Each year the Centre for Health Service Development (CHSD) undertakes ten to fifteen research and development projects from a variety of funding sources: Commonwealth departments, State and Territory departments, local health and community care authorities, and non-government and not-for-profit organisations. CHSD also undertakes projects arising from competitive Australian Research Council (ARC) and National Health and Medical Research Council (NHMRC) grant processes. 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 five 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 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.
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. CHSD has particular expertise in developing funding models, supported by our experience in evaluating different funding approaches such as funds pooling and activity based funding. CHSD has advised Federal and State Governments, as well as local health services, on funding model design. We continue to participate in the design and evaluation of projects that test new funding approaches.
Our research on health service delivery and organisation 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 CHSD, 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. CHSD has responded to these challenges by helping services develop common assessment forms that are reliable and valid measures of clinical function. CHSD has also undertaken various projects that provide agencies with information about the use of services by residents of different jurisdictions. Finally, CHSD 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.
A particular focus of our health services research and development is on program review and evaluation. We have completed a large number of evaluation projects for government health departments and other organisations encompassing the primary care, acute and sub-acute health care settings. For example, we have undertaken national evaluations for the Department of Health and its agencies in areas such as asthma management, better practice in residential aged care and health workforce innovations. Other evaluations have been undertaken in a wide range of areas including mental health, migrant health, and Indigenous health. Our approach recognises that when appropriate conceptual frameworks underpin program reviews and evaluations, they are significantly more likely to produce evidence-based results that can effectively inform future policy developments. Because of the diverse experience and expertise of our staff and our extensive work conducting both large and small-scale program reviews and evaluations we have a deep understanding of the needs and/or sensitivities of special interest groups, including Aboriginal and Torres Strait Islander peoples, people from culturally and linguistically diverse backgrounds and people from rural and remote communities.
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. CHSD works closely in this area with another AHSRI centre, the National Casemix and Classification Centre (NCCC).
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. CHSD 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. Our research in this area focuses on evaluating models of care to improve the coordination of services.
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. Our work in this area includes disseminating information about health outcomes research, providing advice on the selection of measures for health outcomes assessment, providing health outcomes education and training, and distributing measures and instruments used in health outcomes assessment.