HSSR Logo Health Services and Systems Research

Signature Programme
in Health Services and Systems Research
Signature Programme
in Health Services and Systems Research
Signature Programme
in Health Services and Systems Research

What is Health Services and Systems Research?

Welcome to the Signature Program in Health Services and Systems Research (HSSR) at Duke-NUS Medical School.
HSSR is established as a center of academic excellence for research and education on the organization, funding, and delivery of health services. Our focus is on public health and clinical service innovation in an increasingly complex and connected world.
HSSR employs a systems perspective to addressing critical health issues. Systems thinking cuts across all of our research priorities and recognizes the multiple leverage points and feedback loops involved. This includes health, social, economic, political, biological and other systems. Our core funding and mission requires us to conduct research that benefits Singapore. However, we also undertake related regional and international work that is consistent with Duke’s global health mission.
To know more about our research and people, you may click here to have a look at our  publication on 'Bridging Theory & Practice'.
Recent Events at HSSR:

Public Lecture by Dr Leandro Pecchia on 'Early Health Technology Assessment: reverse engineering health economics to inform R&D of healthcare innovation

The public lecture was held on 28 November 2017. Dr Pechhia presented on methods and tools aiming to backpropagate Health Technology Assessment (HTA) prospective during research and development of innovative medical devices and healthcare interventions. This approach, known as early HTA (eHTA) of early health economics, can be adopted by researchers and decision makers. 

Public Seminar by David Webb on 'CHESS: CPRD-COPD Hawthorne Effect Study in Salford: A UK cohort study to characterise patients enrolled in the Salford Lung Study and to evaluate a potential Hawthorne effect

The seminar was held on 21 November 2017. CHESS (CPRD-COPD Hawthorne Effect Study in Salford) was an observational study that evaluated the generalisibility of the Salford Lung Study (SLS) a large randomised trial. Click here to read more about the seminar.
Duke-NUS Medical School /Duke University Bridging Symposium

The Signature Programme in Health Services and Systems Research (HSSR), Duke-NUS Medical School and Duke University jointly organised a Duke-NUS Medical School /Duke University Bridging Symposium. The theme for the symposium was ‘Population Health and Precision Medicine: different paths to a shared goal’ and was held from 27 to 28 March 2017 at Grand Copthorne Waterfront Hotel Singapore. The symposium was a great opportunity for faculty from both institutions and key leaders in population health and precision medicine to share and exchange ideas and foster discussions to advance research in this area.

                                   2017 Symposium 2

Slides of the speakers' presentations can be found below:

Presentation and discussion by Associate Professor Julie Thacker on 'Enhanced Recovery as an Implementation Model for Best Perioperative Care'
The presentation was held on 19 January 2017. Dr. Thacker's talk focused on how the process of implementing enhanced recovery protocol for colorectal surgery can lead to the development of continuous improvement processes in perioperative care.  She shared her experience of NSQIP nationwide implementation collaborative, as well as, local auditing successes and challenges and research potential.
Latest initiative to support improved health outcomes in Asia launched
The IMS Institute for Healthcare Informatics has launched a new branch focused on supporting improved health outcomes across Asia. Duke-NUS Medical School is one of its collaborative partners.


Based in Singapore, the team leverages institutions from the public and private sector - a move supported by Economic Development Board (EDB) Singapore. “The shift from product-centric to patient-centric healthcare requires collaborative innovation between government, health professionals and businesses. Effective solutions to key healthcare challenges will have to incorporate data-driven insights, new technologies, and appropriate business models,” said Ms Ho Weng Si, director, Biomedical Sciences. “EDB welcomes IMS Institute Asia’s decision to co-innovate with partners in Singapore to accelerate healthcare transformation in Asia.”


In Asia, the IMS Institute activities will focus on three areas:

  • Mobilizing and advancing health services and systems research: The Institute will bring together leading policy advisors, educators, researchers and medical care providers to initiate research activities and apply evidence-based approaches to address key healthcare issues.
  • Developing new insights on disease burden in Asia: The Institute will connect clinical, economic and patient-reported outcomes data to provide all stakeholders with deeper insights for improving the care of patients and their treatment journey experience.
  • Advancing decision analytics in clinical practice and public policymaking: The Institute will support efforts by academia, clinicians, health administrators and policymakers to use real-world, data-driven decision analytics for more informed decision making and improved healthcare costs and outcomes.

In addition to Duke-NUS, the IMS Institute in Asia is collaborating with the National Cancer Centre Singapore, National University Hospital and InvitroCue Limited.

