Contract Research and Development Projects

back to top

back to top

back to top

back to top

back to top

back to top

back to top

back to top

back to top

back to top

back to top

back to top

back to top

back to top

back to top

back to top

ACT Cross Border Service Utilisation

The CHSD conducted research using data from two hospitals in the ACT and 15 hospitals in NSW, between March and June 1999. The purpose of the study was to provide an independent analysis of cross border emergency and outpatient services undertaken between the ACT and NSW. The final report was produced in January 2000.

Data on community health activity are not currently collected in a way that would allow for an analysis of cross-border flow, so these were excluded from the study. The inclusion of community health activity would require prospective data collection like that described in earlier studies in northern NSW in 1997 and 1999. Ways of examining this issue are described in last year's annual report.

In total, $36m in ambulatory hospital-based care was costed in the study. A set of 14 recommendations set out the implications of the findings for the sponsoring departments.

Health system outcome:

Key findings from the ACT/NSW Cross Border Service Utilisation were incorporated in the cross-border purchasing agreement between the ACT and NSW.

Associated reports, publications, papers:

Gordon R, Green J and Eagar K (2000) Cross Border Flow over the ACT/NSW Border – a State of Origin Study into Emergency and Outpatient Services. Centre for Health Service Development University of Wollongong.

back to top

Classification of Community Care

This research was mainly carried out in 1999 and its implications and refined versions of the final report continued to be discussed by the co-sponsors of the project – the NSW Ageing and Disability Department (ADD) and the NSW Health Department in 2000.

The purpose of study was to investigate the need for a single classification instrument for community care and support in NSW and advise on the feasibility of its introduction. The secondary purpose, and the subject of further work with the Departments, was to propose a strategic framework for the development, testing and implementation of the necessary tools.

The Centre’s earlier survey work in the Northern Rivers Area showed that a minimal number of systematic descriptions and comparisons of community health and community care clients and activity was difficult but possible. In NSW, community care programs fund a range of different non-institutional, and to some extent substitutable service types. Because of the large number of separate funding programs, each with their own accountability and reporting requirements, arriving at a manageable set of data that can describe community health and community care will always be a complex task.

We reviewed 32 relevant classification instruments and projects on community care and support needs. The aim of the review was to highlight the pros and cons of the different approaches tried to date.

The project tested the feasibility of a single classification instrument and proposed an incremental way forward, over several 'generations', starting with five client types.

Health system outcome:

A building block in the longer-term development and implementation of classification methods in community care.

Associated reports, publications, papers:

Eagar K, Owen A and Quinsey K (1999) Developing a Classification of Community Care and Support Services’ Consumers in NSW. Centre for Health Service Development, University of Wollongong.

Eagar K and Owen A (2000) An Evolving Approach to Client-Based Classification and Performance Indicators in Community Health and Community Care. Centre for Health Service Development, University of Wollongong. Working Paper 3.

back to top

Care Net Illawarra Coordinated Care Trial Evaluation and Phase 2 planning

This Trial aimed to assess whether actively coordinating the care of frail elderly clients improves their overall health status, while costing a similar amount.

During 2000 the evaluation research reports that make up the final evaluation of the Illawarra Coordinated Care Trial were completed. These will form the basis of a series of peer-reviewed journal articles and book chapters from 2001. We also helped in local planning for the next phase of the Trial, based on the evaluation results in the mid term and final reports.

Health system outcome:

The evaluation of the Care Net Trial provided qualitative and quantitative evidence on the effects of funds pooling and implementing a care coordination model. These results provide important lessons locally and have implications more broadly. At the local level, the findings formed a key source of information in the design of a subsequent trial.

Associated reports, publications, papers:

Eagar K, Owen A, Perkins D, Adamson L, Quinsey K, Harvey R and Green J (2000) The Care Net Illawarra Coordinated Care Trial - what it was and how it was managed. Report 1 of the Final Evaluation of the Care Net Illawarra Coordinated Care Trial. Centre for Health Service Development, University of Wollongong. ISBN 0 86418 616 9

Eagar K, Owen A, Perkins D, Adamson L, Quinsey K, Harvey R and Green J (2000) The Care Net Intervention. Report 2 of the Final Evaluation of the Care Net Illawarra Coordinated Care Trial. Centre for Health Service Development, University of Wollongong. ISBN Number 0 86418 622 3

Eagar K, Owen A, Perkins D, Adamson L, Quinsey K, Harvey R and Green J (2000) Care Coordination in the Care Net Trial. Report 3 of the Final Evaluation of the Care Net Illawarra Coordinated Care Trial. Centre for Health Service Development, University of Wollongong. ISBN Number 0 86418 628 2

Cromwell, D. The Use of IT in the Care Net Trial. Report Number 4: of the Final Evaluation of the Care Net Illawarra Coordinated Care Trial. Centre for Health Service Development, University of Wollongong. ISBN Number 0 86418 629 0

Eagar K, Owen A, Perkins D, Adamson L, Quinsey K, Harvey R and Green J (2000) Client Experiences in the Care Net Trial. Report 5 of the Final Evaluation of the Care Net Illawarra Coordinated Care Trial. Centre for Health Service Development, University of Wollongong. ISBN Number 0 86418 635 5

