AUSTRALIAN INSTITUTE OF HEALTH INNOVATION Faculty of Medicine and Health Sciences

Research Insights SEPTEMBER 2017 2 Australian Institute of Health Innovation research insights

Join our team We welcome policy-makers, researchers, clinicians, information technologists, economists, computer engineers, students, government and industry who share our vision of health system sustainability to join our team. For more information on current research opportunities at AIHI visit aihi.mq.edu.au/study-at-aihi Australian Institute of Health Innovation Research insights 3

NHMRC Partnership Centre for Health System Sustainability

Professor Jeffrey Braithwaite, Director of community. The areas of research for the Ms Kim McClymont the Australian Institute of Health Innovation Centre which address these interconnected NSW Ministry of Health (AIHI), with Professor Enrico Coiera and components of health system sustainability are: Mr Babu Simon Professor Johanna Westbrook have been • Using analytics, technology and shared data Department of Health Western awarded a grant of $5.25 million to lead • Reducing waste and low-value care Ms Annette Schmiede and administer the Partnership Centre for • Promoting better value for the health dollar Bupa Health Foundation Health System Sustainability (“the Centre”). Professor Christine Bennett AO The Centre is jointly governed and funded to collaborators of Notre Dame Australia the value of $10.75 million over five years by The Centre will harness the expertise of NHMRC, Bupa Health Foundation, NSW subject matter experts from the public, private Our first symposium Ministry of Health, Department of Health and non-government sectors and is based An inaugural symposium was held in Sydney and the University of at , Sydney. The team on 16 March 2017 to showcase the proposed Notre Dame Australia. The Centre will of investigators on the project are: research to be conducted and stimulate critical support the implementation of research- discussion and involvement in formulating informed improvements in healthcare Professor Jeffrey Braithwaite (CI) Macquarie University the vision and future work of the Centre. system performance sustainability. It will commence in mid-2017 and will take a Professor Enrico Coiera Over 120 people attended the Symposium, co-production approach to research design and Macquarie University representing a broad range of sectors: health implementation. This research collaborative Professor Johanna Westbrook departments and government health agencies, comprises seventeen outstanding academic Macquarie University research institutions, health insurers, private health services, professional and peak bodies, and health system investigators, and a range Professor Paul Glasziou of health service providers, system managers, Bond University Local Health Districts and Primary Health policy-makers, consumers, professional Networks, hospitals, consumers and industry Professor Anthony Scott experts. Feedback was both constructive bodies and insurers from across Australia. and positive, particularly from consumers The objective of the Centre is to investigate Professor Jonathan Karnon who also attended a separate symposium and create interventions to improve health the following day designed to better harness system performance sustainability. The Centre Professor Rachelle Buchbinder consumer input into AIHI’s research agenda. will explore the issues impacting healthcare system sustainability and develop and evaluate The feedback received from the audience can Professor Robyn Ward AM be read in conjunction with the presentations a set of implementable interventions that University of are appropriate from a clinical, patient and given by all Lead Investigators available at: Dr Teresa Anderson healthsystemsustainability.com.au/ economic perspective. The outcomes of this Sydney Local Health District work will be practical in nature and relevant news-events-and-participation/ to governments at all levels. Professor Leonard Gray event-outcomes/ Research themes Professor Helena Teede Health system sustainability requires an Monash Partners Contact the Centre Coordinator at alignment of funding, strategy, delivery, Ms Leanne Wells [email protected] to performance management and information Consumers Health Forum of Australia register your interest in the Centre's to achieve optimal health outcomes, patient Ms Jennifer Nobbs research program. experience and value for money for the Independent Hospital Pricing Authority 4 Australian Institute of Health Innovation research insights

