DHBs funded over $2m to meet health research needs

3 August 2009
District Health Boards funded over $2 million to meet key health research needs

A second round of District Health Board (DHB) research funding for 2009 addresses research needs in the areas of diabetes, cardiovascular disease, obesity and cancer, across nine projects.

The intention of the DHB Research Fund is to commission research that addresses key knowledge gaps for DHBs, with a particular focus on funding projects that can maximise benefit to the health sector and communities. This joint venture funding is administered by the Health Research Council of New Zealand (HRC).

Dr Wendy Steven’s project, on behalf of the Northern DHB Support Agency Limited, was allocated $1.18 million to identify the barriers to early diagnosis of lung cancer.

Lung cancer’s poor prognosis, attributed to late diagnosis, makes it the leading cause of cancer deaths in New Zealand, reflected most strongly in Maori and Pacific peoples.

Dr Robin Olds, Chief Executive of the HRC said “For those working to deliver health care in New Zealand, ongoing research is an integral component in improving effectiveness and efficiency. This ultimately contributes to a health system that is continually progressing.

A further project which was cited by the funding committee as taking a “novel” approach, is being lead by Ms Helen McLauchlan, on behalf of the Counties Manukau DHB. The project will evaluate the use of a cough reflex test for reducing pneumonia in acute stroke patients, who often suffer from swallowing impairment.

A dosage of citric acid spray will be inhaled by patients in the experimental group and the cough response levels will be evaluated against the control group to determine if this will be an effective tool to assess higher risk of contracting pneumonia. If this is proven a successful process, the test can be readily and costeffectively implemented.

The full list of projects funded is outlined below, in the words of the applicants: Translational Research in Cardiovascular Disease, Diabetes and Obesity – Funding Results: Screening for Type 2 Diabetes in early pregnancy Dr Ruth Hughes, Canterbury District Health Board 12 months, $124,220 Objective: To determine whether blood sugar tests in early pregnancy will detect women with undiagnosed diabetes.

Methods: Blood tests for diabetes will be included with the first antenatal bloods.

Women with a positive result will be offered a further test to confirm diabetes and be given treatment as necessary.

Impact: Diabetes may go undetected for several years. In pregnancy, untreated maternal diabetes can cause problems for the baby including birth defects, delayed lung development, and obesity. Currently, women are offered testing for gestational (pregnancy) diabetes at 24-28 weeks of pregnancy. This means that women with undiagnosed pre-existing diabetes remain unrecognised until late pregnancy when treatment may be much less effective in reducing adverse pregnancy outcomes.

Detection and prompt treatment of pre-existing diabetes in early pregnancy can reduce potential immediate and long-term harm to the baby and have a positive impact on maternal health.

Can an integrated heart failure service improve diagnosis and management of heart failure Dr Anita Bell, Waikato District Health Board 12 months, $118,304 In February 2009 the Waikato Heart Failure group received funding for a community-based integrated heart failure service. We wish to investigate the impact of this new service on patient outcomes. This is an observational (comparative) study looking at a quality improvement intervention.

We wish to: Improve detection of heart failure; identify any inequalities; provide better local access to diagnostics and specialist care; and, to improve communication between primary and secondary care providers, and health providers and patients.

Once completed we will have relevant estimates of the numbers with and severity of heart failure against agreed guidelines, relevant risk factors, and a basis for early diagnosis and intervention. The service (intervention) will be evaluated to show whether it has led to an improvement in diagnosis and management of heart failure.

It will inform national strategies about processes that work for timely diagnosis and management of heart failure in primary care.

Identifying aspiration and reducing pneumonia in acute stroke patients using cough reflex testing Ms Helen McLauchlan, Counties Manukau District Health Board 12 months, $91,500 We propose to evaluate the utility of a cough reflex test for reducing pneumonia in acute stroke patients. All stroke patients referred for swallowing evaluation in a 9 month period will be approached for participation in the study.

