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Issue 48 June 2016
The Hospital Alliance for Research Collaboration
In the news
Critical Care Infections
Patient and Staff Flow
Patient Experience

Getting the best evidence to every patient's bedside

Kristina Weeks

Kristina Weeks, an Australian-American Health Policy Fellow currently working with the Clinical Excellence Commission, is determined to break down the barriers that prevent evidence-based medicine being provided to every patient, every time.

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Tackling infections in critical care

This month, we look at some of the latest research on critical care infections, including a study that reveals how a US intervention led to widespread reductions in hospital bloodstream infections that have been maintained for a decade.

In less positive news, another study reveals that patients who survive sepsis face an increased risk of dying in the following two years.

We also bring you research on the impact of the flow of patients and staff around the hospital, including findings that patients who move hospital beds three or more times are at a much greater risk of experiencing adverse events than others.

In our profile, we meet Kristina Weeks, an Australian-American Health Policy Fellow who is currently working with the Clinical Excellence Commission, and who is on a mission to get the best evidence to the bedside of every patient.

The HARC partners are currently undertaking a strategic review of the Hospital Alliance for Research Collaboration, which will likely result in some future changes to the monthly HARC e-Bulletin.

We thank you for your long-running support and readership of the e-Bulletin, and will be in touch again soon regarding future HARC publications.

As always, please forward this edition of the Bulletin to colleagues and get in touch with your feedback or suggestions at:

Megan Howe
Editor, HARC e-Bulletin

Does public reporting of hospital measures improve patient outcomes?

A US study that found improvements in mortality rates slowed after mandatory public reporting of hospital mortality data was introduced raises some questions about public reporting, but does not discount it as a quality improvement tool, Bureau of Health Information Chief Executive Dr Jean-Frederic Levesque says.

The study authors said there was broad consensus that public reporting on the performance of healthcare providers could drive improvements in patient care, but there was surprisingly little evidence that it had actually done so.

They studied mortality trends among Medicare patients before, during and after the 2008 introduction of a system that required US hospitals to publicly report 30-day mortality rates for acute myocardial infarction, congestive heart failure and pneumonia on a website called “Hospital Compare”.

Findings in the Annals of Internal Medicine showed that the during the period when hospitals were only required to report on processes of care, mortality rates for the three conditions fell by 0.23% per quarter. This slowed to a fall of 0.09% per quarter after mandatory reporting of mortality rates was introduced. Reductions in mortality for non-reported conditions also slowed slightly over the same period.

The authors said it was not clear why public reporting did not accelerate overall improvements in mortality, because it was generally expected that “peer-pressure” would motivate hospital leaders to improve outcomes.

It was possible the way the mortality rates were displayed on the website ‒ in three categories of worse than the national average, no different to national average and better than the national average ‒ may have diluted the peer-pressure effect, as most hospitals were labelled as average, they suggested.

Dr Levesque said while the study would contribute to the understanding of public reporting, there were a number of factors which may have influenced the results, including the fact that the US reporting program was introduced at a time when mortality rates had already improved significantly. He said the similar decline in the control group suggested a general slowing in the reduction in mortality rates.

“They came late to it,” he said.” If hospitals have already been looking for 12 years at process measures to improve mortality rates, it is more difficult for public reporting of mortality rates to have an impact because improvements have already happened and improvements in mortality are more difficult to achieve.”

He said the method of reporting in three categories was similar to that used by BHI, but it was important to strike a balance between reporting results that were sensitive to variation, while not unfairly highlighting results that were in reality within the expected range.

Dr Levesque added that while peer pressure was one of the levers on which public reporting could act, it was not the sole means by which the strategy could achieve quality improvement.

“At BHI, we want the information to support the entire system,” he said. "The measures that we report on may put a bit of pressure on hospitals, but they also have a role in supporting quality improvement programs, understanding who is performing well and learning from them and in better understanding the part of the pathway we need to work on and how we can target specific remedial actions.”

