FROM THE DIRECTOR
When you talk to allied health researchers, policy-makers and clinicians from around the world, you realise how small the allied health ‘family’ is (compared to medicine and nursing), and how similar the international concerns are, within and between allied health disciplines. These concerns seem to hinge on providing more service for less money, increasing the recognition within and outside the health sector, of the value of allied health services in cost-effectively improving safety and quality of life across the ages, and providing training and CPD that will keep allied health clinicians at the forefront of evidence-based practice, workforce changes and consumer engagement.
iCAHE has had a concerted campaign for the last 7-8 years to have an impact internationally on allied health quality and safety. This has been multipronged. For instance the iCAHE website contains a wealth of regularly updated information on outcome measures, clinical practice guidelines, critical appraisal instruments and articles, journal clubs and evidence implementation strategies. This is accessed daily by national and international internet traffic.
iCAHE has an increasing number of international PhD graduates who have returned to home to spread the word about evidence implementation (for instance the Philippines and South Africa). iCAHE has formalised international relationships with researchers/ clinicians/ policy-makers in India, California, Hong Kong and South Africa, and there are discussions currently occurring with people in Japan, Singapore, Malaysia and Brunei regarding joint training and scholarship with iCAHE members.
These relationships have not only exposed a number of iCAHE members to the issues of practising, administering and researching allied health in countries with different healthcare systems, cultures, training and funding, but it has also highlighted how much iCAHE can contribute to improving the quality of allied health internationally, by sharing its resources and knowledge, learning from international experiences and encouraging international collaborations. We look forward to a busy and exciting 12 months of extending allied health research and training with international colleagues.
Dr Kylie Johnston, Narasimman Swaminathan, and staff of the Father Muller Medical College (FMMC) Mangalore, India.
Health Consumers Alliance South Australia (HCA SA)
HCA was established in 2002 as the peak SA body for health consumers (http://www.hcasa.asn.au/). It is funded by the SA Minister for Health and Ageing. HCA is an independent alliance of health consumers and health consumer organisations; the organisation works with its members to achieve its vision of consumers at the heart of health care. HCA provides informed strategic advice to health planners and decision makers and independent systemic health consumer advocacy and representation. HCA facilitates, promotes and supports consumer advocacy, networking and leadership and raises awareness through engagement, information dissemination and training.
iCAHE supports HCA’s vision of consumers at the heart of health care and has entered into a formal agreement with HCA to support this shared commitment. The agreement covers a range of research, education and advocacy activity. This month we collaborated in a Master Class for Allied Health Professionals. The one day workshop encompassed consumer centred care, health literacy and consumer engagement policy, evidence and practice. Participants explored how to integrate Australian Commission for Safety and Quality Standard 2: Partnering with Consumers into their practice to ensure genuine, respectful shared decision making in all aspects of health governance, policy and practice.
HCA and iCAHE are now working on a Professional Certificate in Consumer Engagement.
Partnerships to respectfully recruit older consumers for the research study: Older people living in the community: 75+ health checks and functional decline (FD)
Recruitment of consumers for research studies is often challenging and always requires a respectful approach, ideally via a known and trusted third party. iCAHE has been fortunate to enter into two partnerships to support consumer recruitment in this study funded by the Australian Primary Health Care Research Institute (APHCRI). Our partners are Unicare and the Central Adelaide and Hills Medicare Local (CAHML). Unicare has undertaken the partnership in line with its mission to provide quality patient care; provide a quality teaching network for medical, nursing and allied health undergraduate and postgraduate students; and to facilitate research into General Practice. CAMHL has expressed support for the project’s intent to inform early identification and action to enable older people to live in the community, where they want, for as long as they want, with safety and dignity. iCAHE is pleased to have the opportunity to work with our partners’ clinicians and consumers to inform project recommendations that maximise health and economic benefit for the Australian community.
iCAHE Director, Professor Karen Grimmer and Unicare CEO Michael Chalk signing the partnership agreement.
Developing a valid and reliable tool for children with disabilities.
