Better Sooner More Convenient Primary Care - New Zealand Doctor

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The rationale for implementing InterRAI may be found in the many reports on interRAI and assessment tools produced by the Ministry of Health and other organisations since 2003 - see www.moh.govt.nz/moh.nsf/indexmh/hop-projects-assessmentandservicecoordination 9 Risk analysis Risk Probability Impact Contingency plan Lack of strong management or clinical champions for a new model of Older Peoples High Medium Discuss within EOI process. Consider basing HOP service in the community, working into the hospital. Health services Service changes span several management/ funding silos, making DHB High High Discuss within EOI process. Consider basing HOP service in the community, working into the hospital. decisions difficult Many clinical staff work to a traditional model of care for older people Medium Medium Use Care Link and InterRAI to drive changes on a case by case clinical basis. Involve sector in restorative training scheme eg SMART. Difficulty in moving funding because of deficit Medium Medium Discuss in EOI process and get DHB commitment. constraints Lack of connection between PHO and its primary health care programmes and what Care Link and DHB has been doing in HOP Medium Medium Use EOI process to get greater involvement and buy-in among stakeholders. 10 Engagement Working group who developed this plan: Hecta Williams, Robyn McLachlan, Diane Brockbank, Helen Rzepecky, Torfrida Wainwright Other clinicians involved: Tim Bolter, Jocelyn Tracey Business case appendices V12 AC 25Feb2010 Page 108
11 Organisational accountabilities West Coast DHB GM Primary and Community Services is accountable for: changes to Care Link location, working methods, and implementation of InterRAI changes to do with community based nurses and clinical nurse specialists (?) establishment of step-down beds at Westport and Reefton. West Coast DHB GM Planning & Funding is accountable for: the change to a restorative home support service budget management processes for long-term support services initiating a Carer Support Strategy and Action Plan. West Coast DHB GM Secondary Services is accountable for: changes to AT&R services establishment of step-down beds in Greymouth (if hospital-based) changes to do with allied health staff. 12 Costs An increase in community allied health FTEs has been budgeted within the Care Link and long term home support budgets as part of the change to a restorative model of home care. Business case appendices V12 AC 25Feb2010 Page 109
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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
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Health navigators/ kaiawhina: chan
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Committee‟s objectives 41 of prov
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- lack of consistency of care betwe
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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 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: Māori have a higher incidence of m
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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