New cancer funds to boost translational research

New cancer research grants totalling $39 million have been announced by the NSW Government and the Cancer Institute NSW to support emerging cancer research.

More than $9.5 million will support the careers of cancer researchers, $3.8 million will be invested in research infrastructure and $25.9 million will support the state’s translational cancer research centres to advance research from the bench to the bedside, NSW Health Minister Jillian Skinner said.

She said the grants were vital to ensuring the state attracted and retained the best and brightest cancer researchers.

Chief Cancer Officer and CEO of the Cancer Institute NSW, Professor David Currow, said 18 researchers had been awarded fellowships including Future Research Leader Fellowship recipients Dr Mark Polizzotto and Dr Mark Larance.

“Through this year’s Future Research Leader program, we see two outstanding senior researchers return from overseas, bringing with them a wealth of knowledge to establish substantial programs in cancer treatment and prevention,” he said.

He said Dr Polizzotto had returned from the National Cancer Institute in Maryland, US, to establish a clinical trial program at the University of NSW to prevent and treat HIV-associated cancers, testing a new class of drugs called immune modulatory anti-cancer agents.

• See the full list of grant recipients.

Call to prioritise health services research

The Federal Government’s Medical Research Future Fund (MRFF) is being urged to prioritise health services research that can help inform policies to improve the delivery of healthcare and the efficiency of the health system, according to several submissions to the Fund’s five-year Medical Research Innovation Strategy.

The Sax Institute’s submission  calls on the MRFF to work towards its aim of boosting the efficiency and effectiveness of the health system by:
• Further developing use of Australia’s world-class health data
• Evaluating policies and programs or testing strategies for large-scale implementation of programs, and
• Fostering co-production of research by healthcare providers and policy makers to boost knowledge translation.

The Institute’s submission also calls for a focus on research into healthy ageing, which it says will be a critical factor in achieving the Fund’s aim of contributing to economic growth.

Another MRFF submission from Innovative Research Universities (IRU)‒  comprising six Australian universities ‒ urges the Fund to focus on facilitating the translation of research into health outcomes and the continuous improvement and efficiency of healthcare delivery. These are areas where the current health and medical research system are weak, it states.

In its submission, the Health Services Research Association of Australia & New Zealand calls for the establishment of a National Centre for Health Services Research to oversee both local and large-scale health services research and to develop the necessary infrastructure to ensure health services research reaches its potential to improve the health and wellbeing of all Australians.

New cosmetic surgery laws introduced in NSW

From next year, cosmetic procedures such as breast implants and abdominoplasty will need to be carried out in facilities that have the same licensing standards as NSW private hospitals, under new laws announced by the Health Minister Jillian Skinner.

The changes, which involve a new Cosmetic Surgery class being created under the Private Health Facilities Act and Regulation, apply to surgical procedures (other than dental) that are intended to modify a person’s appearance or body, and which involve general, epidural, spinal or major regional anaesthetic or sedation greater than conscious sedation.

Facilities will have nine months to obtain licensing under the laws, which also apply to specific procedures including breast augmentation, abdominoplasty, large-volume liposuction and certain facial implants.

Mrs Skinner said the changes followed reports of cosmetic surgery patients experiencing significant adverse health outcomes and would “ensure a safer regulatory environment for patients undergoing selected cosmetic surgical procedures”.


Change in thinking drives lasting fall in infections

Large-scale healthcare improvement projects can be sustained in the long-term, say US researchers. They were commenting after finding that signficant reductions in bloodstream infection rates in hospital intensive care units (ICUs) were maintained a decade after being targeted by a state-wide intervention.

The study was the first to demonstrate a 10-year impact of a quality improvement intervention, which had established a 'new normal for care'  
Setting a new benchmark

The Michigan Keystone ICU project was cohort collaborative aimed at reducing the common problem of central line bloodstream infections (CLABSIs) in ICUs, through the use of improvement teams that promoted clinicians’ use of five evidence-based infection prevention recommendations.

