Until 2010, our research was administered under the Centre for Health Services Research and Policy (CHSRP). However in 2012, the Health Systems section became an associate of the National Institute for Health Innovation (NIHI). The vision of NIHI is to apply innovative approaches to new models of healthcare and to improving individual and population health.

Research in Health Systems covers a range of disciplines and expertise including health economics, health management, programme evaluation, health services research, organizational psychology and public health ethics. Our broad aims are to advance understanding of the structure, processes and effects of health services and health policy, with a view to the more effective management and delivery of services and a more efficient and equitable health system. Research areas are wide ranging and include, but are not limited to:

• Evaluation of health services and programmes
• Economic evaluation of health interventions
• Health policy analysis
• Development of the conceptual and theoretical components which underlie health services and health policy research
• Conduct and analysis of national surveys
• Analysis of health data
• Analysis of organisational behaviour

Current projects

The QUALICOPC project: This project aims to evaluate primary care systems in 31 countries against criteria of quality, equity and costs. Data collection in New Zealand has been funded by the Ministry of Health. See the Qualicopc website.

Shorter Stays in Emergency Departments (SSED): The SSED National Research Project is a joint HRC-funded project between Auckland District Health Board and The University of Auckland investigating the effect of the 6hr NZ ED time target on clinical markers of quality of care and the process of policy implementation. See the SSED Research website.

The costs and complications of prostate cancer: This HRC-funded study, led by Prof Ross Lawrenson, is investigating the spectrum of complications arising from the diagnosis and treatment of prostate cancer. Researchers from Health Systems are estimating the costs of associated care to individuals and the health service.

Economic evaluations: We are undertaking a number of economic evaluations, usually alongside randomised clinical trials. These include:

• Fit2Quit: a randomised controlled trial to examine the effect of a home and community-based exercise intervention on increasing smoking cessation rates when added to usual care. See the Fit2Quit website.
• EMBRACE: a randomised controlled trial which studies the effect of long term, low dose azithromycin in adult patients with non-cystic fibrosis bronchiectasis.
• BRIGHT: a randomised control trial of a case-finding tool in general practice to identify unmet need and risk of disability among older people aged 75+.

Health Programme Evaluations: We undertake a variety of contracted evaluations of health programmes. Current evaluations include:

• Healthy Village Action Zones HVAZ programme for Auckland DHB: This three year evaluation is in its final year. HVAZ has established 5 geographical HVAZ zones, (incorporating 42 churches) for Pacific peoples in ADHB. The aim of this evaluation is to conduct a process and outcome evaluation of HVAZ to understand whether the HVAZ programme is effective, and obtain information to support its on-going development and adaption to ensure it achieves its vision.
• Pacific Heartbeat Nutrition programme: Funded by the HRC Pacific Kete Fund. Health Systems is working in partnership with Pacific Heartbeat to undertake an evaluation of their services focused on Nutrition.

Recent publications and reports

2012

APPLETON-DYER, S., CLINTON, J., CARSWELL, P., MCNEILL, R. Understanding Evaluation Influence Within Public Sector Partnerships: A Conceptual Model. American Journal of Evaluation 2012; published online May 18 2012, doi: 10.1177/1098214012447672 [online]

ASHTON T., BRAMLEY D., ARMSTRONG D. Improving the productivity of elective surgery through a new 'Package of Care'. Health Policy. Doi: 10.1016/j.healthpol.2012.08.007 [online]

ASHTON, T. and SOPINA, E. Value for money from HPV vaccination an cervical screening. Human Vaccines & Immunotherapeutics 8 (7): 1–3; July 2012. DOI:10.4161/hv.19807 [online]

COSTA M.L., ACHTEN, J., PARSONS, N.R., EDLIN, R.P., FOGUET, P., PRAKASH, U., GRIFFIN, D.R. Total Hip Arthroplasty Versus Resurfacing Arthroplasty in the Treatment of Patients with Arthritis of the Hip Joint: Single Centre, Parallel Group, Assessor Blinded, Randomised Controlled Trial British Medical Journal 2012; published 19 April 2012; 344 doi: 10.1136/bmj.e2147 [online]

CULLEN, J., BRAMLEY, D., ARMSTRONG, D., BUTLER, L., ROUSE, P., ASHTON, T. Increasing productivity, reducing cost and improving quality in Elective Surgery in New Zealand – the Waitemata DHB joint arthroplasty pilot. Internal Medicine, 2012. DOI:: 10.1111/j.1445-5994.2012.02815.x , 2012.