Childhood injury

Traumatic injury is the leading cause of death Fall-related injuries, poisoning and burns and and is a leading cause of hospitalisation and scalds were common among 0-5 year olds, falls long-term disability among children aged from playground equipment common among 1 to 16 years in Australia. Many of the serious 6-10 year olds and falls and road transport injuries sustained by children can have injuries were common among children aged long-term implications, such as physical 11-16 years. Children under 10 were identified disabilities and chronic pain. to be at a higher risk of mortality within “Medical and safety advances, pre-hospital 30 days after the injury. Children who sustained interventions, legislative change and the head injuries, who resided in regional Australia introduction of safety initiatives have all or who were injured following road transport contributed to increasing the survival of incidents or drowning or submersion all had children following an injury and reducing a higher risk of mortality. Associate Professor the severity of injuries sustained. Yet, in Although childhood injury has been a national Rebecca Mitchell Australia there has been no comprehensive public health priority in Australia for 30 years, E: [email protected] examination of injury characteristics and the results indicate that childhood injury has survival over time for injured children.” not significantly decreased over this 10-year “Having accurate and timely information on period, with hospital treatment cost estimated child injury hospitalisations is essential for to be $2.1 billion over this period. identifying the injury burden, determining “Childhood injury is preventable. If it does not healthcare costs and evaluating the impact reduce, it will continue to remain a burden to of injury prevention measures” explains the Australian community. The development Associate Professor Rebecca Mitchell. of a national multi-sectorial childhood injury A recent research study funded by the Day prevention strategy in Australia is long of Difference Foundation aimed to examine overdue.” Associate Professor Mitchell says. patterns of injury and hospitalisation costs in children between 2002 and 2012. Australian Institute of Health Innovation Research insights 5 6 Australian Institute of Health Innovation research insights Australian Institute of Health Innovation Research insights 7

Identification and surgical intervention for refractory epilepsy

Epilepsy is the most common serious outcomes for refractory epilepsy brain disorder in the world. Refractory patients currently being assessed for epilepsy is a complex type of epilepsy that surgery. This will provide a comprehensive leads to high rates of co-morbidity, decreased understanding of epilepsy patient health life expectancy, stigmatisation, reduced service use, a review of health data, and quality of life and extensive psychosocial most importantly, in-depth insights into the problems. One third of all refractory reported outcomes of patients and healthcare patients may be eligible for resective surgical professionals who work closely with them,” intervention, which removes part of the brain. says Professor Rapport. This can lead to positive clinical outcomes if “We hope to examine the implications efficiently managed. of delay in identifying and treating In Australia, however, a critical gap of refractory epilepsy patients who may Professor between six months to two years or more be eligible for surgical intervention. Frances Rapport exists between the initial assessment for This will better inform the rationale for E: [email protected] surgery and the surgical procedure, leading more effective referral and treatment in to extensive impact on the burden of disease the future, and guide the development and on hospital service use, in-patient of a clinical support resource toolkit treatments and costs, patient contacts and for use in the wider Australian context interpersonal relationships. that will benefit patients and healthcare Professor Frances Rapport and her team are professionals alike”. conducting a staged study in collaboration Professor Rapport says this will be the with neurology clinicians at Westmead, Royal first Australian study examining delays in North Shore, and Royal Prince Alfred Hospitals early identification, surgical assessment, in an innovative mixed-methods approach to and treatment of refractory epilepsy assessing gaps in treatment, clinical practices patients. This will provide important for refractory epilepsy patients and patient detailed understanding of challenges facing and healthcare professional experience during practitioners working in complex epilepsy. the period of initial patient assessments. The study has a unique combination of an This will be accompanied by a retrospective epidemiological examination of service use epidemiological study of all individuals alongside a year-long qualitative assessment hospitalised with a diagnosis of epilepsy of patient journeys through the healthcare in in the last five years, system across key New South Wales clinics. examining health services’ use and treatment, “The level of detail in this study will lend including refractory surgery outcomes. itself to the transferability of findings to other “We will gather robust evidence about Australian jurisdictions, and international the treatment, clinical practices and healthcare services,” she says. 8 Australian Institute of Health Innovation research insights

