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Health Services

Led by Professor Harriet Hiscock, the Health Services Group supports the development and use of the best available evidence to increase the quality, accessibility, and value of healthcare that children receive. It aims to reduce disparities and to improve health outcomes for children across Victoria and Australia. With the growing cost and demand for health services and the complexity of health care delivery, health services research can better inform policy makers, clinicians and patients on how best to deliver healthcare.

Health Services Research is a scientific field that examines:

  • How people get access to healthcare
  • How much care costs
  • What happens to patients as a result of this care.

Our research investigates how to improve children’s mental health care through clinical and population trials and studies of the organisation and financing of mental health care. We work in partnership with the Royal Children’s Hospital Health Services Research Unit which focuses on developing and testing novel approaches to shift care from the overburdened hospital system to the community and to reduce low value or wasteful care.

Our work is underpinned by systematic reviews, secondary healthcare data analysis and large, epidemiological studies. Health services research, quality improvement and health economics perspectives are integral to our work.

Group Leaders: 
Team Leaders: 
Group Members: 
Cate Rayner
Role: 
Paediatric Fellow
Dafna Idan Prusak
Role: 
Research Assistant
Alexa Chalmers
Role: 
Research Assistant
Emma Stephens
Role: 
Research Assistant
Prof Gary Freed
Role: 
Honorary Fellow
Hayley Loftus
Role: 
Research Coordinator
Dr Jane Sheehan
Role: 
Research Officer
Jemimah Ride
Role: 
Health Economist
Jeremy Quek
Role: 
Postdoctoral Fellow
Kate Paton
Role: 
Senior Research Officer
Kate Stephens
Role: 
Research Assistant
Leanne Constable
Role: 
Research Affiliate
Li Huang
Nicola Read
Role: 
Research Assistant
Olivia Ng
Role: 
Research Assistant
Rachel O’Loughlin
Role: 
Research Assistant
Rachel Pelly
Role: 
Research Assistant
Renee Jones
Role: 
Research Assistant
Sampada Bhide
Role: 
Postdoctoral Fellow
Dr Shaoke Lei
Role: 
Research Assistant
Stephanie Newman
Role: 
Project Assistant
Suzy Honisett
Role: 
Project Officer
Jono Kaufman
Role: 
Research Affiliate
Tess Hall
Role: 
Post Doc
Tom Butera-Kelly
Role: 
Research Assistant
Sarah Loveday
Role: 
PhD Student
Daniel Peyton
Role: 
PhD Student
Billy Garvey
Role: 
PhD Student
Mary White
Role: 
Research Fellow
Xinyang Hua
Role: 
Health Economist
Belinda Horton
Role: 
Senior Project Coordinator

Current projects

Australian Paediatric Research Network (APRN)  

The APRN is a network of over 500 Australian paediatricians who are keen to contribute to new research that is relevant to both public and private practice.  The network is the first of its kind in Australia. It builds research capacity by involving more clinicians in research activities and enhancing recruitment for community based research projects. Projects include our annual Multi-Topic survey, 5-yearly national 'snapshot' of paediatric practice, Delphi survey to establish paediatrician's research priorities and the Sleeping Sound with ADHD trial.

Baby Business

The Baby Business intervention project provided parents with information about normal infant sleep and cry patterns and strategies to manage these behaviours. Managing sleep and crying with a new baby can be challenging. Baby Business – a guide for parents is a short booklet to help parents to manage baby’s sleeping and crying in the first few months of life. It’s based on the latest research and provides accessible and practical information for parents. A version for maternal and child health nurses was produced for the Victorian Government in early 2014, now there’s a version for parents too. The booklet is available for just $6 per copy (less for bulk orders), plus postage and handling.

Centre of Research Excellence in Childhood Adversity and Mental Health

The Centre of Research Excellence in Childhood Adversity and Mental Health is a five-year research program (2019-2023) co-funded by the National Health and Medical Research Council (NHMRC) and Beyond Blue.  Our vision is to create a sustainable service approach, co-designed with end-users, to improve children’s mental health by early detection and response to family adversity. To achieve our vision we are first reviewing the evidence around what interventions are most effective for reducing the negative effects of adversity on children’s mental health and wellbeing. We are then co-developing, with end-users, systems-based approaches that identify and respond to childhood adversity from before birth and into primary school years (0-8 years).We will then test and evaluate our approach in our Child and Family Hub@Wyndham Vale, and in another hub in Marrickville, NSW.

