Quality & Safety in Primary Care: Understanding the Australian Health System

1. Quality & SafetyPrimary CareKnowledge Understanding, Discussion and Exchange Dr Dale Ford Dr Andrew Knight Improvement Foundation Australia Paris Q S Forum 2014

2. To be covered • Australian Context • What assists with CQI / payment models • Quality & Safety / Health Care Inequities

3. What is the context

4. Health System in Australia • Universal Health Insurance scheme funded through taxes, x% GDP • GPs who are largely in Private Business / Practice, organised through partnerships, cooperatives, corporate models or through Community Health Systems • Federal Government responsible for GPs, private specialists, Practice Nurses, Pharmacy, aboriginal and Torres Strait Islander Health Services

5. Health System in Australia • States responsible for hospitals, nurses, allied health, with crossover with the Federal Government • Incentives for General Practices to provide team based Care Plans, with nurse and allied health involvement • Incentives for undertaking diabetes cycles of care, and other processes which change

6. Australian Context • System of Practice Accreditation (voluntary but gateway to some insurance rebates • Requirement for Australian vocational training or foreign equivalent to enter unsupervised General Practice • Medicare Locals (meso) responsible for supporting Primary Care Practices, accountable for local population health

7. What is the problem? • Evidence / Practice gaps in common chronic diseases (CVD, diabetes, cancer etc) • Largely fee for service care (insurance) with usual care being traditional • Health inequities (socio economic, aboriginal, rural, outer urban, youth) • Variation in access to services • Few systems to promote safety

8. What is the problem? • IT systems for prescribing / EMR but poor ability to obtain measurements from the IT systems

9. What have we done?

10. What have we done? • 2003: Department Health / Australian Government became interested in work of Sir John Oldham UK National Primary Development Team • Breakthrough Collaborative Methodology • … delivered to scale, such that there were system changes in Primary Care designed to support chronic care • System of scholarships and visit to UK to learn, articles, popular press

11. What have we done? • Commonwealth contracted with Australian Team to implement Australian Primary Care Collaboratives • $8 million over 3 years for Diabetes Care Improvements and Coronary Artery Disease Improved Sec Care • $4 million from PM fund(Howard) for improvement of Access

12. Lowitja Institute CQI Conference 2014 Collaborative Methodology

13. Lowitja Institute CQI Conference 2014 • Origins with Deming • Langley, Moen, Nolan, Norman, and Provost combined the three questions and the PDSA cycle

14. What have we done • NACCHO and four Affiliates • Cancer Screening • TORPEDO study • Patient Safety (CRE) • Fitness Australia • Rural Health West – WA - 12 part QI education webinar series • Disability and eRecord • Medicare Local – Population Health • Outreach Services • Vaccination Adverse Event Surveillance System & STARSS • Aged Care Collaborative – VIC • Worksafe VIC • Equipped Long Term Conditions Collaborative - Auckland District Health Board

15. Knowledge and Infrastructure • Many Collaborative handbooks and other technical documents • Quality indicators and capability to electronically submit data • Web portal technology • Training and development courses and programs • Variations of the Collaborative methodology • Just completed Collaborative Handbook for a Patient Safety Collaborative with CRE (UQ and others) Amr Abour (post doc researcher Flinders University / APHCRI

16. Lowitja Institute CQI Conference 2014

18. How can it apply to you? • National Change Program • Improvement Methodology • IT with measurement • Portal Technology • Practice Coaches • Some incentives