Health system research and evaluation

Information on the health system research and evaluation projects conducted by the Health Services Research Centre.

Improving Health Systems Performance: Enhancing Hospital Outcomes (2)

This is a collaborative HRC funded project with the Universities of Auckland and Otago, Motu Public Policy and Research Trust, and the Ministry of Health.

Its purpose is to assess, using New Zealand Health Information Service sources, whether New Zealand has had value for the significant increases in expenditure in hospitals, as judged by throughput, output and quality of care.

Information will be electronically and confidentially linked to core hospital and other currently disconnected data sources. The study will influence health outcomes by contributing hard evidence on the productivity and effectiveness of investment in hospital and related services.

During 2009, the focus was on developing conceptual frameworks to guide the research and assembling key data sets for the research. In 2010, detailed analyses of the data will commence.

Funding

Health Research Council of New Zealand

Researchers

Jackie Cumming, Jaikishan Desai

Improving Health through Primary Care Reform: An economic analysis (2)

This research is using economic techniques and data from three national health surveys to examine the impact that changes in the fees charged by local primary health care providers since 2002 have on utilisation of primary and secondary health care, and on health outcomes.

The project is being undertaken in collaboration with Motu Public Policy and Research Trust and the University of Auckland. The project follows on from an earlier project that examined baseline data prior to the roll out of new funding from 2002 onwards.

A number of papers have resulted from this first project, focusing on the fees that different groups of New Zealanders have been paying for primary health care, utilisation of primary health care services, and differences in health outcomes across population groups.

Funding

Health Research Council of New Zealand

Researchers

Jackie Cumming, Jaikishan Desai, Lynne Pere, Ausaga Fa’asalele Tanuvasa

2006–2007 Health Survey

This Ministry of Health project collected comprehensive health information from more than 17,000 New Zealanders—making it the largest survey of New Zealanders’ health to date.

Our researchers are examining how New Zealanders’ level of alcohol use relates to their health service utilisation (both primary and secondary) at the population level. A descriptive account and a health economic analysis will be conducted. Analyses will be completed and publications produced in 2010.

Researchers

Greg Martin, Megan Pledger, Jackie Cumming

Managing ‘mixed’ financing of privately-owned providers in the public interest

This study examined the ways in which government agencies finance services which are delivered by private providers. It sought to identify the advantages and disadvantages of these alternatives and to make preliminary recommendations to improve policy and practice in public financing of private providers in New Zealand. The project took a cross-sectoral and international perspective, and focused on: general practice, legal aid, early childhood education and long-term care of the elderly. A final report is due for publication in early 2010.

Funding

Emerging Issues Programme, Institute of Policy Studies, School of Government, Victoria University of Wellington

Researchers

Jackie Cumming, Judith Smith, Janet McDonald

Healthy eating—Healthy action: Oranga Kai—Oranga Pumau Evaluation

The Healthy Eating Healthy Action (HEHA) Strategy was launched in 2003 in response to growing concern over poor eating habits, lack of physical activity, and the associated prevalence of obesity and increased risk of adverse health outcomes that result.

A multi-year evaluation of the Strategy is well underway. Following the completion of planning stages of the research, the HSRC in 2009 continued qualitative and quantitative data collection and analysis on implementation and value for money issues to inform the Ministry of Health about the implementation and value for money provided by the Strategy.

There is a major focus on improving Māori and Pacific health. The project is being undertaken in collaboration with Otago and Massey Universities, Auckland University of Technology, independent Māori researchers Terry Ehau and Erana Skudder, and Dr Heather Gifford and Dr Amohia Boulton (Whakauae Research Services).

Funding

Ministry of Health

Researchers

Jackie Cumming, Janet McDonald, Sue Buckley, Mili Burnette, Ausaga Fa’asalele Tanuvasa, Sandra Fowler, Marianna Churchward

Cost effectiveness of interventions to prevent obesity

The Health Research Council of New Zealand and the Ministry of Health have contracted the HSRC to lead a project assessing the cost effectiveness of public health interventions to prevent obesity. The project will provide information to enable public health interventions aimed at preventing obesity to be ranked in terms of their relative cost effectiveness. In this way, the project will provide economic information that can contribute to the development of policy and practice in New Zealand, in particular to guide future resource allocation decisions.

The Centre is working with Sydney based health economics consultancy, HTAnalysts, and Dr Terri Green (Canterbury University) on this project. A reference group consisting of topic experts and people with relevant sector experience is also providing advice on the research as it progresses.