Understanding family preferences for accessing mental healthcare for children with chronic physical health problems

Children with long-term physical health problems, such as diabetes or epilepsy, have high rates of mental health problems that are not being addressed in their usual places of care. This project will look at how pathways into mental health care could be tailored to meet the unique needs of these children and their families. We will do that by understanding what features of mental health care are important to families, and will lead to the greatest uptake of mental health care.

Reducing Asthma re-admissions

Asthma is the most common chronic childhood illness and one of the most frequent reason for a hospital admission. To prevent frequent, costly admissions, we need to understand factors in a child’s care journey associated with re-admissions. This project follows a cohort of 770 children who were admitted to hospital for asthma treatment to understand the burden of the illness on the child, their family, and the health system. Using medical record analysis, GP surveys, family interviews as well as linked hospital and medication administrative data, this project aims to identify modifiable hospital, GP, family and environmental factors associated with asthma re-admissions. Using the findings of this study, we are co-designing interventions with families, GPs, and hospital clinicians to reduce hospital re-admissions with asthma.

This project is supported by the Australian Government’s Medical Research Future Fund (MRFF) as part of the Rapid Applied Research Translation program through the Melbourne Academic Centre for Health.

Strengthening Care for Children (SC4C)

This project is a stepped-wedge randomised control trial being conducted within 22 GP practices across Victoria and New South Wales. SC4C is testing a new model of integrated GP-Paediatrician care for children. The integrated models involves: regular GP-paediatrician co-consultations; monthly case study discussions led by the Paediatrician; and specialist paediatric phone and email support for participating GPs. SC4C aims to reduce paediatric referrals to hospital emergency departments and outpatient clinics, increase GP confidence and knowledge in paediatric care, reduce low value paediatric care in primary health settings, and increase family confidence in GP care for their child while reducing their desire for specialist paediatric care. The SC4C project hopes to produce evidence for a cost-effective and scalable model of integrated care for children. The SC4C trial is a scale-up of a pilot run by the Health Services Research Unit of The Royal Children’s Hospital in 2017-2019.  SC4C is funded through an NHMRC Partnership Grant. The SC4C trial is being conducted in partnership with The Royal Children’s Hospital, The University of Melbourne, University of New South Wales, Sydney Children’s Hospital Network, Macquarie University,  North Western Melbourne Primary Health Network, Central and Eastern Sydney Primary Health Network,  Agency for Clinical Innovation (NSW Health) and the Sydney Partnership for Health, Education, Research and Enterprise (SPHERE).

Reference
•    Hiscock H, O’Loughlin R, Pelly R, Laird C, Holman J, Dalziel K, Lei S, Boyle D, Freed G. Strengthening care for children: Pilot of an integrated GP-paediatrician model of primary care in Victoria. Australian Health Review 12 February 2020

PhD Projects

Audit of source of and adherence to guidelines for peri-operative surgical antibiotic prophylaxis

Perioperative surgical antibiotic prophylaxis (AP) is a single, effective intervention that reduces microorganism burden at the surgical site. Appropriate administration of surgical AP reduces surgical site infection (SSI) risk by minimizing intraoperative wound contamination. Conversely, inappropriate surgical AP can increase the risk of adverse drug events (ADEs), including patient-acquired clostridium difficile infection, and promotes the emergence of multi-resistant organisms. Multiple state and national-level guidelines exist on which to case clinical practice, which have not been adapted for the RCH context to date. This audit aims to 1) establish the source(s) from which AP information is accessed at RCH, 2) describe the guidelines currently in use, 2) establish the rates of appropriate and inappropriate surgical AP in high frequency procedures at RCH, 3) report the rates of SSI in patients who received appropriate and inappropriate surgical antibiotic prophylaxis and 4) report the rates of clostridium difficile in patients who received AP. The results from this project will be used to inform an institution-wide approach to perioperative AP practice.

