role of modern test theory (item banking, item response theory, computer-adaptive testing) in advancing the science of HRQL assessment and (5) the possibilities and limits of using PRO measures in daily clinical practice. Examples of successful applications of PRO’s in both clinical research and practice settings will be provided.

The objectives of the workshop are:
1. To provide a conceptual/theoretical basis for assessing PRO’s in clinical research and clinical practice in oncology
2. To describe the methodological and practical criteria for evaluating existing PRO measures and for choosing an existing measure appropriate to the purpose of your application
3. To describe some of the ways of dealing with missing data, multiple testing and other related statistical problems
4. To provide an overview of methods for interpreting the clinical relevance of PRO results
5. To provide examples of successful application of PRO measures in both clinical research and clinical practice settings

4. Measuring Patient Satisfaction with Health Care
Presenter: Assoc Prof Graeme Hawthorne, Department of Psychiatry, University of Melbourne.

Assessing patient satisfaction with health care is important for three reasons: it provides patients with a voice regarding their relationship with the health care worker, it enables patient views to be taken into account during health care decision making, and at the policy level it assists with the monitoring of health care quality and the legitimization of health care policy. Despite the importance of eliciting this patient perspective on their health care, the assessment of patient satisfaction is often either left to the last minute (as a kind of afterthought) or is misdirected (through excessive questionnaires which may be intimidating for both patients and health care workers).

This workshop is aimed at health care workers and researchers who wish to become more informed about the definition of patient satisfaction and its measurement in a way that is both practical and informative. The workshop will introduce participants to the major patient satisfaction theories and will provide a review of the leading patient satisfaction questionnaires, including the use of single assessment items and multi-scaled instruments. Selected case studies will be presented, illustrating the different kinds of approaches used in the patient satisfaction field, and participants will have the
opportunity to directly compare different patient satisfaction measures. Participants will be introduced to the Short Assessment of Patient Satisfaction (SAPS) instrument, a new user-friendly instrument of patient satisfaction developed to capture satisfaction with health care.By the end of the workshop participants will have a firm understanding of patient satisfaction theory and practice (including the underlying principles, scoring algorithms, strengths and limitations of the leading instruments), an introduction to some of the key literature, a working knowledge of the different uses to which patient satisfaction can be put, and sufficient understanding to be able to make informed judgements about the level of patient satisfaction assessment which should be used under differing circumstances (from individual consultation to system wide quality assurance).

Afternoon

5. Designing and Assessing Measures for use with Indigenous People
Presenters: Dr Kate Senior, Division Leader, Education and Training and Dr Richard Chenhall, Senior Research Fellow, Menzies School of Health Research.

This workshop will address the issues concerning the measurement of health outcomes and health related quality of life in Indigenous populations. It will provide an overview of the range of measures that have been used with Indigenous people; both in Australia and overseas. It will identify some of the problems that have been encountered.

Participants will discuss a range of measures to consider their applicability in a range of settings (e.g. rural, remote and urban settings). The workshop will discuss a range of innovations in Indigenous health outcomes measurement with a specific focus on dementia, cognition and drug and alcohol research. The workshop will also examine the SEIQOL, an individual quality of life measure, to discuss the potential uses of this instrument in Indigenous populations.

6. Designing and Implementing Measurement Suites: Screening, Assessment,
Outcomes Evaluation and Service Benchmarking
Presenters: Professor Kathy Eagar, Centre for Health Service Development (CHSD), University of Wollongong; Ms Frances Simmonds Australasian Rehabilitation Outcomes Centre, CHSD; Ms Prue Watters, Palliative Care Outcomes Collaboration, CHSD; Mr Nick Marosszeky, CHSD, Ms Janette Green, CHSD.
Target Audience: Those interested in assessing needs and outcomes for a range of health conditions with a particular focus on chronic disease and rehabilitation.

In recent project work the CHSD, in conjunction with other collaborating centres, has developed measurement suites for screening, assessment, outcomes evaluation and benchmarking for a range of government programs. When information on the costs of services can be linked to reliable estimates of client need, then there is a classification basis that will give more powerful applications of the same routinely collected data. The CHSD has been involved in establishing and operating the Australasian Rehabilitation Outcomes Centre (AROC), the Palliative Care Outcomes Centre (PCOC) has also worked closely with the Australian Mental Health Outcomes and Casemix Collection Network (AMHOCCN), and these initiatives have allowed benchmarking for facilities in ways that control for patient variation. This workshop will focus on the processes that have been undertaken in development of suitable measurement suites for these purposes, discuss the similarities and differences between these initiatives and outline the lessons learnt from these activities. Data interpretation and implications for service improvement will be discussed.