Children with disabilities may need to use a switch to operate machines to help them speak, learn and play. Occupational Therapists (OTs) help in the provision and training of this assistive technology and until now have not had a reliable tool to help them measure the child’s ability to use the switch. OT honours student Michelle Keane is working with Novita Children’s Services to validate their recently devised assessment tool. Michelle is following on from the work of recently graduated student Grace Hoppenbrouwers and is working with supervisors Jocelyn Kernot and Hugh Stewart to provide a tool which is valid and reliable.
iCAHE Master Classes July 2014
SA Health’s Allied and Scientific Health Office (ASHO), via Chief Allied & Scientific Health Advisor, Ms Catherine Turnbull, has again supported participation by SA Health’s allied health professionals in iCAHE Master Classes. This is the 7th Master Class conducted with ASHO support
25 people attended the classes with feedback showing not only satisfaction with the program, but also many clearly stated intentions to improve practice and services as a result of their attendance.
The Master Class encompassed 3 sessions:
Clinical audits (half day): The role of clinical audits in allied health care: allied health practitioners experiences and recommendations from local initiatives , facilitated by Dr Saravana Kumar
ASPIRE for quality framework (half day: Assisting allied health practitioners in clinical performance evaluation, facilitated by Dr Lucylynn Lizarondo
Consumer centred care, health literacy and engagement for safety and quality (full day), conducted with Mr Michael Cousins from Health Consumers Alliance SA
Clinical audits - report from facilitator, Dr Saravana Kumar
Special thanks to the professionals who presented their clinical audit report for the benefit of Master Class Participants. The presenters were:
In 2013, under the auspices of the SA Health Allied and Scientific Health Office, through the AHP+ Professional Development Reimbursement Program, iCAHE in partnership with Royal Adelaide Hospital as the lead site, initiated an innovative training program titled “Improving quality and safety of allied health through mentoring for clinical audits”. The objective of the training program was to provide allied health professionals from SA Health with the knowledge, skills and competencies in planning, conduct and reporting of methodologically rigorous clinical audits which could inform and underpin allied health service planning and delivery. Each participating allied health professional was provided with opportunities for training and mentorship with researchers from iCAHE on a clinical audit topic of their choice. Over the past 12 months, these allied health clinicians planned and implemented clinical audits at their local health settings. As part of the 2014 masterclass series, these clinicians presented an overview about their clinical audit project, its processes, key findings and their perspectives about undertaking such projects at their local health settings. A range of allied health professions were represented including physiotherapy, speech pathology, nutrition and dietetics and pharmacy and the clinical audits focussed on a diverse range of topics such as chronic pain and low back pain, stroke, spinal cord injuries, faltering growth in infants, falls and also included best practice (such as use of lead markers in medical imaging) and emerging models of care such as tele health in rural South Australia. The presentations provided a firsthand account of undertaking research in clinical practice and provided an insight into what worked, what didn’t and lessons for the future. Every presentation showcased the important role of allied and scientific health in ensuring health care in South Australia is underpinned by quality and safety. The presentations also shone light on the important and ongoing role allied and scientific health could play in further improving the quality and safety of health care by addressing some gaps in best practice service delivery. The presentations provided an ideal opportunity for participants of the masterclass to see, hear and engage with these clinicians and be inspired to undertake similar projects themselves. Having been part of the training program, these clinicians are now armed with the knowledge and skills to assist their peers to undertake similar projects. By doing so, allied and scientific health can continue to positively impact the quality and safety of health care in South Australia.
From the participants:
"I am likely to commence involvement in up to 2 clinical audit projects in the near future...."
"I plan to implement clinical audits within (my) department, ensure that it is evidence based...."
"(I am going to) get stuck into my audit, look in to future opportunities (was unaware of the level of support available to assist me!)..."
