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Health Services Research in Hong Kong Print E-mail
The Quarterly 2012

Dr Jenny LAMABSTRACT

Given the challenges facing the healthcare systems worldwide, including ageing populations, escalation of healthcare costs, healthcare manpower shortages and ever-increasing patient expectations, health services research becomes an essential component of a modern and reliable healthcare system. Knowledge generated by local health services research is important and useful in the formulation of evidence-based policies relevant to maintaining an efficient and cost-effective health care system and enhancing public health.

Over the past two decades, the Government of Hong Kong has provided strategic steer and dedicated funding support for health and health services research with a view to maximizing population health, improving the quality of life, and enhancing the standard and cost-effectiveness of the health system through the generation of new knowledge in areas of human health and health services.

Nearly 400 health and health services research projects have been approved. Of these, about 260 have been completed. These projects cover a broad scope of topics including primary care, elderly care, mental health and public health issues that have provided useful references guiding health policy formulation and health services delivery.

To achieve the strategic objective of research funds, critical success factors include dedicated funding support, good governance and administration system, focused research agenda, robust peer-review system, network of local and overseas experts and proactive dissemination of research findings.


IMPORTANCE OF HEALTH SERVICES RESEARCH

Health services research is "a multidisciplinary field of scientific investigation that studies how social factors, financing systems, organizational structures and processes, health technologies, and personal behaviors affect access to healthcare, the quality and cost of healthcare, and ultimately our health and well-being".1

Given the challenges facing the healthcare systems worldwide, including ageing populations, escalation of healthcare costs, healthcare manpower shortages and ever-increasing patient expectations, health services research becomes an essential component of a modern and reliable healthcare system. It plays a pivotal role in ensuring that the healthcare provided is of high quality, is at an appropriate cost and clinically effective, accessible and affordable. Moreover, health services research is an important and useful tool to assist in the formulation of evidence-based policies relevant to maintaining an efficient and cost-effective healthcare system and thereby enhancing public health.


FUNDING FOR HEALTH SERVICES RESEARCH IN HONG KONG

Over the past two decades, the Government of Hong Kong has provided strategic steer and dedicated funding support for health and health services research, over and above the general funding for local tertiary academic institutions and health and medical institutions.

In 1993, the Government of Hong Kong established the Health Services Research Fund (HSRF) with a capital commitment of HK$ 50 million to support local health services and public health research into assessment of health care needs, the operation of the health service, and the delivery of health care.

In 2002, HSRF was re-focused to become the Health and Health Services Research Fund (HHSRF), which is of a new mode of operation and a more focused research agenda. HHSRF has a total capital commitment of HK$ 226 million. Its strategic objective is to maximize population health, improve the quality of life, and enhance the standard and cost-effectiveness of the health system through the generation of new knowledge in areas of human health and health services. Three broad themes have been identified under HHSRF as priorities for research, namely public health, health services and Chinese medicine. 2


KEY FEATURES OF HHSRF

To achieve the strategic objective of HHSRF, a number of key features have been identified and elaborated in the ensuing paragraphs.

Well Established Governance Structure

HHSRF is administered under the Food and Health Bureau (FHB), which is a government bureau overseeing health and food-related matters in Hong Kong. HHSRF is governed by the Research Council (RC) that makes executive decisions on policy, strategy and funding allocation. RC is chaired by the Secretary for Food and Health (SFH) and comprises prominent members from public institutes and leaders from the academic arena. RC is underpinned by working committees, namely the Grant Review Board (GRB) and the Referee Panel which provide an independent two-tiered peer review. The day-to-day administration of research funding is supported by the Research Fund Secretariat of the Research Office established under FHB.

Focused Research Agenda

For research to exert its impact, the research topics and findings must be of local relevance and importance. Hence, a clear and focused research agenda in which thematic priorities are formulated and updated with key stakeholders regularly is imperative. It steers the research direction and the decision on fund allocation. Grant applications falling within the thematic priorities are given precedence.

