Lessons learnt workshop may 4 5 2004 sydney
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The Health Roundtable. New Zealand. Lessons Learnt Workshop May 4-5, 2004 - Sydney. Index of Presentations. Improving the Journey for Chronic Complex Patients. Index of Stream 1a Presentations with Quick Links Workshop Aims and Honour Code

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Lessons learnt workshop may 4 5 2004 sydney

The Health Roundtable

New Zealand

Lessons Learnt WorkshopMay 4-5, 2004 - Sydney


Index of presentations

Index of Presentations

Improving the Journey for Chronic Complex Patients

  • Index of Stream 1a Presentations with Quick Links

  • Workshop Aims and Honour Code

  • Session 1a – Improving alternatives to inpatient admissions

If you view this document as a “Slide Show”,

clicking on the hyperlinked text (the turquoise and underlined text) will take you to that particular page in the report


2 workshop aim

2. Persuasion

3. Decision

3. Decision

2. Workshop Aim

AIM: SHARE INNOVATIONS TO IMPROVE HEALTHCARE

Looking for differences!

How to speed up action?

1.Knowledge

5. Confirmation

The Roundtable

Process

4. Implementation


2 hrt honour code

2. HRT Honour Code

  • All those who participated in the workshop and who have received this set of slides agreed to be governed by the following HRT Honour Code

    • No participant shall criticise the performance of other member hospitals, or use any of the information to the detriment of a fellow member.

    • No external distribution of data or conclusions based on Health Roundtable workshops or data is made without the consent of each person contributing materials.


Stream 1 improving the journey for chronic complex patients

Stream 1 - Improving the Journey for Chronic Complex Patients


Disease management programs for copd in primary care

Disease Management Programs for COPD in Primary Care

Session 1a – Improving alternatives to inpatient admissions

Prof Harry Rea

Department of Medicine,

University of Auckland, Middlemore Hospital,

Auckland, New Zealand


Lessons learnt workshop may 4 5 2004 sydney

Will Acute Growth Swamp Middlemore?

  • Medical 10% pa

  • Population growth 2%

  • Ageing 1%

  • Trend consistent over 10 years

  • Prevalence of respiratory disease high


Key problems

Key Problems

Random & often

frequent visits to GP

(cost to patient)

Hospital

Admission

(no cost to patient)

Knowledge of

disease(s) poor

(No planned prevention)

Recognition

of symptoms

poor

Exacerbation

unrecognised


How we did it

How we did it

  • COPD Project Started: August 1999

    Collaboration between:

  • GP Practices, Respiratory Physicians, Respiratory Specialist Nurse, Managers, Physiotherapists, Community Services, Patients

  • Communication channels & support provided

  • Clinical governance & funding by joint venture between all parties


Innovations implemented

Innovations Implemented

EXTRA TIMEwith GP

& Practice Nurse

Design Care Plan

& Review regularly

(no cost to patient)

DISEASE EDUCATION

for practices &

patients

Supported by practice & respiratory nurse

Recognise

exacerbation

Follow

Action Plan

Awareness of

symptoms &

Action Plan

(Planned Prevention)


Mean respiratory bed days reduced per patient per annum

Mean Respiratory Bed Days Reduced(Per Patient per annum)

CONTROL PATIENTS(n=52)

INTERVENTION PATIENTS(n=83)

* Respiratory bed days, t-test, mean 2.3 days 95% CI(0.1, 4.4)


Health status improved

Health Status Improved

Intervention Group (n=84)


Lessons learnt practices

Lessons Learnt - Practices

  • Potential to benefit best assessed by general practice

  • Lack of time greatest barrier

  • Complex patients can be disincentive

  • Stable “care team” needed to develop relationships

  • Building trust with patient (& family) often requires creativity & persistence

  • Specialist resources must support “general” practice


What patients want

What patients want

  • Individual Care Plan important for patients

  • Respect & acknowledgment of beliefs essential

  • Simple goals and outcomes best

  • Increased patient confidence better self-management

  • Patients want information but prefer to leave clinical decisions to GP

  • Continuity of care in hospital & consistent clinical advice trust


Implementation issues

Implementation Issues

  • Recruitment - assessing potential to benefit

  • Disease priorities depend on practice location

  • Matching incentives to practices

  • Co-morbidities = > time with patient

  • Education & training time essential

  • Consider practice organisation

  • Clinical Information Systems


Decision support

Decision Support


Lessons learnt workshop may 4 5 2004 sydney

Session 1aTopic: Improving Alternatives to Inpatient AdmissionCase management- An effective diversionary strategy to manage those with chronic illness/complex needs who frequently present at Emergency Department Presenter: Andrea Leonard Hospital: Barwon Health


