Research Stream 4
How can we embed and scale proven interventions in policy and practice?
Research overview
Streams
Stream 1: Exploration
Stream 2: Preparation
Stream 3: Implementation
Stream 4: Sustainment
Seed funding
Sustainability, spread and scale-up of promising interventions is a widely recognised challenge in health services research. Innovations that research has demonstrated as successful fail to become embedded in the habits, routines and infrastructure of health care organisations or scale beyond the immediate project setting. In this stream, we will develop and evaluate strategies to address these issues at both research project and health system levels. We will also develop and evaluate a framework for real-time policy evaluation to monitor and inform the significant aged care policy changes that are occurring in Australia.
Project 4.1: Scale and sustainment at a project level: iSupport for carers of people with dementia
Project leads: Professor Lily Xiao
Rationale: Guided by the Medical Research Council (MRC) Framework for designing and evaluating complex interventions, the iSupport program has demonstrated effectiveness as a model for supporting carers of people with dementia – one of the main conditions affecting older people as they age and placing a considerable burden on unpaid, informal carers. However, translating the intervention from proof of efficacy within a clinical trial to wider scale-up and sustainability as a routine offering available to informal carers requires a detailed appreciation of implementation barriers and enablers, and strategies to address them, including relevant funding mechanisms and policy levers. We will use iSupport as an exemplar of moving along the translation pathway to scale and sustainability, building on prior research led by Professor Lily Xiao with health and aged care partner organisations.
Project 4.1 will build on Professor Xiao’s previous work with 2 hospitals and 2 large aged care providers to adapt, evaluate and implement the WHO iSupport program in a local context. The next phase of research to be undertaken within the CRE will identify transferable strategies and funding/policy levers to inform scale-up and sustainment of proven interventions by conducting a hybrid type 3 implementation-effectiveness trial. Implementation will be monitored by an embedded process evaluation and outcomes evaluated using the RE-AIM framework (reach, effectiveness, adoption, implementation and maintenance).
Project 4.2: Sustainment at a health system level: Establishing a state-wide aged care observatory
Project leads: Professor Gillian Harvey, Professor Kate Laver, Professor Gillian Caughey, Professor Craig Whitehead
Rationale: Analyses from the ROSA registry show that older people in receipt of Commonwealth funded home care are especially vulnerable to unplanned hospital presentations and admissions. As described in Project 3.2, a lack of integrated information systems across acute, primary and aged care means this population cohort are often invisible in the health system. This project will develop and test a sustainable digital intervention, embedded in the statewide electronic medical record, to identify older people in receipt of home care when they enter hospital, and manage their care appropriately.
We will create a new Aged Care Observatory to enable knowledge and data exchange across settings and enhance understanding of patterns of use, including equity of access, and provide a way of routine monitoring of care pathways and outcomes to inform policy and funding decisions. We have previously worked in partnership with SA Health and the Commission for Excellence and Innovation in Health (CEIH) to successfully link an enhanced discharge note in the hospital electronic medical record (EMR) with a clinical dashboard. This digital capability flags older people moving to permanent residential aged care for the first time and stratifies their risk of re-presentation to hospital using an algorithm developed by ROSA to initiate and trigger a nurse-led transitional care intervention. We will build on these studies in collaboration with CEIH to apply a range of advanced data analytics (including large language models) to the EMR to identify the cohort of older people receiving home care and establish an Aged Care Observatory within SA Health. We will test the application of the Aged Care Observatory to develop and evaluate a transitional shared care model to improve integration across services and reduce avoidable hospitalisations in Project 3.2.
Project 4.3: Developing methods for real-time policy evaluation
Project leads: Associate Professor Rachel Milte, Professor Tracy Comans, Professor Julie Ratcliffe
Rationale: The Australian aged care industry is going through an unprecedented period of change, to ensure the system is fit for purpose for the coming decades. The Australian Government will be implementing the biggest changes to aged care since the last Aged Care Act was passed in 1997. Over the past two decades, the expectations of consumers on how the government should implement and evaluate their activities have changed significantly. The extent and volume of changes to be implemented in the aged care system require timely and efficient methods for evaluation, both to understand whether the changes are being implemented as intended, if their objectives are well aligned, and if any unintended consequences have occurred. This will facilitate adaptation and refinement of new policies as they are being implemented, thus promoting the best outcomes for our health and aged care systems, government and consumers. For this to occur efficiently, instead of re-inventing the wheel for each evaluation of a specific change in the system, we will develop a framework for evaluation across the sector, ready for implementation to provide real-time feedback on roll-out of policy changes. This will save time and ultimately resources and ensure evaluation can occur when it is needed to inform future implementation and policy change.
We will undertake a comprehensive process of co-design to create a fit for purpose evaluation framework which will cut across the silos of health (acute and primary) and aged care to provide a whole-of-system lens and meet the current needs of aged care policy makers. Workshops will be held involving policy makers, health and aged care professionals, peak-bodies and consumers, including from priority populations, to develop a framework for evaluation, drawing on resources developed more generally for evaluation of government programs and public health policy. From this, a process of peer-review, where the framework is evaluated in detail by experts in the field will be undertaken. The result will be a comprehensive evaluation framework to provide a clear picture of the success (or otherwise) of policy reforms which cut across the health and aged care system, to support evidence-based policy making.