 IMS Institute for Healthcare Informatics in Asia Unveiling ceremonyUnveiling ceremony IMS Institute for Healthcare Informatics in Asia (From left to right): Christoph Glätzer, Dipl. Kfm, VP Commercial Strategies & Market Access Asia Pacific, Janssen, Pharmaceutical Companies of J&J, Dr. Loke Wai Chiong, Project Director, Sheares Healthcare Management (A subsidiary of Temasek International), Prof. Peter J. Pitts, Former Associate Commissioner, US Food and Drug Administration, Murray Aitken, Executive Director, IMS Institute, Ho Weng Si, Director, Biomedical Sciences, Economic Development Board Singapore, Prof. Pierce Kah-Hoe Chow, NCCS Course Director, Duke-NUS Medical School, Prof. David Matchar, Director, Programme in Health Services and Systems Research, Duke-NUS Medical School, Xavier Xuanhao Chan, Director, IMS Institute in Asia
Duke-NUS’ Professor David Matchar Photos (Credit: IMS Institute in Asia)

Duke-NUS’ Professor David Matchar (in red tie, top photo and second from right in bottom photo) will lead the partnership with IMS Institute in Asia. Prof Matchar is also a member of the IMS Institute External Advisory Board. Right: Amit Backliwal, Vice-President, Technology and Services, IMS Health China and South-East Asia


Public Lecture by Dr Jaime Caro on 'Changing the paradigm: Discretely Integrated Condition Event (DICE) Simulation for HTA
The public lecture was held on 6 September 2016. In this lecture, a modeling approach expressly designed for Health Technology Assessment (HTA) was introduced. The two core concepts of DICE (conditions, which represent aspects of the problem that persist over time; and events, which reflect instantaneous occurrences) was explained along with the approach to integrating them over time. Click here to read more about Dr Caro's presentation.
Public Lecture by Professor Mark S. Roberts on 'What does the value of modern medicine say about the $50,000 per QALY Threshold?'
The public lecture was held on 5 September 2016. This lecture was an evaluation of the value of modern medicine. There is an almost mythical value of $50,000 per quality-adjusted life year that is felt to be the level at which an intervention is “cost effective”. The origins of this number, and its validity was examined in the context of health care choices that can be observed in society. Click here to read more about Prof Roberts's presentation.

Public Lecture by Associate Professor Shalini Kulasingam on 'Combining decision modeling and epidemiologic studies to determine optimal cervical cancer control policies in the era of HPV vaccines'                      

The public lecture was held on 22 August 2016. In the lecture, Dr Shalini used a combination of modelling and epidemiology to illustrate predicted changes to cervical cancer in the era of HPV vaccines. She also drew on examples from different parts of the world to raise questions regarding how best to reduce cervical cancer in countries with and without screening. Click here to read more about Dr Shalini's presentation.

Public Lecture by Dr Akihiro Nishi on 'Social Inequality, Health, & Experimental Social Science'

The public lecture was held on 1 March 2016. Health inequality has been one of the most important topics in social science and medicine. In the lecture, Dr Nishi covered the general background of social inequality in health. He also presented his recent experimental work on visibility of wealth inequality at dynamic social networks (Nishi et al, 2015, Nature). He also discussed the future direction of experimental social science and its application into public health and health services research.                                                                              


Public Lecture by Dr Masayoshi Oka on 'Neighborhoods and Health: Concepts, Methods and Applications'

The public lecture was held on 6 October 2015.  The current state of knowledge about neighborhoods and their links to health encourages us to think that “where we live” matters to our health over and above “who we are.” A growing number of studies have demonstrated the associations of neighborhood physical and/or social characteristics with various health behaviors and health outcomes after accounting for individual socio-demographic characteristics (e.g., age, gender, race/ethnicity, income level, educational attainment, and/or employment status). In other words, the place of residence may either be beneficial or detrimental to our health. Hence, ignoring the possible role of neighborhoods may lead to an incomplete understanding of the determinants of health, and thus result in developing ineffective prevention and health promotion strategies. Dr Oka presented an interdisciplinary approach to the study of neighborhood effects on health. 

