- •Embedding researchers in health service organization can optimize research coproduction through greater knowledge exchange and alignment of research with health policy and practice needs.
- •An embedded coproduction approach makes policy and practice-relevant research immediately available to end users, accelerating the use of evidence in decision making of health and other services.
- •A coproduction approach provides opportunities to leverage academic and health services resources to achieve scientific and service delivery objectives.
What this adds to what is known?
- •End-user organizations should seek to embed staff with academic expertise in senior leadership positions.
What is the implications and what should change now?
1. The Hunter New England Population Health research-practice partnership
1.1 Supporting service innovation and improvement and accelerating research translation
|Trial objectives and partners||Key study considerations||Research findings||Translation outcomes|
|Pragmatic efficacy or effectiveness trials|
|Aim: To assess, the efficacy of an intervention in improving smoking cessation of patients attending preoperative clinics for elective surgery preparation |
Intervention: Tailored computer-based cessation counseling, nicotine replacement therapy, brief clinician advice, referral to Quitline.
Partners: Newcastle University; HNEPH; surgical preoperative services.
Design and setting: RCT in outpatient clinics.
|Relative to a usual care control, there was a significant improvement in preoperative and postoperative smoking cessation among patients in the intervention group.||Intervention adopted as routine care for tobacco users by the surgical preoperative service and informed clinical practice guidelines.|
A fax-based system of referring patients to a Quitline tested as part of the trial was adopted for use across hospitals in the state.
|Aim: To examine the effectiveness of an intervention in reducing risky alcohol consumption and harm among community football club members |
Intervention: Sporting clubs supported to implement alcohol management practices consistent with liquor licensing requirements.
Partners: Newcastle University; HNEPH; Deakin University; Australian Drug Foundation.
Design and setting: RCT in community sports clubs.
|Relative to an information only control, there were significant reductions in excessive alcohol use among member of intervention clubs.||Intervention was rolled out across Australia by the Alcohol and Drug Foundation.|
|Aim: To assess the efficacy of a telephone-based intervention for parents to increase the fruit and vegetable consumption in their 3- to 5-y-old children |
Intervention: Printed resources with four 30-min scripted behavioral counseling telephone support calls delivered by call center staff.
Partners: Newcastle University; HNEPH.
Design and setting: RCT in home settings.
|Relative to an information only control, there were significant improvements in fruit and vegetable intake of parents and children in the intervention group.||The intervention was included in the state health plan as a state-wide service for parents.|
|Dissemination and implementation trials|
|Aim: To assess the impact of an intervention on the provision of smoking cessation care to nicotine-dependent smokers by clinicians across a network of hospitals |
Intervention: A multicomponent intervention was implemented over a 2-y period in all 37 public general hospitals and included clinician training, endorsement by the Chief Executive of the health district, telephone implementation support calls from HNEPH staff, care protocols, and performance monitoring and feedback.
Partners: Newcastle University; HNEPH, Hunter New England Local Health District.
Design and setting: Interrupted time series in a single health district in New South Wales.
|The provision of smoking cessation care increased significantly six of the seven measures of clinician care provision between the baseline and follow-up periods, respectively.||The intervention improved care smoking cessation care provision across the entire HNE hospital system.|
The implementation model has been used by HNEPH and the Local Health District to implement other district-wide preventive health initiatives.
|Aim: To examine the effectiveness of a multistrategy intervention in increasing the implementation of vegetable and fruit breaks by all (>400) primary schools in the Hunter New England (HNE) region.|
Intervention: The implementation strategy included consensus processes; leadership from school executive; staff training; program materials; implementation incentives; follow-up implementation support delivered by HNEPH staff and performance feedback
Partners: Newcastle University; HNEPH, Hunter New England Local Health District.
Design and setting: Quasiexperimental. All schools in HNE region receive implementation support. A random selection of schools in the rest of the state served as controls.
|Relative to control, the prevalence of vegetable and fruit breaks increased significantly in intervention schools.||The model of implementation was used by the department of health to implement obesity prevention programs in schools across the state.|
|Aim: To determine the effectiveness of an intervention in facilitating police recording of the alcohol consumption characteristics of people involved in assaults across the entire state of New South Wales (NSW) to improve targeted policing |
Intervention: The implementation strategy included implementation support by the Police Commissioner, modification to standard operating procedures, training of police officers, performance feedback, and communication and implementation support staff.