The study, which covered data from 121 ICUs across 73 hospitals between March 2004 and December 2013, showed that the annual mean rate of bloodstream infections dropped from 2.5 infections/1000 catheter-days in 2004 to 0.76 in 2013. The rate remained below one infection per 1000 central-line days from 2008 onwards.

“It was found that the markedly reduced BSI [bloodstream infection] rates achieved in the initial Keystone ICU project were sustained for 10 years, setting a new benchmark for rates of CLABSI among ICU patients,” the authors wrote in the American Journal of Medical Quality.

The authors said the study was the first to demonstrate a 10-year impact of a quality improvement intervention, which had established “a new normal for care”.

Active involvement of hospital leaders and the Keystone Center, as well as ongoing monitoring and performance feedback ‒ with hospitals facing peer pressure to match infection rates of other hospitals ‒ had helped sustain the results, they suggested.

But they said the largest driver was likely a shift in the clinicians’ beliefs – from viewing such infections as inevitable to viewing them a preventable and acknowledging they could prevent them.

Meanwhile, a separate study on the first four cohorts of a program to reduce catheter use and catheter-associated urinary tract infections (UTIs) in US hospitals found that a collaborative effort focusing on both technical and socio-adaptive interventions reduced UTI rates in non-ICU settings, but not in ICUs.

Pronovost PJ, Watson SR, Goeschel CA, Hyzy RC, Berenholtz SM. Sustaining reductions in central line-associated bloodstream infections in Michigan intensive care units: A 10-year analysis.  American Journal of Medical Quality 2016: 31;197-202

Saint S, Greene MT, Krein SL, Rogers M, Ratz D et al. A program to prevent catheter-associated urinary tract infection in acute care. N Engl J Med 2016;374:2111-19


Review confirms benefits of care bundles to cut ICU infections

Central-line bundles ‒ packages of care aimed at reducing central-line associated bloodstream infections (CLABSI) ‒ significantly reduce the incidence of such infections in ICUs, a major review has confirmed.

The researchers said bundles were sets of evidence-based practices that had been proven to improve patient outcomes, if completed collectively and reliably.

They reviewed evidence on central-line insertion and maintenance bundles, which were defined as a combination of evidence-based interventions, such as full barrier precaution during the insertion of a central line, cleaning of the skin with chlorhexidine, applying appropriate hand hygiene and prompt removal when the central line was no longer needed.

The meta-analysis of 79 studies covering neonatal, paediatric and adult ICUs showed that the incidence of infections decreased significantly from a median of 6.5 per 1000 catheter-days to 2.5 per 1000 catheter-days after implementation of bundles, according to findings in The Lancet Infectious Diseases.

While various implementation approaches were taken, the most successful was reported to be a combination of leadership by a recognised authority with strict protocol or checklist compliances, and when nurses were empowered to stop the procedure if a physician breached protocol.

“The question of whether central-line bundles are effective is no longer open to debate ‒ we have shown that they are,” the authors wrote.

They said the review also showed that using such bundles of care could achieve cost savings, estimated at $US42,609 per one prevented CLABSI.

Ista E, van der Hoven B, Kornelisse RF, van der Starre C, Vos MC et al. Effectiveness of insertion and maintenance bundles to prevent central-line-associated bloodstream infections in critically ill patients of all ages: a systematic review and meta-analysis. The Lancet Infectious Diseases 2016(16)724‒34.


The deadly legacy of sepsis

Patients who survive sepsis face an increased risk of mortality in the following two years, according to a US study which suggests such patients may benefit from interventions and discussion of end-of-life planning.

While sepsis mortality in hospitals was falling, many patients died over subsequent months and the researchers said there was debate about whether such “late mortality” reflected underlying comorbidities in patients who developed sepsis, or was a result of the sepsis itself.

