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Issue 41 October 2015
The Hospital Alliance for Research Collaboration
In the news
Hospital shifts
Improving care of the elderly
Patient outcomes

New sepsis alert to save lives

New "sepsis alert" technology now being piloted at one Sydney hospital could help further reduce deaths from the condition across the state.

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Hospital shifts in focus

In this month’s e-Bulletin, we focus on shifts in the way hospitals are managed, from the way wards are organised to the way staff are rostered. We look at research into how both staff and patients reacted to a move to single-bed wards as well as new findings that 12-hour nursing shifts come at the expense of nurses’ psychological wellbeing.

We also outline some of the latest research on improving care in the elderly, with an Australian study showing that one in four older patients admitted to hospital have not had their medications managed appropriately in the community prior to their hospitalisation.

In our profile article, we meet Associate Professor Mary Haines, the initial director of HARC, who today holds roles at both the Sax Institute and Cancer Institute NSW and works across the research and policy fields in research translation.

Please forward this edition of the Bulletin to colleagues who might be interested in joining the HARC network and get in touch with your feedback or suggestions at:

Megan Howe
Editor, HARC e-Bulletin

New alert to save lives of patients with sepsis

New “sepsis alert” technology now being piloted at one Sydney hospital could help to further reduce deaths from the condition across the state, according to the Clinical Excellence Commission.

CEC Medication and Deteriorating Patient Programs Director Dr Harvey Lander said since the introduction of the SEPSIS KILLS program in 2011, the risk of a patient dying from sepsis in NSW public hospitals has dropped by more than 30%.  In the three years before the SEPSIS KILLS program began, 3053 people died from sepsis (about 1020 deaths per year) but that had fallen to 979 in 2012 and 870 in 2013.

“In early 2011, it took more than four hours for antibiotic treatment to begin on sepsis patients across NSW emergency departments,” he said. “With the introduction of the pathways, that reduced to less than 60 minutes by 2012.”

The new “sepsis alert” program now being trialled at Blacktown Hospital in Sydney’s west had seen the average time to starting antibiotics on the ward cut to 42 minutes, Dr Lander said.

The technology combines known risk factors for sepsis, patient observations and laboratory results so that as soon as the algorithm detects a sepsis risk, an alert is sent to the treating team.

The Sepsis Alert program will be rolled out across the state’s public hospitals next year. The trial involves a co-ordinated approach from the CEC, Western Sydney Local Health District, eHealth NSW and Health Infrastructure.

Survey reveals wide variation in outpatient experiences

Patients undergoing oncology and chemotherapy outpatient services in NSW hospitals were more positive about their care than those undergoing orthopaedic and other surgical services, the first survey of people who received outpatient services in NSW public hospitals has revealed.

The Bureau of Health Information Snapshot Report, based on a survey of 18,000 outpatients conducted in 2014, showed that patients’ experiences were generally positive, but varied depending on the type of service received.

The report found the proportion of people who said their care was “very good”, ranged from 62% of those receiving orthopaedic and other surgical services to 84% of those attending an oncology or chemotherapy appointment.

Measures for which patients’ experiences varied widely included:

• Waiting less than a month for an appointment: 27% for ophthalmology patients to 75% for gynaecology and obstetrics patients
• The time they waited for an appointment was ‘about right’: 69% for ophthalmology to 93% for oncology and chemotherapy
• Care was ‘very well organised’: 56% for orthopaedic surgery to 81% for oncology and chemotherapy
• The clinic was ‘very clean’: 54% for paediatric medical to 86% for oncology and chemotherapy.

BHI Chief Executive Dr Jean-Frederic Levesque said the findings would help focus efforts on where improvements could be made in outpatient services.

Call for input on “inefficient and unsafe” MBS items

Health professionals are being urged to speak up about any Medicare-funded services, tests or procedures they believe are “out-of-date, unnecessary or unsafe under certain circumstances” as part of the federal government’s wide-ranging review of the Medicare Benefits Schedule (MBS).

Health Minister Sussan Ley this month launched the consultation for the review of all 5700MBS items, releasing two discussion papers and an online survey aimed at encouraging input from stakeholders.

She said only 3% of all MBS items were assessed or tested to see whether they actually worked, and the review wanted to hear from health professionals and patients about any MBS items they believed were unnecessary or unsafe.