ASPIRE for quality framework – report from facilitator Dr Lucylynn Lizarondo
Special thanks to the professionals who presented their clinical audit report for the benefit of Master Class Participants. The presenters were:
Alison Ryan, working with Thomas DiSanto and Angela Knolder
Meagan Reeve, working with Michael Martin and Fiona Murray
Megan Kretschmer, working with Sophie Lia and Marion Champion
In this session, Dr Lucy Lizarondo presented the findings of a research project commissioned by the Allied Health & Scientific Office, SA Health. Lucy reported the results of the systematic review and survey which underpinned the development and operationalisation of ASPIRE, an evidence-based framework designed to assist allied health practitioners examine their clinical service performance. Lucy also discussed the implementation of ASPIRE and presented the evaluation findings from pilot sites. Representatives from the pilot sites shared their experiences and perspectives regarding the use of ASPIRE and facilitated discussion with other allied health practitioners in the audience.
From the participants:
"I’ll be utilising the ASPIRE tool in future audits......"
"I will take framework back to my department and present what I learned today, discuss how we can use it..... "
"(I plan to explore) opportunities to collaborate on an evaluation project (with) a colleague in other local health network and iCAHE........"
For more information about ASPIRE, please visit iCAHE’s website http://www.unisa.edu.au/research/sansom-institute-for-health-research/research-at-the-sansom/research-concentrations/allied-health-evidence/quality-care/aspire-for-quality/
Consumer centred cares, facilitated by Mr Michael Cousins
iCAHE was delighted to have Michael as a facilitator in this one day session. Michael has over 20 years of experience in community services and the public sector and has worked with the Health Consumers Alliance (HCA) since 2011. He currently sits on a number of strategic health committees in South Australia and nationally, advocating for health consumers; these include the SA Health Safety and Quality Consumer and Community Advisory Committee and the Primary Care Committee, Australian Commission on Safety and Quality in Health Care.
This session explored the imperative for consumer/client/patient centred care; for a focus on health literacy; and for genuine engagement of consumers in all aspects of health service governance, design and delivery and evaluation.
Evidence is building about the link between consumer centred care and clinical outcomes. Consumer centred care and partnerships with consumers have been associated with decreased readmission rates, decreased healthcare acquired infection rates, reduced length of stay, and improved adherence to treatment regimens. These kinds of outcomes provide benefits across the healthcare system, including benefits for primary, acute, and aged care services. ACSQHC http://www.safetyandquality.gov.au/our-work/patient-and-consumer-centred-care/health-literacy/
Participants considered challenges in terms of engaging consumers in shared decision making and self-management; being inclusive of vulnerable groups; and in moving beyond token consumer participation in committees and working groups.
Approximately 60 per cent of Australians have poor health literacy and are not able to effectively exercise their ‘choice’ or ‘voice’ when it comes to making health care decisions . Individual health literacy is the knowledge, motivation, skills and capacity of a person to access, understand, appraise and apply information to make effective decisions about health and health care, and make appropriate decisions. The health literacy environment is the infrastructure, policies, processes, materials, people and relationships that have an impact on the way in which people access, understand, appraise and apply health-related information and services. ACSQHC Consultation Paper, Consumers, The health system and health literacy: Taking action to improve safety and quality 2013 (revised definition March 2014)
Michael provided an overview of evidence-based policy and practice for consumer centred care, health literacy; and consumer engagement for quality and safety in health care. This included international and national policy and frameworks and evidence-based principles for practitioners. Australian Commission for Safety and Quality in Health Care (ACSQHC) goals, standards, principles and frameworks in relation to partnering with consumers; barriers to implementing these and examples of best practice in hospital and community health care.
From the participants:
"(I plan to) share with my team, consider my own practice e.g. use teachback with clients, ensure consumer voice in planning rather than just evaluation......"
"reflect further on how well this is done with my organisation and implement strategies for improving client experience........"
"be more aware of the consumer experience in the bigger picture around their clinical situation and trying to work with other disciplines to improve the care they provide......"
"implement more consumer involvement at all levels of department and project work...."
RESOURCES FOR YOU
Outcome Measure Corner - See this editions Feature Outcome Measure, the Disabilities of the Arm, Shoulder and Hand (DASH) scale.
Feature Guideline - see this months Feature Guideline.
