Advances in health outcomes assessment: Implications for current practice
Health outcomes seminar series with Dr John Ware
Adelaide, 5 May 2011
Attended by Bradley Smith, Belinda Lunnay & Rachel Katterl, PHC RIS
Dr John Ware, Professor and Chief, Outcomes Measurement Science at the University of Massachusetts Medical School, a world authority on healthcare outcomes assessment (and developer of the SF-36 general health survey), visited Adelaide in May as part of a national health outcomes seminar series. Dr Ware focused on the application and interpretation of patient reported health outcome measures, as well as the implications for current practice.
The underlying theme of the seminar was the principle that health outcomes should be measured on a continuum (over four domains) in order to cover everything from clinical to generic information. The domains include biomarkers of disease-› symptoms-› functional implications of impairments-› general health outcomes. The best measures are those that use a combination of these domains (for example, the HR-QOL). However this may not necessarily be found within a single measurement instrument. The use of multiple domains of evidence supports the case more comprehensively and convincingly.
In his research, Dr Ware follows the simple idea that "patients are the experts on what they are able to do and how they feel". He adds that generic measures (such as general wellbeing, eg. "Overall, how would you rate your health during the past 4 weeks?") can provide extremely complimentary, useful and predictive information, and should be applied to all health outcome studies. He demonstrated this by asking the audience whether a walk test on a treadmill (requiring patient to stop when experiencing pain) provides a valid indicator of pain and quality of life impact for a particular patient.
Dr Ware also mentioned the importance of addressing the needs of different audiences. For example, data on the mobility or flexibility of a limb may be important to policy makers, but for others (eg. the patient's GP) determining the patient's experience may be just as important. It is also necessary to consider the practical significance of the data being used. Practical and statistical significance do not always point to the same conclusions when it comes to the real life significance of results.
Dr Ware concluded with the hope that health outcomes will become standardised throughout the world to enable appropriate comparisons between different populations.
For more information about Dr Ware's research see <http://jwrginc.com/>
 Adolescent Health: Embrace the Future, Better the World
24th East Asian Medical Students’ Conference (EAMSC) 2011
Bangkok, 19-23 January 2011
Written by Victoria Cox (University of Adelaide Hons III&IV) &
Marta Zajaczkowska (University of Western Sydney MBBS IV) on behalf of the Australian delegation, sponsored by PHC RIS
EAMSC 2011 proved to be an enlightening and eye-opening conference which highlighted the importance of recognising issues affecting adolescents such as alcohol and drug abuse, body image disorders, sexual abuse, unwanted pregnancy and mental illness.
The academic program was based around group activities with keynote lectures. Each group had a topic and scenario which we discussed in small groups over the course of the week and made a presentation on the final day. Groups discussed ways in which adolescents could be encouraged to engage in healthy thoughts and behaviours, both at an individual and community level. Keynote lecturers included Dr Maureen E Birmingham, who as the WHO representative to Thailand discussed a global overview on adolescent health.
Australia’s academic poster and paper teams addressed the theme by exploring issues that are pertinent to Australian youths. The paper team explored the importance of skin cancer prevention through altering sun exposure behaviours. The paper was written and presented by Trung Nguyen, Jim Soares, Frances Chen, Harshita Rajasekariah, Victoria Cox and Kathleen Lim. The poster presentation allowed for a creative visual representation of the issue of body image: the team consisting of Deepa Mahananda, Paulina Suo, Matthew Crilly, Jacqueline Loprete and Marta
Zajaczkowska did an excellent job of demonstrating the multifactorial nature of body image by looking at a number of contributors to a negative self-perception. Congratulations should go to both Paper and Poster teams for their detailed research and well presented work.
This Conference was an enriching opportunity that imprinted onto all Australian delegates the importance of adolescent health issues and their impact on the future. Without proper understanding and recognition of adolescent health problems and neglect of care, many of the issues present during adolescent years will continue on into adulthood - affecting society and the future generations.
We would like to thank all sponsors for their generous contributions which helped provide us with the opportunity to experience this highly rewarding and prestigious conference.
Further information is available at <www.eamsc2011.com/>
Diffusion, spread and sustainability of innovation
Knowledge translation & exchange masterclass
Canberra, 29 March 2011
Attended by Petra Bywood, PHC RIS
The Masterclass, presented by Professor Jonathan Lomas,was based on the concept of an 'innovation adoption chain'. The key message was that both individual and organisational factors are required to create a receptive context for adopting innovations, by changing structures, processes and cultures.
Despite the size of the audience (~30), Jonathan's engaging manner enabled a very interactive discussion, beginning with the concept of innovations: who initiates them, why people are resistant to adopting them and why it is important to ensure that only proven, evidence-based innovations are adopted and spread. The main challenges to spread of proven innovations are the very elements that make them innovations, including:
- novelty: the status quo dominates and people typically resist novelty and change
- problem-orientation: identifying 'the problem' elicits a defensive response, such as "it won't work here".