Chair of the MBS Review Taskforce Professor Bruce Robinson said it was important to look not just at the items, but at the relevance of the rules and restrictions governing their use.

“It has been estimated that 30% or more of health expenditure is wasted on services, tests and procedures that provide no or negligible clinical benefit and, in some cases, might be unsafe and could actually cause harm to patients,” he said.

While some procedures were out-of-date and should be removed from the MBS, in other instances, the test or treatment was not appropriate in every circumstance and needed restrictions placed on its use, he suggested.

Committee to oversee move to electronic medical records

A new committee has been appointed to oversee the reboot of the Federal Government’s e-health record system, with trials of the records set to begin next year, according to Health Minister Sussan Ley.

Ms Robyn Kruk AM, former chief executive of the National Mental Health Commission, was appointed as independent chair of the eHealth Implementation Taskforce Steering Committee, which is responsible for establishing the Australian Commission for eHealth.

The committee would also oversee the operation and evolution of the national electronic “My Health Record” system. Trials of different participation models for the e-health record system for doctors and patients would start next year, including a trial of an opt-out system.

“If automatic registration for digital health records in the opt-out trials leads to higher participation in the My Health Record system, the Government will consider adopting opt-out on a national scale,” Ms Ley said.

Overhaul of US medical research rules in sight

A push to overhaul US rules governing consent to participate in medical research could see researchers able to use  biospecimens in secondary research without having to obtain further consent, according to a report in The Lancet.

US health officials were expected to update 25-year-old regulations on human participation in research by the end of next year, according to the report.

One of the major changes under consideration is the current requirement of investigators to obtain informed consent from research subjects to use biospecimens collected for one study in any future secondary study, regardless of whether the samples are identifiable.

The report stated that the proposed, updated broad informed consent provision would contain “information a reasonable person would want to know” without extraneous, lengthy details.


Single-bed wards: pros and cons

Single-bed wards are popular with patients, but hospital staff have concerns about visibility, surveillance, teamwork, monitoring and keeping patients safe in single rooms, a UK study finds.

The researchers conducted a study of patient and staff experiences and safety outcomes around the 2011 opening of the first English NHS hospital to have 100% single inpatient rooms in all wards.

Nurses felt ill-prepared for working on single-bed wards and had to adapt their working practices significantly, the study found. The move to single rooms also resulted in staff walking distances increasing  
Popular with patients

Two-thirds of patients preferred single rooms with comfort, control, privacy, flexibility for visitors and en-suite bathrooms among the factors they liked. 

However, only 18% of staff indicated a preference for 100% single rooms, with most saying they would prefer a mix of single rooms and multi-bedded accommodation to allow them more panoptic surveillance of very sick and frail elderly patients in particular.

Nurses felt ill-prepared for working on single-bed wards and had to adapt their working practices significantly, the study found. The move to single rooms also resulted in staff walking distances increasing, according to findings in BMJ Quality and Safety.

A temporary increase in falls and medication errors found in one ward was likely to be associated with the need to adjust work patterns, rather than associated with single rooms per se, the authors said.

“Our findings suggest that a move to all single rooms may have significant implications for the nature of teamwork in the longer term, confirming evidence that suggests 100% single room facility-design made team communication and patient-monitoring difficult,and that it limited social interaction among staff,” the authors wrote.

Maben J, Griffiths P, Penfold C, Simon M, Anderson JE, et al. One size fits all? Mixed methods evaluation of the impact of 100% single-room accommodation on staff and patient experience, safety and costs. BMJ Qual Saf 2015 [Internet] 2015-004265


Night work doesn’t compromise surgeons’ day procedures

Surgeons who provide medical care after midnight then go on to perform daytime elective procedures do not pose any additional risk to patients, a study shows.

The study covered almost 40,000 patients in Ontario, Canada, undergoing 12 different procedures performed by 1448 physicians across 147 academic and community hospitals.

Despite concerns that surgeons’ sleep loss might have an effect on patient outcomes, there was no significant difference in the primary outcomes of death, readmission or complications between patients who underwent a daytime procedure performed by a physician who had provided patient care after midnight compared with patients treated by the same physician but after a night when they had not performed any clinical work.

“The results were consistent across a wide range of procedures and physician characteristics and in academic and non-academic institutions,” the researchers wrote in the New England Journal of Medicine.

The authors suggested that the physicians working nights might self-regulate their practice the next day by cancelling surgeries or arranging for cover by colleagues if they felt too fatigued to perform surgery safely. 

