Quality & SafetyPrimary CareKnowledge Understanding, Discussion and Exchange
Dr Dale Ford Dr Andrew KnightImprovement Foundation AustraliaParis Q S Forum 2014
To be covered• Australian Context• What assists with CQI / payment models• Quality & Safety / Health Care Inequities
What is the context
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
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
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
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
What is the problem?• IT systems for prescribing / EMR but poor
ability to obtain measurements from the IT systems
What have we done?
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
10
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
11
Collaborative Methodology
Lowitja Institute CQI Conference 201412
• Origins with Deming• Langley, Moen, Nolan,
Norman, and Provost combined the three questions and the PDSA cycle
13Lowitja Institute CQI Conference 2014
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 201417
How can it apply to you?• National Change Program• Improvement Methodology• IT with measurement• Portal Technology• Practice Coaches• Some incentives