Eagar K, Owen A, Perkins D, Adamson L, Quinsey K, Harvey R and Green J (2000) The Care Net Trial – Impact on General Practitioners. Report 6 of the Final Evaluation of the Care Net Illawarra Coordinated Care Trial. Centre for Health Service Development, University of Wollongong. ISBN Number 0 86418 641 x

Eagar K, Owen A, Perkins D, Adamson L, Quinsey K, Harvey R and Green J (2000) The Care Net Trial – Impact on Health and Community Care Providers. Report 7 of the Final Evaluation of the Care Net Illawarra Coordinated Care Trial. Centre for Health Service Development, University of Wollongong. ISBN Number 0 86418 647 9

Eagar K, Owen A, Perkins D, Adamson L, Quinsey K, Harvey R and Green J (2000) The Care Net Trial – Impact on the Wider System. Report 8 of the Final Evaluation of the Care Net Illawarra Coordinated Care Trial. Centre for Health Service Development, University of Wollongong. ISBN Number 0 86418 653 3

Eagar K, Owen A, Perkins D, Adamson L, Quinsey K, Harvey R and Green J (2000) The Care Net Trial – Value for Money? Report 9 of the Final Evaluation of the Care Net Illawarra Coordinated Care Trial. Centre for Health Service Development, University of Wollongong. ISBN Number 0 86418 659 2

Eagar K, Owen A, Perkins D, Adamson L, Quinsey K, Harvey R and Green J (2000) The Care Net Trial – The Evaluators Conclusions. Report 10 of the Final Evaluation of the Care Net Illawarra Coordinated Care Trial. Centre for Health Service Development, University of Wollongong. ISBN Number 0 86418 665 7

Lessons in Coordinated Care

We took our research findings about care coordination to the Health Outcomes Conference held in Canberra 2-3 August and the Australian College of Health Service Executives' annual conference at stadium Australia in Sydney in June. The Conferences provided a forum for the exchange of ideas and experiences by health services researchers, policy analysts, administrators and decision-makers.

At the more local level the lessons from the evaluation of coordinated were used to assist in the planning for a possible second round of the Trials in the Illawarra, called 'Care Connect', and an Aboriginal trial on the Mid-North Coast.

Associated papers, presentations and reports:

Cromwell D (2000) Illawarra Care Connect: Fund Pool Methodology, Centre for Health Service Development, University of Wollongong.

Eagar K (2000) Health Outcomes: Best Bets and Best Buys. Opening Address of the Health Outcomes for the Nation: Best Bets and Best Buys Conference. Australian Health Outcomes Conference, Canberra August 2000, ISBN 0957776713.

Eagar K, Owen A, Perkins D, Adamson L, Quinsey K, Harvey R and Green J (2000) Illawarra Care Connect - The Illawarra Coordinated Care Trial Model of Care: defining consumer needs, community care interventions and care packages. Centre for Health Service Development, University of Wollongong.

Owen A, Perkins D, Eagar K, Adamson L, Quinsey K, Harvey R and Green J (2000) Illawarra Care Connect: Evaluating the Illawarra Care Connect Trial. Centre for Health Service Development, University of Wollongong.

Perkins D and Owen A (2000) Controlled trials of service systems - what can we control and what variation can we measure? Conference Proceedings, Health Outcomes for the Nation: Best Bets and Best Buys, Australian Health Outcomes Conference, Canberra, August 2000, ISBN 0957776713

Perkins D, Owen A, Eagar K, Adamson L, Quinsey K, Harvey R and Green J (2000) Illawarra Care Connect: Illawarra Coordinated Care Trial: Organisation and Management. Centre for Health Service Development, University of Wollongong.

Perkins D and Owen A (2000) Learning from Coordinated Care Trials. Australian College of Health Service Executives National Congress: Choices for Health Care in the New Millenium, Stadium Australia, Sydney June, 2000. Accepted for publication.

back to top

Design of the national evaluation of Chronic Disease Self Management Projects

The 1999 Commonwealth Budget provided funding for the Enhanced Primary Care Package, one component of which was the Chronic Disease Self-Management Initiative. The Centre was contracted by the Commonwealth Department of Health and Aged Care to develop the Evaluation Framework.

The Centre participated in the National Chronic Disease Self-Management Conference (31 July - 1 August 2000) as part of the preparation of a paper for stakeholders. The initiative was renamed the Sharing Health Care initiative and expressions of interest were called for projects to be funded. The evaluation framework was used to establish criteria for project selection.

The Sharing Health Care Initiative was intended to have the following components:

• A series of locally based projects to trial a number of service delivery models.
• Education modules and guidelines for GPs, allied health professionals, nurses and Aboriginal health workers on how to use self-management principles when working with patients.
• Accreditation guidelines for consumer self-management education courses.
• A database/website of accredited self-management/self-help programs.
• A communication strategy.

Health system outcome:

The evaluation model developed for the National Chronic Disease Self-Management/Sharing Health Care Program was adopted for national implementation.

Associated report:

Harvey R, Eagar K, Perkins D, Owen A, Sansoni J and Adamson L (2000) National Evaluation Framework for the Sharing Health Care Initiative. Centre for Health Service Development, University of Wollongong.

back to top

Measuring functional dependency in Home and Community Care clients

This nationally-funded research has grown out of earlier work in NSW on community care classification (see the 1999 Annual Report and associated publications). It carries over into 2001 and has a finish date of May 2001 to coincide with the workplan and meeting cycle of the commissioning authorities - the steering committee of National HACC and Aged Care Officials.

