Medicine (Northwest Academic Centre) - Theses

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Pragmatic research in elderly multimorbid populations: A case study of community-acquired pneumonia

Lloyd, Melanie ( 2020)

This thesis explores pragmatic research methodologies that can be embedded into routine clinical practice to simultaneously implement and evaluate health-system interventions. It is centred around the design and implementation of the IMPROVing Evidence-based GAPs and outcomes in community-acquired pneumonia (IMPROVE-GAP) project, which evaluated the effectiveness of a multidisciplinary care bundle for treatment of Australia’s most common illness requiring hospitalisation. This project addressed three key barriers restricting generalisability of experimental results to routine clinical practice for hospitalised multimorbid populations: i) limited representativeness of participants, setting or intervention delivery, ii) failure to utilise randomisation and minimise potential for confounding and bias, and iii) failure to select outcomes that measure the value of interventions to end users. IMPROVE-GAP’s novelty lay in the way it facilitated clinical practice and evaluation operating in tandem, eliminating costly parallel data and outcome collection. It represents a vital precedent for conducting robust clinical trials in the hospitalised elderly, and provides a template for future high-quality, low-cost health-services research.