EuroQoL grant: testing EQ-5D-Y for use in children aged 2-5 years

Few Health-related Quality of Life (HRQoL) measures are available for estimation of child quality-adjusted life-years (QALYs) with a nearly clear absence of measures for children under 5 years, despite younger children being greater consumers of health care services than older children. The EQ- 5D-Y is recommended for children 4-7 years using parent proxy, but there has been relatively little research into its use for children under 4 years. There could be a key opportunity to extend the use of EQ-5D-Y for proxy completion for children aged 2-4 years. This research project establishes if the EQ-5D-Y can be used for children 2-4 years and to co-design a suitable adaptation for testing with parents/carers. A further aim is to validate the adapted EQ-5D-Y with proxy completers alongside CHU9D and PedsQL.

QUOKKA Project- Quality Of Life in Kids: Key evidence to strengthen decisions in Australia

Decisions about health care rely on evidence that treatments work and are value for money. This is typically assessed by the improvements in Quality adjusted life years (QALYs) from treatment, and its cost effectiveness.  Methods conventionally used to measure and value adults’ health related quality of life (HRQoL) do not work well in valuing paediatric HRQoL and preclude asking children for their views. Given these problems, there has been low uptake of these tools in the evidence used to inform healthcare decisions. The resulting gap in evidence risks significant misallocation of funds, potentially denying access to effective and cost-effective paediatric interventions.
Our research will comprehensively address these issues in measuring and valuing child health for use in assessing effectiveness and cost effectiveness. Deliverables will include (i) a database of paediatric HRQoL data across different questionnaires and diseases (ii) improved methods for self-and proxy-report of child HRQOL (iii) state of the art methods for valuing child health states, including producing Australian value set for at least one widely used paediatric HRQoL questionnaire (iv) evidence on the weight placed on child vs. adult QALYs by patients, the general public and decision makers.

Completed projects

 

Does the treatment of anxiety in children with ADHD improve outcomes? A large-scale randomised controlled trial. (Calm Kids Study - NHMRC project grant) 
The Calm Kids Study is about anxiety in children with Attention Deficit Hyperactivity Disorder (ADHD). A large number of children with ADHD also experience anxiety (25-50%). We know that anxiety in children with ADHD makes daily life harder for children and their families. The study aims to see whether treating anxiety in children with ADHD improves child anxiety, as well as broader child and family functioning. The intervention program we use to treat anxiety involves teaching children and parents what anxiety is, what causes anxiety, and what children and parents can do to lessen anxiety. To know whether this 10-session program helps, we need to compare children who receive the program with children who do not. Children are randomly placed in either the ‘Intervention Group’ or the ‘Usual Care Group’. The study is funded by the Besen Family Trust, the Myer Foundation, and the National Health and Medical Research Council.

Changing agendas on sleep, treatment and learning in childhood epilepsy (CASTLE) 
Most children with epilepsy have sleep problems and wake in the night. Disturbed sleep in turn reduces learning ability and can also trigger seizures. Parents often get up to check on their child in case s/he is having a seizure, and sometimes sleep with the child because they are worried. This can make the parent very tired the next day and affect their stress and concentration levels. Led by colleagues in the UK, we are adapting an existing sleep behavioural treatment to the sleep problems experienced by parents of children with epilepsy. We are testing how well it works compared to standard treatment in a randomised controlled trial.

Children’s Attention Project (CAP) 
The Children’s Attention Project (CAP) is a longitudinal cohort study looking at the long-term effects of children’s attention and hyperactivity difficulties on children’s behaviour, learning and day-to-day living, as well as their parents’ well-being. Some children in CAP have attention and/or hyperactivity difficulties, others do not. There are 497 families participating in CAP. Families were recruited when children were in their second year of schooling (Grade 1 in 2011 or 2012). We have since completed three follow ups with families (every 18 months) to see how outcomes vary over time between those with and without these difficulties. We also have a neuroimaging sub-project (the Neuroimaging of the Children’s Attention Project; NICAP) which is looking at how the brain develops across childhood into early adolescence.

Digital Sleep App
Behavioural sleep problems are common in children and are associated with poorer behaviour, learning and parent mental health. Our team has developed a suite of sleep intervention strategies and evaluated them in a series of randomised controlled trials. The strategies are effective in reducing child sleep and behaviour problems and poor parent mental health. However, many parents to do have ready access to these interventions and instead find themselves on long waiting lists for specialist help. This digital sleep app aims to change this. Using strategies tested in our trials, we are building an app to help parents to manage sleep problems in children aged 1- 13 years. We aim to see whether use of this app reduces parent need to stay on a waiting list for specialist sleep support, reduces child sleep problems and has flow on effects with improved child behaviour and parent mental health. Costs of the app from the healthcare and family perspective will be recorded.