Despite strong evidence to support an innovation (eg. citrus juice to avoid scurvy in sailors), stronger forces (eg. status quo and vested interests) may delay adoption and spread. Barriers to adoption may be overcome when a number of elements are established to smooth their progress.
The three interlinked stages of the 'innovation adoption chain' are:
- Production/evaluation: Linkage and exchange between the creators/evaluators of an innovation and the potential end-users. "The best way to spread innovation locally is to co-produce the evaluation"
- Dissemination: Importance of networks, 'communities of practice' and other social (rather than technical) processes of dissemination. "Disseminating and spreading innovation is a contact sport - more of a social process than a technical fix"
- Adoption (behaviour change): Need to balance better dissemination processes (by the creators) with better receptor capacity for evidence-based innovations (by the adopters). "It is as important to equip adopters in the system with the tools to find and use proven innovations as it is to help evaluators (and others) to disseminate them – 'pull' versus 'push'".
Think Global!
Scottish School of Primary Care (SSPC) Annual Conference 2011
Edinburgh, 19‑20 April 2011
Attended by Ellen McIntyre, PHC RIS
 Edinburgh turned on great weather for the 100 or so delegates who congregated there for the SSPC Conference. The four keynote speakers were excellent both in their presentation style as well as the substance of their talk.
Professor Jane Gunn, from the University of Melbourne and the current SSPC Visiting Fellow, outlined a mixed methods approach to mapping the longitudinal patterns of depression. She used this example to describe how primary health care research focuses on time, individuals, their experience and symptoms.
Professor Carmel Hughes from Northern Ireland was the first pharmacist to be awarded a Harkness Fellowship in Healthcare Policy. Carmel outlined the lessons learned from her research on nursing home care and the use/misuse of medications - regulation works, information is care, and research matters.
Senior Scientist Merrick Zwarenstein came from Toronto to present the research he has conducted on health service delivery in South Africa over a decade. This has led to the formation of national policy on primary care of HIV/AIDS. Implementation of the service delivery is based on designing care for the setting, using existing knowledge and experience, producing short key messages, being interactive, and providing training that is in-service and on-site.
Professor Jan de Maeseneer, from Ghent University, Belgium, provided delegates with a fast paced presentation of a global approach to general practice focusing on the social determinants of health. He outlined how 'proportionate universalism' (whereby actions are universal but with a scale and an intensity proportionate to the level of disadvantage) would reduce the steepness of the social gradient in health.
The concurrent papers and posters covered a range of topics from multi-morbidity, clinical decision making, early assessment and nursing, workload, organisation of care, prescribing, mental health, and cancer. Workshops covered topics from mindfulness practice to weight management and knowledge exchange.
The content presented at this conference as well as those who attended ensured that the conference theme Think global! worked well.
For further information visit <www.sspc.ac.uk/events/sspc_conference2011.htm>
 Better health, safer care, lower costs
International Forum on Quality & Safety in Healthcare
Amsterdam, 5-8 April 2011
Virtual delegate Petra Bywood, PHC RIS
The Conference attracted 2 800 delegates from 83 countries plus a large number of 'virtual' delegates, who could 'attend' at their leisure. Following the theme of: Better health, safer care, lower costs, there were six streams of presentations, including:
- Clinical improvement and innovation
- Leadership and business management
- Learning education and culture
- Patient partnerships
- Safe and reliable care
- Service redesign and transformation.
Keynote speaker, Maureen Bisognano, described global changes, such as ageing populations, obesity trends and the increasing complexity of care, which has led to patients seeing many different health care providers. Typically, patients report poor communication between their different providers and with the patient; and the focus of care is on the intervention or treatment rather than the patient. That is, care should be "a journey - not a visit", particularly for patients with chronic or complex conditions.
Maureen also outlined the IHI philosophy of "All-teach, All-learn", describing a number of strategies to facilitate improvements in the quality and safety of patient care:
structured huddles: fast and focused impromptu meetings in which everyone contributes and a proactive decision emerges
'Gemba walks': walking the care pathway from end to end to identify barriers and problems and to improve the flow of patient care
spread of innovation: enabling best practice to be adopted everywhere - locally, regionally, nationally and internationally.
Emily Friedman, another inspiring keynote speaker, took the audience on a tragic historical journey through Cambodia. Under the rule of Khmer Rouge, doctors and nurses were systematically murdered and by the time Khmer Rouge was defeated, only 25-75 doctors and no nurses remained in the country. Today, Cambodia still faces enormous challenges in terms of health care, including corruption, lack of funding and appropriately trained personnel, a 'mix-and-match' approach to traditional and western medicine and prohibitive costs for the poor. Despite these challenges, there have been outstanding improvements in many areas, including: safer water supplies, reduced child mortality, low rates of tobacco use, high child immunisation rates, self-management and peer education and reduced rates of HIV transmission.
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