Computerised decision support to improve antibiotic prescribing in hospitals

There is now little doubt that the inappropriate 550 antibiotics prescribed over a 2-month use of antibiotics contributes to the emergence period in a teaching hospital in Sydney, of resistance and that improving antibiotic Australia, and compared the indications use is necessary for the containment of recorded in the ePS to the indications resistance. Studies have shown that up to 50% documented in patient medical records of antibiotics are prescribed inappropriately. (i.e. their clinical notes). We found that Many interventions designed to improve an accurate indication was recorded in antimicrobial prescribing in hospitals have the electronic system in only 39% of the been trialled with varying levels of success. antibiotics reviewed. In 31% of cases, no One intervention shown to significantly indication was recorded in the electronic increase appropriate use of antibiotics is system at all, even though this information computerised decision support embedded in was mandatory. Instead, prescribers entered Dr Melissa Baysari electronic prescribing systems (ePS). nonsensical text (e.g. “fsdf”) or entered E: [email protected] Computerised decision support can take punctuation (e.g. “.”) to move onto the next many forms. For example, computerised screen in the system,” says Dr Baysari. alerts can trigger at the point of prescribing “Prescribers were interviewed and we to warn prescribers that a particular identified that there were a number of antibiotic is restricted, or drop-down lists reasons for inaccurate documentation of can restrict the use of antibiotics to particular indications in the electronic system.” A key indications (reasons for use). The design of factor was found to be that indications decision support assumes that prescribers entered into the ePS were not monitored or will record or select accurate indications followed-up. Although ePS enable greater in the ePS. For example, it is assumed that visibility, and as a consequence, greater prescribers will select an indication from a accountability than traditional paper-based drop-down list that accurately reflects what systems, this research has shown that they intend to use the antibiotic for. this benefit is realised only if computerised In this research, Dr Melissa Baysari and her data are reviewed and followed-up. team set out to determine whether this was Thus, implementation of computerised actually the case. “Specifically, we aimed to decision support, although often viewed as determine whether the indications recorded a panacea to inappropriate antibiotic use, by prescribers in an ePS reflected true may require ‘human’ support and resources indications for use. To do this, we audited to achieve anticipated benefits. Australian Institute of Health Innovation Research insights 9

“Studies have shown that up to 50% of antibiotics are prescribed inappropriately. Many interventions designed to improve antimicrobial prescribing in hospitals have been trialled with varying levels of success.”  Dr Melissa Baysari

Australian Institute of Health Innovation Research insights 11

Ageing well Improving Social Engagement in Older Adults

Older adults often feel fulfilled when they “Our work so far has examined the engage and participate in their community. levels of social engagement and quality Existing evidence shows that it contributes of life of over 340 consumers in Sydney. to increased quality of life. We’ve received very positive feedback from However, as adults age they are more likely community care staff that administered to suffer from social isolation and are often the tool, ranging from its ease of use, to unable to participate like they once did finding out important information that in the community. Community aged care they would otherwise not have known. providers aim to improve service delivery to Importantly, on a practical level, the staff enhance social engagement and quality of were able to identify consumers’ needs life in older adults. and utilise that information to deliver appropriate services.” “Ideally, community care providers should Professor Andrew Georgiou This research is now undergoing additional be able to identify what older people need E: [email protected] to reconnect with society,” explains analyses and will explore the relationships Professor Andrew Georgiou from the Centre between social engagement and client for Health Systems and Safety Research. outcomes such as quality of life, and health “This should involve a list of options that outcomes, such as hospitalisations, and matches their requirements and successful transition to residential care. pairing of activities and services to “This is a great opportunity to harness the ensure that older adults are provided the power of big data to monitor service use and opportunity to build long-lasting social outcomes, and to understand the profiles of networks and connections.” older adults who are more or less socially Professor Georgiou co-leads a team of engaged,” says Dr Mikaela Jorgensen, researchers with Professor Johanna Westbrook a Research Fellow on the team. aimed at using social engagement instruments From this work, an evidence base can be to enhance the appropriateness and quality of created to inform the community aged community aged care service delivery. care sector about the specific factors which Dr Joyce Siette affect social engagement, the quality of “This is quite an exciting new area of research. E: [email protected] There is a definite lack of focus on how we care, and allow for future tailoring of quality can integrate technology to improve social improvement initiatives and interventions. engagement and improve outcomes,” says This research is funded by an ARC Linkage Dr Joyce Siette, a member of the research team. Grant with Uniting. 12 Australian Institute of Health Innovation research insights