Key problems1

KEY PROBLEMS

  • Our target group are high users of acute services, high cost and resource intensive

  • In 2002, before project implementation, 995 persons accounted for 7045 presentations at ED in a 20 month period. The majority of presentations by individuals were for different chronic conditions/reasons at each attendance


Innovations implemented1

INNOVATIONS IMPLEMENTED

  • The Assertive Case Management Project targets those with chronic illness/complex needs presenting 4 or more times at ED in a 12 month period.

  • Model is underpinned by recognition health is a resource rather than a state and the adoption of a population health approach.

  • Focus is on self management, integrated disease management and achieving an integrated service response


Innovations implemented2

Innovations Implemented

Team works across the system and is not constrained by “artificial” program boundaries.

Contributing to integrated services and systems complimentary projects focused on streamlining assessment, integrating direct care, establishing single point of contact forhome base care and simplifying transition from hospital to home


How we did it1

HOW WE DID IT

  • Project Started: 2003

  • Project Champion:

  • Team Composition: Multidisciplinary team comprising 4.6 Community Heath Nurses (one with Psych Reg) Social Worker and Psychologist

  • Resources Required: $640,000


Outcomes so far

OUTCOMES SO FAR

No of referrals (Dec2003) 148

No of clients actively case managed 137

Target group population average

EMD Visits

30 Sep ’03

Before case management 5.33

After case management 2.27

Dec ‘03

Before case management 6.3

After case management 2.79


Lessons learnt

LESSONS LEARNT

  • Multidisciplinary case management is an effective tool for linking clients to primary and social supports

  • Need for greater executive/ organisation “by in” of project

  • Need to recognise the complexity of the target group which impacts on outcomes

  • Need to address levels of depression, anxiety, psychological distress before “condition’


Lessons learnt workshop may 4 5 2004 sydney

Session 1aTopic: Improving Alternatives to Inpatient Admission

Early Multidisciplinary Assessment(Beyond MAPU)Presenter: Cam BennettHospital: Royal Brisbane & Women’s Hospital

4-5 May 2004Sydney


Key problems2

KEY PROBLEMS

  • Over 4000 unplanned admissions annually to the Dept of Internal Medicine with :-

  • Complex care Needs

  • Hospitalist approach

  • Attendance at case conferences inconsistent

  • Organisation of services inconsistent

  • Staffing of allied health inadequate


Innovations implemented3

INNOVATIONS IMPLEMENTED

  • Consistent, coordinated team with shared goals

  • Programmed consultant lead early multidisciplinary meetings

  • Implemented as a controlled study


How we did it2

HOW WE DID IT

  • Project Started: August 2002

  • Project Champion: Chairs of Medicine and Allied Health and Director of Finance

  • Team Composition: Multidisciplinary including administrative staff

  • Resources required : (next slide)


Outcomes so far1

OUTCOMES SO FAR


Results bed day savings

Results: bed day savings

1927 BED DAYS IN 9 MONTHS (7 BEDS PER DAY)

EMC


Results acute los reduction

Results: acute LOS reduction

AVERAGE ACUTE LOS REDUCED FROM 7.35 DAYS TO 6.7 DAYS

EMC


Lessons learnt workshop may 4 5 2004 sydney

Cumulative readmission numbers

EMC start


Lessons learnt1

LESSONS LEARNT

  • What we recommend to other hospitals on this topic : Try it if you haven’t already and be prepared to invest some money to save some money

  • What we would do differently : Not to get too caught up in the paperwork and never underestimate the effort required to “maintain the rage” for sustaining large process reorganisations.


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