“These data suggest that calls for broad-based policy shifts in duty hours and practices at attending surgeons may not be necessary at this time,” they wrote, although they added that the effect of profound sleep loss may warrant further study.

Govindarajan, A, Urbach DR, Kumar M, Li Q, Murray BJ, et al. Outcomes of daytime procedures performed by attending surgeons after night work. N Engl J Med 2015;373:845-853


Longer shifts for nurses linked to dissatisfaction

Nurses who work shifts of 12 hours or longer have higher rates of burnout and job dissatisfaction and are more likely to plan to leave their job than those working shorter shifts, according to a study that shows longer shifts come at the expense of nurses’ psychological wellbeing.

The study involved a sample of 31,627 registered nurses in 488 hospitals across 12 European countries, including some countries such as England, Ireland and Poland, where it has become increasingly common for nurses to be rostered on for shifts of 12 hours or longer.

While the most common shift length was ≤8 hours, 31% of nurses worked shifts of 8.1‒10 hours, 4% worked 10.1 to ≤12 hours and 14% reported working from 12‒13 hours. More than a quarter of the nurses reported working overtime on their last shift.

Findings in BMJ Open showed that all shifts longer than eight hours appeared to be detrimental to nurses’ job satisfaction. Those nurses working shifts of 12 hours or more were more likely than those working shorter shifts (≤8 hours) to experience burnout in terms of emotional exhaustion, depersonalisation and low personal accomplishment. They were also more likely to experience job dissatisfaction, dissatisfaction with work schedule flexibility and to report intention to leave their job due to dissatisfaction.

“Employers should be aware of the multiple consequences of burnout, including higher risks of medical error, decreased quality of care, reduced wellbeing and economic loss through increased absenteeism and higher turnover rates,” they wrote.

Managers and nurses alike should question routine implementation of shifts longer than eight hours, the authors said.

Dall’Ora C, Griffiths P, Ball J, Simon M, Aiken LH. Association of 12 h shifts and nurses’ job satisfaction, burnout and intention to leave: findings from a cross-sectional study of 12 European countries. BMJ Open 2015;5:e008331 doi:10.1136/bmjopen-2015-008331


Medication shortfalls common in elderly before hospitalisation

One in four older patients admitted to hospital have not had their medications managed appropriately in the community prior to their hospitalisation, according to an Australian study that calls for routine monitoring of medication-related clinical indicators in the elderly.

The study of 164,813 hospitalisations of veterans over a five year period (encompassing 83,430 patients) assessed patients’ medication-related care before they were hospitalised, as defined by a set of clinical indicators.

It found that 25.2% of hospitalisations were preceded by suboptimal medication–related processes of care, according to findings in the MJA. The conditions most likely to be preceded by inappropriate medication-related care were fracture and congestive heart failure.

Of patients admitted for fractures, 85% were aged over 65 years and had received a medicine which posed a falls-risk before admission, while 20% of men and 17% in women with fractures had a history of prior fracture or osteoporosis but had not received osteoporosis medication.

At least one in 10 hospitalisations for chronic heart failure, ischaemic stroke, asthma, gastrointestinal ulcer or bleeding, fracture, renal failure or nephropathy, hyperglycaemia or hypoglycaemia was preceded by inappropriate medication management, the study found.

The authors suggested that collaborative home medicine reviews involving the patient, pharmacist and GP could potentially identify and resolve some of the medication issues highlighted in the study.

They said the study also showed that administrative health databases were a useful tool for monitoring and improving health system performance, and suggested there should be routine prospective monitoring of evidence-based, medication–related clinical indictors to help improve the management of common conditions.

Caughey GE, Kalisch Ellett LM, Goldstein S, Roughhead EE. Suboptimal medication-related quality of care needing hospitalisation for older patients. Med J Aust 2015;203(5):220


Delirium a predictor of poor outcomes

Researchers have called for routine monitoring of older emergency department (ED) patients to identify patients at high risk of delirium, after confirming the condition is associated with poorer outcomes in elderly patients. They assessed 260 patients daily for delirium for three days in a US hospital inpatient ward.

It is remarkable that delirium status over such a short period of time can still be predictive of poor outcomes, the authors wrote  
Many cases not recognised

Findings in BMJ Open showed that 15% of the patients (aged 65 amd older) were delirious at least once during the first three days of hospitalisations, and in nearly three-quarters of those patients, the condition persisted in ensuing days when the patients were moved to inpatient wards.