GLIDEWELL, L., THOMAS, R., MACLENNAN, G., BONETTI, D., JOHNSTON, M, ECCLES, M.P., GRIMSHAW, J., EDLIN, R., PITTS, N.B., CLARKSON, J., STEEN S., WALKER, A. Do incentives, reminders or reduced burden improve healthcare professional response rates in postal questionnaires? Two randomised controlled trials. BMC Health Services Research 2012, 12:250 (14 August 2012) doi: 10.1186/1472-6963-12-250 [online]

HALL, P., EDLIN, R., KHARROUBI, S., GREGORY, W., MCCABE, C. Expected Net Present Value of Sample Information: from burden to investment. Medical Decision Making, April 2012. DOI: 10.1177/0272989X12443010

JAYARAM L, WONG CA, KARALUS N, ASHTON T. Azithromycin decreases exacerbations in non-cystic fibrosis bronchiecytasis Respirology 17:35-35 01 April 2012

JONES, P., CHALMERS, L., WELLS, S., AMERATUNGA, S., CARSWELL, P., ASHTON T., CURTIS E., REID P., STEWART J., HARPER A., TENBENSEL. T. Implementing performance improvement in New Zealand emergency departments: the six hour time target policy national research project protocol. BMC Health Services Research, 12 (45):, 2012. DOI:10.1186/1472-6963-12-45, 2012.

KOLT, G., SCHOFIELD, G., KERSE, N., GARRET, N., ASHTON, T. AND PATEL, A. Healthy Steps trial: Effectiveness of a pedometer-based Green Prescription for low-active older adults - randomized controlled trial. Annals of Family Medicine, 2012;206-212. DOI:10.1370/afm.1345. [online]

LEUNG, W., ASHTON, T., KOLT G., SCHOFIELD, G., GARRETT, N., KERSE, N. and PATEL, A. Cost-effectiveness of pedometer-based versus time-based Green Prescriptions: The Healthy Steps Study. Australian Journal of Primary Health. 2012. DOI.org/10.1071/PY11028 [online]

NORTH N, HUGHES F. A systems perspective on nursing productivity. Journal of Health Organization and Management 2012, Vol. 26 Iss: 2 pp. 192 - 214 [online]

NORTH, N., MAHONY, F, (Feb 2012) Increasing the effectiveness of the HEHA (Healthy Eating Healthy Action Oranga Kai Pumau) Workforce – Overview. Auckland: UniServices: University of Auckland

NORTH, N., MAHONY, F, (Feb 2012) Increasing the effectiveness of the HEHA (Healthy Eating Healthy Action Oranga Kai Pumau) Workforce – Part One: Overview of the Study. Auckland: UniServices: University of Auckland

NORTH, N., MAHONY, F, (Feb 2012) Increasing the effectiveness of the HEHA (Healthy Eating Healthy Action Oranga Kai Pumau) Workforce – Part Two: Individual reports on Improvement Interventions. Auckland: UniServices: University of Auckland

O’SULLIVAN, J. ASHTON. T. A minimum income for healthy living: older New Zealanders. Ageing and Society. 32: 747-768, 2012. DOI:10.1017/So144686X11000559

TENBENSEL, T., EAGLE, S. and ASHTON, T. Comparing health policy agendas across eleven high income countries: Islands of difference in a sea of similarity. Health Policy, 2012. DOI: 10.1016/j.healthpol.2012.04.011 [online]

ZENG W, NORTH N, KENT B. A framework to understand depression among older persons. Journal of Clinical Nursing 21(17-18):2399-2409 Sep 2012 [online]

ZENG W, NORTH N, KENT B. Methodological Challenges to Research Among Chinese: Using Mixed Methods to Investigate Older Persons with Depression in Macau. Journal of Mixed Methods Research 2012 Vol 6: 154-165 July 2012 [online]

2011

ASHTON. T. AND BAUTISTA, M. ‘Purchasing Health Services in New Zealand’ In: Jalilian, H., & Sen, V. (Eds.), Improving Health Sector Performance: Institutions, Motivations and Incentives, 2011. p136-148, Singapore, Institute of Southeast Asian Studies.