FROM THE OFFICE OF THE ALLIED HEALTH ADVISOR
Bulletin from Chief Allied & Scientific Health Advisor, SA Health Catherine Turnbull
With the ever growing focus on the fiscal environment both at a state and commonwealth level, it is essential that Allied Health provides cost effective, clinical services that are meeting consumer needs. It is with this thought in mind that it is exciting to be able to promote the ASPIRE for quality framework which has been developed by iCAHE with support from SA Health’s Allied and Scientific Health Office (ASHO).
ASPIRE has been developed to assist allied health practitioners evaluate their clinical service performance as a means of improving the quality of allied health services. The framework is based on a systematic review of the literature on performance evaluation systems, layered with a local snapshot of current practice in performance evaluation in South Australian health networks. The model captures the core elements of performance evaluation which include prioritisation of clinical area for evaluation, upfront articulation of goals, careful identification of performance measures, mapping of measures to information sources, analysis of performance data and reporting of results, and evaluation of the performance evaluation system (iCAHE 2014) as a joint collaboration between allied health practitioners and researchers.
Another body of work which ASHO to promote is the launch of the SA Health Allied Health Clinical Supervision Framework and On-Line Clinical Supervision Courses.
The SA Health Allied Health Clinical Supervision Framework outlines SA Health’s commitment to supporting Allied Health Professionals working within their Local Health Network in accessing consistent, appropriate and effective clinical supervision and support mechanisms.
Funded by ASHO and developed under the guidance of the Clinical Supervision eModules Steering Committee with Local Health Network support, the courses support clinical staff in the development and maintenance of their skills in supervision. A robust evauation is currently being undertaken by iCAHE to evaluate the effectiveness of the on-line modules to meet the learning needs of clinicians as well as opportunities for further improvement.
Finally the other parcel of work being developed in South Australia is the conversion of the ICAHE Outcomes Calculator into a web based version so that staff using the wonderful new electronic health medical record (EPAS) can access outcome measurement tools from the EPAS environment while seeing clients and recording their interventions and outcomes.
All of this work is assisting AHPs to continue to adjust to the changes and pressures of the currently challenging environments across health care.
Until next time……..
ACTIONS IN ALLIED HEALTH
- The George Institute for Global Health is holding a two day workshop in injury prevention at the University of Sydney in October. For more details or to book see the Info sheet (pdf 74KB)
- the 11th National Allied Health Conference will be held at the Crowne Convention Centre in Melbourne, from the 9th -11th of November 2015. Preconference workshops will be held on the 9th. Registration and calls for papers will open in 2015, For more details go to http://www.nahc.com.au/index.html
- Indigenous Allied Health Australia (IAHA), the national Aboriginal and Torres Strait Islander allied health peak body, is holding a National Forum for allied health graduates and students and the wider allied health workforce from 24-27 November 2014 at the Hyatt Hotel in Canberra. For more details, or to register, go to: http://iaha.com.au/events/2014-iaha-national-forum/#sthash.1KGqIDIX.dpuf
- SARRAH are hosting a National Conference for Rural and Remote Allied Health Professionals from the 17-20th September 2014, at Mantra on Salt Beach. For more information go to: http://www.conferencedesign.com.au/sarrah2014/
Banwell, H., Mackintosh, S., Thewlis, D. 2014. Foot orthoses for adults with flexible pes planus: a systematic review. Journal of Foot and Ankle Research. 2014 (7): 23
Brink, Y., Louw, Q., Grimmer, K., Jordaan, E. 2014. The spinal posture of computing adolescents in a real-life setting. 2014 (15) 212
Buist, M., Jaffray, L., Bedll, E., Hanna. L., Weinstein, P., Kumar. S., Grimmer. K. 2014. Utilisation of beds on the general medical unit by ‘non-acute medical’ patients: a retrospective study of incidence and cost in two Tasmanian regional medical hospital units. Internal Medicine Journal 2014 (44): 171-177
Causby, R., Reed, L., McDonnell, M., Hillier, S. 2014. Use of Objective Psychomotor Tests in Health Professionals. Perceptual and Motor Skills 2014 118(3): 765-804.
