Embedding an economist in regional and rural health services to add value and reduce waste by improving local-level decision-making: protocol for the ‘embedded Economist’ program and evaluation

Abstract

Background Systematic approaches to the inclusion of economic evaluation in national healthcare decision-making are usual. It is less common for economic evaluation to be routinely undertaken at the ‘local-level’ (e.g. in a health service or hospital) despite the largest proportion of health care expenditure being determined at this service level and recognition by local health service decision makers of the need for capacity building in economic evaluation skills. This paper describes a novel program – the embedded Economist (eE) Program. The eE Program aims to increase local health service staff awareness of, and develop their capacity to access and apply, economic evaluation principles in decision making. The eE program evaluation is also described. The aim of the evaluation is to capture the contextual, procedural and relational aspects that assist and detract from the eE program aims; as well as the outcomes and impact from the specific eE projects. Methods The eE Program consists of a embedding a health economist in six health services and the provision of supported education in applied economic evaluation, provided via a community of practice and a university course. The embedded approach is grounded in co-production, embedded researchers and ‘slow science’. The sites, participants, and program design are described. The program evaluation includes qualitative data collection via surveys, semi-structured interviews, observations and field diaries. In order to share interim findings, data are collected and analysed prior, during and after implementation of the eE program, at each of the six health service sites. The surveys will be analysed by calculating frequencies and descriptive statistics. A thematic analysis will be conducted on interview, observation and filed diary data. The Framework to Assess the Impact from Translational health research (FAIT) is utilised to assess the overall impact of the eE Program. Discussion This program and evaluation will contribute to knowledge about how best to build capacity and skills in economic evaluation amongst decision-makers working in local-level health services. It will examine the extent to which participants are able to improve their ability to utilise evidence to inform decisions, avoid waste and improve the value of care delivery.

Relational aspects of building capacity in economic evaluation in an Australian Primary Health Network using an embedded researcher approach

“…This site was unique -the others being large health services centred on hospitals. The full planned program protocol, including a brief literature review and overview has been reported in an earlier edition of this journal [30]. The conceptual underpinnings are also reported elsewhere in detail [31].…”

“…3. To facilitate health service practice change and the routine application of economic evaluation principles in decision making [30].…”

“…The aims of the evaluation are to capture the outcomes and impact of embedding an economist and to evaluate the contextual, procedural and relational aspects that facilitated or acted as a barrier to the program [30]. More detail is provided on the relational ndings as they add considerably to the published literature.…”

“…The program was structured into three phases: planning, embedding and post-embedding [30]. A description of each phase and how they were implemented in the HNECCPHN is set out in Table 2.…”

When Health Systems Consider Research to Be Beyond the Scope of Healthcare Delivery, Research Translation Is Crippled Comment on "Academic Health Science Centres as Vehicles for Knowledge Mobilisation in Australia? A Qualitative Study"

“…1 Central among the key principles proposed for effective KM is fostering and sustaining relationships between researchers and research users over time (as interactions and collaboration co-produce knowledge). 4,6 Our own work on embedded economic research 7 suggests that strong relationships are integral to influence and learning and time is essential to building these. 5 The approaches reported by RTC Board members: participatory, capacity building, co-production and clinical engagement -are all relationship building.…”