Delirium was not recognised in 52% of the ED patients.

Even one episode of delirium between ED and day three in hospital was associated with an increased risk for unanticipated ICU admission or in-hospital death, they found.

The study also found that persistent delirium during early hospitalisation was associated with a higher risk for decline in discharge status, even after adjusting for confounding factors.

“It is remarkable that delirium status over such a short period of time can still be predictive of poor outcomes,” the authors wrote.

They added: “These findings are important because they identify delirium status during early hospitalisation as a useful prognostic factor for poor short-term outcomes, highlighting the clinical importance of early detection and serial delirium screening in older adults."

Jean Hsieh S, Madahar P, Hope AA, Zapata J, Gong MN. Clinical deterioration in older adults with delirium during early hospitalisation: a prospective cohort study.  BMJ Open 2015;5:e007496 doi:10.1136/bmjopen-2014-007496


Safety concerns over opioid patch use in aged care

Researchers have raised safety concerns about the use of opioid patches for managing residents’ pain in aged care homes, after finding that the patches are initiated inappropriately in a third of cases.

The study, which covered 60 aged care facilities in NSW, looked at the proportion of residents who had were not taking any opioid medication (or were opioid-naïve) in the four weeks prior to being started on an opioid transdermal patch to manage chronic, non-cancer pain.

Australian guidelines recommend a stepwise approach to treating such pain, with gradual increases in the potency and the dose of medications.

The authors said fentanyl patches were not recommended in opioid-naïve patients because of the risk of toxicity, including respiratory depression and overdose-related mortality.

The study found that an opioid patch was initiated in 596 of 5297 residents, with 2.6% of residents receiving fentanyl patches and 8.7% receiving buprenorphine patches.

The proportion of recipients who were opioid-naïve before patch initiation was 34% for fentanyl and 49% for buprenorphine, according to findings in the MJA.

Most patients were started on the lowest available patch strength, and the dose was increased if needed after initiation, as recommended, the study found

The authors said the findings suggested there was a degree of inappropriate initiation of opioid patches in Australian residential aged care.

They wrote: “Given the difficulties with the dose titration of transdermal buprenorphine patches and concerns about the safety of fentanyl in opioid-naïve patients, the use of transdermal preparations in older patients should be limited to opioid-tolerant patients with stable opioid requirements.”

Gadzhanova S, Roughead EE, Pont LG. Safety of opioid patch initiation in Australian residential aged care. Med J Aust 2015;203(7):298


Hip fracture: same outcome, big cost difference

Costs and the use of resources for treating hip fractures varies widely among Australian states, despite there being little difference in patients’ outcomes after one year, a study shows.

The study, covering the six states, found the adjusted total hospital cost of treating hip fracture, ranged from $24,792 in South Australia to $35,494 in Western Australia, with the mean cost across the six states being $31,208.

There were no significant differences in fracture incidence, patient demographics or fracture type among the states, but the adjusted total mean length of hospital stay ranged from 24.7 days (SA) to 35 days (WA). Rates of referral to rehabilitation ranged from 31.7% to 50.4%, with Victoria and NSW having the highest rates.

However, the findings, in Australian Health Review, showed that after one year, there were no differences among the states in key outcome determinants for patient mortality, or for the proportion of patients who retained their independent living status.

“These findings indicate a potential for substantial cost-efficiencies in hospital management of hip fractures without compromise in patient outcomes,” the authors wrote.

The study comes after a report released by the National Health Performance Authority earlier this year also found wide variations in the cost of treating hip fractures across hospitals. It found that in 2011‒12, the average cost of hip replacement without complications in a major public hospital was $19,400, but the average cost per admission ranged from $12,500 at one hospital to $25,600 at another hospital.

Meanwhile, a study of 690,995 French patients found that those who undergo surgery for a hip fracture have higher risks of mortality and of major complications than those who undergo an elective total hip replacement, even after adjusting for confounding factors like age and comorbidities.

The authors, writing in JAMA said more research was needed into the causes of the difference, but they suggested reducing the delay between a hip fracture and surgery may limit the excess risks.

