ome of the most pressing issues in Australian health care are not about the efficacy of particular treatments, but rather how health services can be organised to deliver optimal care. Examples of service-related initiatives familiar to most clinicians include:

• multidisciplinary teams to improve coordination of cancer care;

• designated trauma centres to optimise management of injured patients;

• financial incentives to encourage particular services;

• restricted licences for overseas medical graduates to increase the rural workforce;

• specialist outreach and telemedicine to improve access in remote areas;

• clinical audit and review to enhance care quality; and

• management and prescribing guidelines.

Broadly speaking, these represent a spectrum of organisational, financial, regulatory and professional interventions aimed at improving service delivery and achieving best practice.

Just as clinicians and patients are concerned with the effectiveness of clinical treatments, policy-makers and the public are interested in the effectiveness of health system interventions. For clinical treatments, questions about “what works” may be best answered using randomised controlled trials and other experimental designs. Those studying the effectiveness of health service interventions, however, face some specific methodological and analytical challenges, and often need to consider other types of designs. Is it possible to randomise communities to receive outreach visits, for example? What are the important outcomes of employing nurse practitioners in remote areas? Can we effectively control for other health service changes, such as closure of a hospital, or loss of staff, that may be unavoidable during a study period? In studies in which the intervention is delivered to a population, but the outcomes are measured in individual patients, how do we take clustering effects into account in the analysis?

Australians have contributed to developing appropriate methods (some adapted from economics and social sciences) for addressing such questions in real-world situations. Support for the Australian health services research community has come from the Health Services Research Association of Australia and New Zealand (http://www.chere.uts.edu.au/hsraanz/), established in 2001, the longstanding interest of The Medical Journal of Australia, as well as other organisations, and the Australian and New Zealand Journal of Public Health, Australian Health Review, and a new open-access journal, Australia and New Zealand Health Policy (http://www.anzhealthpolicy.com).

Syntheses of available research also contribute to rational health policy-making. The international Cochrane Collaboration maintains systematic reviews in which the research literature on a topic has been identified, selected, appraised and synthesised in a transparent way.1 Such reviews reduce the likelihood of people being misled by research findings, and increase the confidence in what outcomes can be expected from an intervention.2,3 However, reviews of health service interventions differ in that, to be useful for policy-makers and managers, the goal of methodological rigour that characterises Cochrane reviews needs to go hand in hand with an understanding of the challenges inherent in health services research.

The Cochrane Collaboration’s Effective Practice and Organisation of Care (EPOC) Group, based in Ottawa, Canada, is dedicated to conducting reviews of interventions designed to improve professional practice and the delivery of effective health services, potentially spanning any clinical area.4 It has already produced 37 reviews on topics such as audit and feedback, discharge planning, hospital in the home, printed educational materials, telemedicine and specialist outreach. A particular focus of EPOC has also been how to broaden the types of included studies beyond blinded randomised trials, while at the same time optimising validity and generalisability. These include designs such as controlled before–after studies and interrupted time series studies.

Recognising that evidence for policy-making is not always readily available, the Australian Government has provided for a new partnership between EPOC and the National Institute of Clinical Studies (NICS). The Australian EPOC satellite at the National Institute of Clinical Studies was officially announced at the Cochrane Colloquium in Melbourne on 22 October 2005. NICS is funded by the Australian Government to help improve uptake of evidence into clinical practice, and to use evidence about individual, organisational and system change in designing implementation programs. In addition, free access to the Cochrane Library (and a user’s guide) is available through the NICS website (http://www.nicsl.com.au).

The overall goal of the satellite is to assist evidence-based policy-making through systematic reviews of interventions designed to improve health care practice and the delivery of effective health services relevant to Australia and our region. In particular, the satellite aims to:

• identify and help produce priority EPOC reviews relevant to Australia;

• support EPOC review activity through training and mentoring of researchers; and

• foster a culture of evidence-based health policy and knowledge translation by promoting the use of the Cochrane Library, and EPOC reviews in particular.

In addition, the Australian satellite will:

• support the EPOC editorial base in Canada by editing, producing and updating EPOC reviews, especially reviews relevant to rural areas;

• collaborate with the Australasian Cochrane Centre and the other Australian-based Cochrane groups to further the work of the Cochrane Collaboration in the region; and

• contribute to the international effort of synthesising research to improve evidence uptake.

We hope that the satellite will make an ongoing contribution to Australian health services research, implementation and effective health policy-making.