The first stage completed in 2000 was a review of literature and current practice, a recommended set of forms for a screening tool and set of second-tier assessment instruments. The domains of function covered self-care, domestic, cognitive and behavioural attributes of clients. The recommendations for field testing and valuation research in stage 2 were accepted by the steering committee.

Empirical field testing and a final report will be completed in 2001.

Health system outcome:

None at this stage. The second and final stage will be completed in 2001.

Associated report:

Eagar K, Owen A, Cromwell D, Poulos R and Adamson L (2000) Stage 1 Report of the HACC Dependency Data Items Report. 2000, Centre for Health Service Development, University of Wollongong.

back to top

Design of National Demonstration Projects in Mental Health Integration, national evaluation framework and Phase 1 and Phase 2 planning

The research and development agenda of the National Mental Health Strategy and the second National Mental Health Plan includes the aim of testing models for integrating private psychiatrist services and public sector mental health services, including the use of pooled budgets. Under this aim of the national strategy, the CHSD has been contracted to design the national evaluation strategy, work with local evaluators and project managers to build evaluation in from the planning stage and write guidelines for helping the projects achieve their objectives in line with the national strategy.

The team that has been brought together for the project is headed by Professor Kathy Eagar, and involves the CHSD working with Dr Michael Epstein (a private sector psychiatrist) and Associate Professor Philip Burgess (Mental Health Research Institute, university of Melbourne). The team has been providing technical support to the areas selected for trialing the integration models.

The MHIP projects will continue into 2001/2 and the Centre’s technical assistance has been used in drafting Tripartite Agreements (between local projects, State Health Authorities and the Commonwealth). We have a continuing brief to help design the local arrangements so that they are capable of being evaluated, and with careful attention to the incentives involved for all participants. The guidelines for the projects have been included on the Commonwealth's mental health website, as well as being published as a series of eight papers by the CHSD, as detailed in the 1999 Annual Report.

Phase 1 of the projects saw initiatives developed in NSW, Victoria and South Australia, not all of which successfully navigated the planning stage. Phase two sees the continuation of projects in Melbourne, Illawarra and Far West NSW, and new projects likely to develop in other States.

Health system outcome:

The first national demonstration project in integrated mental health went live in 2000 and a further two will commence in 2001. Each is being independently evaluated. The CHSD will continue as the national design team until at least 2002.

Associated reports and papers:

Owen A, Perkins D, Burgess P and Eagar K (2000) National Evaluation Framework for National Demonstration Projects in Integrated Mental Health Care. Centre for Health Service Development, University of Wollongong.

The MHIP discussion paper series contains the following papers:
1: Planning issues in designing national demonstration projects in integrated mental health.
2: Issues in the establishment of the funding pool.
3: Payment options for private providers.
4: Payment options for public providers.
5: Clinical issues and planning for patient care.
6: Evaluation guidelines.
7: Guidelines for managing the project in the live phase.
8: MHIP is not Managed Care.
9. Planning Guidelines
http://www.health.gov.au/hsdd/mentalhe/pubs/nihs.htm

back to top

Multi Purpose Services Minimum Data Set and Benchmark Costs project

Multipurpose services are part of the Flexible Rural Health Service Program in NSW. Small rural facilities incorporating pooled funding and co-located services, (inpatient, residential aged care and community services) are part of a stronger response to rural needs under the influence of the Sinclair Report on rural health services, published in 2000.

CHSD was contracted by NSW Health to assist in developing a minimum data set for multipurpose services and to propose a set of benchmarks, including benchmark costs. A field survey of MPS staff examined the issues from their perspective – multiple reporting requirements for small numbers of people, counting anomalies, overlap and duplication of data items.

The project used the Department’s Rural Forum to get feedback on data items, and volunteers for a three-month trial of the MDS, plus a benchmark costing exercise. The project was scheduled to end in December 2000.

Health system outcome:

None at this stage. The second and final stage will be completed in 2001.

Associated report:

Gordon R (2000) Development of a Minimum Data Set for Multi Purpose Services: Flexible Rural Health Services Program. Centre for Health Service Development, University of Wollongong.

back to top

Private Rehabilitation Research Project Phase 2

This project was initially funded in 1999 through the National Private Rehabilitation Working Group to develop a recommended national classification and payment system for private rehabilitation services in Australia.

It involved a literature review, consultation with key industry stakeholders, an analysis of the public and private sectors, a statistical analysis leading to a recommended classification system and the development of a payment model.

Several important building blocks were recommended for a system that has built in incentives for rehabilitation.

These included a move away from only classifying programs to an approach that involves the classification of rehabilitation patients, and using the episode of care as the preferred level of reporting and purchasing.

The key issue in designing a new system is how to most fairly share the risks between purchasers, providers and consumers. As a result, this project recommends a classification that is setting specific because a single classification and payment system is not realistic and creates perverse incentives.

This work is of interest to the Centre because the payment model in the private sector is different and innovative, it is interesting statistically, has implications for the Commonwealth and for State government authorities, and involves recommended measures of outcome and function for rehabilitation settings.

Health system outcome:

The AN-SNAP classification developed by the CHSD was adopted as the national standard for private rehabilitation services and was implemented nationally on 1 July 2000. The proposed national payment model is being field-tested, with an independent evaluation due to report in 2001.

