Submission to the Australian Commission on Safety and Quality in Healthcare: Exploring Healthcare Variation in Australia

This submission to the Australian Commission on Safety and Quality in Health Care responds to its discussion paper on exploring healthcare variation in Australia, addressing consultation questions 5 and 6 on actions to reduce unwarranted variation. Research Australia maintains that variation signals room for improvement but does not itself show what the improvement should be, citing the 2012 CareTrack study’s finding of relatively low levels of guideline-appropriate care and evidence from the National Health Performance Authority. It recommends a strategic national investment in data linkage and clinical registries capturing conditions, interventions, outcomes, length of stay, readmissions, costs and waiting times, prioritising high-prevalence, high-cost conditions, along with additional funding for health systems research. To establish best practice, it recommends national clinical trial infrastructure and networks building on the NHMRC Translation Faculty and the Australian Clinical Trials Alliance, dedicated clinical research budgets within public health facilities, and greater use of comparative effectiveness research. It proposes that the Commission offer incentives for providers to nominate innovations for evaluation with the National Health and Medical Research Council (NHMRC), drawing on state initiatives such as Victoria’s Redesigning Hospital Care Program and the Australian Resource Centre for Healthcare Innovations. Finally, it recommends using the NHMRC’s 2014 Annual Report on Australian Clinical Guidelines to set minimum standards for guidelines, and using evidence of variation to encourage clinicians to adopt Clinical Care Standards and high-quality guidelines.