They followed up 960 older US patients who were hospitalised with sepsis, and matched controls of 777 adults who were not currently in hospital, 788 patients admitted with non-sepsis infection, and 504 patients admitted with acute sterile inflammatory conditions.

More than one in five patients who survived sepsis died acutely within the next two years and their death was not explained by their prior health status – suggesting it was a consequence of the sepsis, the authors wrote in the BMJ.

They said interventions during the admission for sepsis, such as timely resuscitation and early mobility, may benefit patients with sepsis more than generic post-admission care.

The findings might also be of value to patients, families and health systems seeking information about life after an admission for sepsis, they said.

“The high rate of late mortality suggests that physicians should perhaps discuss advanced directives and end of life planning in patients who survive sepsis,” they wrote.

Prescott HC, Osterholzer JJ, Langa KM, Angus DC, Iwashyna TJ. Late mortality after sepsis: propensity matched cohort study.  BMJ 2016; 353 doi:


Bed moves increase risk of harm

Patients who move hospital beds several times face an increased risk of adverse events, according to an Australian study that suggests clear targets need to be set around bed moves.

Among 566 patients admitted to a tertiary referral hospital, 28% were moved once, 8% were moved twice and 5% were moved at least three times, according to the study in Australian Health Review.

An adverse event was almost three times more likely to occur among patients who were moved three or more times, compared with patients moved fewer times, it found.

Some of the reasons for patient bed moves were inevitable, such as return from theatre to a different ward if the patients’ condition deteriorated; moves from intensive care and from flexible bed/short-stay units, they said.

“However, most moves were classified as ‘bed needed for another patient’, and this group may need closer scrutiny,” they wrote.

The study also found that that the length of stay among patients who were moved three or more times was twice as long as for those moved fewer times. The authors said the study did not control for acuity and illness severity, so it was possible sicker patients had longer lengths of stay and were potentially exposed to more opportunities for adverse events too occur.

As well as safety concerns, there were substantial economic implications associated with frequent patient moves, they suggested. Based on an estimate of $A600 per bed day, an increased cost of about $A4200 could be incurred for each patient who was moved three or more times, as they stayed in hospital an extra seven days.

“Efforts to reduce the number of bed moves, both within and between wards, needs to be part of strategic planning, with clear targets set for acceptable standards,” they wrote.

Webster J, New, K, Fenn M, Batch M, Eastgate A, et al. Effects of frequent Patient moves on patient outcomes in a large tertiary hospital (the PATH study): a prospective cohort study. Australian Health Review 2016:40;324‒39


Call to review four-hour rule targets for EDs

The National Emergency Access Targets (NEAT) ‒ which stipulate what proportion of patients should be admitted, discharged or transferred from EDs within four hours of presentation ‒ are only effective in reducing patient mortality up to a certain point, Australian research shows.

The authors suggested their findings should be considered when formulating future targets for access to emergency care.

We found that there is no robust evidence regarding a clinically significant mortality benefit associated with total and admitted NEAT compliance rates above 83% and 65% respectively  
Mortality impact of targets studied

The NEAT targets, which varied from state to state, were set for all Australian EDs by the National Partnership Agreement in 2012, with the aim of incrementally increasing targets to 90% in all jurisdictions by 2015, in line with the UK’s “four-hour rule” target.

While the NEAT incentives are no longer funded following the end of the National Partnership Agreement in 2014, all states have so far maintained pursuit of some form of four-hour ED target, study author Dr Andrew Staib said.

The study examined the relationship between the risk-adjusted mortality of patients who were admitted acutely from ED and the NEAT compliance rates both for all patients who presented to ED (total NEAT) and for those who were admitted to hospital from the ED (admitted NEAT).

Findings in the MJA showed as the NEAT compliance rates increased, there was a decline in the in-hospital mortality among admitted patients, which was expressed as a risk-adjusted ratio of observed to expected number of deaths known as the ED Hospital Standardised Mortality Rate (eHSMR).