Dizon, J., Dizon, R., Region, J., Gabriel, A. 2014. Evidence-based practice training for health professionals in the Philippines. Advances in Medical Education and Practice 2014 (2014:5): 89-94
Dones, V., Grimmer,K., Thoirs., K, Suarez., C., Luker, J. 2014. The diagnostic validity of musculoskeletal ultrasound in lateral epicondylalgia: a systematic review. BMC Medical Imaging 2014 (14): 10
Dones, V., Grimmer, K., Milanese, S., Atlas, A. 2014. Association between Lateral Epicondylalgia and Upper Extremity Anthropometric Measurements: A case Control Study. International Journal of Physical Medicine & Rehabilitation. 2014 S5:003
Grimmer, K., Dizon, J., Milanese, S., King, E., Beaton, K., Thorpe, O., Lizarondo, L., Luker, J., Machotka, Z., Kumar, S. 2014. Efficient clinical evaluation of guideline quality: development and testing of a new tool. BMC Medical Research Methodology 2014 (14): 63
Grimmer, K., Lizarondo, L., Kumar, S., Bell, E., Buist, M., Weinstein, P. 2014. An evidence-based framework to measure quality of allied health care. Health Research Policy and Systems. 2014 12:10
King, S., Grimmer, K., Atlas, A., Milanese, S. 2014. Synthesizing complex data on functional decline in older people using partial least squares (PLS) analysis 2014. DOI: 10.1111/jep.12213
Lizarondo, L., Grimmer, K., Kumar, S. 2014. The Adapted Fresno test for speech pathologists, social workers and dieticians/nutritionists: validation and reliability testing. Journal of Multidisciplinary Health Care 2014 (7): 129-135.
Luker, J., Bernhardt, J., Grimmer, K., Edwards, I. 2014. A qualitative exploration of discharge destination as an outcome or a driver of acute stroke care. BMC Health Services Research. 2014 (14):193
Maywald, A., & Stanley, M. 2014. Occupational therapists’ experience of motorized scooter prescription. Australian Occupational Therapy Journal. 2014 doi:10.1111/1440-1630.12131
Milanese, S., Grimmer-Somers, K., Souvlis, T., Innes-Walker, K., Chipchase, L. 2014. Is a blended learning approach effective for learning in allied health clinicians? Physical Therapy Reviews 2014 (19): 86-93
Article (pdf 191KB)
Morris, J., Grimmer, K., Gilmore, L., Perera, C., Waddington, G., Kyle, G., Ashman, B., Murphy, K. 2014. Principles to guide sustainable implementation of extended-scope-of-practice physiotherapy workforce redesign initiatives in Australia: stakeholder perspectives, barriers, supports, and incentives. Journal of Multidisciplinary Healthcare. 2014 (7): 249-258
Stanley, M., Nayar, S. 2014 Methodological rigour: Ensuring quality in occupational therapy qualitative research. New Zealand Journal of Occupational Therapy 2014 60 (1): 6-12.
Van Niekerk, S-M., Grimmer, K., Louw, Q. 2014. The prevalence of underweight, overweight and obesity in a multiracial group of urban adolescent schoolchildren in the Cape Metropole area of Cape Town. South African Journal of Clinical Nutrition. 2014 18
Article (pdf 5.63MB)
Recently the iCAHE team moved to a new location: Playford Building level 4-18. This is well sign-posted should you need to find us.
Those of you who attend training sessions at iCAHE will soon get to know our new location. One of the benefits is that we are now co-located with some of our PhD team and have work space for others when they visit. One of our PhD students isprofiled in this newsletter, along with one of our more recent addition Research Fellows, Dr Louise Wiles.
Dr Louise Wiles
I am the Technical Manager for a NHMRC Partnership Project CareTrack Kids (0.8FTE), and work as a Research Fellow at the International Centre for Allied Health Evidence (0.2FTE). I am passionate about patient safety and quality, evidence based practice and consumer-centred healthcare. Currently, I am working on a range of research projects with a focus on allied health professional standards, delivery of appropriate health care, and chronic disease management.
