Better Sooner More Convenient Primary Care - New Zealand Doctor

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Rapid rise in figures on use of the website containing the HealthPathways. Statistics show average pages per day per month accessed for February 09, was 405 pages, June 09, 647 pages and November 09, 1404 pages. Participation by hundreds of clinicians in Canterbury means the site is designed by the users for their needs. Regular and frequent feedback from participants in the Canterbury Initiative process has enhanced the content. A high participation rate by specialists and general practitioners was achieved in Canterbury in education sessions with positive feedback indicates the programme fulfills a need for information. Multiple changes in clinical service provision were achieved with gradually increasing uptake such as subsidised skin cancer surgery, gynaecology procedures and respiratory investigations. West Coast general practice is already accessing the Canterbury HealthPathways site for reference material and sees the value in customising it to fit the West Coast. Canterbury Initiative are evaluating effectiveness using a number of methods including an online questionnaire repeated over time to general practitioners and specialists, monitoring changes in service utilization with many sets of usually collected DHB data. As well, research programmes have been initiated for significant changes in service delivery including prioritisation of colorectal symptoms and the community management of post-menopausal bleeding. Canterbury clinicians have noted that the use of the pathways: Provide better outcomes for patients. Can provide alternatives to a referral from general practice to hospital for an FSA. Have improved the quality of information being provided by general practice enabling more effective and consistent triage. Allow hospital clinicians to discharge patients back to general practice for follow-up care. 10 Risk analysis Risk Probability Impact Minimisation plan Low clinician engagement in High High Personal approach, pay for their time, share the load. workshops Relationship with CDHB deteriorates Low High Regular meetings and shared decision making. Business case appendices V12 AC 25Feb2010 Page 68
Low uptake by primary and secondary care clinicians Local adaptation process not effective Low - moderate High Educational sessions, assist clinicians to put in „favourites‟ in their web browser, multiple reminders about the pathways, link on PHO and DHB websites. Low High Will need to revert to joint workshops, if necessary. 11 Engagement Working group who developed this plan: West Coast: Vicki Robertson, Chief Medical Officer Jane O‟Malley, Director of Nursing and Midwifery for West Coast District Health Dr Jocelyn Tracey, West Coast <strong>Primary</strong> Secondary Liaison Officer Alison McDougall, Patient Journey Improvement Coordinator Canterbury: Graham McGeoch – Canterbury Initiative Clinical Leader and Clinical Editor for HP Juanita Gibson – Technical Writer – Streamliners. Emma Harding Streamliners Ian Anderson – Streamliners, also working on CDHB EOI project. Bronwyn Petrie – Project Manager – Canterbury Initiative team. Other clinicians involved: Dr Greville Wood, Dr Carol Atmore, Dr John Garret, Alison Lobb (RN), Liz Burns (RN). 12 Organisational accountabilities Canterbury will retain ownership of the Health Pathways. 13 Costs The Canterbury Initiative is supporting and funding the West Coast adaption of the pathways as follows: access to HealthPathways web site Business case appendices V12 AC 25Feb2010 Page 69
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Business Case Better, Sooner, More
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1 Caveats/status This business case
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Current situation By three years Wa
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staffed on a capacity model - in wh
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support from DHBs, specialist clini
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10.4 Key milestones................
