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 (i.e. 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 research and development (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 assessment 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, as well as management decision-making.
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 have 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 in 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.
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 having a large beneficial impact on patient care, 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 about implementation that benefit from research projects on (and for) health services. For the Centre, a particular impetus has been the movement 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.
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 Institute but is located 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.