However, the eHSMR reached its lowest point of 73, when total NEAT total compliance rates rose to about 83%, and when the compliance rates for admitted patients reached 65%. When compliance with NEAT targets increased beyond those levels, there was no further reduction in mortality rates.

“We found that there is no robust evidence regarding a clinically significant mortality benefit associated with total and admitted NEAT compliance rates above 83% and 65% respectively,” the authors wrote.

They also suggested NEAT compliance rates should be embedded within a suite of patient-focused outcome measures that could signal any “unintended adverse consequences of pursuing ever higher NEAT compliance rates”.

Sullivan C, Staib A, Khanna S, Good NM, Boyle J, Cattell R, et al. The National Emergency Access Target (NEAT) and the 4-hour rule: time to review the target. Med J Aust 2016;204;354. [Internet] doi:10.5694/mja15.01177


Study reveals impact of nursing interruptions

Interruptions, often instigated by patients and family members, increase the amount of time it takes nurses to complete clinical tasks and could place patients at increased risk of harm, new research suggests.

The observational study looked at the effect of interruptions on common nursing interventions in the emergency department (ED) of a large US hospital.

Findings in BMJ Quality and Safety showed that the average time spent on an uninterrupted intervention was about five minutes, while interrupted interventions took 11.5 minutes.

After controlling for intervention type and other confounding factors, they found interrupted interventions were just over two minutes longer than interventions without interruptions, after excluding the length of the interruption.

One reason for the increased time may be that nurses performed task steps again if interrupted, the authors suggested. For example, after being interrupted while setting up an infusion pump, a nurse would repeat the last few pump inputs so as not to miss one accidentally.

The study found that family/patient interruptions had the greatest impact on the time taken to complete procedures, compared with interruptions by other staff.

“While seemingly trivial, in an emergency care setting, additional minutes translate into increased patient risk,” they wrote, adding that the additional time spent on tasks may also have financial implications.

“Organisationally, such interruptions lead to inefficient practice and a drag on productivity.”

They said findings should give clinical leaders and administrators an incentive to explore ways of reducing the interruptions that were most detrimental to care delivery, or perhaps making nursing practices more resilient to the potentially harmful effects of such interruptions.

Cole G, Stafnus D, Gardner H, Levy MJ, Klein EY. The impact of interruptions on the duration of nursing interventions: a direct observation study in an academic emergency department. BMJ Qual Saf 2016;25:457‒65.


Does patient experience equate with quality of care?

Measures of patient reported experience should not be used to conclude that the quality of healthcare is good, according to a study that suggests the data is best used to identify potential problems and priorities for improvement.

The review of 51 studies focused on the association between delivered care and patient reported experiences.

The authors said the studies revealed six broad themes, all of which influenced the association between patient reported experiences and the quality of care received: the patient characteristics; patients backing up their own healthcare choices; loyalty to health care professionals; the timing of the survey; and the questionnaire and item design.

For example, they said patient reported experience could be influenced by gratitude, loyalty and a need to maintain a good relationship with healthcare professionals. Also, patients with better health tended to report more positive experiences with healthcare, while those with high educational levels tended to be more critical.

While measures of patient experience were important and should remain a priority for healthcare managers, the study authors said the findings showed such measures might reflect neither high-quality care nor satisfied patients, according to their findings in Patient Experience Journal.

“Practitioners must be cautious when using the information in quality assessment and decision-making processes,” they wrote. “It is important to be aware of the differences between received care, patient experience and reported patient experience as these are very different concepts and a number of factors influence the association between them.”

They developed a model which they said was starting point for understanding the complex association between received care and patient reported experience and factors that influence that association.

Sandager M, Freil M, Lehmann Knudsen J. Please tick the appropriate box: Perspectives on patient reported experience. Patient Experience Journal 2016;3:63‒73.


Volunteer program helps impart safety message

A program in which volunteers were used to deliver safety messages to patients and their families in a paediatric hospital helped to impart key safety information, new research shows.