Ireland AW, Kelly PJ, Cumming RG. State of origin: Australian states use widely different resources for hospital management of hip fracture but achieve similar outcomes. Australian Health Review [Internet] August 2015

National Health Performance Authority. Hospital Performance: Costs of acute admitted patients in public hospitals in 2011–12. April 2015.

Manach YL, Collins G, Bhandari M, Bessissow A, Boddaert J, Khiami, F et al. Outcomes after hip fracture surgery compared with elective total hip replacement. JAMA 2015;314(11):1159-66.


Bariatric surgery effective for long-term diabetes control

Bariatric surgery is more effective than medical treatment for the long-term control of type 2 diabetes in obese patients, according to a study that suggests surgery should be considered among the treatment options for diabetes. 

While several studies had shown that bariatric surgery improved diabetes in the short-term, the Italian study involving 60 obese patients who received either medical treatment or bariatric surgery, was one of the first to follow up patients for a longer period of five years, the researchers said.

They found that both gastric bypass and biliopancreatic diversion surgery were more effective than standard medical treatment for the long-term control of hyperglycaemia and for patients’ overall metabolic profile.

More than half of the patients who had bariatric surgery were diabetes-free after five years, compared with none of the medically-treated patients, the study found.
Patients who underwent surgery also had a better quality of life than those treated medically, and had greater reductions in cardiovascular risk, diabetes-related complications and medication use, according to findings in The Lancet.

The authors said continued monitoring of glycaemic control was warranted in patients who underwent bariatric surgery, as some of those in the study did have a relapse of hyperglycaemia after two years in remission.

But they said the findings supported “consideration of surgery in the treatment algorithm of type 2 diabetes”.

Meanwhile, another study found that people who believed their weight was genetically determined did less exercise, made less healthy food choices and had poorer health than those who believed they could change their weight. The US study, in Health Education & Behaviour, suggested that by fighting the perception that weight is unchangeable, healthcare providers might be able to increase healthy behaviour among their patients.

Mingrove G, Panunzi S, De Gaetano, A, Guidone C, Iaconelli A, et al.  Bariatric-metabolic surgery versus conventional medical treatment in obese patients with type 2 diabetes. Lancet 2015;386:964‒73

Parent MC, Alquist JL. Born Fat: The Relations Between Weight Changeability Beliefs and Health Behaviors and Physical Health. Health Education & Behaviour. [Internet] September 2015. doi:10.1177/1090198115602266


Borderline pneumonia patients do better in ICU

Admitting older, low-risk or borderline patients with pneumonia to the ICU rather than treating them on general wards reduces their risk of dying, without increasing costs, according to a US study.

The researchers said that pneumonia was a leading reason for hospitalisation, so it was important to understand the implications of delivering intensive care to such patients.

Factors that may have influenced the reduced mortality rate included closer attention from nurses in ICU allowing for more timely recognition if a patient’s condition worsened and earlier, more aggressive care in the event of sepsis  
Reduced mortality

They analysed data from a cohort of more than one million patients aged over 64 years with pneumonia who were admitted to almost 3000 hospitals in the US. Of those, 30% were admitted to ICU.

The decision to admit to the ICU was deemed discretionary in 13% of patients, as it depended only on how close they lived to a hospital with a high ICU admission rate.

The findings, published in JAMA, showed that the 30-day mortality rate among borderline patients was 14.8%, compared with 20.5% among patients admitted to general wards ‒ a 5.7% absolute decrease in mortality.

However, there were no significant differences in Medicare spending or hospital costs for those patients.

Factors that may have influenced the reduced mortality rate included closer attention from nurses in ICU allowing for more timely recognition if a patient’s condition worsened and earlier, more aggressive care in the event of sepsis, the authors hypothesised.

Patients in ICU may have been treated by pulmonary and critical care specialists, they suggested, and previous studies had suggested that ICU admission for pneumonia was associated with higher adherence to guideline-based treatment which was linked with improved mortality and reduced cost.

They suggested a randomised trial may be warranted to assess whether more liberal ICU admissions policies could improve mortality for older patients with pneumonia.

Valley TS, Sjoding MW, Ryan AM, Iwashyna TJ, Cooke CR. Association of Intensive Care Unit Admissions with Mortality among older patients with pneumonia. JAMA 2015;314(12):1272‒9


Study finds more aggressive blood pressure treatment saves lives

A major US trial of hypertension treatment has been stopped ahead of schedule, after it found more aggressive treatment of high blood pressure reduced rates of cardiovascular events such as heart attack, heart failure and stroke by almost a third and the risk of death by almost a quarter.

