Ray Wihapi 14 November 2013

1. Ray Wihapi • 14 November 2013 • Te Whiringa Ora

2. Te Whiringa Ora/Care Connections • Background • The model • The results

3. Why we developed Te Whiringa Ora

4. Why (continued...) • Te Whiringa Ora • Chronic health conditions are increasing globally. New Zealand has followed this trend, with an estimated 80% of all deaths resulting from a chronic condition (National Advisory Committee on Health and Disability, 2007). • Need for a more proactive and responsive approach. • Current reactive models of health care are failing to meet the needsof some individuals

5. Our people • Te Whiringa Ora • Eastern Bay of Plenty • Population of 50,000 • 48% identifying as Māori (national average is 14%). • The area has high levels of long-term conditions which are higher than the national average • Clients are those who have been admitted to hospital two or more times over the past 12 months and/or have had six primary care visits in the past 12 months (including ED visits)

6. Te Whiringa Ora approach • Te Whiringa Ora • Underpinned by the principles of Whānau Ora • Innovative and evidenced-based approach to addressing long term conditions • The client and their whānau in the driver’s seat • Facilitating interdisciplinary care • Complex health needs and high users of hospital services • Provide a ‘web of care’ to connect what exists already • Time-limited support phase of three to six months

7. What we do • Te Whiringa Ora • Home visits – CM and KTT • Engage, relate and build trust • Holistic assessment at intake and discharge

8. What we do (continued) • Te Whiringa Ora • Shared support plan • Client prioritised goals • Interventions associated with goals • Linking to the right service at the right time • Enabling people to better understand and manage their condition - health literacy • Provide information and support • Tele-monitoring

9. Linking people to the right service at the right time • Te Whiringa Ora

10. Key objectives • Te Whiringa Ora • Improve access to primary, secondary and community health care to achieve better health outcomes for clients and whānau • Provide seamless access to quality health services that meet clinical, social and cultural needs • Reduce disparities in health outcomes • Contribute to improving primary care management of chronic and long-term conditions • Improve client self-management of long-term conditions • Support the health outcome priorities for Eastern Bay of Plenty

11. Key objectives (continued) • Te Whiringa Ora • Reduce preventable hospital admissions and hospital length of stay • Increase proactive intervention to prevent or delay deterioration which results in increasing levels of care and acute admissions • Provide a holistic client-centred and whānau ora approach to care • Educate service users and their whānau in self-management of chronic care and lifestyle changes • Increase sustainability of future health services by increased use of the unregulated workforce

12. Results - Synergia evaluation • Te Whiringa Ora • SF12 scores - quality of life • Analysis of baseline and follow-up SF-12 data • Physical composite score: bodily pain, physical functioning, role-limitation physical and general health • Mental composite score: mental health, energy/vitality, role limitation - emotional and social functioning

13. Results - Synergia evaluation • Te Whiringa Ora • Whose health improved? • Māori and non-Māori (approach applies cross culturally) • Males and females • All age groups • All showed a clinically significant increase in their SF-12 scores

14. So what does this mean? • Te Whiringa Ora • TWO assists in the improvement of clients’ quality of life • Deterioration is typical for clients with multiple long-term conditions • SF-12 struggles to monitor change in smaller samples • Many evaluations of other models have found no change in these outcomes

15. Use of inpatient services • Te Whiringa Ora Time in hospital: • A 10% reduction in bed days for TWO clients • A 47% increase in bed days for the control group Hospital admissions: • A reduction in the use of inpatient services for TWO clients. No change for the control group • TWO clients were spending more time at home and using inpatient services less frequently

16. Use of outpatient services • Te Whiringa Ora TWO clients usage of outpatient services decreased in frequency or stabilised: • Decreased for COPD • Stabilised for diabetes • Decreased for heart disease Control groups’ use of outpatient services: • Increased for COPD • Increased for diabetes • Remained the same for heart disease patients

17. Emergency Department presentations • Te Whiringa Ora • ED presentations occurred less frequently for most TWO clients - especially COPD and diabetesclients.

18. TWO potential savings (per client) • Te Whiringa Ora

19. Evaluation summary • Te Whiringa Ora • TWO evaluation findings are very positive • Evidence provides support for TWO and the model underpinning it TWO supports: • Improvements in service coordination and access • Improvements in self-management • Improvements in clients’ quality of life • Reductions in clients’ use of hospital services

20. Te Whiringa Ora “ People don’t care how much you know until they know how much you care”