UNSW: using evaluation to drive change

This is part of a series of articles showcasing the Sax Institute members’ diverse range of research with implications for future health policy and practice.

Centre for Primary Health Care and Equity

Julie McDonald
Dr Julie McDonald, senior research fellow at the Centre for Primary Health Care and Equity at the University of New South Wales

The integration of health services for the many NSW patients with chronic disease is being improved , in response to valuable learnings from a major evaluation of the state government’s Chronic Disease Management Program (CDMP), says Dr Julie McDonald.

Dr McDonald, senior research fellow at the Centre for Primary Health Care and Equity at the University of New South Wales, says the Centre co-authored a three-year evaluation of the program  aimed at measuring its impact, reach, equity and costs.

With chronic disease contributing to more than 70% of the disease burden in Australia, the program aims to improve health outcomes and prevent complications through providing care coordination and self-management support to help people better manage chronic disease conditions and access appropriate services.

The Centre for Primary health Care and Equity led the process component of the program’s evaluation and The George Institute for Global Health led the quantitative component.

Surprising findings

While it was hoped better care coordination would reduce preventable hospitalisations, the evaluation report found no evidence of such an effect. Instead, there was an unexpected increase in unplanned admissions, potentially preventable admissions and emergency department presentations for patients enrolled in the program compared to a control group. Patients were most likely enrolled in the program at peak period of illness when they were also reaching a peak of hospital services utilisation, the evaluation found. Their use of health services continued to escalate, before falling.

The evaluation suggested that patients may be better identified for enrolment in the program in primary care, rather than once their condition was already exacerbated and they needed acute care.

It also found variations in how the program was implemented across local health districts. For example, only eight LHDs had systems in place for monitoring the progress of patients at the time of the evaluation, and information systems at some LHDs were not adequate for identifying, recruiting and monitoring patients, or for sharing information across the LHD and with primary care.

Dr McDonald says the strength of the evaluation lay in it having a comparison cohort, which enabled the researchers to assess whether changes in healthcare utilisation were actually attributable to the program or to other factors.

The report recommended a range of systemic changes to improve the program, including strengthening the system of chronic care and better integrating it with existing systems, harnessing the potential in primary care, and ongoing investment in infrastructure, training and re-orientation to chronic care, rather than an acute focus.

Influencing program changes

The process evaluation findings were fed back to local health districts throughout the evaluation process, and the Centre has continued to disseminate the findings through a series of presentations and webinars with key stakeholders since the evaluation report was published.

She said the evaluation report findings were valuable in deciding the program’s future direction.

“The findings have informed the redesign of the Chronic Disease Management Program which is currently underway, and have fed into the broader design of the Integrated Care Strategy,” Dr McDonald says. “Learnings from different stages of the evaluation have informed the development of the program at local and at state level”.

Dr McDonald says the Centre’s mission is to contribute to better, fairer health in the community, and the evaluation is a key example of how research can feed into policy and programs.

“Our focus is very much on applied primary health care research that informs practice and policy and improves health equity,” she says.

The Sax Institute’s unique organisational structure, with 47 members from public health and health services research groups and their universities, connects us with a powerful public health network and world‑leading research expertise.

Find out more