The US National Institutes of Health (NIH) announced that its Systolic Blood Pressure Intervention Trial (SPRINT) had been stopped earlier than originally planned in order to quickly disseminate the significant preliminary results.

The study, which began in 2009, included more than 9300 participants aged 50 and older across the US and Puerto Rico. It evaluated the benefits of maintaining a target of systolic pressure of less than 120 mm Hg, compared to the target systolic pressure of 140 mm Hg that was recommended for healthy adults in well-established clinical guidelines.

The study found that maintaining a systolic pressure of 120 mm Hg by using more intensive use of hypertension medication, could help save lives among adults aged 50 and older who had a combination of high blood pressure and at least one additional risk factor for heart disease.

The NIH said the full trial results would be published within the next few months.


Diagnostic error in the spotlight

The US National Academies of Sciences, Engineering and Medicine convened an expert committee to address the fact that diagnosis ‒and diagnostic errors ‒ had been largely overlooked in efforts to improve the quality and safety of health care. The Committee’s report, Improving diagnosis in healthcare, outlines eight goals to reduce diagnostic error and improve diagnosis. They include providing dedicated funding for research on the diagnostic process and diagnostic errors and ensuring health information technologies support patients and healthcare professionals in the diagnostic process.


Download report

Australia’s 50,000 premature deaths

Of all deaths in Australia in 2012, almost 50,000 ‒ or 34% ‒ were considered premature, meaning they occurred in people under the age of 75 years, according to this Australian Institute of Health and Welfare report. In half the cases, the deaths were also considered avoidable, according to the report. The leading cause of premature death was coronary heart disease, while suicide was the third leading cause of early mortality accounting for 4.5% of all premature deaths. For Indigenous Australians, 80% of deaths were premature.


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Antibiotic resistance around the globe

This report, entitled State of the World’s Antibiotics, 2015, released by the US Center for Disease Dynamics, Economics and Policy, outlines the current state of antibiotic use and resistance in humans and animals around the globe. It includes interactive maps showing drug resistance trends in 39 countries and antibiotic use in 69 nations including Australia. The maps track infections caused by 12 common and sometimes lethal bacteria, including Escherichia coli, Salmonella, and methicillin-resistant Staphylococcus aureus (MRSA).

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Cost and access barrier to healthcare

Almost one in 10 people living in some parts of Australia say they have delayed or avoided seeing a GP due to cost, while up to 13% in some areas have avoided getting prescribed medication due to the cost, according to this report. The National Health Performance Authority data update for 2013‒14 reveals wide differences in people’s experiences with the healthcare system across the new Primary Health Networks (PHNs). The percentage of adults who said they delayed seeing a GP due to cost ranged from 2% in Central and Eastern Sydney to a high of 9% in Murray PHN, Victoria. 

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Providing care close to home not a cost-saver

This report, Moving healthcare closer to home, by the UK health service regulator Monitor, analyses the financial impact of models that aim to provide healthcare closer to home. It finds that while moving healthcare closer to home will be important in addressing the pressures of future demand and that this may avoid further costs in the longer run, it is not a “panacea”. The report finds that the new models of care being promoted in the NHS are unlikely to break even within five years.

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Mary Haines  

Associate Professor Mary Haines

Cancer Institute, NSW, Director Strategic Research Investment

Sax Institute, Director, Implementation Research Group

A passion for research translation

As a psychology undergraduate, Associate Professor Mary Haines saw how well-researched road traffic interventions such as random breath testing and seatbelt laws became recipes for policy and population health success.

“It sparked my passion for how policy that was rigorously designed, evaluated and rolled out could have really big outcomes for the population,” she says.

That passion led to a career that has spanned the academic, corporate, independent and public sectors, and has seen Associate Professor Haines develop expertise in academic research as well as building research capacity, overseeing research funding schemes and getting evidence into policy and practice. 

Public health focus

After gaining her psychology degree, she spent eight years working and studying in the UK, during which time much the focus of her research was answering policy questions about the impact of social and envirnonmental factors on child and adolescent health and she gained her Doctorate of Philosophy, Epidemiology and Public Health.

Having learned the skills of applied epidemiology and public health, she returned to Australia and into a role as a consultant, advising government agencies on how to apply health research to policy.

