What is the project about?
Western Health’s General Internal Medicine’s flagship research has been the landmark IMPROVE-GAP (IMPROVing Evidence-Based Treatment Gaps and Outcomes in Community Acquired Pneumonia: Standardizing Evidence-Based Interventions to Shorten Length of Stay, Reduce Readmissions, Reduce Hospital Costs and Improve Patient-Reported Outcomes) study. Supported by a grant from the HCF research foundation, this study aimed to evaluate a new model of care for managing community acquired pneumonia utilizing a novel “stepped-wedge” clinical research design to address the gap between evidence and practice. Commenced in 2016, it enrolled 816 participants, making it the largest clinical trial of pneumonia conducted in Australia.
Who was involved?
Associate Professor Harin Karunajeewa devised the trial. The trial was run through Western Health’s General Internal Medicine Units in collaboration with the Department of Physiotherapy. Western Health has a total of eight general internal medicine units split evenly across the two participating hospitals, Sunshine Hospital and Footscray Hospital. Associate Professor Karunajeewa reserved particular praise for the involvement of Allied Health staff in the trial, particularly physiotherapists Melanie Lloyd, Elizabeth Skinner and Melina Shackell. The study also received some support from researchers from the University of Melbourne and Monash University.
What were the outcomes?
Its remarkable findings were that interventions previously shown to have efficacy (including routine use of steroids, early mobilization antibiotic stopping rules) failed to translate into improved patient- or heath service- outcomes when implemented as a bundled intervention in our GIM population. This research was published in the prestigious Journal of American Medical Association (Internal Medicine) and its findings incorporated into the Infectious Diseases Society of America/American Thoracic Society treatment guidelines for pneumonia. It has seen Western Health’s GIM unit emerge as Australia’s leading academic centre for research in the GIM population. It has prompted us to think deeply about whether and how evidence from clinical trials conducted under tightly controlled clinical trial conditions translates to real effectiveness when implemented in the “real world” under routine conditions of care.