The researchers evaluated the Patient Safety Ambassador (PSA) program, which used trained volunteers to deliver information about inpatient safety to patients and their families. The volunteers delivered five key safety messages verbally and with a fact sheet, regarding:  infection control protocols; proper medication administration; utilisation of the SPOT (speed, proactive, outreach teaching) critical care team as necessary; and speaking up and asking questions.

The researchers examined whether 40 parents/guardians of children and four inpatients at a Canadian children’s hospital were able to recall the key safety messages imparted by the PSA program after 48 hours, either with or without cues such as key words.

The study found that 95% of parents could remember all safety messages with cues, but could only remember one or two messages without cues, according to findings in Patient Experience Journal.

The inpatient participants could remember up to four messages with cues, but none without cues.

Interviews with parents about their attitudes and perceptions about patient safety revealed they were most concerned with knowing about their child’s medication, being involved in their child’s care, having trust in the healthcare team, asking questions to understand their child’s medical situation, and in advocating on behalf of their child to facilitate ongoing patient safety.

Cooke C, Vaillancourt R, Villarreal G, Pouliot A, Labelle N, et al. Evaluating recall of key safety messages, and attitudes and perceptions of a patient safety initiative at a pediatric hospital. Patient Experience Journal 2016:3:25‒34.


Online cancer information falls short

Patients seeking online information about pancreatic cancer may end up confused or misguided, new research suggests.

A study of 50 websites found they were designed for people with a reading level well above that of the general population, and lacked accurate information about alternative therapies.

The general population and vulnerable groups with particularly low health literacy will likely struggle to understand this information, the authors said  
Alternative therapy websites inaccurate

The researchers evaluated 50 websites that discussed five pancreatic cancer treatment methods, using standardised tests to assess the readability of the websites and an expert panel to assess the accuracy of information. 

Findings in JAMA Surgery showed that the median readability level of all website categories was higher than the recommended sixth-grade reading level, requiring at least 13 years of education to be understood ‒ a level that was attained by only 58% of the US adult population.

“The general population and vulnerable groups with particularly low health literacy will likely struggle to understand this information,” the authors said.

Overall, websites discussing treatment modalities for pancreatic cancer were reasonably accurate, except for those discussing alternative therapies.

“Alternative therapy websites contained more noticeable inaccuracies and contained seemingly incorrect information,” they wrote.

Non-profit, academic, and government websites had the highest accuracy, particularly websites relating to clinical trials and radiotherapy, the study found.

The authors said online health resources could be powerful tools to help patients become better informed, but unguided searches could have a negative effect on patient care, decision making and outcomes.

Healthcare professionals should be aware that online information on aggressive diseases like pancreatic cancers could be potentially harmful, and should take an active role in evaluating and recommending suitable online resources for patients, they suggested.

Storino A, Castillo-Angeles M, Watkins AA, Vargas C, Mancias JD et al. Assessing the accuracy and readability of online health information for patients with pancreatic cancer. JAMA Surg 2016 [Internet] doi:10.1001/jamasurg.2016.0730


Report calls for action on suicide

This report, released by a coalition of not-for-profit leaders in suicide and mental health, calls for all major Australian political parties to spell out what they will do to address the nation’s rising toll from suicide. The report includes details of suicide rates across 28 Federal electorates and sets out an action agenda aimed at reducing suicide rates.

Download report

Snapshot on insulin-treated diabetes in Australia

In 2014, nearly 30,000 Australians began using insulin to treat their diabetes ‒ 67% had type 2 diabetes, 23% had gestational diabetes, 9% had type 1 diabetes and 2% had other forms of diabetes, according to new data released by the Australian Institute of Health and Welfare. Almost two in three people diagnosed with type 1 diabetes were aged under 25, whereas almost all (93%) new cases of insulin-treated type 2 diabetes occurred in those aged over 40, it shows.

