The Health Roundtable Osteoarthritis Chronic Care Program (OACCP) Presenter: Matthew Jennings Hospital Code Name: Innovation Poster Session HRT1215 – Innovation Awards Sydney 11 th and 12 th Oct 2012

The Health Roundtable KEY PROBLEM  People with Hip/Knee OA managed with analgesia and referred to orthopaedic surgeon for joint replacement  Long and increasing elective joint replacement waiting lists:  Hips: 91 days (2003/04) → 167 days (2009/10)  Knees: 168 days (2003/04) → 301 days (2009/10)  No further assessment: arrive at pre-admission with co- morbidities not managed, home not assessed  No pathway for re-prioritisation based on clinical need  No pathways to facilitate uptake of conservative options, MDT support or self-management

The Health Roundtable AIM OF THIS INNOVATION  Provide comprehensive disease management within a chronic care model for people with OA:  Reduce pain, improve functional capacity and quality of life  Improve coordination of care  Provide access to appropriate inter-disciplinary, conservative management for OA and identified co-morbidities  Better monitoring and pre-operative management of people on elective joint replacement surgery waitlist:  Decrease LOS, earlier discharge home, better outcomes  Maximise participants’ overall health  Minimise risk factors associated with and optimise preparation and expectations for surgery and recovery

The Health Roundtable BASELINE DATA  Nearly one in five Australians has arthritis, mostly OA  Minimal uptake of conservative management options prior to joint replacement surgery  Only 3.9% of GP encounters for OA referred to allied health  >60 % of OACCP cohort no previous conservative mx  Increasing demand for joint replacement surgery predicted to continue

The Health Roundtable KEY CHANGES IMPLEMENTED  Musculoskeletal Coordinator (Senior Physio) and multidisciplinary team appointed at each site  Nominated executive sponsor  Medical governance  Engagement of orthopaedic surgeons  Comprehensive assessment, review and monitoring of participants with re-prioritisation where indicated  Health coaching approach with individualised goals and components (eg. weight management, adequate, appropriate exercise, diabetes control, medication review)  Data system to support care planning, participant management and program evaluation

The Health Roundtable OUTCOMES SO FAR  Model of Care published and launched May 2012  100% of MSK coordinators and MDT members trained in health coaching – changing practice in CDM  90% participants satisfied or very satisfied with program  81 participants (7%) removed from surgical waitlist as no longer requiring surgery  83 participants (7%) escalated to surgery  Waist circumference: 45% reduced by > 3 cm - Week 26  14% lost more than 5% body weight at Week 26  Fewer participants at risk of falls based on Timed Up and Go of >13.5 sec ( 40% at entry; 34% at week 26)

The Health Roundtable LESSONS LEARNT  Change management strategies  Support clinicians to change practice; provide training  Critical to instil and maintain inter-disciplinary focus  Build on collaborative team approach that includes patient  Identify and utilise efficiencies with current programs/services  Clinical champions and medical buy-in crucial  Collaborative approach for optimal program delivery  Primary Care/Community sector, NGO’s and Hospitals/LHD  Chronic disease management programs must:  Identify goals to deliver patient-centred and holistic care  Support overall health and lifestyle change strategies for people with complex health issues and goals