The project runs for one year from 1 September 2009 until 31 August 2010.

Funding

Health Research Council of New Zealand, Ministry of Health

Researchers

Jackie Cumming, Janet McDonald

2007 Alcohol and Drug Use Survey

This Ministry of Health project was the first national population based survey in New Zealand to collect both alcohol and drug use data in the same survey. It was carried out from July 2007 to April 2008, and collected information on over 6000 respondents aged between 16-65 years. The report was published in the first half of 2009.

Researcher

Aloka Bhattacharya

Evaluation of the Implementation and Intermediate Health Outcomes of the Primary Health Care Strategy

The aims of this research are to reach an in depth understanding of the experience and activities of Primary Health Organisations in responding to the Primary Health Care Strategy.

It is measuring change in programmes, processes and outcomes during the adoption and implementation of the Strategy; assessing the impact of the Strategy on reducing health inequalities involving Māori, Pacific peoples and the financially disadvantaged; and identifying positive and negative influences. The project is in its final stages of completion, with a number of reports completed in 2009 and several more due for publication in 2010.

In collaboration with CBG Health Ltd, and the Universities of Auckland, Otago and Canterbury, the London School of Hygiene and Tropical Medicine, and Health Services Management Centre, University of Birmingham.

Funding

Health Research Council of New Zealand, Ministry of Health, ACC

Researchers

Jackie Cumming, Lynne Pere, Kirsten Smiler, Ausaga Fa’asalele Tanuvasa, Marianna Churchward, Joanna Minster, Judith Smith, Antony Raymont, Janet McDonald

European Observatory on Health Care in New Zealand

This is a Ministry of Health funded project being undertaken by the HSRC on behalf of the European Observatory. The European Observatory on Health Care Systems publishes country based reports on the progress of Health Care Systems in Transition (HiT).

The profiles provide information ranging from national health statistics to the development of financing, organisation and delivery of health care services.

Prescribed quantitative data allows the comparison of health systems in Europe and abroad, and provides up to date information to support policy makers. The HSRC is responsible for a new volume on New Zealand, due for publication in 2010.

Funding

Ministry of Health on behalf of the European Observatory

Researchers

Jackie Cumming, Janet McDonald, Zac Gerring, Greg Martin

Tracker Pilot Project

A pilot study for a project investigating young people’s use of places and spaces was undertaken late 2009/early 2010. This pilot study used GPS tracking devices and cell phones to gather data from a group of 10-13 year olds about the places they visited and how they got there. We have applied to the Marsden Fund to undertake a larger study which will use GPS, SMS communication and detailed interviews to record the location and activities of boys and girls from a range of different backgrounds.

Researchers

Sue Buckley, Megan Pledger, Jake Daube, Jackie Cumming, Nicola Grace, Marianna Churchward

What’s happening with abusive and inappropriate sexual behaviour among Year 7 and 8 students?

This project is being undertaken with WellStop Incorporated (a group that provides programmes for men and adolescents who have been sexually abusive) and is looking at the issues for teachers around inappropriate sexual behaviour of 11-13 year olds at school. The research is investigating the issues for teachers concerning sexually inappropriate behaviour amongst young people in this age group and what information and support teachers might find helpful. Focus groups, interviews and a brief survey of teachers of Year 7 and 8 students in Wellington and Lower Hutt have been undertaken and the analysis of the data is underway.

Funding

WellStop Inc.

Contact

Sue Buckley, Marie Russell

Population health: putting theory into practice

This two-day development workshop was designed by HSRC as an opportunity for managers, clinicians, board members and policy makers in the NZ health sector to come together to explore what is meant by the term ‘population health’ and to share local good practice examples of such an approach.

The workshop was held in Wellington in November 2007 and attracted over 50 participants from across the country.

Case studies of population health work were complemented by inputs from academics carrying out research in this area, and a summary of the workshop has been prepared for publication.

Contact

Judith Smith

Commissioning for health gain: NHS executive study programme

This five-day study programme for NHS senior managers and clinicians was designed and facilitated by HSRC in partnership with the Centre for Public Policy and Management at the University of Manchester Business School.

The programme entails a preparatory block in the UK, a five-day study tour of planning and funding organisations in NZ, and a plenary block in the UK.

Fourteen participants came to NZ in November 2007 and spent time visiting district health boards, primary health organisations, the Ministry of Health and providers, with a specific focus on the ways in which NZ is seeking to plan and fund health services in a way that enables a reduction in health inequalities and an overall improvement in health status.