Public Lecture by Dr Sorapop Kiatpongsan on 'Spreading the Wealth and Health(care)'
The public lecture was held on 9 September 2015. The speaker shared findings from his recent publication and ongoing research on economic and health inequalities. His studies show how much people think CEOs and cabinet ministers should be paid and how people think the government should allocate healthcare spending to the rich and poor.       
Workshop by Professor Hayden B. Bosworth on Program Implemenation and Evaluation
HSSR hosted a series of workshops on Program Implementation and Evaluation from 13 to 16 July 2015. During this period, over 150 participants from the Agency for Integrated Care, the Ministry of Health, Duke-NUS, the National University of Singapore, Singhealth, National Healthcare Group, Khoo Teck Puat Hospital and other healthcare institutions were trained. The workshops provided an overview of utlilising conceptual frameworks, identifying types of program evaluation, choosing appropriate methods and programs designs, selecting primary and secondary outcome measures and disseminating results. The instruction was made pertinent through the use of concrete examples based on completed projects and, where possible, local examples. 
                           Workshop on 'Program Implementation and Evaluation' at Duke-NUS Graduate Medical School Singapore
The workshop was conducted by Professor Hayden B. Bosworth, Professor of Medicine, Psychiatry and Nursing at Duke-University Medical Centre. Professor Bosworth is the Associate Director of the Center for Health Services Research in Primary Care and Adjunct Professor in the Department of Health Policy and Administration in the School of Public Policy at the University of North Carolina at Chapel Hill. He teaches a semester long course on implementation research and dissemination at Duke University. He also lectures internationally on additional topics including quality improvement, implementation science, methodology, and health care disparities. His research interests include: clinical research that provides knowledge for improving patients’ treatment adherence and self-management in chronic care, implementation and dissemination research to improve access to quality of care and eliminate health care disparities

StudentsProfessor Bosworth with students from Duke-NUS(From Left: Alfred Wong, Medical Student, Zhou Ke, MD/PhD Student, Chong Jia Loon, MD/PhD Student)


HSSR, Duke-NUS representation at the 2015 AcademyHealth Conference
                                                               Zhou Ke, Amina Islam, Prof David Matchar, Dr John Ansah, Dr Liu Chang
Public Lecture by Associate Professor Antonio Sarria-Santamera on 'Are Hospital Readmissions in the Elderly Preventable?'
The public lecture was held on 29 May 2015. This presentation showed the use of different methodolgies to describe and analyse hospital readmissions in the elderly and discussed how the production of evidence could be used in order to identify factors associated with this problem as well as to explore interventions that could be proposed to reduce their consequences. Click here to read more about his presentation.

Duke-NUS/Duke-Durham Bridging Symposium on 'Global Burden of Non-communicable Diseases with a focus on Vascular Disease'
 Bridging Symposium 2015
Duke-NUS hosted the Health Services and Systems Research (HSSR) themed bridging symposium entitled, ‘Global Burden of Non-communicable Diseases with a focus on Vascular Disease.’ The meeting brought together experts from Duke-NUS, Duke University, Duke Global Health Institute, Duke-Kunshan, the Singapore Ministry of Health, the National University of Singapore and other collaborating institutions. 

Led by Professor Tazeen Jafar from the HSSR Programme at Duke-NUS, a major objective of the Symposium was to share recent advances in the field of public health and identify innovative ways to move both research and practice forward. Some of the topics covered were the health systems and economic challenges of coping with Non-communicable Diseases (NCDs), including cost-effective interventions that target obesity, hypertension, heart disease, stroke and kidney disease, as well as access to care and universal health coverage. 


The Symposium, held on 26 and 27 March, is the third Duke/Duke-NUS bridging symposium to be held in 2015 by Duke-NUS to mark its 10th year. 

Public Lecture by Dr Giridhara Babu on 'Primary Prevention of Hypertension & Diabetes with the focus on Psychosocial and Maternal Environment'
On 12 January 2015, Dr Giridhar Babu gave a lecture on the potential role of reduction in burden of hypertension and Type 2 DM by modifying the risk factors namely the job stress and maternal milieu.

Public Lecture by Dr Sukhmeet Panesar on 'Patient safety: from enthusiasm to evidence-based, system-wide change'
Dr Sukhmeet Panaesar gave a lecture on 25 September 2014 on the progress made for patient safety and the need for a step-change in the discipline if harm free patient care is to be made a reality.

Public Lecture by Professor Anushka Patel on 'Innovation for Primary Healthcare Delivery in Resource-Constrained Environments'

The public lecture was held on 24 October 2014 at Duke-NUS Amphitheatre. This presentation discusses examples of  innovation relating to technology, workforce engineering and pharmacological approaches to improve access to high quality affordable healthcare. Click 

here to read more about her presentation.
Public Lecture by Dr Adnan Hyder on 'Interventions for Global Road Safety: Evaluation in Ten Countries'
On 30 June 2014, Dr Adnan Hyder from Johns Hopkins International Injury Research Unit, gave us a lecture on road safety issues as well as their Road Safety Program in overcoming the issues. Click here to read more about his presentation. 
Public Lecture by Dr Janet Bettger on 'Mind the Gap: Supporting Successful Care Transitions & Recovery after a Stroke'
The public lecture was held on 24 June 2014 at Duke-NUS Amphitheatre. This presentation described the ongoing comparative effectiveness research examining models of post‐acute stroke care in the U.S. and China. Click here to read more about her presentation.
Duke-NUS Receives UK Funding for Cardiovascular Health Study

Cardiovascular diseases (CVD) such as strokes and heart attacks have become the leading causes of dealth globally and in South Asian countries. High blood pressure or hypertension confers the highest attributable risk of CVD. About 1 in 4 adults suffer from hypertension in South Asia.