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Costly delays in discharging older patients

This report from the UK’s National Audit Office shows that the way the health and social care system manages the discharge of older patients from hospital does not represent value for money. The report estimates that the gross annual cost to the NHS of treating older patients in hospital who no longer need to receive acute clinical care is in about £820 million. However, it acknowledges that caring for older people in more appropriate settings at home or in their community instead could result in additional annual costs of around £180 million for other parts of the health and social care system.

Download report

Global plan to defeat threat of superbugs

Ten million people could die by 2050 unless sweeping changes are agreed upon to tackle mankind’s increasing resistance to antibiotics, this report warns. The final report from the Review on Antimicrobial Resistance, commissioned by the UK Government, outlined steps to fight the emergence of “superbugs". Meanwhile, the Australian Commission on Safety and Quality in Health Care released a landmark report outlining the most comprehensive picture of antimicriobial resistance and antimicrobial use in Australia, setting a baseline to allow trends to be monitored over time.

Download report

Social housing waiting lists shorten

There were 6000 fewer households on housing assistance waiting lists in 2015 than the previous year, although lists remain long with 200,000 applicants awaiting housing, according to this report from the Australian Institute of Health and Welfare. The Housing Assistance in Australia 2016 report shows that there were 427,800 social housing dwellings in Australia (about 4% of all households) as at 30 June, with 817,300 tenants. Three in five main tenants were women, 44% of tenants reported they had a disability and 53% were single adults who lived alone.

Download report

Social expenditure link to health outcomes

This report from RAND Europe, a not-for-profit research institute aimed at improving policy through research and analysis, looks at whether spending more on healthcare alone is the best way to improve public health. Findings from a comparative analysis using 30 years of data across 34 OECD countries show that higher levels of social spending are strongly associated with better health, and that spending on old age programs demonstrate the strongest association with better health outcomes, including in unexpected areas such as infant mortality and low birth weight.

Download report

Kristina Weeks  

Kristina Weeks

Australian-American Health Policy Fellow
Clinical Excellence Commission

Getting the best evidence to the bedside of every patient

There’s a mantra of sorts that health services researcher Kristina Weeks comes back to again and again when talking about her work.

“Are we getting the best available evidence to every patient, every time?” she asks.

All too often, she has found that the answer is no – a situation she’s determined to address.

Ms Weeks, a doctoral candidate and faculty member from Johns Hopkins School of Medicine in Baltimore, US, has been working with the Clinical Excellence Commission since November last year after being awarded an Australian-American Health Policy Fellowship.

The Commonwealth-sponsored Fellowship gives her the opportunity to spend up to 10 months conducting research and working with Australian health policy experts on issues relevant to both countries.

A drive to change the system

She began her career studying exercise science, with the aim of becoming a physiotherapist, but found she was drawn to broader applications of public health and health policy, rather than clinical medicine.

“I had the notion that I wanted to make things better not just for one person, but for the system and policy,” she says.

Originally from Alabama, she had seen family members denied the best healthcare due to prohibitive costs, and her growing concerns about inequity were compounded by her research.

She gained an internship in clinical epidemiology at Johns Hopkins University and was initially involved in a major study on social and environmental factors affecting African Americans in Baltimore with hypertension.

“I loved the work, but I was frustrated by finding again and again, that through no fault of their own, people had health issues – often linked to income and housing and health insurance and transport.”

“We found over and over again, the same disparities when it comes to chronic diseases. Sometimes there are social conditions that make it almost impossible for patients to be adherent to clinical guidance. I wanted to know how policy could influence that.”

She “got the bug” and shifted her focus to looking at the barriers that prevented the healthcare system from providing the best science possible to everyone, all the time.

Making a difference

Ms Weeks was mentored by patient safety guru Dr Peter Pronovost, and worked on his much-lauded project to reduce deadly bloodstream infections linked to central lines or catheters used in intensive care units.