Associated reports, publications, papers:

Eagar K (2000) The National Private Rehabilitation Project. Proceedings of the NSW Health Insurance Association Annual Conference, Sydney, March 2000

Green J (2000) SNAP-the Project and its Aftermath. Proceedings of the 15th Australian Statistical Conference, Adelaide, July 2000.

Green J (2000) Cedar Court Non-Admitted Rehabilitation Service Trial – Preliminary Data Analysis. Centre for Health Service Development, University of Wollongong.

Green J (2000) Sample Size for a Clinical Trial for Stroke Victims. Centre for Health Service Development, University of Wollongong.

Green J (2000) Benchmarking of Allied Health Time Data. Centre for Health Service Development, University of Wollongong.

Gordon R (2000) Brain Injury Rehabilitation Program: Review of Schedule of Fees. Centre for Health Service Development, University of Wollongong and Phillipa Milne and Associates.

back to top

Sub-acute and Non-acute Care Project (SNAP)

The SNAP study was a three-year patient classification project conducted by the Centre between 1995 and 1998. In terms of the resources applied to gathering primary data, it was the largest casemix study carried out to date. The study captured extensive data for three months (and up to 6 months for spinal and brain injury patients) from a range of settings. It involved 104 hospitals and community health services, 14,742 staff and over 38,216 episodes of care, including 18,221 community episodes.

The Project’s National Steering Committee and the Australian Clinical Casemix Committee recommended the adoption of AN-SNAP as a national classification to run in parallel with the DRG system.

back to top

SNAPshot Implementation

SNAPware, and its latest version SNAPshot, grew out of the data collection software developed for use in local settings as part of the SNAP study. As it develops through new versions, it has proven to be a very useful ‘front end’ to assembling related data on clients. Versions 3.2 and 3.3a were produced in 2000.

There are growing numbers of staff with experience in its use in aged care assessment, home and community care, as an addition to the client information and referral record, and as a way of integrating mental health and data on measures of function. These various applications are being explored in a number of pilot centres and other research studies.

Other Centre research projects such as those associated with the evaluation of coordinated care and mental health integration projects, the development of an MDS for multipurpose services, and work on assessment tools measures of function, are also influenced by developments in the SNAPshot software.

The most difficult issue in implementing AN-SNAP and its associated data collection tools, is how to refine and develop the current system for use in community settings. This issue is being explored further by the Centre in its NSW-based research on community care assessment and classification and research on measures of functional dependency.

A complete list of reports, publications and papers published in relation to AN-SNAP and its associated software is contained on the Centre’s website.

Health system outcomes:

The different States have varied in their approaches to using the AN-SNAP classification. NSW has formally adopted the AN-SNAP classification and has a three year plan where by July 2001 all Areas will be expected to have a system to implement AN-SNAP in both their inpatient and their community services. Implementation in community settings relies on the arrival of a useable version of the expected CHIME software for community health that is linked to the Centre’s SNAPshot software.

Implementation has also commenced in South Australia and Queensland. Other States continue to show interest in using the system, either for more detailed data collection on sub-acute and non-acute clients, or as part of a funding system. AN-SNAP is now the national standard for private sector rehabilitation.

Associated papers and reports:

Eagar K (2000) The State of Play in Contemporary Healthcare Payment Systems – Acute, Sub-Acute and Non-Acute Care. Proceedings of National Congress 2000 – Health Reform, Rhetoric or Evolution. National Congress of the Australian Healthcare Association, Adelaide, July 2000.

Eagar K (2000) Rehabilitation Classification and Funding. Proceedings of the 8th Annual Scientific Meeting of the Australasian Faculty of Rehabilitation Medicine: Rehabilitation – New Millennium, Melbourne, August 2000

Green J (2000) SNAP - the Project and its Aftermath. Proceedings of the 15th Australian Statistical Conference, Adelaide, July 2000.

back to top

Victorian Mental Health Outcomes Project

This project, led by the CHSD, included a number of Victorian collaborators and team members from the University of Wollongong's Illawarra Institute for Mental Health. Its aims are to provide training and operational support for the introduction of outcome measures in adult area mental health services, to consult with consumers on self-assessment and outcome measurement, and to provide a framework for the analysis and reporting of outcome data.

Training material including workshops and an instructional video are part of Victoria’s objectives to implement outcome measures on all patients seen by adult mental health services. The aim is to have in place the information systems to store, analyse and report on the data.

Health system outcomes:

The four Stage 1 agencies in Victoria successfully began the routine collection of health outcome data in 2001. Implementation throughout the rest of Victoria is expected to commence progressively from 2001. Implementation of routine mental health outcome measures in all other States and Territories is also expected to commence in 2001 as part of the National Mental Health Information Strategy. Negotiations are in progress to make the training materials, data collection protocols and data reporting model developed by the CHSD available for use across Australia. New Zealand will begin testing the same suite of measures in 2001.

Associated reports and presentations:

Earlier products included a 'Train the Trainer‘ workshop and video package.
Eagar K, Burgess P and Buckingham B (2000) Towards National Benchmarks for Australian Mental Health Services. Mental Health Research Institute, Melbourne.