ASHTON, T., SOPINA, E., WALTON, L. AND LEUNG W. Productivity Of Models Of Elective Surgery. Report prepared for the Waitemata Disctrict Health Board. July 2011.

CLINTON, J. M., PERCIVAL, T., O'CONNOR, T., & MAHONY, F. M. Evaluation of the Enua Ola: Pacific HEHA project A Summative Report of the past three years. Auckland: UniServices: University of Auckland. July 2011.

CLINTON, J. M., ANDREWS, S., MAHONY, F. M., & CHIANG, W. The Selwyn Foundation Parish Partnership Scheme: Selwyn Centres Independent Evaluation Final report. Auckland: UniServices: University of Auckland. May 2011.

EDLIN, R., TSUCHIYA, A., DOLAN, P. Public preferences for responsibility versus public preferences for reducing inequalities. Health Economics, 2011. DOI: 10.1002/hec.1799.

DRETZKE, J., EDLIN, R., ROUND. J., CONNOCK, M., HULME, C., CZECZOT, J., FRY SMITH, A., MCCABE, C., MEADS, C. A systematic review and economic evaluation of the use of tumour necrosis factor alpha (TNF α) inhibitors adalimumab and infliximab for Crohn’s disease. Health Technology Assessment 15(6), 2011. DOI: 10.3310/hta15060

NORTH, N., KERSE, N., MAHONY, F. M., & CHIANG, W. (2011, December). Independent Evaluation of the Enhanced Home Based Support Services for Older People. Auckland: UniServices: University of Auckland.

OKMA, K. CRIVELLI, L., ASHTON, T., TENBENSEL, T. CHENG, T-M.,et al. ‘Under the Radar Screen: Health Care Reforms in Seven Small Countries’. Ch 8 in G. Cohen, BW Ansell, J Gingrich and RH Cox (eds) Social Policy in the Smaller European Union States. New York: Berghahn Books. 2011, pp179 – 214.

PANATTONI, L., VAITHIANATHAN, R., ASHTON, T., LEWIS, G. Predictive risk modelling in health: options for New Zealand and Australia. Australian Health Review. 35:45-51, 2011

ROY, D. E., MAHONY, F. M., HORSBURGH, M., & BYCROFT, J. Partnering in primary care in New Zealand: clients' and nurses' experience of the Flinders Program in the management of long term conditions. Journal of Nursing and Healthcare of Chronic Illness, 3, 140-149, 2011. DOI:10.1111/j.1752-9824.2011.01088.x

SHERIDAN, N. F., KENEALY, T. W., CONNOLLY, M. J., MAHONY, F., BARBER, P. A., BOYD, M. A., MOFFITT, A. Health equity in the New Zealand health care system: a national survey. International Journal of Equity in Health, 10, 45, 2011. Doi:10.1186/1475-9276-10-45

SILVA, M., ASHTON, T., MCNEILL, R. Improving termination of pregnancy services in New Zealand. New Zealand Medical Journal. 124(1339). 29 July 2011.

SILVA, M., MCNEILL, R., ASHTON, T. Factors affecting delays in first trimester pregnancy termination services in New Zealand. Australian and New Zealand Journal of Public Health. 35(2): 140-145, 2011.

SOPINA, E., ASHTON,T. Cost-effectiveness of a cervical screening programme with HPV Vaccine. International Journal of Technology Assessment in Health Care. 27 (4): 290-297, 2011.

TENBENSEL, T., MAYS, N. & CUMMING, J. M. A successful mix of hierarchy and collaboration?: Interpreting the 2001 reform of the governance of the New Zealand public health system. Policy & Politics, 39: 2 pp239-256, 2011..