Better Sooner More Convenient Primary Care - New Zealand Doctor

Outcome measures
Indicator Baseline Target – Yr
1
Rate of admission for falls-related
fracture, for people aged 75+
years, over 3 year rolling period
Average length of stay in specialist
Health of Older People (AT&R)
service
Rates of re-admission to acute
hospital care over a 6-month
period for people aged 75+
Rate of „frequent fliers‟ (6+ acute
hospital admissions per year) for
people aged 75+
Rate of admission to permanent
rest home level care per capita of
people aged 75+ years
Rate of ambulatory sensitive
admissions 45-74 years
Carer stress as measured by
average years duration of
employment for carers
TBC
TBC
TBC
TBC
5.98%
(July-Dec
2009)
TBC
Not yet
measured.
Same as
baseline
Same as
baseline
Same as
baseline
Same as
baseline
Year 2 Year 3
5% reduction
on baseline
5% reduction
on baseline
5% reduction
on baseline
5% reduction
on baseline
5.75% 5.5% 5.0%
Same as
baseline
5% reduction
on baseline
5%
reduction on
baseline
10%
reduction on
baseline
10%
reduction on
baseline
10%
reduction on
baseline
5%
reduction on
baseline
Baseline Baseline 5%
reduction on
baseline
5 Deliverable / activities
Implementation plan:
To June 30
Identify the process, timeframe, resources and accountabilities for establishing a
single shared patient record that is available to all appropriate primary, community,
hospital and residential care staff.
Introduce clinical protocols whereby stroke patients and frail older people admitted to
Grey Hospital are routinely referred to the specialist Health of Older People Service
(AT&R), with their primary health teams and case managers being alerted electronically
Progress the planned changes to a restorative model of homecare that have already
started, aligning with similar work by Nelson Marlborough and Canterbury DHBs
Complete implementation of InterRAI at Care Link and ensure read-only access to at
least other DHB services
Set up a robust budget management system for the long-term support services
accessed through Care Link, and a plan for linking InterRAI data to volumes and
expenditure data
Business case appendices V12 AC 25Feb2010 Page 104