Funding

NHS Institute for Innovation and Improvement, UK

Contacts

Judith Smith and Jackie Cumming

Just who do we think children are?

This project involved an analysis of the submissions received by Parliament’s Justice and Electoral Select Committee on the Bill to repeal S.59 of the Crimes Act. The research was to ascertain whether submitters’ views of children and childhood influence their support or opposition to the use of physical punishment. The research is completed and will be published in 2007.

Funding

Save the Children New Zealand, 2006

Researchers

Sophie Debski, Marie Russell, Sue Buckley

The health impacts of violence and abuse: A literature review

HSRC undertook a literature review on the health impact of childhood violence and abuse to inform the Ministry of Health’s strategic direction in respect of future health promotion services. Topics covered included: school bullying; dating violence; childhood physical abuse; intimate partner violence; childhood sexual abuse; rape; and children witnessing partner violence. This research was a collaboration with the Crime and Justice Research Centre for the Ministry of Health.

Funding

Ministry of Health, 2006

Researchers

Sue Buckley, Marie Russell, Hilary Stace

What’s happening with abusive and inappropriate sexual behaviour among Year 7 and 8 students?

This project is being undertaken with WellStop Incorporated and will look at the issues for teachers around inappropriate sexual behaviour of 11-13 year olds at school. WellStop is a group that works with people who have sexually abused and research what’s happening with young people and whether and what interventions at that stage might be effective. Focus groups, interviews and a brief survey of teachers of Year 7 and 8 students in Wellington and Lower Hutt will be undertaken in 2007.

Funding

WellStop Inc, 2006–2007

Researchers

Sue Buckley, Marie Russell

Achieving change in primary health care services

The project is researching Primary Health Care Organisations’ (PHOs) experience in generating change in general practice as they work to implement the primary Health Care Strategy. It involves examining PHOs’ “visions of the future” of general practice and their experience in implementing these visions. The final report was released in 2006.

Funding

Health Research Council Foxley Fellowship, 2005–2006

Researcher

Craig Johnston

NHC Report: Informal caregivers literature review

This review examines a sample of a large volume of work on the implications of being an informal caregiver. Key aspects of caregiving, including health inequalities and financial implications, are addressed in the review as well as possible interventions to help caregivers.

Funding

National Health Committee, 2006

Researchers

Anne Goodhead, Janet McDonald

Assessing governance, purchasing and accountability in the New Zealand health care sector

This project documents and analyses the new relationships under District Health Boards, assessing their strengths and weaknesses compared with other ways of organising health care systems. All fieldwork on the project has been completed and research reports will be finalised in early 2007.

Funding

Health Research Council, Ministry of Health, The Treasury, State Services Commission, 2001–2006

Researchers

Jackie Cumming, Tai Walker, Anne Goodhead, Marie Russell, Sue Buckley, Roshan Perera, Marianna Churchward, Janet McDonald, Lynne Pere, Toni Ashton, Tim Tenbensel, Michael Powell (University of Auckland), Lanuola Asiasiga, Fuafiva Fa’alau (Independent Researchers), Pauline Barnett, Clare Clayden (Christchurch School of Medicine, University of Otago), Chris Cunningham, Amohia Boulton (Massey University), and Nicholas Mays (London School of Hygiene and Tropical Medicine).

Identifying key indicators of wellbeing for young New Zealanders

This research aims to understand what wellbeing means to young New Zealanders in three ethnic groupings: Māori, Pasifika and Pākehā, and to identify key wellbeing indicators, based on the views of the informants. The study included literature reviews, focus groups and personal interviews with young people.

Funding

Health Research Council of New Zealand, Ministry of Youth Development, 2005–2007

Researchers

Marie Russell, Kirsten Smiler, Marianna Churchward, Paul Jose (School of Psychology), Maia Bennett, Tai Walker, Jackie Cumming, Aliitasi Tavila, Mili Burnette, Jan Pryor (Roy McKenzie Centre for the Study of Families) and Liz Richardson (Faculty of Science)

Improving performance in New Zealand health care: Hospital outcomes

This new project will adapt and apply new outcome measures and modern statistical approaches to evaluating hospital performance in New Zealand. As well as providing information on variability and trends in in-patient outcomes and hospital-level predictors of these outcomes, the project will provide the statistical basis for a sophisticated system for analysis and monitoring of hospital outcomes. A particular focus of this project is the identification of aspects of hospital organisation and working environment which may be related to patient outcomes.

