HCF research challenges traditional models of hospital care

HCF-funded research showcased at Parliament House is exposing both the promise of new models of care and the challenges of what happens when novel approaches disrupt established clinical and financial models.

At the HCF Research Foundation’s inaugural Research to Reality Parliamentary Showcase during National Science Week, Foundation Chair Adjunct Professor Karen Price emphasised that research matters, but its value is ultimately realised only when evidence is translated into meaningful changes in the care patients receive.

“Health services research helps us understand how healthcare is accessed, delivered and experienced, and how we can make care safer, more effective, more equitable and more sustainable,” said Adjunct Professor Price. “The real measure of success isn’t how many studies are published. It’s whether the evidence improves the care people receive and the outcomes they experience.”

The showcase brought together HCF-funded research tackling some of the health system’s most pressing challenges, illustrating how evidence can transcend the academic sphere to reshape clinical practice and the delivery of care. Among the projects is I-HEART, which is expanding access to specialist heart failure services in regional and rural communities through an advanced telehealth model supported by nurse-led clinics.

The need is particularly acute outside metropolitan centres, where heart failure mortality rates are 16% higher than in urban areas, yet only 6.9% of patients hospitalised with heart failure receive all recommended therapies. Since its launch in 2022, I-HEART has translated research into practice, implementing more than 30 decision-support tools and establishing two nurse-led heart failure clinics.

“Telehealth has been a game-changer, especially for those living in regional and rural areas where heart failure patients previously lacked specialist care. Patients are seen within a week of hospital discharge and then weekly for five weeks to prevent readmission,” said project lead, Professor Andrea Driscoll from Deakin University and Austin Health.

Despite challenges such as staffing costs, connectivity issues and natural disasters like floods, the benefits of the model far outweigh the obstacles.

“If you implement the telehealth clinic and fund a coordinator, the cost savings from reduced hospitalisations can cover the clinic’s expenses,” Professor Driscoll added.

The same tension between clinical evidence, patient outcomes and health system economics emerges in another HCF-funded project examining how to keep people with knee osteoarthritis out of hospital and avoid surgical intervention through knee arthroplasty.

More than 55,000 total knee replacements (TKRs) are performed in Australia each year, but about 20% of patients continue to experience pain after surgery and up to 24% have a serious adverse event.

“Unfortunately, patients won’t know if the benefits outweigh the risks until after they’ve had the surgery, so all they can do is look at the probabilities of each,” explained Professor Ian Harris, Professor of Orthopaedic Surgery at UNSW Sydney. “Generally, the more severe the symptoms and disability associated with osteoarthritis, the greater the benefits [of surgery].”

With a grant from the HCF Research Foundation, researchers at the University of Melbourne developed the SMART Choice tool to help patients assess how likely they are to benefit from a TKR. Patients reported a reduced desire to have a TKR when the SMART Choice tool indicated a low likelihood of improvement after surgery.

“Exercise, walking aids and anti-inflammatory medication are commonly prescribed, but possibly the most effective non-surgical treatment is weight loss,” said Professor Harris. “Most patients undergoing [knee replacement] are obese, and studies have shown that weight loss in patients who need a knee replacement can significantly reduce their symptoms, often to the point where they no longer even need surgery.”

For patients who proceed to knee replacement surgery, short-stay surgical models aim to discharge patients within 24 to 48 hours after surgery.

The NSW Agency for Clinical Innovation (ACI) reviewed the clinical and economic implications of same-day joint replacement, assessing outcomes against conventional inpatient care. Drawing on 29 systematic reviews, the assessment found that same-day procedures (also described as outpatient surgery) generally delivered comparable outcomes to inpatient care across a range of measures, while reducing costs.

Modelling from Monash University’s School of Public Health and Preventive Medicine estimates that broader adoption of same-day joint replacement could deliver $641 million in savings and free up 337,000 acute hospital bed days between 2023 and 2030, representing an overall return on investment of approximately $9 for every dollar spent.

The evidence base, however, has important limitations. Most studies focused on knee, hip and shoulder replacement, with fewer examining ankle and elbow procedures, and were based predominantly on retrospective or prospective cohort studies from single centres, as well as larger database and registry analyses. There were relatively few randomised controlled trials, and the authors of the reviews frequently identified a high risk of bias. The evidence also offered limited insight into outcomes in rural and regional settings, while the availability and use of early rehabilitation and postoperative follow-up were not consistently reported.

Importantly, the patients selected for same-day procedures were generally younger, more likely to be male, had lower body mass index (BMI) and fewer comorbidities. These are critical factors that influence both patient eligibility and potential clinical outcomes.

Yet the economics of shifting care out of private hospitals is more complex in the short-term than the headline savings suggest. Efficiency gains create financial pressures elsewhere, particularly for private hospitals whose current revenue models are dependent on inpatient activity and which are already confronting viability challenges.

The distribution of those savings also remains an open question. As health insurers incur lower costs through reduced inpatient care, it is unclear how those efficiencies will ultimately translate into additional services and greater value for patients.

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