Various Funding Opportunities

HHSRF supports a variety of research activities including investigator-initiated studies, commissioned research projects and capacity building initiatives. While investigator-initiated studies encourage the development of innovations from individual researchers, commissioned research projects aim to generate more focused and coordinated research response to particular areas of health policies or issues; to fill scientific gaps and respond to public threats or needs.

Robust Peer Review System

A robust 2-tier peer view system for grant proposals and reports is the cornerstone of HHSRF. In line with international standards, all eligible grant applications undergo stringent two-tier peer review to ensure that funded projects are of appropriate scientific design and high scientific merit. The first-tier is performed by the Referee Panel. Overseas referees are recruited to review grant applications according to their specific areas of expertise. The second-tier is conducted by the GRB, which comprises local experts with technical skills and experience in a wide spectrum of health sciences. Together they assess the scientific merit of the research projects, such as originality, significance of the research questions, quality of scientific content, credibility of design and methods and applicability to the local context. Other objective assessment criteria including research ethics, justification of budget, and the track record of grant applicants are also considered.

Wide Dissemination of Research Findings

To facilitate knowledge translation, research reports of successfully completed projects are disseminated to the community via promulgation by FHB on its website and publication in the Hong Kong Medical Journal which is distributed to relevant healthcare professionals. In addition, research symposia have been organized to recognize outstanding studies that have set a benchmark for good research and assisted the formulation of health policies, and to provide a platform of sharing with international and local researchers.


EVALUATION OF PERFORMANCE OF RESEARCH FUNDS

Since 1994, nearly 400 health and health services research projects have been approved. Of these, about 260 have been completed. These projects cover a broad scope of topics including primary care, elderly care, mental health and public health issues that have provided useful references guiding health policy formulation and health services delivery.

The impact of completed research projects is evaluated on a regular basis using a "payback framework" – an internationally recognized measure of health research activities. The payback framework allows a quantitative assessment to be made of the value for money invested in research funding. Including data from the most recent round of evaluation conducted in mid-2010, the impact of the funded research projects is summarized as follows:
  • The majority (nearly 80%) of funded projects reported publication of research findings. There were, on average, 4.88 publications per project generated. Evidence-based knowledge will help shape and direct healthcare policy.
  • Up to one-third of the funded projects reported impact on informing policy through production of new or revised treatment guidelines, treatment protocols, reference standards, and Cochrane reviews.
  • HHSRF and the former HSRF have been instrumental in building research capacity and infrastructure in Hong Kong. Work related to funded projects has enabled research staff to improve scientific and healthcare-related research skills and to gain promotion at their institutions. Career advancement of research team members was reported for one third of projects. Acquisition of higher qualifications was reported for nearly 40% of projects. These highly skilled talents form an important strategic research asset for Hong Kong.
In summary, health and health services research generated under HHSRF and the former HSRF has helped support health policy formulation and health care services delivery, has generated a critical mass of health-related knowledge, increased health and health services research capacity, created a strategic reserve of talent and offers good value for money.

Notable Examples of Funded Health Services Research Projects

A few notable examples of completed projects contributing to health policies and practices are highlighted in the following paragraphs.

Enhancement of primary care

Primary care is an important component of the healthcare system. It produces better health outcomes at lower costs by providing patients with a comprehensive spectrum of care, both preventive and curative, continuously over a period of time and coordinates the care that patients receive. Over the years, HHSRF has supported a number of primary care research projects exploring the effectiveness of the interdisciplinary team and patient empowerment which are key concepts on which the primary care conceptual model is built upon.

A study evaluating the effectiveness of different models of health care delivery in the primary care setting demonstrated the advanced practice nurse clinic as a suitable model of care for monitoring patients with stable hypertension and diabetes mellitus in the community. This service model has since been extended to several sites within the Hospital Authority of Hong Kong. Research findings would positively impact the Task Force on Primary Care Delivery Models and the development of an integrated primary care model for the management of common chronic diseases. These research findings have assisted the Government in formulating primary health care reform initiatives.