Using Twitter as a signal of public opinion about HPV vaccines

Human papillomavirus (HPV) vaccines the United States and followed users who are a relatively recent introduction to the posted tweets about HPV vaccines, to look armament of public health and despite at which topics were likely to have received their potential to reduce rates of cancer more attention in each of the 50 states. (especially cervical cancer), coverage varies We found that differences in exposure to certain substantially across and within countries. topics could be used to explain differences in The variable coverage partly relates to how state-level HPV vaccine coverage, and models easy it is for people to access the healthcare built from Twitter data could be used to they need, and partly relates to acceptability explain more of the differences than models – the perception of the risks and benefits of built from socioeconomic information like the vaccine in the public. insurance coverage, poverty, and education. In our research in the area, we have been The results of our research suggest that Dr Adam Dunn using very large scale datasets from Twitter to Twitter might be useful as a signal of vaccine E: [email protected] characterise the way HPV vaccines have been acceptance. In the same way as rain gauges represented, how people in different locations are spread out across a region to help estimate might have been exposed to different rainfall, our research suggests that monitoring types of information about HPV vaccines, the information diets of Twitter users might and checked to see whether differences help us estimate public opinion by location or in populations’ information diets can help by community. explain differences in coverage. With new funding from the NHMRC to Our most recent study used topic modelling investigate vaccine misinformation in the – a machine learning method for grouping public domain, we are now expanding on documents based on natural clusters in their this work to help Australian public health language – to group more than 250,000 tweets organisations better track the specific about HPV vaccines posted in 2014 and 2015. vaccine concerns that cluster within certain We then looked at the locations of more than communities in Australia, and better track the 34 million Twitter users who were based in impact of their health promotion activities. Australian Institute of Health Innovation Research insights 13 14 Australian Institute of Health Innovation research insights Australian Institute of Health Innovation Research insights 15

Improving the safety of digital health by understanding risks to patients

The use of information technology (IT) or factor issues were proportionally higher in digital health is revolutionising healthcare, the events involving patient harm.” with 97 per cent of GPs using electronic “For example, if prescribing systems require records systems and IT systems playing a users to scroll through too many options, mission-critical role in hospitals. or they are not arranged intuitively, then “IT has the potential to bring many benefits to patients may be prescribed the wrong quality and safety but we need to understand medication simply through a pick list error.” the risks as well,” explains Associate Professor “How many times have you hit the send Farah Magrabi, who leads the Centre for button on your email and said ‘oops’, or Health Informatics’ research program on mistakenly picked the wrong option when Patient Safety Informatics. shopping online? It’s easy to do, but when Her team has pioneered the study of IT-related that happens in health there can be real Associate Professor harms by looking at different data sets from consequences,” she says. Farah Magrabi both Australia and overseas to help identify Associate Professor Magrabi says that risks E: [email protected] the role IT plays in patient safety risk. inherent in IT are also different from other “We have made a major contribution to sources of risk. documenting the risks of IT to patient safety “A safety incident such as a fall is usually by examining incidents in Australia, the USA confined to one patient, but an IT incident and England,” she adds. “From our analysis has the potential to expose multiple patients of IT safety events, we have developed a new to the risk of harm.” classification system for IT risks. This has “In 2015 for example, an IT system failure become the de facto international standard affected hospitals across an Australian state. for analysing IT safety events.” We know from our analysis of UK data that “Our work is also shaping policy to govern IT such events can disrupt the delivery of care safety in Australia and overseas.” and harm patients.” Risks arise when technology does not work It’s an issue we need to take seriously, she as intended, for example, when a prescribing adds. “We need to be actively managing the system fails to display important allergy risks of digital health alongside our efforts to information, patients can be harmed. introduce technology.” Risks also arise when technology does not “By better understanding the origins of fit with our bodies or cognitive abilities. this risk, problems can be detected early “Our analyses of safety events across England and we can mitigate hazards ahead of over a five-year period revealed that human harming patients.” 16 Australian Institute of Health Innovation research insights

