Chronic Disease Management and Hospital CareDeakin Health Economics
Improving efficiency in the acute management of chronic disease is a focus of the Economics of chronic disease management and hospital care research stream at Deakin Health Economics. This includes understanding where the disease burden lies for specific diseases (for example, osteoporosis and Parkinson’s disease); how efficiency in hospital care can be improved (for example, rehabilitation, medical emergency teams, diagnostic error and non-admitted patient services); technology-based interventions to find substitutes for hospitalisation (for example, telehealth and remote patient monitoring); and exploring alternative funding models to improve efficiency through payment incentives.
The increasing prevalence of chronic disease impacts significantly on all healthcare systems worldwide, with ongoing consequences for individuals, households, funders, service providers and communities. This is especially so for the hospital sector, where impacts are particularly high. Despite the increasing prevalence of chronic disease, health systems are characterised by reactive management to the acute exacerbation of established disease. Funding models and the preference of individuals for “a quick fix” promote acute hospital, medical care and pharmaceutical management, rather than primary and secondary disease prevention.
Our team members are experts in the analysis of case-level hospital data, including costing data, MBS and PBS data and self-reported data. Combining data sets, we have been able to model and analyse impacts of chronic disease interventions over time. The evaluation of Barwon Health’s remote tele-monitoring intervention provided insights into the value of ongoing support and self-managed care for people with diabetes and chronic obstructive pulmonary disease, including both savings in hospitalisation and improvement in health related quality of life.
Trial-based economic evaluations
We specialise in partnering with our collaborators to ensure that all the trials we are involved with have robust, practical and state of the art economic evaluation techniques embedded within the trial protocols. Our evaluations range from preventative to treatment interventions across all areas of chronic disease and across multiple settings (such as acute care, non-admitted services, community and international settings).
Socio-economic burden and disease modelling
We specialise in using economic modelling techniques to evaluate the socioeconomic burden of disease over populations, communities and time incorporating both primary and secondary data sources. Data from secondary sources include data estimated from systematic literature review, meta-analysis and meta-regression techniques, and large data sets. We investigated the impact of HIV/AIDS on households and individuals in Southeast Asia using primary data collected from a household survey, with data from systematic review, combined with regression techniques to determine the predictors of socioeconomic burden.
Service delivery and efficiency
Our team has investigated the efficiency of alternative service delivery models for acute care, especially in the context of chronic disease management. We’re interested in technical efficiency from the perspective of the provider, and factors impacting technical efficiency. Findings from our research suggest a link between efficiency improvements and an improvement in patient wellbeing. For example, a recent study found a tele-monitoring intervention for people with chronic lung disease and/or diabetes was associated with a reduced length of hospital stay and an improvement in health related quality of life over 12 months.
Trial based methods for economic evaluation
Our team has been involved in a large number of methodologically diverse clinical trials, including RCTs, cluster RCTs and step wedge designed trials. We have also investigated patient recall bias (in 12 month follow-up studies comparing self-reported data with administrative data sets); and mapping health outcome instruments such as the functional independence measure against a HRQOL instrument.
Brief examples of our more recent work spanning these areas of research include:
Trial-based economic evaluations:
Bohingamu Mudiyanselage S, Stevens J, Watts JJ, et al. Personalised telehealth intervention for chronic disease management: A pilot randomised controlled trial. Journal of Telemedicine and Telecare. 2019 Jul;25(6):343-52.
Brusco NK, Watts JJ, Shields N, Taylor NF (2014). ‘Are weekend inpatient rehabilitation services value for money? An economic evaluation alongside a randomized controlled trial with a 30 day follow up’ BMC Medicine 12:89
Socio-economic burden and disease modelling:
Bohingamu Mudiyanselage S, Watts JJ, Abimanyi-Ochom J, Lane L, Murphy AT, Morris ME, Iansek R. Cost of living with Parkinson’s disease over 12 months in Australia: a prospective cohort study. Parkinson’s Disease. 2017.
Service delivery and efficiency:
Abimanyi-Ochom J, Mudiyanselage SB, Catchpool M, Firipis M, Dona SW, Watts JJ. Strategies to reduce diagnostic errors: a systematic review. BMC Medical Informatics and Decision Making. 2019 Dec 1;19(1):174.
Harding KE, Leggat SG Watts JJ, Kent B, Prendergast L, Kotis M, O’Reilly M, Karimi L, Lewis AK, Snowdon DA, Taylor NF (2018) “A model of access combining triage with initial management reduced waiting time for community outpatient services: a stepped wedge cluster randomised controlled trial”, BMC Medicine 16(1), 182
Trial based methods for economic evaluation:
Soh SE, McGinley JL, Watts JJ, Iansek R, Murphy AT, Menz HB, Huxham F, Morris ME, (2013). “Determinants of health-related quality of life in people with Parkinson’s disease: A path analysis”, Quality of Life Research, 22(7): 1543-53.