In recognition of the growing burden of CVD morbidity and mortality from hypertension, Professor Tazeen Jafar and team at Duke-NUS Singapore have been funded by the UK-based Joint Global Health Trials Scheme of the Medical Research Council (MRC), the Wellcome Trust, and the Department for International Development (DFID), to lead the design of Control of Blood Pressure and Risk Attenuation-rural Bangladesh, Pakistan, and Sri Lanka (COBRA-BPS) feasibility study.
This study will evaluate evidence-based potentially sustainable health systems interventions to control blood pressure and decrease the risk of developing cardiovascular diseases among hypertensive patients in the primary care settings in rural Bangladesh, Pakistan, and Sri Lanka.
The partnering centers include the International Center for Diarrhoeal Disease Research, Bangladesh, Aga Khan University (Pakistan), University of Kelaniya (Sri Lanka) and the London School of Hygiene and Tropical Medicine (United Kingdom). Duke-NUS is the coordinating center and held the first Study Group meeting at it campus in Singapore on April 24th and 25th with the international delegates to discuss implementation strategies.
For more information on the study, contact:

Professor Tazeen H. Jafar

Program in Health Services & Systems Research

Duke-NUS Medical School 

Tel: (65) 66012582

Email: tazeen.jafar@duke-nus.edu.sg

Web: www.duke-nus.edu.sg 

HSSR Symposium on 'Using Modeling to Prepare for Changing Healthcare Needs'.

The Signature Program in Health Services & Systems Research (HSSR) held its fourth annual symposium, “Using Modeling to Prepare for Changing Healthcare Needs,” on 14 – 15 April, 2014.  The symposium was designed to examine the challenges and opportunities that face us in the coming years and to exhibit different modeling techniques and illustrate how these techniques have been applied to various healthcare scenarios.  It was joined by a diverse group of over one hundred and twenty attendees from Duke-NUS Graduate Medical School, Saw Swee Hock School of Public Health, National University of Singapore, Alexandra Health, SingHealth, National Health Group, Eastern Alliance Health, Jurong Health Services, National University Health System, Agency for Integrated Care, Singapore Institute of Technology, Singapore Ministry of Health, and Singapore Ministry of Social and Family Development. 
Prof.  David B. Matchar, the Inaugural Director of the Program in Health Services and Systems Research, presented the audience with a list of changing needs and growing challenges in healthcare as well as applications of dynamic modeling in response to these concerns.  The keynote address on The Future of Healthcare 2030 was delivered by Prof. Gabriel M. Leung, Dean of Li KaShing Faculty of Medicine at the University of Hong Kong.  In addition, a number of distinguished speakers – clinical modeling scientists, population health modeling experts, health economists, health systems researchers and consultants, and biostatisticians – presented various applications of modeling to complex healthcare issues, ranging from workforce planning to evaluation of intervention and treatment strategies.  Led by Prof. Peter Hovmand, Director of Social System Design Lab at Washington University in St. Louis, an interactive panel session on Hopes and Fears of Healthcare in Singapore 2030 provided the audience with a platform to discuss their concerns and aspirations with panelists from Saw Swee Hock School of Public Health, National University of Singapore, and Ministry of Health, Singapore. Also, several exemplary simulation modeling projects from different Singapore healthcare sectors, including the Ministry of Health, the Singapore National Eye Center, the Agency for Integrated Care, and Singapore General Hospital, were presented at the symposium.
Following the two-day symposium, three one-day workshop sessions – Agent-Based Modeling (ABM), Discrete-Event Simulation (DES), and Group Model Building (GMB) – were offered to bring together concepts and applications of different dynamic modeling techniques.  Over fifty academics, clinician researchers, health administrators, policy analysts, and students participated in the workshop sessions.
"Building Models to Inform Ageing Policy: Getting It Right Before Time Runs Out" - Symposium on Modelling
On April 11 and 12, HSSR hosted a modelling symposium. A panel of distinguished speakers and international experts in the fields of System Dynamics, decision analysis, long-term care and ageing presented on topics related to modelling. For a detailed overview of the modeling symposium, click here.
Videos of the symposium can be found here:

Workshop on the Theory of Constraints

On April 10, HSSR hosted a workshop on the Theory of Constraints (TOC), an approach to improving systems and identifying and implementing change by finding the constraint or limiting step in a system. Designed for clinicians, health administrators, and policy analysts, the workshop was led by TOC and decision analysis expert, Dr. Steve Pauker, MD, MACP. More information about the workshop is available here.