Liz is investigating the implementation of the Assessment for Rehabilitation Tool (ART) –
a decision-making tool designed to assist stroke clinicians determine the rehabilitation requirements of people with stroke. The first stage of the study was to investigate how people with stroke were being assessed for rehabilitation prior to the release of the ART. Data were gathered via observation on stroke units and via auditing of medical records. The second stage of the study was to provide interventions; 5 hospitals received an education session about the ART, and 5 hospitals received a multi-faceted intervention (including feedback from the audit, education, facilitated session to identify barriers and strategies to use of the ART, recruitment of opinion leaders and reminders). The third stage of the study was to evaluate the effectiveness of the interventions and gather data about use of the ART. Data are currently being collected via focus groups and more medical record audits. Our results will be used to guide the national roll-out of the ART to improve processes of care for people with stroke in Australia.
The US Agency for Healthcare Research and Quality’s Effective Healthcare Program’s Scientific Resource Center (SRC) maintains a database of articles related to Comparative Effectiveness Research Methodology and sends out a weekly email alert of new additions. A recent paper by the iCAHE team about its new, validated, user-friendly clinician-focused critical appraisal tool for clinical practice guidelines was featured in this alert. The team is delighted that its work has been recognized in such a prestigious way. This email alert goes internationally to researchers, clinicians, policy-makers and consumers, whose use of the iCAHE instrument may never be able to be ‘tracked’ except by article downloads, and hits on the iCAHE website. Thus research citations of the iCAHE paper may measure only a fraction of the real impact of the iCAHE tool.
Grimmer K, Dizon J, Milanese S, King E, Beaton K, Thorpe O, et al. Efficient clinical evaluation of guideline quality: development and testing of a new tool. BMC Medical Research Methodology 2014;14(1):63
Free Full Text: http://www.biomedcentral.com/content/pdf/1471-2288-14-63.pdf (pdf 275KB)
Clinical practice guidelines (CPGs) provide recommendations derived from a synthesis of research and clinical evidence for the diagnosis / treatment/ maintenance of a huge number of medical conditions. There is no internationally agreed standard for guideline development or writing, and there is a plethora of variable quality guidelines produced by individuals or organisations to suit their specific purposes. Consequently, the quality of clinical practice guidelines, and their application outside the purpose for which they were developed, varies broadly. Whilst most clinicians would agree that CPGs provide them with a quicker reference to evidence than they would have if they attempted to make their own synthesis and judgement on evidence, they would also agree that it is difficult to identify good quality guidelines quickly from within the very many that are publically available. NB Most CPGs can be found through google.com as they are classed as 'grey literature' (they are too big to publish in a peer reviewed journal, and there is no universal 'good quality guideline' screening approach). So time-poor end-users such as clinicians and policy-makers need a critical appraisal tool to help them quickly identify good guidelines from poor guidelines, so that they can focus on guideline implementation. The only critical appraisal tool to date has been the AGREE instrument, which was developed mostly for research purposes. It requires at least two independent critical appraisers, using 23 questions in six domains, each question scored 1-7. Composite domain scores are derived from a scoring rubric relevant to the number of independent critical appraisers. This is not a simple, or time-efficient task, and consequently the AGREE instrument is rarely used in clinical practice or policy decisions. Moreover there is no central database of AGREE scores for CPGs that can be used as a go-to reference point.
The iCAHE guideline quality checklist was developed in response to policy-maker and clinician frustration, about identifying good CPGs quickly and independently (i.e. without needing to have multiple critical appraisers to make a decision). The iCAHE tool has 14 binary questions (Yes/No) which largely address the same domains as AGREE. The iCAHE tool uses a total score of the number of Yes responses. Our recently accepted paper in BMC Research Notes reports on the validation findings of the iCAHE tool compared with the AGREE II instrument. We found good correlation between the scores from both tools, and better inter-rater reliability with the iCAHE tool than with the AGREE tool (because of the ease of making Yes/No decisions with the iCAHE tool, compared with the 1-7 linear decisions required in AGREE). The iCAHE CPG section of its website provides a growing repository of CPGs which have been critically appraised with the iCAHE tool, so that clinicians and policy-makers can go directly to their area of interest, and find up-to-date web links to CPGs as well as critical appraisal scores out of 14. This provides them with simple, efficient access to good quality guidelines, which allows them to focus specifically on uptake and implementation.