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Annual government health funding pe
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Ambulatory Sensitive Hospitalisatio
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The base populations of the three d
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Māori/Pacific Not Māori/Pacific D
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4.7 West Coast region service deliv
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5 Future model of care 5.1 The desi
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support them. Help with understandi
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LEVERS VISION Better, sooner, more
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providing the majority of care). Th
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The Community Health System Deliver
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To better integrate the support pro
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5.5 Enablers A key aspect of this b
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Two rounds of meetings with front l
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While doctor-nurse substitution has
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Nick Goodwin, Kings Fund 14 , in hi
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Quality domains Each new initiative
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Preventative Acute LTC management R
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Preventative Acute LTC management R
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The core services are provided or p
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Total required FTEs for the Grey IF
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7 Governance, Ownership & Managemen
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Option D: PHO/DHB jointly owned Pri
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The IFHS will need the ability to b
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Of note, a large proportion of the
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The DHB delegates decision making o
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Limited integration of community se
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10.4 Key milestones The table below
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Expanded pharmacy roles Improving a
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Devolved community based services w
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Appendices Appendix One: Health Equ
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ongoing GP shortage creating an env
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10. What are the unintended consequ
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It is common for people with an acu
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Outcome measures Indicator Baseline
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determine ratio of nurses and GPs t
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C. Extended role for pharmacists:
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11 Engagement Working group who dev
Page 87 and 88: Appendix B: Acutely unwell adult pa
Page 89 and 90: 4 Objectives to implement nur
Page 91 and 92: Review Buller after hours arrangeme
Page 93 and 94: Year three Community education camp
Page 95 and 96: 13 Costs Budget considerations:
Page 97 and 98: established. This group now oversee
Page 99 and 100: Output measures Tobacco control / s
Page 101 and 102: Improving immunisation coverage - h
Page 103 and 104: Year three Continued joint plan
Page 105 and 106: extending health promotion activiti
Page 107 and 108: Immunisation Coverage Funder Provid
Page 109 and 110: The Community Health System Deliver
Page 111 and 112: Clinical care Practice self managem
Page 113 and 114: and increases in the numbers of pat
Page 115 and 116: Ambulatory Sensitive Hospitalisatio
Page 117 and 118: % CVD on lipid lowering drugs, beta
Page 119 and 120: Health navigators/ kaiawhina: chan
Page 121 and 122: Committee‟s objectives 41 of prov
Page 123 and 124: - lack of consistency of care betwe
Page 125 and 126: qualifications and skills. Where ca
Page 127 and 128: 6 Deliverables / activities Impleme
Page 129 and 130: “With an aging population and an
Page 131 and 132: Differences between revenue generat
Page 133 and 134: Appendix Seven: Integration - Healt
Page 135 and 136: It is expected that HealthPathways
Page 137: Year two implement the process to
Page 141 and 142: Appendix Eight: Improved access to
Page 143 and 144: to easily access by telephone). Oth
Page 145 and 146: Year One - July 2010 to June 2011 T
Page 147 and 148: LECG 50 evaluated whether “the im
Page 149 and 150: Appendix Nine: Referred services 1.
Page 151 and 152: them by technical errors or lack of
Page 153 and 154: Identify patients that would benefi
Page 155 and 156: • Provision of patient specific m
Page 157 and 158: 12 Organisational accountabilities
Page 159 and 160: emain under the care and management
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Page 163 and 164: Model for shared care pathways deve
Page 165 and 166: Implementation plan: to June 30 Dev
Page 167 and 168: Year two Review progress, outcome m
Page 169 and 170: 10 Risk analysis Risk Probability I
Page 171 and 172: Appendix Eleven: Frail older people
Page 173 and 174: ehab and treatment programmes that
Page 175 and 176: Year one: Maintain and continue the
Page 177 and 178: Māori have a higher incidence of m
Page 179 and 180: 11 Organisational accountabilities
Page 181 and 182: There are often vacancies for allie
Page 183 and 184: 6 Deliverables / activities Program
Page 185 and 186: Professional development: Provide
Page 187 and 188: Mainstream arguments are concerned
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Appendix Thirteen: IFHCs - Faciliti
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A key possibility is that land at t
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This option is effectively a Greenf
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7 Westland IFHC Facilities options
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Year two Substantive-IFHC in Greymo
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12 Costs Capital costs Greymouth IF
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utilize MedTech, but via their own
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4 Objectives: To implement c
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Security An individual‟s health i
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8 Effect on inequalities The increa
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Appendix Fifteen: Project advisory
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