Consenting participants will be randomly assigned to either a 1) standard evaluation group or 2) standard evaluation with inclusion of cough reflex testing. For those in the experimental group, concentrations of inhaled, nebulised citric acid will be administered to assess cough response and results will contribute to usual clinical decision making. Outcomes for both groups will be measured by pneumonia rates by 3 months post discharge and other clinical indices of swallowing impairment.

If successful in reducing morbidities associated with acute stroke, this test can be easily implemented by clinicians without significant cost or resources and consequently reduce the impact of diabetes, cardiovascular disease and obesity on health status and quality of life.

Whole of system approach to cardiovascular disease interventions in Hawke’s Bay in conjunction with Counties Manukau District Health Board – a parallel application to the HRC Mrs Dianne Keip, Hawke’s Bay District Health Board 12 months, $27,900 This research will build on a national cardiovascular dynamic simulation model to explore how it can be translated to a the specific regional context of Hawke's Bay.

We will partner with local experts to identify: Local priority questions that might be addressed by the model; where local data is available, or not, to apply within the national model; to quantify local changes in service during the time of the study and determine whether the model accurately reflects the effects of these changes on the system of cardiovascular services in Hawke's Bay. By involving local experts we expect to transfer knowledge of how to use these tools, and assess whether these experts consider this modelling process will help refine local decision making and therefore improve delivery of services within the available resources.

A parallel application from Counties Manukau DHB will enable triangulation between a national perspective and two distinctly different regions.

Is measurement of skin autofluorescence an effective method for both screening and monitoring of diabetes? Dr Brett Shand, Canterbury District Health Board 12 months, $108,232 This study will evaluate whether a new developed, non-invasive skin test is effective for screening for diabetes in the community and also for identifying patients with diabetes at increased risk of developing the serious vascular complications associated with the disorder. The test involves ultraviolet measurement of the fluorescence intensity of proteins in the skin.

The proposed study represents the final clinical phase of a series of studies that will validate and calibrate the method in both diabetic and non-diabetic people. The study will involve placement of the portable fluorescent measuring device in primary healthcare settings and also in hospital diabetes out-patient clinics. The ability of the skin test to identify subjects with undiagnosed diabetes and/or diabetic patients at increased vascular risk will be compared against currently used standard procedures. Depending on the outcome of these comparisons, it is possible this simple and inexpensive skin test may improve the ability to screen and monitor diabetes in the community.

Reducing length of stay and improving quality of care for inpatients with diabetes Dr Paul Drury, Auckland District Health Board 12 months, $148,110 Diabetes is present in 10-15% of patients admitted to hospital in New Zealand; about one in six of people with diabetes are admitted each year. Their stay in hospital is roughly doubled compared with non-diabetic patients. Our aim is to try three models of care delivery to see if they can reduce length of stay and/or improve quality of care. We will trial the methods below with teams involving specialist nurses and doctors, over an eight month period: Proactive - Daily ward visits/phone calls to identify patients and arrange treatment.

Reactive - Rapid responses to ward-initiated referrals.

Electronic - Immediate email notification of all admissions, then prioritising.

Measures will include time from admission to discharge, nursing staff time, quality of care and patient/staff satisfaction surveys. A positive result would allow shorter stays and better care for patients, with major savings of beds and costs for DHBs.

Evaluating the MEND (Mind Exercise Nutrition… Do It!) programme: Obesity management in children with disability Mrs Madeleine Sands, Auckland District Health Board 12 months, $78,435 Programmes aimed at the management and treatments of obesity in the general child population are often not appropriate for children with disability. The objective of this research is to evaluate the effectiveness and appropriateness of the modified Mind Exercise Nutrition… Do it! (MEND) pilot programme used by the Auckland District Health Board as a way of addressing the health issue of obesity in children with disability.

The MEND pilot programme will be evaluated through the use of the Framework for Programme Evaluation in Public Health (Centres for Disease Control and Prevention, 1999) which includes engaging stakeholders; description and evaluation of the program; gathering credible evidence and conclusions; and dissemination of the findings. Identification of successful interventions and effective service delivery to manage obesity, increase physical activity, improve nutrition and contribute to well being are critical to address the health issues (both present and future) of children and families with disability.

