Monthly Archives: September 2014

A funding model that works (for me)

I’ve been a strong critic of the bias towards project rather than people based funding in public grants for science research.  Now, I celebrate being the recipient of people based funding thanks to a combined initiative of the Emergency Care Foundation, the Canterbury Medical Research Foundation, and the Canterbury District Health Board. What has transpired is exactly what I believe the country needs much much more of, namely initiatives that get behind people and teams with broad goals and long term vision rather than narrow projects and annual funding angst.

Below is a press release.  Over the next 5 years I’ll share the ups and downs of the research we undertake.  I’ve already posted about a study I’m currently analysing the results of, which was designed to rapidly assess patients presenting to the ED with chest pain and to safely reduce unnecessary admissions to hospital.

On a more personal note I am grateful to Dr Martin Than (ED) who has championed this intiative and employed me to date this year, to Kate Russell and the CMRF board who have shown great support and helped to put this together, and to Carolyn Gullery and several others of CDHB Planning and Funding who have made possible those very important linkages and collaborations within the DHB. For the record, this is an 80%, 5 year, fellowship; I retain a 20% position with the University of Otago Christchurch, and will continue to undertake collaborative work with many research teams based there.

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MEDIA RELEASE

Health Board and Private Health and Research Foundations join forces to improve outcomes in Acute Care Delivery

The Canterbury Medical Research Foundation, The Emergency Care Foundation and the Canterbury District Health Board have put their collective might behind a new Senior Research Fellowship in Acute Care based at Christchurch Hospital.

The five-year fellowship will improve the quality of Acute and Emergency Care delivery at the hospital through targeted research and close collaboration with clinicians eager to see positive research outcomes translated into real-world clinical practice and, importantly, into improved patient outcomes.

The demand on acute services is large, around 140,000 patient visits a year across the health system. The challenge is to quickly, accurately and safely assess a patient’s condition and to ensure they access the services they need and don’t unnecessarily access the services they don’t need. The first projects this Fellowship supports will better identify which patients presenting to the emergency department with chest pain need admission and intensive monitoring, and who can be safely discharged home.

The Fellowship will be undertaken by Associate Professor John Pickering. Dr Pickering’s research has been cross-disciplinary. This began with the application of physics in dermatology and plastic surgery through the use of lasers in medicine, in particular he helped develop the use of lasers to remove birthmarks. Over the past seven years through he has advanced the diagnostic methods to detect acute kidney injury and most recently, has become involved in research to discover and translate into clinical practice, diagnostic protocols in the emergency department, particularly for patients presenting with chest pain and the possibility of a heart attack.

Dr Pickering sees medical science as a team effort involving, not only doctors, nurses, and scientists, but also the patients themselves, and funders. He is a keen advocate that publically funded research be made known and understandable to a lay audience through blogs and social media. He writes a blog on the Sciblogs.co.nz web site as “Kidney-punch.”

The Canterbury Medical Research Foundation and Emergency Care Foundation are delighted to be partnering with the DHB on a project that is likely to have long term effects on the delivery of acute care in the Canterbury Health system and further afield.

“This type of directly translational research that will give us definite and measureable improvements in patient care is something we are particularly interested in. Committing to five years will allow enough time for research findings to be properly utilized in improvement in practice patterns in real life clinical situations and that is very exciting.” Says Kate Russell, Chief Executive of the Foundation

“I believe that this is an excellent collaborative project to better integrate medical research with clinical care delivery. This initiative will actively facilitate the alignment of some excellent medical research that is taking place in Christchurch with the Canterbury District Health Board’s priorities and plans for improving care for patients with suspected acute, and particularly cardiovascular, illness” said Dr Martin Than, Emergency Care Foundation

For Canterbury DHB it represents an exciting era of partnering with private trusts and foundations to make inroads into issues of quality improvement and better outcomes for Canterbury people.

“We have already made significant progress in reducing acute demand on our hospitals, with more than 28,911 people receiving treatment and care in the community in the past year. This research will provide important evidence to support future decision-making about how, where and which services are funded and provided to ensure Canterbury people receive the right care, at the right time, in the right place, by the right person.” Said Carolyn Gullery, General Manager of Planning and Funding at the DHB.

ENDS
For further information please contact Dr Martin Than on Martin.Than@cdhb.health.nz

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It’s all about the math, dummy!

No one understands the electoral maths of the NZ electoral system including the electoral commission apparently. Last night I put the latest figures from the “Poll of Polls” into the electoral commission calculator and I discovered the calculator was broken! I put the figures in with United Future winning one electorate seat, but when it crunched the numbers it gave me a parliament without United Future in it. Hmmm… have I uncovered a conspiracy to keep Peter Dunne out of parliament, or is it just evidence that someone got their math wrong. Let’s hope it’s the latter and that they’ll get it right on the night.

Electoral Commission calculator results captured 17 September 2014

Electoral Commission calculator results captured 17 September 2014

In the meantime, let’s consider two concepts this election hangs on – the so called “Wasted vote” and the “Overhang.” The Wasted Vote is the proportion of votes that go to parties that do not make it into parliament by either crossing the 5% Party vote threshold OR by winning at least one electoral seat. The overhang is when a party or parties win more electoral seats than the proportion of their Party vote entitles them too. This means that the size of parliament would increase. Normally 120 and 1/120th of the party vote (0.83%) is equivalent to one member of a party. However, for example, if a party receives just 1% of the vote, but wins 2 electorate seats then this will increase the size of parliament to 121. The various permutations of polls have the current election resulting in a parliament ranging from 120 to 124 seats.

The number of seats in parliament is crucial because it means the effective number of seats a party of block of parties must win in order to form the majority to govern increases. 61 seats are needed for a 120 or 121 member parliament, 62 for a 122 or 123, and 63 for a 124 member parliament.

About the Wasted vote two ideas are important:

The Wasted vote supports the party already with the most votes the most

The Wasted vote could determine who governs!

Let’s assume that 61 seats are necessary in a 120 seat parliament. Ie a block needs 61/120th of the party vote (50.83%) to govern. Crucially this percentage, though, is NOT the percentage of the vote that block gain on the night (which is what the polls try and predict). What it is, is the “effective percentage” after the Wasted votes are taken into account. A scenario could help. Consider an election with two parties crossing the 5% threshold to get into parliament and all the rest being wasted votes. Let’s call the two parties the Big, Rich and Totally Selfish (BRATS*) party and the Really After Total State (RATS**) party. Consider this, there are 1 million voters. BRATS gets 450,000 votes on the night (45%). But, 10% (100,000) of the vote is Wasted. That means the proportion of votes the BRATS get out of the non-wasted votes is 450,000/900,000 giving an “effective percentage” of 50% which would give them 60 seats in parliament.  The RATS would have the same in this scenario. We can turn this question around the other way and ask how high a proportion of the total vote does the Wasted vote have to be for the BRATS “effective percentage” to cross the 50.83% threshold needed to govern? This will depend on the total proportion of votes the BRATS receive  (in our example 45%). The graph below illustrates this.

The percentage of wasted votes the BRATS need in order to govern based on the actual percentage of votes they receive

The percentage of wasted votes the BRATS need in order to govern based on the actual percentage of votes they receive

So, folks, if on the night your vote is in the waste basket, rest assured it will have an effect on the outcome of this election.  The only truly wasted vote is the one that is not cast!

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*Led by Mr I.M. Wright

** Led by Mr M.Y. Tern