Better Sooner More Convenient Primary Care - New Zealand Doctor

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Shared <strong>Care</strong> MDT‟s - Long Term MHS users – Physical Health $40,000 (100 patients with 4 meetings/pa @$100 per 50meetings) $ 25,000 (350 annual checks @ $65 & seasonal influenza vaccinations) Community Providers $ 2,164,717 $3,007,422 Secondary Mental Health $9,358,288 $7,863,577 Secondary IDFs $788,675 $788,675 TOTAL $12,619,960 $12,199,960 Business case appendices V12 AC 25Feb2010 Page 100
Appendix Eleven: Frail older people 1. Aspirational statement: Frail older people and others with long term disabling conditions will be able to access support services that are timely, flexible and appropriate to their individual needs and those of their carers. The pathway of care among primary, secondary and community based services for older people and those with long term disabling conditions will operate smoothly with excellent informationsharing among all services and with people and their families. All health and support service workers will be proactive in helping the person and their carers maintain and regain their functional abilities and prevent further illness or injury. 2 Problem definition Lack of clarity/agreement on appropriate pathway of care for frail older people, within Grey Hospital as well as between hospital and primary health services and home based and residential care services. Stroke patients not transferred to specialist care soon enough and sometimes not at all, and national stroke guidelines have not yet been adopted. Opportunities missed for keeping frail older people fit and well and preventing admission to the acute hospital and to long term residential care – lack of a pro-active approach to reducing the risks of avoidable hospital admission or rest home entry. Frail older patients admitted to the acute medical and surgical wards or presenting at ED are not always appropriately referred to specialist Health of Older Peoples services. Lack of a shared client information system even among DHB services, let alone primary care, home support or residential care. Lack of step down beds for convalescence and slow stream rehabilitation, and continued inappropriate use of long term respite care and carer support budgets for this purpose. Over use of long term residential care (particularly rest home level) due to under development of home based alternatives, (eg. flexible homecare packages, planned respite, dementia day care, support for carers). Under development of home support services – most carers are untrained and casual, with limited supervision or linkage to district nursing, community allied health, <strong>Care</strong> Link or primary health services. Home support agencies cannot always provide staff for high/complex packages Business case appendices V12 AC 25Feb2010 Page 101
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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
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Appendix B: Acutely unwell adult pa
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4 Objectives to implement nur
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Review Buller after hours arrangeme
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Year three Community education camp
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13 Costs Budget considerations:
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established. This group now oversee
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Output measures Tobacco control / s
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Improving immunisation coverage - h
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Year three Continued joint plan
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extending health promotion activiti
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Immunisation Coverage Funder Provid
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The Community Health System Deliver
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Clinical care Practice self managem
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and increases in the numbers of pat
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Ambulatory Sensitive Hospitalisatio
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% 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 and 138: Year two implement the process to
Page 139 and 140: Low uptake by primary and secondary
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
Page 161 and 162: Service user pathways in an optimal
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: 10 Risk analysis Risk Probability I
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
Page 189 and 190: Appendix Thirteen: IFHCs - Faciliti
Page 191 and 192: A key possibility is that land at t
Page 193 and 194: This option is effectively a Greenf
Page 195 and 196: 7 Westland IFHC Facilities options
Page 197 and 198: Year two Substantive-IFHC in Greymo
Page 199 and 200: 12 Costs Capital costs Greymouth IF
Page 201 and 202: utilize MedTech, but via their own
Page 203 and 204: 4 Objectives: To implement c
Page 205 and 206: Security An individual‟s health i
Page 207 and 208: 8 Effect on inequalities The increa
Page 209: Appendix Fifteen: Project advisory
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