Partners: Newcastle University; HNEPH, NSW Police.
Design and setting: Stepped wedge trial was conducted across police jurisdiction of the state of New South Wales, Australia.
|The intervention was effective in enhancing the recording of alcohol-related information for assault incidents.||The model of implementation support improved recording to facilitate targeted policing of alcohol-related harm across NSW and was used to similarly improve recording of alcohol use of people involved in assaults in other jurisdictions internationally.|
|Aim: To determine the effectiveness of an intervention to close the gap in aboriginal infant immunization coverage in New South Wales (NSW) |
Intervention: Aboriginal immunization officers were used to contact the families of aboriginal children by telephone before their due immunization date (precall) to provide the rationale for timely immunization, and to facilitate contact with culturally safe local immunization services if this was required.
Partners: Newcastle University; HNEPH, Aboriginal Controlled Community Health Services,
Design and setting: Before–after and stepped wedge trial across NSW.
|Three study periods with the initial phase demonstrating significant gap between aboriginal and nonindigenous infant immunization rates both in HNE and rest of NSW.|
During the second phase, HNE employed aboriginal immunization officers to precall mothers.
In the third phase, on the basis of the success in HNE, aboriginal immunization officers were employed across NSW, but the precall strategy was only fully implemented in HNE.
|There was a significant decrease in the immunization coverage gap between aboriginal children and nonindigenous children in HNELHD (P < 0.0001) and the rest of NSW where only aboriginal immunization officers were employed, but no precall strategy implemented (P = 0.004).||The employment of aboriginal immunization officers was associated with closing of the gap between aboriginal and nonindigenous infants' immunization coverage in HNELHD and NSW. The precall telephone strategy provided accelerated benefit in closing this gap in HNELHD.|
1.1.1 Trials assessing intervention effectiveness in addressing chronic disease risks
- Sutherland R.
- Campbell E.
- Lubans D.
- Morgan P.
- Nathan N.
- Okely A.
- et al.
1.1.2 Trials of strategies to improve implementation of evidence-based health interventions
1.2 Leveraging resources to achieve scientific and service delivery objectives
1.3 Knowledge exchange and building the capacity of researchers and practitioners
2. Factors that enhance the effectiveness of research-practice partnerships
- 1.Similar to that found in evaluations of QUERI [], the embedding of researchers into HNEPH service delivery teams and organizational governance positions and processes and of HNEPH staff in research teams is considered a critical feature in the achievement of enhanced research and service delivery performance. This strategy maximizes bidirectional knowledge transfer and exchange and enables immediate translation of research into practice. Few research-practice partnerships have involved such integration. Having senior leadership positions, including that of Director, with dual university and health service appointments enables the accountabilities of each organization to be met in a synergistic manner.
- 2.Successful research-practice partnerships require cocontribution of resources if the partnerships are to endure. In the case of CLAHRCs [], the requirement of cofunding (at least 50%) of research activities by research partners was considered an important component of the success of the scheme. Similarly, financial and in-kind contributions are made by both parties in the HNEPH partnership (commensurate with their priorities) demonstrated commitment to the partnership and the value of its outcomes.
- 3.Research-practice partnerships must produce cobenefits if they are to be successful. For the HNEPH service delivery partner, the partnership has yielded improvements in health system performance, demonstrated through exceeding service delivery performance indicators and the receipt of national awards for innovation and excellence in service delivery. The partnership has also fostered one of the more highly performing research groups at the university attracting $40m in grant income since 2005, publications in prestigious journals, research awards, demonstrable research translation impact, and research higher degree completions.
- 4.Evidence clearly suggests that the benefits of research-engaged health services accrue over time []. Time is also required to achieve research translation on a systematic and continuing, not one-off, basis. More concretely, in the case of the HNEPH partnership, time (more than a decade) has been an essential ingredient for the development of an integrated team of service delivery-focused research staff and research-focused practitioners, a development achieved through the time consuming training of partnership-based PhD and postdoctoral researchers.
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Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
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