Priority research areas
Excellent rehabilitation models in cardio and orthopaedic
The most common cardiac interventions funded by health insurers are: percutaneous coronary angioplasty (stenting), value procedures and coronary bypass/vascular surgery
The goals of cardiac rehabilitation are to improve functional capacity, reduce symptoms and subsequent morbidity and mortality post intervention
Cardiac rehabilitation is usually targeted at exercise, lipid management, hypertension control, and smoking cessation can reduce cardiovascular mortality
What is best practice in cardiac rehabilitation? How does this differ/vary with patient characteristics, comorbidities or procedure types? What is the best way to deliver rehab? Is rehab at home or in the community as good as inpatient rehab? How to best influence patient lifestyle factors that impact cardiac rehab? How does rehab impact inpatient readmission rates?
Knee and hip replacement are the top individual procedures types by cost for orthopaedic elective surgery.
What are the optimal rehab programs to return patients to full function? How to reduce re-admissions and other complications? The role of exercise in rehab?
When is inpatient rehab necessary following these procedures? Which patients get better outcomes from rehab in the home/community?
How do we reduce the need for revisions or repeat procedures 5-10 years down the track?
Potential overall objectives of research: which rehab programs work and the benefits of best practice rehab on reduce morbidly, mortality, disability and cost
Low value care in the cardiology (or rehabilitation)
Low value care is ‘care which evidence suggests confers little benefit, or imposes a risk of harm that exceeds likely benefit, or incurs cost grossly disproportionate to the added benefits obtained.
In healthcare, the fee for service model doesn’t provide enough incentive to avoid low value care
Many examples of low value care are in the diagnostic space and cardiac care includes several expensive and invasive diagnostic tests – e.g. cardiac stress testing for asymptomatic patients prior to undergoing low to intermediate risk non-cardiac surgery
Consequences of the overuse of cardiac investigations to further determine cardiac risk include over-estimation of operative risk, unnecessary high-risk revascularisation or delayed vascular surgery and higher cost to member and health funds
What are the alternatives to unnecessary and low value diagnostic tests and interventions?
Potential overall objectives of research: which cardiology diagnostic tests and interventions do not add value and the cost/benefit of avoiding these (particularly to the patient)
Impact of co-morbidities in mental health treatment
Much of the research in this area considers the interaction of cognitive disorders (acquired brain injury, dementia etc.) with psychiatric disorders (anxiety, depression etc.)
However, it is assumed the intention was to consider the impact of mental health co-morbidities (e.g. anxiety with obsessive compulsive disorder or post-traumatic stress disorder) on optimal treatment pathways, relapse and recovery
Potential overall objectives of research: better treatment guidelines and more sustained recovery and lower readmission rates for patients with multifaceted mild to moderate mental health issues
Researchers should be aware of the potential difficulties recruitment wise if the project seeks significant numbers of volunteers within both the ADF and veteran communities