An overview of research projects and directions of the Simpson Centre

Transcription

1 An overview of research projects and directions of the Simpson Centre 2014 AIHI Research Symposium Associate Professor Jack Chen MBBS PhD MBA(Exec) Simpson Centre for Health Services Research Australian Institute of Health Innovation & South Western Clinical School The University of New South Wales

2 Outlines Who we are What is the focus of our research Howe we are going to do it What we are doing What is the plan for future research

3 Who we are 1. We are mostly interested in doing translational research, in particular, in developing and evaluating complex system intervention in improving patients safety and quality of care 2. We are a small centre which pouches over its weight 3. We have one of the longest practicing intensivists as our director (Prof. Ken Hillman)

4 Where is the Simpson from? 4 John "Jack" Simpson Kirkpatrick (6 July May 1915), who served under the name John Simpson, was a stretcher bearer with the Australian and New Zealand army Corps (ANZAC) during the Gallipoli Campaign in World War I. After landing at ANZAC Cove on 25 April 1915, he obtained a donkey and began carrying wounded British Empire soldiers from the frontline to the beach, for evacuation. He continued this work for three and a half weeks, often under fire, until he was killed. Simpson and his Donkey are a key part of the ANZAC legend".

5 5 The ANZAC Legend

6 The legend or myth? 6 That Simpson had ''saved the lives'' of at least 300 Diggers. Historian:it was physically impossible for Simpson to have assisted more than half that number of wounded in the few weeks before his death

7 Our People 7 Director & Professor Ken Hillman (PA: Mrs. Sue Williams) Associate Professor & Senior Research Fellow Jack Chen MBBS PhD MBA(Exec) Senior Research Fellows: Dr. Roberto Forero & Dr. Magnolia Cardona-Morrell Research Follows: Dr. Lixin Ou MPH MBA PhD Dr. Stephanie Hollis BSc DipEd BEd MMedSc PhD Dr. Hassan Assareh BEng BSc MSc MEng PhD Research Officer: Ms Brydon Leme (PhD candidate) PhD Candidates: Alvin Tay & Dr. Su-Jen Yap

8 The focus of our research: complex system intervention and evidence-based health policy through 1. Well-designed cluster randomised controlled trials(crct) and simple RCT (23-hospital crct MERIT study, simple RCT on stroke model) 2. Rapid systematic and structured review on the evidence-base of important health policies (EOL, Public Reporting, Patient Reported Outcomes, Overcrowding in ED) 3. Large population-based data-linkage and mixed- method study 4. Landmark longitudinal studies (Longitudinal Study of Australian Children (LSAC) and 45s and Up study)

9 The research projects currently we are doing - 1 The evaluation of the effectiveness of the medical emergency team (MET) (NHMRC funded & led by A/Prof Jack Chen) The evaluation of the world first state-wide Between the Flags program by the Clinical Excellence Commission of New South Wales a population-based mixed method study (NHMRC funded & led by A/Prof Jack Chen) The evaluation of the world first state-wide Blood Watch programme by the Clinical Excellence Commission (CEC) of New South Wales (Joint project with CEC, National Blood Authority and led by A/Prof. Jack Chen; finalising two papers) The evaluation of a new health services model in stroke patients (NHMRC funded & led by Professor Daniel Chan with A/Prof Jack Chen as one of the CIs: Chan et al, 2014: International journal of Stroke)

10 The research projects currently we are doing - 2 BTF goes wireless: Rapid Response to wireless detection of deteriorating patients: ( Part of the NHMRC Program grant: Professors Ken Hillman, Johanna Westbrook, Jeffrey Braithwaite, A/Profs Joanne Callen, Julie Johnson & Drs. Magnlia Cardona- Morrell, Mirela Prgomet) Validation and Impact of the four-hour rule in the Emergency Department : A large data linkage study: ( Funded by an NHMRC partnership grant and led by Dr. Roberto Forero & Prof. Ken Hillman) The Medical Emergency Response Intervention Therapy (MERIT)- a 23-hospital cluster randomized controlled trial (led by A/Prof. Jack Chen, another four papers planned)

11 The evaluation of the effectiveness of the medical emergency team (MET) a large population based data linkage study 1. a state-wide survey of RRS status across all public hospitals 2. the ethic approval extension in order to survey all the private hospitals as well 3. a population-based data linkage study was done: two important papers published or accepted: three under review Chen J, Ou L et al. MJA accepted; 2014: the largest study to show that a MET reduced CA and its related deaths by 50%; it potentially saved over 12,000 patient lives per annum. Chen J. Ou L et al. Resuscitation, final review; Ou L, Chen J, et al. Trends of failure-to-rescue (FTR); published PLOS One; 2014 Ou L, Chen J, et al. Why sepsis is till a major killer in NSW hospitals ; 2014; under preparation Assareh H, Ou L, Chen J, et al. Geospatial distribution of FTR; under review. Assareh H, Chen J, Ou L, et al. VTE epidemiology & its policy implications; under review