Eagar K, Buckingham B, Coombs T, Trauer T, Graham C, Eagar L and Callaly T (2000) Outcome Measurement in Adult Area Mental Health Services: Implementation Resource Manual. Department of Human Services Victoria. ISBN 0 86418 648 7

Eagar K (2000) Best Bets for Mental Health: there’s more to it than just cost. Health Outcomes for the Nation: Best Bets and Best Buys Conference. Australian Health Outcomes Conference, Canberra August 200,ISBN 0957776713.

back to top

Australasian Rehabilitation Outcomes Centre

The Australasian Rehabilitation Outcome Centre (AROC) is a joint initiative of the Australian rehabilitation sector (providers, funders, regulators and consumers) and, in 2001, planning for its establishment in 2002 was completed. With the support of the rehabilitation sector, AROC is to be established by the Australasian Faculty of Rehabilitation Medicine (AFRM) of the Royal Australasian College of Physicians (RACP) and the CHSD. An AROC Planning Group, consisting of representatives from across the sector, worked together during 2001 to plan for the establishment of AROC as a not-for-profit self-funding organisation. The AFRM will be the data custodian of the AROC data set and has appointed the CHSD to manage the AROC data set on its behalf and to undertake the day to day management of AROC.

There are approximately 150 rehabilitation units in Australia and the goal is for all of them to be submitting data to AROC by the second year.

Other positives to come out of the AROC project in 2002 are likely to include a clearer understanding of the potential for this approach in other areas eg, cardiology, home andcommunity care, and residential care.

Associated publications in 2001

AROC Planning Group (2001) Australasian Rehabilitation Outcome Centre Business Plan.

Eagar K, Gordon R and Green J (2001) The National Private Rehabilitation Project and the Australasian Rehabilitation Outcomes Centre – the next stage of the journey. Proceedings of Health Outcomes 2001 - The Odyssey Advances: 7th Annual National Health Outcomes Conference: 27-28 June 2001, Canberra.

Marosszeky J E and Eagar K (2001) The Australasian Rehabilitation Outcome Centre (AROC). Proceedings of Health Care in Perspective 2001 – Incorporating the 13th National Casemix Conference: 16-19 September 2001, Hobart.

Health system outcome

None at this stage. However, in addition to fulfilling it’s role in rehabilitation, AROC is expected to provide a benchmarking model that will be useful in other areas like mental health and community care.

back to top

Sharing Health Care (Stage 2 of Chronic Disease Self Management)

The Centre was commissioned by the Commonwealth Department of Health and Aged Care to design the Evaluation Framework for the Chronic Disease Self-Management Initiative (CDSM). This was part of the package of Budget initiatives announced with the Enhanced Primary Care strategy. In particular, it sought to address the growing burden of chronic disease in the Australian community. Most of the work was undertaken in 2000 and the final stage completed in 2001.

The Centre was contracted to design the framework to encourage collaboration between individuals, their families and health care professionals in the management of chronic conditions. The Evaluation Framework was to ‘allow the key aspects of the evaluation (including the data requirements) to be built into the demonstration projects, the education modules and the communication strategy’.

Associated publications in 2001

Harvey R (2001) Coordinated Care and Chronic Disease Self Management – Substitutes, Complements or Alternatives? Proceedings of Health Outcomes 2001 - The Odyssey Advances: 7th Annual national health outcomes conference – 27/28 June 2001, Canberra.

Health system outcome

Local projects and local evaluation efforts both used the national evaluation framework developed by the Centre.

back to top

Griffith Area Palliative Care Service (GAPS)

This research is funded under the National Palliative Care Strategy (under the Australian Health Care Agreements) and its National Framework for Palliative Care Service Development. The Murrumbidgee Division of General Practice, the Greater Murray Area Health Service and the CHSD are working together to test whether the National Palliative Care Strategy can work in rural Australia.

The CHSD role is in evaluating the model of care developed by the Murrumbidgee Division of General Practice, the Greater Murray Area Health Service and their local partners.

The baseline report on the project and various conference papers were completed in 2001. The emphasis in this work is increasingly on questions of information management (related to AN-SNAP) and how to assess the sustainability of the project.

Associated publications in 2001

Owen A, Perkins D, Senior K and Eagar K (2001) The Griffith Area Palliative Care Service: a baseline assessment of its evaluability, sustainability and generalisability. Centre for Health Service Development, University of Wollongong

Perkins D, Owen A and Fildes D (2001) Indicators of Fairness and Sustainability in Palliative Care, Proceedings of Health Outcomes 2001 - The Odyssey Advances: 7th Annual national health outcomes conference – 27/28 June 2001, Canberra.

Health system outcome

The first evaluation report identified the areas for closer attention as the model develops and the report has been used to inform the Greater Murray Area Palliative Care Plan.

back to top

Development of a national measure of function for the Home and Community Care Program

The HACC dependency data items project began in 2000 and was completed in 2001. It recommended a screening tool and the use of validated and reliable instruments for measuring the dependency of people eligible for Home Community Care (HACC) services.

The research tested whether or not screening and assessment instruments chosen after a review of the literature were appropriate for the HACC and aged care target population when administered by HACC funded staff.

The two reports on the project have formed the basis for regional, State and national training and conference presentations and the dependency screen has been widely discussed and used in various different settings, in surveys and in trials. The strategy of using the HACC screening tool as part of a more standardised and comprehensive approach to screening in primary care was adopted and tested by the Department of Human Services in Victoria in 2001 (see BATS project below).

