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Pop Health Congress

Graves
by

Nicholas Graves

on 24 August 2015

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Transcript of Pop Health Congress

Using current information for health decision-making and generating new knowledge
Research generates new knowledge
Nicholas Graves
NHMRC Funds 2010-11
Basic Science & Clinical Medicine
80%
"mechanism of disease"
Elizabeth Blackburn
Barry Marshall and Robin Warren
Peter Doherty
John Eccles
Frank MacFarlane Burnet
Howard Florey
Ian Frazer
Terry Dywer
sudden deaths in infants
vaccine against cervical cancer
A long time between drinks
?
Large but infrequent benefits
massive health benefits
1950
2010
build Health Services Research capacity
Flavour of the month (to taste)
three cups of assumptions, sweated in butter
a good handful of risk aversion
fresh bunch of diffused budgets
a bucket of missing information
a glass of lobbying from special
interest groups (over ice)
mass produced
homogenous
quick and easy to prepare
last a long time
cheap ingredients
a bit bland
many shapes and sizes
carefully crafted
recipies tested until perfect
good quality ingredients
time and love put into their production
Are politicians really interested in doing the right thing?

Or will they say and do anything to win votes?
Public Health & Health Services
20%
"organisation of health services....in the face of scarcity"
Resources are scarce
do the right things
do things right
good decision making is important
do the right things
do things right
try to be fair
In health services we should
Should we invest in:

more infection control for hospitals?


complementary therapies to treat depression?


interventions to change exercise & diet?


safer blood, from 100% universal leucodeplation?
We should:

use laproscopic (not open) surgery for endometrial cancer


screen for colon cancer among population using FOBT kits


discharge elderly hospital patients appropriately
vs.
fairness & equity
Is there variability for

how resources are allocated among sub-populations

access to services

health outcomes
More frequent benefits......can still be large
Research to improve health services
Six examples
days in hospital during 24 weeks after first discharge
770 years of life foregone
2,203
4,051
4,155
A policy of universal leucodeplation of blood reduces years of life among the Australian population by ........
every year

118,000 Quality Adjusted Life Years gained

$333,000,000 saved
for annual investment of $60M in Universal Leucodeplation .......
enhanced discharge planning
normal discharge planning
"extra nursing & physiotherapy"
"improve strength, balance and diet"
"24 weeks of telephone follow up and home visits"
For the at risk Australian population
153 extra years of life
Investing in good hospital discharge planning
Pay less for generic drugs to lower cholesterol
January 2005 to Oct 2009
May 2010 and October 2011, another $130M lost
Don't routinely follow up hip replacements
Stopping all routine follow up ...cost savings between $6.5M & $11.9M
gains of between 1.8 and 8.8 QALYs
Use antimicrobial-coated catheters in ICU patients
Annual cost savings of $2.65M
gains of 34 QALYs
Don't use of laminar airflow in operating rooms
Annual cost savings of $4.65M
gains of 127 QALYs
Restrict the use of leucodepleted blood products
Changing these six things would lead to
100 grams of research data, beaten to a pulp, ground to a fine powder, stored in a cave for five years then re-constituted with luke warm water
health policy has many ingredients
penicillin
Helicobacter pylori infection and stomach cancer
cell mediated immune defence
Basic Science & Clinical Medicine
Public Health & Health Services
$540M saved

118,096 extra years of life

Make partnerships
Do research to improve health services
A faceless decision making making authority



interpret the evidence
can endure media scrutiny
protect vulnerable politicians
Basic Science and Clinical Research vs. Population Health and Health Services Research

Discuss potential uses

Show six examples of applied and useful research

Discuss why good decisions are sometimes not made

Discuss an emerging HSR programme
In this talk....
25%
50%
25%
70%
5%
25%
1
2
3
4
5
6
$900m lost
easy to digest
WIKIPEDIA

"NICE is often associated with controversy, because the need to make decisions at a national level can conflict with what is (or is believed to be) in the best interests of an individual patient."
WWW.AUSHSI.ORG.AU
FUNDING AGENCY

DEVELOP SKILLS

CONSULTING
SUMMARY

Do more health services research
Make changes to health services
Change health policy infrastructure

Population health research & HSR can improve decision making in health
good ideas trump track record
easy and low cost applications
unambiguous feedback
Thanks For Listening
Full transcript