Health benefits of high intensity exercise for populations at risk of diabetes and cardiovascular disease Dr Helen Lunt, Canterbury District Health Board 12 months, $161,699 Traditionally low intensity ‘fat burning’ endurance training (LIET), for example walking or jogging, has been prescribed for those at-risk of developing type 2 diabetes and cardiovascular disease (CVD). This type of exercise has met with limited risk factor reduction and exercise adherence success. Recent research suggests high intensity exercise (HIIT) or combined high and lower intensity exercise (MIXT) may provide a time efficient method for improving risk factor reduction and exercise adherence. Our objective is to examine whether these findings can translate to populations at-risk of diabetes and cardiovascular disease in an Aotearoa/New Zealand context. In the first 12 week phase of the research translation of HIIT and MIXT to at-risk populations will be examined and in the second 6 month phase the exercise interventions will be adapted to match those readily available to participants in their local area. Changes in risk factors will be assessed along with exercise adherence.

Cancer - Funding Results: Assessment of barriers to the early diagnosis of lung cancer within primary care Dr Wendy Stevens, The University of Auckland, Northern District Health Board Support Agency Limited 36 months, $1,176,789 Lung cancer is the leading cause of cancer deaths in New Zealand, and its poor prognosis is largely attributed to late diagnosis.

The study aims to identify barriers, especially for Māori and Pacific peoples, to timely diagnosis and appropriate initial cancer care, and to recommend service change to facilitate diagnosis and coordinated care.

A stock take of primary care services and documentation of the lung cancer patient’s journey from presentation to primary care until the first specialist assessment will be performed in three Primary Health Organisations in greater Auckland. Reasons for not attending appointments and initial presentation to secondary care via the emergency department will be explored by interviews and focus groups.

Improved understanding of the barriers to early diagnosis and recommendations for service modification to better meet community needs and expectations have the potential to result in earlier diagnosis, improving quality of life and survival for people with lung cancer.

About the District Health Board Research Fund

The 21 District Health Boards, through District Health Boards New Zealand (DHBNZ), have established a health research fund for the purpose of commissioning research that addresses key knowledge gaps for District Health Boards (DHB).

The fund intends to support and promote the translation of research findings into practice and is particularly focused on the principles of funding projects that can maximise benefit to the health sector and communities, provide opportunities for knowledge transfer, ensure that the investments meet national and international best practice, focus on health services and population health and to contribute to improved health service delivery and outcomes over the short to medium term.

A total funding pool of approximately $6 million is available over three years for research focusing on DHB service development and delivery.

This fund is sponsored by the National DHB CEO forum, and governed by the District Health Board Research Fund (DHBRF) Governance Group with members representative of the DHB CEO’s, DHB funder and provider services, primary care, mental health, Maori health, community health and health researchers.

This joint venture is being administered by the Health Research Council of New Zealand (HRC). This project along with all research contracts awarded through the DHBRF will be subject to the same quality assurance processes, contestability regime and monitoring protocols as is standard with research awarded through the annual HRC funding round and Partnership Programme.

About the Health Research Council of New Zealand (HRC) The HRC is the Crown agency responsible for the management of the Government’s investment in public good health research. Ownership of the HRC resides with the Minister of Health, with funding being primarily provided from Vote Research, Science and Technology. A Memorandum of Understanding between the two Ministers sets out this relationship.

Established under the Health Research Council Act 1990, the HRC's statutory functions include:
• advising the Minister and administering funds in relation to national health research policy;
• fostering the recruitment, education, training, and retention of those engaged in health research in New Zealand;
• initiating and supporting health research;
• undertaking consultation to establish priorities in health research;
• promoting and disseminating the results of health research to encourage their contribution to health science, policy and delivery, and
• ensuring the development and application of appropriate assessment standards by committees or subcommittees that assess health research proposals.

ENDS

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