The research commenced in 2005, with an initial data analysis to begin in 2006.

Funding

Health Research Council of New Zealand, 2005–2008.

Researchers

Jackie Cumming, Antony Raymont, John Fraser, Patrick Graham, Phil Hider (Christchurch School of Medicine, University of Otago), Gregor Coster and Mary Finlayson (University of Auckland).

Improving health through primary care reform: An economic analysis

This research will use economic techniques and data from two national health surveys to examine the impact that fees charged by local primary health care providers have on utilisation of primary and secondary health care, and on health outcomes.

The implementation of the Primary Health Care Strategy has resulted in a large reduction in the fees charged by primary health care providers and, by examining data from both before and after its introduction, we can identify whether lowering fees affects health-related behaviours, and if so who is most affected.

This preliminary research to test the feasibility of this approach will also more broadly describe the experiences of different population groups over time in relation to fees paid, health care utilisation, and self-reported reasons for not accessing care, to provide context for our main results.

Data analysis commenced in 2005, and early findings are due in 2006.

Funding

Health Research Council of New Zealand, 2005–2008.

Researchers

Jackie Cumming, Antony Raymont, Steven Stillman (Motu Economic & Public Policy Research and Gregor Coster (University of Auckland).

Identifying key indicators of wellbeing for young New Zealanders

During 2005 the study commenced with literature reviews and focus groups with young people. These will be analysed in early 2006 before the project moves into a second phase of data collection.

Funding

Health Research Council of New Zealand, Ministry of Youth Development, 2005–2007

Researchers

Marie Russell, Kirsten Smiler, Marianna Churchward, Paul Jose ( School Of Psychology), Maia Bennett, Tai Walker, Jackie Cumming, Jan Pryor (Roy McKenzie Centre for the Study of Families) and Liz Richardson (Faculty of Science)

Evaluation of the implementation and intermediate health outcomes of the Primary Health Care Strategy

The aim of this research is to reach an in-depth understanding of the experience and activities of Primary Health Organisations in responding to the Primary Health Care Strategy. It will also measure change in programmes, processes and outcomes during the adoption and implementation of the Strategy; and assess the impact of the Strategy on reducing health inequalities.

In 2005 the team published a report on the interim findings and began developing publications from the research. A number of presentations on the research took place in New Zealand and overseas. A further data collection round will begin in 2006.

Funding

Health Research Council of New Zealand, Ministry of Health, ACC, 2003–2006

Researchers

Research managers: Jackie Cumming, Antony Raymont, Barry Gribben, Carol Boustead (CBG Health Research)

Researchers: Jackie Cumming, Antony Raymont, Roshan Perera, Marianna Churchward, Janet McDonald, Anne Goodhead, Barry Gribben, Carol Boustead, (CBG Health Research) Pauline Barnett (Christchurch School of Medicine, University of Otago), Nicole Coupe, Fuafiva Fa’alau (CBG Health Research), and Terri Green (Department of Management, University of Canterbury)

Consultant researchers: Professor Tony Dowell (Wellington School of Medicine and Health Sciences, University of Otago), Professor Margaret Horsburgh (University of Auckland), Dr Bridie Kent (Independent Researcher), Professor Nicholas Mays (London School of Hygiene and Tropical Medicine), and Judith Smith (University of Birmingham)

In addition, Durga Rauniyar and Mahi Paurini are seconded to the research team from the Ministry of Health, with Bronwyn Croxson seconded to the team from The Treasury.

Experiences of primary health care

A number of projects are underway in conjunction with the Ministry of Health, researching the experiences of New Zealanders with respect to primary health care, using data from the New Zealand Health Survey 1996/97 and 2002/03.

These projects commenced in 2005 with a focus on Māori health services utilisation, Pacific health services utilisation, chronic care service utilisation and utilisation by different socio-demographic groups. Reports are due for publication in 2006.

Funding

Ministry of Health, Health Services Research Centre, 2005–2006

Researchers

Jackie Cumming, Megan Pledger, Arama Rata, Matt Viliamu, Renee Sowman, Emma Scheib, (summer students), Niki Stefanogiannis, Durga Rauniyar, (Ministry of Health)

Information for patients

A suite of projects funded by the Ministry of Health, Victoria University of Wellington Research Fund and the Cancer Society of New Zealand are exploring the experiences of information for patients.