Mental Health Services (Towards an evidence-based and equitable mental health system for children in Australia -NHMRC Project grant)
An NHMRC funded study to investigate the mental health service use in Australian children. This study characterises those Australian children with mental health difficulties who are not receiving any treatment or services and documents the types and costs of services amongst those who are receiving treatment. The study focuses on identifying modifiable child, family, and system level factors associated with access to services and variation in treatments provided to children who do access services.

Sleeping Sound with Autism (Tailoring a brief sleep intervention for autism: a randomised controlled trial. NHMRC Project grant) 
This randomised controlled trial, led by researchers at Deakin University, aims to adapt our effective sleep interventions for children with ADHD to determine whether similar benefits to child sleep, behaviour, learning and parent mental health can be realised for children with autism and behavioural sleep problems. 

Early Minds Mindfulness Study
Smiling Mind in partnership with Early Childhood Australia (ECA) have developed a new pre-school mindfulness program called Smiling Mini Minds. Smiling Mind and ECA have asked the Murdoch Children’s Research Institute (MCRI) to evaluate the Smiling Mini Minds program. As part of the evaluation, the study team want to find out how easy / hard it is for educators to run the program within their early learning centre (ELC) room and whether the program makes any difference to children’s emotions, behaviour or sleep. To find this out, the study will compare ELC educators and children that run and receive the program with educators and children who do not. Following baseline data collection, educators will be randomly assigned to either the ‘Program Group’ or the ‘Usual Care Group’. Children will be placed in the group their educator is in. Educator and parent-reported follow-up data collection will occur three and 12 months post randomisation.

Ambulatory care sensitive conditions across Sweden, USA, Canada, Australia and England (SUCA)
This project aims to compare admission rates for paediatric ambulatory care sensitive conditions (ACSC) in 5 different countries which have different health care systems and providers of primary care to determine if : (i) there is a difference in 10 year trends for rates of admission for paediatric ACSC (per 100,000 population) by jurisdiction and (ii) if there are differences in 10 year trends for rates of admission for paediatric ACSC (per 100,000 population) by socioeconomic group across jurisdictions. ACSC's are considered to be an indicator of primary care accessibility and effectiveness. Comparing ACSC admission rates across these five different jurisdictions may enable policy makers and clinicians to better pinpoint how best to provide primary health care, reduce avoidable admissions and create more equitable and effective systems of primary care. The jurisdictions being compared for this project are California-USA, Ontario-Canada, Sweden, England and Victoria-Australia.. 

Funding: 
  • National Health and Medical Research Council (NHMRC)
  • The Royal Children’s Hospital Foundation
  • Better Care Victoria (Department of Health and Human Services)
  • Safer Care Victoria (Department of Health and Human Services)
  • Besen Trust
  • Myer Foundation
  • Ian Potter Foundation
  • Royal Australasian College of Physicians Foundation
  • Royal Melbourne Institute of Technology (RMIT) Translational Seed Grant
  • MCRI Population Health Theme Funding
Collaborations: 

National

  • Royal Children’s Hospital, Health Services Research Unit
  • University of Melbourne, Department of Paediatrics
  • University of Melbourne, Centre for Health Policy, Health Economics Unit
  • University of Melbourne, Health and Biomedical Informatics Centre (HaBIC) Research Unit
  • School of Psychology, Deakin University
  • Menzies Kids, University of Sydney
  • Royal Australasian College of Physicians (RACP)
  • Australian Institute of Health Innovation, Macquarie University
  • Sunshine Hospital
  • North Western Melbourne Primary Health Network
  • Werribee Mercy Hospital
  • Curve Tomorrow
  • Monash Children’s Hospital
  • Ballarat Hospital
  • Royal Melbourne Institute of Technology (RMIT)
  • Food & Mood Centre, IMPACT SRC, Deakin University
  • The Australian Centre for Ecogenomics, The University of Queensland

International

  • University of Michigan, Child Health Evaluation and Research Center, Michigan, USA
  • Stanford University, California, USA
  • Toronto Sick Kids, Ontario Canada
  • Trinity College, Dublin, Ireland
  • King’s College, London, UK
  • University College, London, UK
  • Karolinska Institute, Sweden
  • University of Southern Denmark, Centre for Global Health, Denmark