Healthcare for an ageing population

The local population is ageing rapidly. By 2033, it is estimated that 27% of the Hong Kong citizens will be 65 or above. Health for older adults therefore constitutes one of the major research themes locally. Three completed projects have addressed issues related to elderly care. These include a case management model of interdisciplinary care to improve the quality of life of older people with early dementia and to reduce their caregiver burden. The study found that case management and home visits reduced depressive symptoms in community dwelling older people with mild dementia, encouraged family caregivers to seek outside help, e.g. paid attendants and day care, and improved the psychological health of family caregivers. As the dementia day care system develops, this case management model may have a bigger impact and such models may help prevent or delay institutionalization in the longer term.

Mental health service delivery

Mental disorders cause a significant healthcare burden in Hong Kong and studies on mental health service delivery models are useful in assisting formulation of an integrated mental health policy by the Working Group on Mental Health Services. The results of a project evaluating an intervention program for psychosis showed that both hospitalization rate and duration were significantly decreased, functional outcomes enhanced, and risk behaviors reduced with early intervention characterized by case management and a specialized multidisciplinary team. The evidence generated has contributed to the deliberations of the Working Group on Mental Health Services and the planning of services by the Hospital Authority.

Smoking and health

Breaking the chemical and psychological dependence on nicotine is an essential step in reducing smoking. HHSRF supported the first ever randomized controlled trial in Hong Kong designed to examine the effectiveness of smoking reduction counseling combined with free nicotine replacement therapy on smoking cessation in Chinese smokers who were not willing to quit smoking but who intended to reduce cigarette consumption. The smoking reduction intervention was effective in helping unmotivated smokers quit or reduce their daily cigarette consumption by 50% or more. Offering assistance to reduce smoking can attract smokers who are not willing or ready to quit. The results are important for planning smoking cessation services in Hong Kong.


THE WAY FORWARD

Building on the successful experience of FHB administered research funds including HHSRF and leveraging the expertise established to support health and medical research, the Government approved the creation of a new research fund, Health and Medical Research Fund (HMRF) in Dec 2011. HMRF will consolidate the existing FHB administrated research funds including HHSRF and broaden the funding scope with an additional injection of HK$ 1 billion.3 With increased commitment and expanded funding scope, the consolidated fund will provide a dedicated, comprehensive and coordinated support for health and medical research in Hong Kong. This will further the objectives of informing health policies, improving population health, strengthening the healthcare system, enhancing clinical practices and building research capacity in Hong Kong.


CONCLUSION AND LESSONS LEARNT

Knowledge generated by local health services research is important and useful in the formulation of evidence-based policies relevant to maintaining an efficient and cost-effective health care system and enhancing public health. To this end, critical success factors include dedicated funding support, good governance and administration systems, focused research agendas, robust peer-review systems, a network of local and overseas experts and proactive dissemination of research findings.

As the Associate Consultant of the Research Office, I lead a multi-disciplinary team of staff in the Research Fund Secretariat and oversee the administration of research funds under FHB. The team comprises scientific review professionals; grant managers, executive and clerical officers. With the increased commitment and expanded funding scope of HMRF, the number and complexity of grant applications are expected to increase substantially. To cope with the challenges ahead, strategic foci are identified. These include enhancement of capacity and capability of the Secretariat, streamlining of workflow and strengthening the network of local and overseas experts. To put them into practice, various administrative competencies, in particular, leadership, change management and people management would be of paramount importance.



FRACMA
Associate Consultant, Research Office, Food and Health Bureau, Hong Kong SAR Government


ACKNOWLEDGEMENTS

I wish to thank all applicants who submitted research grant applications to HSRF and HHSRF over the years, and all professional peer reviewers, both local and overseas, who contributed their time and effort to assess grant proposals and reports. Moreover, I would like to express my heartfelt gratitude to Dr SV LO, Head of Research Office, for his invaluable guidance, support and care, and all the Research Fund Secretariat staff for their professionalism, commitment and teamwork.

References
1 Lohr KN, Steinwachs DM. Health services research: an evolving definition of the field. Health Serv Res. 2002;37(1):7-9.
2 Finance Committee, Item on Health and Health Services Research Fund. Hong Kong: Legislative Council (FCR(2004-05)42); 2005.
3 Finance Committee, Item on Health and Medical Research Fund. Hong Kong: Legislative Council (FCR(2011-12)57); 2011.