Collaboration RECENT Institute seminars

Modernising patient safety: Evolving models of health The bright and dark side of Reconciling work-as-imagined consumer and community knowledge mobilisation: Learning and work-as-done engagement in the Australian from a large-scale collaborative Presenter: Professor Jeffrey Braithwaite health sector research partnership Founding Director and Director of the Centre Presenter: Ms Serena Joyner Presenter: Dr Roman Kislov for Healthcare Resilience and Implementation Consumer Engagement Manager at Health Research Fellow in the Health Services Science, AIHI, Macquarie University Consumers NSW, Australia Research, Manchester Business School, University of Manchester, UK Towards an exnovative turn The many lenses of HPV in patient safety research vaccine hesitancy Clinical work patterns, safety and Presenter: Associate Professor Presenter: Ms Gilla Shapiro health information technology Jessica Mesman PhD candidate in clinical psychology at Presenter: Professor Johanna Westbrook Maastricht University, The Netherlands McGill University, Canada Director Centre for Health Systems and Safety Research, AIHI, Macquarie University Diagnostic errors: A new Populating patient safety: A new chapter in patient safety perspective on intersectional Making care safer through EHR's improvement science patterns of iatrogenic harm Presenter: Professor Chris Lehmann Presenter: Associate Professor Presenter: Professor Joanne Travaglia Professor for Pediatrics and Biomedical Hardeep Singh Professor of Health Management, Informatics, Vanderbilt University, USA Michael E. DeBakey VA Medical Center and and the Director of the Centre for Baylor College of Medicine, Houston, USA Health Services Research, University Resilient leadership: Exploring the of Technology, Sydney most appropriate leadership style Working with patients and for resilient organizations within professionals in setting research Not your average guideline: the health care sector priorities: The case of ENT, Hearing Clinical pathway discovery from Presenter: Associate Professor and Balance electronic health record data Eric Arne Lofquist Presenter: Associate Professor Presenter: Professor Rema Padman BI Norwegian Business School, Anne Schilder Professor of Management Science and Bergen, Norway Professor of Otorhinolaryngology at the Healthcare Informatics in the H. John UCL Ear Institute and at the University Heinz III College at Carnegie Mellon Making good quality care Medical Center, Utrecht, The Netherlands University in Pittsburgh, USA habitual: An exploration of the concept habit in relation The relationship between using Antimicrobial stewardship for UTI to healthcare professional electronic health records and in US nursing homes behaviour meeting accreditation outcomes Presenter: Associate Professor Presenter: Mr Sebastian Potthoff in Australian residential aged Heidi Wald Doctoral Research Fellow, Institute of Health care homes Associate Professor of Medicine, and Society, Newcastle University, UK Presenter: Associate Professor Ping Yu University of Colorado, USA and Visiting Director of the Centre for IT-enabled Professor, AIHI, Macquarie University Increasing the effectiveness Transformation, Faculty of Engineering and understanding of health and Information Sciences at University of Creating learning systems for informatics interventions Wollongong, Australia quality improvement through theory-informed, Presenter: Ms Carrie Marr unobtrusive quantitative process Research solution to chronic Chief Executive, The Clinical Excellence evaluations disease burden in the community: Commission (CEC) Presenter: Mr Wouter Gude Osteoarthritis Department of Medical Informatics, Presenter: Professor David Hunter Academic Medical Center, University of Florance and Cope Chair of Rheumatology Amsterdam, The Netherlands and Professor of Medicine at The , Australia Australian Institute of Health Innovation Research insights 17

The Institute delivers a regular lunchtime seminar program to encourage the exchange of ideas across the Institute, University and health sector both nationally and internationally. We invite distinguished professionals to our offices at Macquarie University to give presentations on topics of current interest. Speakers may discuss recently completed or early-stage research they have undertaken or report other types of professional activity they are involved with. The topics presented align closely with the Institute’s current research directions. Below is a list of seminars held in the last financial year ending 30 June 2017.