Today, she works at both the Sax Institute and Cancer Institute NSW and is an adjunct associate professor with the Menzies Centre for Health Policy at the University of Sydney.

Putting research into practice

At the Cancer Institute NSW, she directs the research funding program with the ultimate aim of lessening the impact of cancer across the state. One of the key elements of that program is the establishment of seven translational cancer research centres around the state that aim to link leading research and clinical centres and to facilitate more efficient and effective incorporation of research, clinical training, education and service delivery.

Associate Professor Haines says her next challenge at the Cancer Institute is to continue to ensure the strategic research investment makes a difference to cancer care in NSW and this will be a big feature of the new fivr-year Cancer Plan which will be implemented from July 2016.

“We are working to build globally relevant cancer research capacity that can foster the translation back into cancer care to improve outcomes for patients,” she says.

In her current role at the Sax Institute, Associate Professor Haines works with healthcare providers such as hospitals and local health districts conducting research to test implementation strategies to embed research into practice.

The genesis of the HARC network

When Associate Professor Haines joined the Sax institute in 2006, one of her first tasks was to establish the HARC Network – an idea that had its genesis in a conversation  between the then CEOs of the Sax Institute and Clinical Excellence Commission (CEC).

“They wanted to bring researchers and policy makers together to focus on how to achieve better healthcare policy around how hospitals are run and healthcare is delivered in this state,” she says. “I was appointed to make the idea a reality”.

The HARC Network has now grown to involve six partners, including Cancer Institute NSW, and around 5000 members. It has opened the way for discussion and collaboration between agencies that are working to improve health outcomes across the state, she says.

“You can see from the HARC forums that the network has really sparked conversations between researchers and policy makers and the bulletin provokes ideas, while the scholarships are wonderful for staff of the agencies to go overseas and find out about what is happening internationally.”

Information, integration and relationship seminar

This free seminar hosted by the Menzies Centre for Health Policy at the University of Sydney will be presented by Professor Martin Connor, executive director of the Centre for Health Innovation, a collaborative venture between Griffith University and the Gold Coast Hospital and Health Service. He will present three interlocking strategies that are live within the Gold Coast HHS as part of a systematic attempt to deliver world-class patient-centred care.

5 November Sydney
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Linking data for better healthcare performance measurement
9 November Sydney
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The Bureau of Health Information (BHI) and UNSW Centre for Primary Health Care and Equity is hosting this “Challenging Ideas” event that will feature international and local healthcare experts exploring the use and benefits of linked healthcare datasets to assess performance. The keynote address will be delivered by Dr Rick Glazier, Senior Scientist and Program Lead of Primary Care and Population Health at the Institute for Clinical Evaluative Sciences, Canada.

45 and Up Study Collaborators’ Meeting

The 45 and Up Study’s 12th Annual Collaborators’ Meeting is themed: Opportunities and challenges in a big data environment. NSW Minister for Health Jillian Skinner will open the event and Professor Karen Canfell, Director, Cancer Research Division at Cancer Council NSW, will provide the keynote address on big data’s potential for predictive modelling in health. Plenary presentations will be on population-based data linkage, patients’ experiences of adverse events, visualisation of linked health data, community pathology, and genome sequencing.

12 November Sydney
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NSW Respiratory Clinical Innovations Forum 2015
27 November Sydney
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This forum, hosted by the Agency for Clinical Innovation, will target multidisciplinary clinicians and managers involved in the delivery of care to adults or children with respiratory disease across acute, subacute, community and primary care settings. NSW clinicians, managers and researchers will showcase their work across the themes of delivering evidence-based care, integrated care and effective partnerships, patient-centred outcomes and solutions to address local needs

Acute Care Taskforce (ACT) State-wide Meeting

This meeting hosted by ACI will focus on Criteria Led Discharge, with presentations from clinicians who have successfully implemented this patient-centred initiative to enhance patient flow. All Local Health Districts Acute Care Taskforce representatives are invited, along with LHD staff who have an interest in Criteria Led Discharge.

27 November Sydney
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9th Health Services and Policy Research Conference
7‒9 December Melbourne
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The Health Services Research Association of Australia and New Zealand (HSRAANZ) biennial conference at the Melbourne Convention and Exhibition Centre has the theme: “From data to delivery: Connecting research, policy and practice for better health outcomes” and will focus on the interface between research, practice and policy, with the ultimate aim of using research to improve health outcomes for society.
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