Research is a remarkably powerful tool in shaping how healthcare is delivered. It can offer an objective guide to using medical tests, devices, and drugs.
By Qasim Hussaini
Duke-NUS Year 2 MD student
Research is a remarkably powerful tool in shaping how healthcare is delivered. It can offer an objective guide to using medical tests, devices, and drugs. It also helps support clinical and public policy decision-making regarding the development and dissemination of new health services and strategies for funding and reimbursement. This domain of research is referred to as health services research.
One area of health services research of special interest in Singapore, and Duke-NUS in particular; relates to services for prevention, acute treatment, and rehabilitation of stroke. In Singapore, stroke is the leading cause of long-term disability and accounts for 9.1% of years of life lost and 6.1% of disability-adjusted life years. As a matter of clinical policy (what we can do within our health care organisations) and public health policy (what we can do in funding and priority setting), stroke is a hugely important topic.
At Duke-NUS, we are currently leading a study, SPORT (Stroke Patients Outpatient Rehabilitation Therapy), a randomised controlled trial that investigates the health and economic impact of strategies for improving the uptake of stroke rehabilitation services. The study will recruit patients at a local hospital identified by their care team as candidates for rehabilitation, and randomly assign them to usual reimbursement for rehabilitation services, or to an intervention that provides additional incentives in the form of funding for out-of-pocket costs for escort, transportation and rehabilitation services.
The key goal of [the study] is to assess whether the impact of incentives relative to their costs is sufficient to make such funding a good way to allocate social resources.
Though increased funding is expected to increase service uptake, the key goal of SPORT is to assess whether the impact of incentives relative to their costs is sufficient to make such funding a good way to allocate social resources. The primary study outcome will measure uptake of services, and secondary study outcomes will include adherence, disability and health service utilisation.
This study was developed based on previous research done in Singapore. First, a series of studies lead by Associate Professor Gerald Koh showed that only about 1 in 3 individuals who are candidates for rehabilitation actually use these services. The chief contributors to this lack of uptake are cost and inconvenience of transport. These studies also indicated that rehabilitation services in Singapore are effective in improving functional outcome.
[Health Services Research] helps support clinical and public policy decision-making regarding the development and dissemination of new health services and strategies for funding and reimbursement.
The second line of research by Professor David Matchar’s research team from Duke-NUS, involved a simulated study of the likely impact of improved uptake of rehabilitation services in Singapore. They constructed a synthetic cohort representing the Singaporean population and examined how the increased uptake of outpatient rehabilitation services aimed at improving functional recovery may generate gains on quality-adjusted life years and provide a financial return on investment of public funds. In other words, it may be something that is economically beneficial for the nation.
In addition to the general importance of the topic, it is worth emphasizing here the process of how we as researchers have worked hand-in-hand with stakeholders to engage in a coherent series of investigations that lead to the current study as a logical next step, a step that will help inform health care decision-making. This process included separate phases that began with critically reviewing and assessing available evidence; identifying practice variations, explaining observed variations; performing “what if” analyses of new strategies, and testing those strategies in real-world settings.
The second point worth underscoring here are the tremendous gains that may be obtained from investing in projects related to healthcare systems, infrastructure and policy. While it is clearly important to discover tests and treatments that have the potential to improve outcomes, in many cases we may get at least as much benefit with the knowledge that we are delivering care that we know already works.
Qasim Hussaini is a graduate of Johns Hopkins University with a Master's degree in Biotechnology/Regulatory Affairs. He completed his graduate work in neuroscience at the Johns Hopkins School of Medicine and the Mayo Clinic. A Duke-NUS M.D. student from the Class of 2017, he is mentored by Professor David Matchar, Director of the Health Services and Systems Research Programme at Duke-NUS.
This story was first published on Vital Science in April 2015. Read more Duke-NUS stories here.
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