12 The trends of cardiopulmonary arrest and mortality and their association with rapid response system expansion. (Chen J, Ou L et al. 2014; MJA accepted) Number of events per 1,000 admissions > 12,000 patient lives could have been saved per annum if all hospitals in Australian had implemented a RRS. Over 80,000 cardiac arrest related deaths may be prevented by the RRS alone in the USA no any other single intervention had claimed such a benefit; 95% reduction in cardiac arrests related deaths over the period was due to prevention instead of resuscitation technology. Redefine resuscitation Mortality IHCA mortality IHCA % of RRS % o 40 f R 30R S

13 The evaluation of world-first Between the Flags program by the Clinical Excellence Commission A mixed-method study (the academic partner of CEC on BTF) Three sub-studies: 1. A statewide online survey of hospital staff s perception of the BTF program and its implementation ( A summary report to CEC and an individual report for each local health district; a paper under preparation) 2. A ten-session hospital focus group study (Report submitted to CEC Academic Research Committee of BTF; and a manuscript is under preparation) 3. A six-year population-level data linkage study : pilot study done and waiting for the final data delivery from CHeReL

14 What are we planning to do? -1 Continue our reputation as the worldleading centre in developing and evaluating new systems in providing optimal health care to those in-hospital critically ill patients 40+ papers and book chapters on the topic The European Intensive Care Society Research Prize Winner Leading thinking tank for IHI Save 100,000 lives & Save 5 millions lives campaign MET/RRS recommended in the USA, the UK, and Australian (Standard 9) Our MERIT Lancet publication (Hillman& Chen et al, 2005) was cited over 550 times so far

15 What are we planning to do? Explore the effectiveness of BTF on reducing children cardiac arrests and related deaths an NHMRC grant application submitted: led by Associate professors Jack Chen & Arthas Flabouris 2. Evaluate another world-first, state wide Sepsis Kills program by the CEC and Agency of Clinical Innovations an NHMRC project grant submitted led by Associate Professors Jack Chen & Arthas Flabouris an NHMRC partnership grant with CEC is currently under discussion.

16 Figure: The incidence and mortality of sepsis and severe sepsis in elective surgical patients (Ou & Chen et al, 2014) Incidence rate Mortality Severe sepsis All sepsis Sepsis without organ dysfunction % Severe sepsis All sepsis Sepsis without organ dysfunction Year Year

17 Figure: Trends in the proportion of severe sepsis among all sepsis (a) and the proportion of severe sepsis related deaths among all in-hospital deaths (b) a. Severe sepsis among all sepsis b. Severe sepsis related deaths among all in-hospital deaths % Observed Adjusted % Observed Adjusted Year Year

18 What are we planning to do? To evaluate the AMBER (end of life planning) project which is currently piloted in New South Wales hospitals by the CEC (The first attempt to develop a system response to inappropriate EOL) 5. To develop and test an integrated system (MET/RRS/Sepsis/EOL and related automated patients stratification and monitoring system) in dealing with critical ill and end-of-life patients (its cost saving and improving care quality potential)

19 We also plan to: Develop suitable indicators in measuring system performance in treating critical ill patients such as cardiac arrests and its related deaths, overall hospital mortality; failure-to-rescue (sepsis, VTE, pneumonia; GI haemorrhage; renal failure; cardiac arrests and cardiac shock); deaths in low mortality DRG categories 2. Understand the methodological and conceptual challenges facing public reporting and performance comparison between care providers: the risk of risk adjustment ; the issues of over-reporting and under-reporting of comorbidities and its impact on the performance reporting ; the most appropriate statistical methods in the risk adjustment models and in the comparison between care providers; (O-E difference; Funnel plot method; Multilevel modelling based approaches CMS ) needs for a Monte Carlo Simulation study to provide assurance on the proper methodology in the Australian Setting.

20 We also plan to: To evaluate the new care model in blood management (not only the reduction of unnecessary red blood cell transfusion) with CEC 4. To continue our collaborations with both Chinese Health Authorities (National Institute of Hospital Administration, Health Ministry of China, National Medical Information Institute, Shanghai Centre of Disease Control ) and academic groups (We have just signed an MOU with a Consortium of 15 most leading universities in China which was led by Department of Health Management, Fudan University China to further the work on Chinese Health Care Reform.

21 We also plan to: Continue our researches (as one the longest participating research groups) based on the landmark Longitudinal Study of Australian Children (LSAC)) in addressing the most challenging health problems facing ethnic Australian children (such as the epidemiology and developmental trajectories of obesity among ethnic and Indigenous Australian children: two manuscripts under preparation) 6. Collaborate with researchers both nationally and internationally in developing and evaluating the most challenge complex interventions in order to improve care quality, reduce cost and improve patient experience.

22 Thank you!!