Kathy Eagar describes a range of recent projects, addresses the different purposes of measurement suites and discusses key issues that have arisen during their development. Nick Marosszeky will discuss issues concerning the selection and
development of measures. Janette Green will discuss the analysis and interpretation of the data and how to avoid some common pitfalls. The similarities and differences between these initiatives will be discussed by Prue Watters from PCOC, and Frances Simmonds from AROC.

Kathy Eagar will conclude the session with a discussion of applications for outcome evaluation and benchmarking in developing service networks, promoting information exchange and for service improvement. There will be a discussion on the lessons learnt in the development of measurement suites and on ways of avoiding problems when introducing standardised tools into routine practice.

7. Assisting Health Professionals use Quality of Life Assessment in Primary Care
Presenter: Professor Suzanne Skevington, Director World Health Organisation Centre for the Study of Quality of Life, and Professor of Health Psychology, The University of Bath, Bath, UK.
Target Audience: This workshop will be at an introductory level. No special research skills are required.

In 15 years, quality of life assessment has become important in health research, and essential as an internationally accepted outcome measure in clinical trials. More recently, some measures have shown such high quality performance that it enables them to be used with confidence at a one-to-one level. This has the potential to directly improve the lives of patients, and assist health professionals to better understand their patients’ response to illness and treatment. An individual approach was pioneered in oncology and palliative care, but here we consider using quality of life assessment in primary care, and in clinical situations where different diagnostic groups are present e.g. pain management. The presenter will introduce research findings and questions in this area. Answers are only partially available because conditions in practice are so varied so there will be scope for participant contributions.

We start off by considering which patients would benefit most from quality of life assessment in primary care, and ask who would be the best person to assess them. With the assistance of a software package, we look at user-friendly ways to assess patients and the best time to do this. There will be a demonstration of an electronic version of a quality of life measure - the UK WHOQOL-Bref - and its results. Quality of life profiles obtained from patients with different diseases and conditions will be inspected and interpreted in groups. The next step will be to consider ways in which health professionals might discuss this information with patients, with different aims in mind. Lastly, we look at different ways of absorbing quality of life assessment into clinical practice. In particular, we address how to different barriers might be overcome to establish a routine, and finish by sharing solutions.

More information is available at www.bath.ac.uk/whoqol where participants can assess their own quality of life.

8. Introducing Innovation in to Health Care: How to Generate a Sustainable Service
Presenters: Assoc Prof Richard Osborne Centre for Rheumatic Diseases, The University of Melbourne, Ms Jenni Livingston, Centre for Health Policy, Programs and Economics, The University of Melbourne and Ms Nicola Reavley, Centre for Rheumatic Diseases, The University of Melbourne.

All too often, innovations that are both soundly evidence based and successful in small pilots founder when rolled out on a large scale. Providing health care managers and other stakeholders with ways to make their intervention work well and be sustainable requires much more than throwing money at the problem or writing good policy.

This workshop will look at the characteristics of successful innovations to find out what makes them work and be sustainable. We will examine the reasons why the program, its providers, the context in which it operates and the nature of the program users work together to build success and sustainability. Different ways of looking at the sustainability of innovations will be provided.

Cases of successful innovation in a variety of health care situations will be explored and the critical attributes that make them work examined. One example is a checklist developed to examine the feasibility of piloting the Orthopaedic Waiting List intervention in Victorian hospitals.

As well, some of the more commonly encountered problems in setting up innovations will be described. Workshop participants will be invited to examine workplace-based examples to suggest appropriate ways in which programs might be made more effective and sustainable. Ways in which barriers to success and sustainability of innovations might be reduced will also be explored.

Full 2008 Conference Proceedings

• Click here to go to the full 2008 Conference Proceedings.

Conference Evaluation Report

• The Conference Evaluation Report is available for download here.

Sansoni J, Barr A and Rodgers E (2008) Health Outcomes 2008: Facilitating Knowledge Exchange and Transfer For a Dynamic Future, 13th National Health Outcomes Conference, Proceedings Canberra April 29 to May 1, 2008. The Australian Health Outcomes Collaboration, Centre for Health Service Development, University of Wollongong. ISBN - 0 9577767 80S.

©The Australian Health Outcomes Collaboration 2008. 
This work is copyright.  Apart from any use as permitted under the Copyright Act 1968, no part may be reproduced without written permission from the Australian Health Outcomes Collaboration.  Requests and enquiries concerning reproductions and rights should be directed to Ms Jan Sansoni, Director , Australian Health Outcomes Collaboration, Bldg 8, The Canberra Hospital, PO Box 11, Woden ACT 2606, Australia.

back to top