Associated publications in 2001

Eagar K, Owen A, Cromwell D, Poulos R and Adamson L (2001) Towards a National Measure of Functional Dependency for Home and Community Care Services in Australia: Stage 1 report of the HACC dependency data items project. Centre for Health Service Development, University of Wollongong

Eagar K, Owen A, Green J, Cromwell D, Poulos R, Gordon R, Quinsey K, Adamson L and Fildes D (2001) A National Measure of Functional Dependency for Home and Community Care Services in Australia: Stage 2 report of the HACC dependency data items project. Centre for Health Service Development, University of Wollongong

Eagar K, Green J and Adamson L (2001) Clinical, functional and social assessment as a predictor of costs and outcomes. In press

Health system outcome

The two-tiered functional screening and assessment model developed by the CHSD has been adopted as the national standard, as have the four functional domains developed in the project. The adopted functional items will be incorporated into the next version of the HACC Minimum Data Set (MDS).

back to top

Victorian Better Access to Services (BATS)

Primary Care Partnerships in Victoria are a State-wide initiative and are supported by the Better Access to Services (BATS) Project. The role of the CHSD is to develop tool templates for Initial Needs Identification and Care Planning.

This is a research project in which the CHSD is in consortium with the Health Issues Centre, HDG Consulting and La Trobe University’s Australian Institute of Primary Care (AIPC). Our contribution includes a literature review and review of current practice, and the assessment of existing forms in common use. This analysis guided the design of tools that are now being evaluated by AIPC. The project will be completed in 2002.

Associated publications in 2001

Owen A, Poulos R and Eagar K (2001) Using the evidence to develop best practice models for identifying initial primary and community care needs. Centre for Health Service Development, University of Wollongong
www.wrhs.sa.gov.au

CHSD (2001) Pilot Testing of Tools: Guidelines for Undertaking Initial Needs Identification and Developing a Service Coordination Plan. Centre for Health Service Development, University of Wollongong and Australian Institute for Primary Care, La Trobe University. http://aipc.latrobe.edu.au/pcpssc/

Health system outcome

None at this stage. The tools and associated guidelines developed by the CHSD are being field tested in 2001 and an evaluation report will be released in 2002. The work is provoking considerable interest in other States, particularly South Australia and NSW, and has already generated additional work for 2002 (see page 28).

back to top

IAHS Planning Agreement

The IAHS entered into an agreement with the CHSD in 2001 to fund one FTE at the CHSD for 2 years to provide advice on statistical, operational and health systems issues. A draft proposal was agreed in 2001 to be in place in early 2002. The main aim of the work is the analysis and reporting of statistical and epidemiological information for the IAHS to use in planning and population health.

The research component of this agreement builds on collaboration between CHSD and the University of Newcastle, which has long had a role in statistical analysis for NSW Health. The School of Applied Mathematics and Statistics, the Graduate School of Public Health and the School of Geosciences in the University of Wollongong share an interest with CHSD in managing small area data.

Health system outcome

This agreement has not been in place long enough to see outcomes. The achievement in reaching this specific agreement, in conjunction with the University-wide role of the conjoint (UOW-IAHS) Director of Research position, indicate improved integration of the university with one of its key industry partners.

back to top

GP Epi-Beacon

The CHSD collaborated with staff from the Graduate School of Public Health and the Illawarra Division of General Practice to assess the feasibility of using data that GPs routinely collect on their clinical management software to provide them with local epidemiological information. The project was funded by the General Practice Branch of the Commonwealth Department of Health and Aged Care.

The study enrolled a sample of Illawarra GPs who had indicated that they would like to use the data collected on the computers for epidemiological purposes. A focus group meeting was held to identify information needs and agree data privacy protocols for the study. De-identified data were then extracted from their computerised patient databases, and analysed.

Reports containing the results of the analysis were given to the GPs, and another focus group was held in which they commented on the benefits and limitations of the report. The report contained statistics on, among other things, immunisation rates and prescription profiles for antibiotics, cardiovascular drugs and central nervous system drugs.

Overall, the reaction to the information was positive, and suggestions were made to improve the structure of the report. However, data quality and completeness was a concern. These issues, as well as concerns about privacy, meant that creating such reports on a routine basis was not yet considered to be feasible.

Associated publications in 2001

Cromwell D, Arora M, Dalley A and Kreis I (2001) The Epi-Beacon: A feasibility study on providing local epidemiological information to general practices. Melbourne: 11th RACGP conference on medical informatics, August 2001. Reviewed abstract.

Cromwell D, Arora M, Dalley A and Kreis I (2001) The Epi-Beacon: A feasibility study on providing local epidemiological information to general practices within the Illawarra derived from routinely collected, computerized data. A first report into the literature and needs. Report for Commonwealth Dept of Health and Family Services. University of Wollongong, Centre for Health Service Development.

Cromwell D, Arora M, Dalley A and Kreis I (2001) The Epi-Beacon: A feasibility study on providing local epidemiological information to general practices within the Illawarra derived from routinely collected, computerized data. A second report on data analysis and GP reaction. Report for Commonwealth Dept of Health and Family Services. University of Wollongong, Centre for Health Service Development.