Ms Weeks, who worked on the project from 2008‒2012, said the framework he developed had been adopted in hospitals in 43 US states as well as Puerto Rico and Washington DC and was being applied to other hospital-related infections and risks, such as surgical site infections, hospital–acquired pneumonia and falls.

Focus on patient safety

While in Australia, she is working closely with the CEC’s Director of Patient Based Care, Dr Karen Luxford, and is researching the intersection between patient-centred care and patient safety. She aims to identify NSW hospitals that perform highly in those two areas and study what they are doing differently, so it might be replicated in other healthcare organisations.

“I want to be explicit in looking at that crossroads in a system that does have universal [health insurance] coverage,” she says. “I think the learnings from my research may be applicable to the US. It is focused on systems of organisational behaviour: what happens within healthcare as a system.”

She says the biggest difference she has noted between the US and Australian healthcare systems has been the “safe space” afforded to people by Australia’s universal healthcare coverage – meaning they do not live in fear of bankruptcy if they become ill.

“Everyone in Australia has some kind of health insurance which is a strong signal of the importance of health and wellbeing,” she says. “My message to Australia is: do not take for granted having a healthcare system that allows everyone to get the care they need.”

Specialist Pain Symposia

This one-day symposium, hosted by the Pain Management Research Institute at the University of Sydney, is targeted at multidisciplinary researchers, clinicians, policy makers and healthcare providers with an interest in patient adherence as a vehicle for improving treatment outcomes. Internationally renowned experts will be presenting their latest work on obstacles to ‒ and ways of improving ‒ treatment adherence.

1 July, Sydney
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Drug and Alcohol Innovation Forum 2016
11 August, Sydney
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The Agency for Clinical Innovation (ACI) Drug and Alcohol Network are hosting this forum, the first of its kind in NSW to showcase innovative and creative solutions to address the diverse and complex needs of people accessing drug and alcohol services. Abstracts are open for the forum, which will be live-streamed. 

Youth Health Forum

Youth Health Forums are held several times a year by the Office of Kids and Families to disseminate up-to-date information and knowledge on youth health issues. This forum is entitled “Weighty matters: what do we know and what can we do?”

24 August, Sydney
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45 and Up Collaborator’s Meeting 2016
6 September, Sydney
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The Sax Institute is inviting invite research collaborators, partners, supporters and others with an interest in the 45 and Up Study to save the date for this year’s 45 and Up Study Collaborators’ Meeting, which showcases innovative large-scale population health research on all aspects of healthy ageing. The theme for this year’s meeting is: Data, evidence and decision making for a better future.

5th Rural and Remote Health Scientific Symposium

This two-day symposium will be of interest and value to academics, program managers, non-government organisations and state and federal government policy makers who are seeking to deliver better health outcomes for rural and remote communities through research, policy and practice. It will enable rural health experts to share insights and learn from innovative research and service developments that may transform how services are delivered in years to come.

6‒7 September, Canberra
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APAC Forum
12‒14 September, Sydney
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The APAC Forum health improvement conference is being held in Sydney for the first time and is themed: “Exploring new frontiers ‒ creating your blueprint for a healthy future”. The forum aims to attract health leaders, policy makers, patients, consumers, carers, doctors, nurses, allied health and quality improvement specialists, providing a platform to improve the health and wellbeing of the population.

3rd Biennial Australasian Implementation Conference

This conference, co-hosted by the Centre for Evidence and Implementation and the University of Melbourne, aims to advance implementation science ‒  the integration of research findings and evidence into policy and practice ‒ to lead to better health, education and wellbeing for individuals, families and communities. 

5‒6 October, Melbourne
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5th Annual NHMRC Symposium on Research Translation

Abstracts are invited for this year’s NHRMC Symposium on Research Translation, which is themed:  “Embedding research into health care: building a culture of quality”. The symposium aims to inspire, influence and create a culture in health care that focuses on quality, underpinned by strong research evidence.

23 November, Melbourne
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