Delivering best practice in Germany: Expedited drug approval programs The economics of patient safety: specialist multidisciplinary care in the United States and Canada OECD report on a value-based for motor neurone disease patients Presenter: Professor Emeritus Joel Lexchin approach to reducing patient harm Presenter(s): Dr Johannes Dorst and the York University, Canada Presenter: Mr Luke Slawomirski MND Clinic Team Health Economist, OECD Health Division, Department of Neurology, University of Conflicts of interest in medicine: Paris, France Ulm, Germany taking diversity seriously Presenter: Dr Wendy Lipworth Taking innovation to the bedside Enhancing the validity of the Senior Research Fellow, Centre for to improve outcomes: empowered conceptual framework for a new Values, Ethics and the Law in Medicine, improvers at Cincinnati Children’s PROM of perceived listening effort The University of Sydney Presenter: Professor Stephen Muething in hearing loss Professor, Department of Pediatrics, Presenter: Ms Sarah Hughes Public, private and both: University of Cincinnati, USA, South Wales Cochlear Implant Programme, UK organisational hybrids and change Fulbright Scholar in healthcare Being willing to see things clearly: Presenter: Associate Professor Consumer perspectives, leadership lessons for quality Simon Bishop telehealth and the impact on improvement Associate Professor in Organisational healthcare systems Presenter: Professor Paul Levy Behaviour, Nottingham University Presenter: Dr Malcolm Fisk Author, speaker and corporate adviser and Business School, UK Senior Research Fellow, Centre for Computing former President and Chief Executive Officer and Responsible Research, De Montfort of the Beth Israel Deaconess Medical Center, Scale up systems for faster more University, Leicester, UK Boston, USA widespread take up of improvements in healthcare – research and Data mining in pathology Three islands in the sea of data: development challenges and Presenter: Dr Tony Badrick observations on out of pocket solutions Chief Executive, Royal College of expenditure, alcohol consumption Presenter: Professor John Øvretveit Pathologists of Australasia Quality and hysterectomy Professor John Øvretveit, Karolinska Assurance Programs (RCPAQAP) Presenter(s): Emeritus Professor Institutet, Sweden, Visiting Professor AIHI, Stephen Leeder and Emeritus Professor Macquarie University Strategies for changing the health Farhat Yusuf system: Implementing a clinical Menzies Centre for Health Policy, Analysis of skilled nursing pathway for anxiety and depression The University of Sydney, Australia facility transfers using a quality in cancer patients improvement tool Presenter: Professor Phyllis Butow AM From the bench to the bedside and Presenter: Professor Greg Alexander NHMRC Senior Principal Research Fellow, back, the TCRN as an example of University of Missouri, Sinclair School School of Psychology, The University of Sydney fostering translational research of Nursing, Fulbright Scholar, Visiting Presenter: Professor David Goldstein Professor, AIHI, Macquarie University Conjoint Clinical Professor, UNSW Sydney Prince of Wales Clinical school and Director Health services research in South UNSW Sydney Cancer Institute NSW Western Sydney Translational Cancer Research Centre Presenter: Professor Geoff Delaney (TCRN), Australia Director of Cancer Services for Sydney South West Area Health Service, Australia A new informatics geography Presenter: Professor Enrico Coiera Director Centre for Health Informatics, AIHI, Macquarie University

‘Our work is shaping policy to govern IT safety in Australia and overseas.’ Associate Professor FARAH Magrabi Australian Institute of Health Innovation L6, 75 Talavera Road Macquarie University New South Wales 2109 T: (02) 9850 2400 mq.edu.au

Professor Jeffrey Braithwaite Founding Director, AIHI Director, Centre for Healthcare Resilience and Implementation Science E: [email protected] Professor Johanna Westbrook Director, Centre for Health Systems and Safety Research E: [email protected] Professor Enrico Coiera Director, Centre for Health Informatics E: [email protected] Mr Reza Bilimoria Institute Manager E: [email protected]

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