Health system outcome

None at this stage. Recommendations were made to the Commonwealth Department that would overcome barriers to the use of GP data for epidemiological purposes

back to top

Review of 2nd tier benefit levels for private hospitals’ inpatients

Evaluation of IDGP Consumer Consultation Mechanisms

The Illawarra Division of General Practice (IDGP) has used the Centre to expand their research capacity. The aim is to facilitate the production of research bids, the evaluation of local health programs, the publication of results from local projects and the development of a research culture and associated skills within the Division.

In 2001, as a continuation of this role, a study of the consumer consultation strategies of the IDGP was conducted using interviews and survey data. CHSD also assisted the Division in achieving its own local aims by supervising students, and by advising in an ad hoc way on projects and submissions,

Health system outcome

Developing research culture and expertise in General Practice.

back to top

Design of the NSW funding model for emergency department (ED) and intensive care (IC) services

As part of her advisory role on health system funding issues, Kathy Eagar was engaged by NSW Health to develop the funding model and to determine NSW benchmark costs for ED services and for IC services. The ED and ICU projects are part of the broader introduction of a new funding model for NSW. The Department of Health engages the CHSD at various levels on an ongoing basis to provide advice on these types of funding reforms.

This work proved to be useful for the Centre in preparation for two related bids for national research funding that were submitted at the end of 2001. Both research proposals were accepted and are part of the work plan for 2002 (see page 29).

Associated publications in 2001

Eagar K (2001) NSW Emergency Department Episode Funding Guidelines for Area Health Services 2001/02. NSW Health Department Sydney

Eagar K (2001) NSW Intensive Care Episode Funding Guidelines for Area Health Services 2001/02. NSW Health Department

Eagar K, Sondalini R, Bennett D and Mazevska D (2001) The NSW Emergency Department Funding Model. Proceedings of Health Care in Perspective 2001 – Incorporating the 13th National Casemix Conference: 16-19 September 2001, Hobart.

Eagar K, Sondalini R, Bennett D and Mazevska D (2001) The NSW Intensive Care Funding Model. Proceedings of Health Care in Perspective 2001 – Incorporating the 13th National Casemix Conference: 16-19 September 2001, Hobart.

Health system outcome

NSW Health implemented its new ED and ICU funding models from 1 July 2001. The full funding models will be progressively implemented over 3 years.

back to top

Community health classification

The Centre’s earlier survey work in Western Sydney and the Northern Rivers Area showed that a minimal number of systematic descriptions and comparisons of community health and community care clients and activity was difficult but possible.

In NSW, community care programs fund a range of different non-institutional and, to some extent, substitutable service types. Because of the large number of separate funding programs, each with their own accountability and reporting requirements, arriving at a manageable set of data that can describe community health and community care will always be a complex task.

Our earlier work in NSW in 1999 reviewed 32 relevant classification instruments and projects on community care and support needs. The aim of the review was to highlight the pros and cons of the different approaches tried to date. The Centre did not undertake any community health survey work in 2001, but the community health classes were used to develop population weights for community health for inclusion in the NSW Resource Distribution Formula (RDF).

Health system outcome

Population weights for primary and community care developed by the CHSD are being incorporated into the next version of the NSW Resource Distribution Formula (RDF).

back to top

Lessons in Coordinated Care

In 2000, the CHSD completed the evaluation of the Illawarra Coordinated Care Trial, Care Net. The refinement of the results from the evaluation provided a number of useful ‘spin-offs’ in 2001. The evidence on client needs and how these can be taken into account when implementing a care coordination model was used as one element in the design of a suite of tools for measuring function in the HACC and aged care sectors. The chronic disease self-management framework was used to guide national and project-based developments. The results and lessons from coordinated care, the various evaluation frameworks developed by the Centre, were discussed at a number of national and international conferences and have broad implications for service development.

Associated publications in 2001

Cromwell D, Bomba D, Hang T and Dalley A (2001) Dividends for care coordination from investments in information technology. In press

Cromwell D (2001) Falling in the water: Funds pooling in the Illawarra Coordinated Care Trial. In The Australian Coordinated Care Trials: reflections and lessons. Commonwealth Department of Health and Aged Care, Canberra. ISBN 0 642 44745 4

Eagar K, Green J and Adamson L (2001) Clinical, functional and social assessment as a predictor of costs and outcomes. In press

Perkins D and Owen A (2001) Learning from Coordinated Care Trials in Fine M, Perkins D, Owen A, and Warner M. (2001) Coordinated care on trial: Background to the emergence of the national coordination agenda in health care, Australian Studies in Health Services Administration, (ASHSA), No. 90, UNSW, Sydney.

Owen A and Perkins D (2001) The Impact of Care Net Illawarra on the Wider System, In press

Perkins D and Owen A (2001) Lessons in governance from Care Net Illawarra, in The Australian Coordinated Care Trials: Reflections and Lessons. Commonwealth Department of Health and Aged Care, Canberra. ISBN 0 642 44745 4

Perkins D and Owen A (2001) GPs and the Care Net Trial. In press

Perkins D, Owen A, Cromwell D, Adamson L, Eagar K, Quinsey K and Green J (2001) The Illawarra Coordinated Care Trial: better outcomes with existing resources? Australian Health Review, Vol 24, No 2, 161-171.

Harvey R (2001) Coordinated Care and Chronic Disease Self Management – Substitutes, Complements or Alternatives? Proceedings of Health Outcomes 2001 - The Odyssey Advances: 7th Annual national health outcomes conference – 27/28 June 2001, Canberra.

Health system outcome

At the local level, the lessons from the evaluation of coordinated were used in 2001 to assist in the planning for a possible second round of the Trials. Planning was carried out in the Illawarra, and assistance was provided to an Aboriginal trial on the Mid-North Coast. Coordinated care lessons were also used in the Commonwealth’s Sharing Health Care initiative, as well in planning for the evaluation of NSW HACC-sponsored, comprehensive assessment pilot projects.

back to top

SNAP Costing Study

The early work in the development of the AN-SNAP classification highlighted the need to measure functional status using consistent assessment tools. In the SNAP study, function was linked with both resource use and outcomes and was measured with a suite of measures incorporated into a software program (SNAPware) built specifically for the purpose of the study. The SNAPware software has been subsequently developed into a software package called SNAPshot that is now widely used across Australia.

In 2002, a revised set of cost weights for the AN-SNAP classification was developed . Financial and service utilisation data were obtained from a sample of sub-acute and non-acute services across NSW. These data were used to identify changes that have occurred in cost structures since 1996. The revised cost weights also reflect changes in clinical practice that have occurred during this period.

back to top

Emergency Department Research

As part of a strategy to support health service research, funding became available through the NHMRC and the States/Commonwealth Research Issues Forum (SCRIF) to address health service system priorities. CHSD submitted two bids, which were well received, and succeeded in getting funding for a period of three years through SCRIF for a study on the relationship between the usage of ED services and the availability of community-based primary care services (DC)

The aim is to examine the relationship between the use of Emergency Department (ED) services by patients in triage categories 4 and 5 and the availability of various types of community-based primary care services, including local GP practices, after hours home visiting medical services and Hospital in the Home services. The quantitative component of the research will analyse 5 years of emergency department data.

back to top

Illawarra Area Health Quantitative Research

The aim is a ‘joint’ quantitative analysis team working together to manage the workload of reporting, organising data for planning purposes and the analysis of strategic issues.
In 2002 CHSD provided advice on the area strategic plan, including flow reversal strategies and activity projections, mental health planning, waiting list management, and the evaluation of VMO payments under fee for service and sessional models.

To strengthen the internal skills to support joint activities in 2003 the focus will be on professional skill development through a ‘train the trainer’ approach with both health service and CHSD quantitative staff. Other work includes a planners' tool kit to assist with activity projections, waiting lists management - improving effectiveness of waiting list reports, the creation of service utilisation reports for senior managers, and helping to devise projections for a comprehensive flow reversal plan.

back to top

Southern Area Health Service Community Health Survey

This research built on earlier work carried out in Western Sydney, the ACT and the Northern Rivers of NSW. The report describes patterns of community health service provision and client characteristics in the Southern Area Health Service (SAHS).

SAHS wanted to have a better understanding of their service utilisation and client flows. They have approximately 500 CH staff and the research was aimed at establishing who they see and what service they provide and where. CHSD is interested in improving the tools for understanding who the clients are, and refining the community health code set, which has now been modified over four surveys.

The survey findings were presented to the management of the service and the implications for funding, improved planning and organisation were able to be drawn from the excellent quality of the data set produced. The final recommendations for SAHS were expected to be acted upon, both internally and in negotiations with adjoining areas.

back to top

HACC: Screening and Assessment

In a major project from 1997-2000, the CHSD evaluated a local coordinated care trial that included the use of functional measures to assist clinical decision-making . Following that work, the CHSD was commissioned to develop a national measure of functional dependency for Home and Community Care services in Australia . A national working group, on which all health and community care authorities and key providers were represented, guided the work and the timetable was determined by the meeting cycle of key decision-makers. The outcomes of that project were adopted as the national standard and implementation has commenced. Further projects (listed below) have been generated in several States and Territories based on the tools we developed and consistent with our research themes .

back to top

Development of an Evaluation Framework for the ERA (Equity Responsiveness Access) Project

NSW Assessment System Pilots

This is research sponsored by the NSW Department of Ageing Disability and Home Care. The project will involve the design, implementation and evaluation of standard screening and assessment tools for HACC clients.

This project links with the national HACC functional dependency project as the NSW Department is proposing to use the screening tool that CHSD developed. Work is expected to commence in 2002.

NSW Department of Ageing Disability and Home Care : Program Planning

Home Care Service, NSW

ATLAS Data and Service Coordination

In the disability sector the ATLAS program – for young school leavers – is using the HACC standardised screening and assessments, based on the training provided to teacher aids in mainstream schools, and CHSD is doing the data analysis of scores for three cohorts of young people with disabilities. This work is important for the department concerned as they are moving towards a more equitable distribution of money for disability support services. The Centre is also being asked to do a more detailed (but smaller) study of care packaging and service coordination planning for this group in the Illawarra in 2003.

back to top

Illawarra Pharmacy

This was an initiative funded under the HACC Program from Kiama and Shellharbour Councils who investigated risk management for helping consumers manage their medicines. The evaluation of the project included support strategies around the use of the Home Medications Review jointly conducted by the GP and pharmacist. The findings include medico-legal issues which were analysed in terms of client, organisational and system risks. The aim was to develop a set of risk management strategies for the service system, and for implementation of revised policies and procedures for community service organisations. The next stages should lead to further research and can also be timed to link to the proposed local assessment system pilots.

back to top

Carer Survey

Small Areas Project

back to top