Quality & Safety Primary Care Knowledge Understanding, Discussion and Exchange Dr Dale Ford Dr Andrew Knight Improvement Foundation Australia Paris 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?

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

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

The results Practices Practice Software extraction systems Program supported by “coaches” form Medicare Locals Improvement Foundation portal de-identified data submission regularly Diabetes CVD COPD CKD Access and Care Re-design Closing the Gap (QLD and VIC) Prevention of Chronic Disease Training and development for support staff QIP with Medicare Locals Ochrestreams eCollaboratives Lowitja Institute CQI Conference

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

J Ovretveit Workshop

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

"One of the most effective quality improvement programs to be introduced into general practice has been the Australian Primary Care Collaboratives.“ A systems approach to the management of diabetes. A guide for general practice networks. P23, June 2010, Royal Australian College of General Practitioners.

“Quality improvement initiatives, such as the APCC, should be made available more broadly to practices to support continuous quality improvement in the provision of care for people with, or at high risk of, CVD.” Improving cardiovascular health outcomes in Australian general practice. Facts and recommendations to support government relations and policy development. July Heart Foundation.

“The APCC Program has been instrumental in developing and enhancing General Practice processes of care which lead to better health outcomes for people living with chronic disease.” Professor Claire Jackson, former president, Royal Australian College of General Practitioners, 2010

“Today, the Australian Primary Care Collaborative Program is a highly successful mission, making a real difference to people’s quality of life through a pursuit of excellence and continued improvement. Since the launch, the Program has improved in the care of hundreds of thousands of patients with a chronic disease.” Senator for New South Wales, Australia and Assistant Minister for Health, Fiona Nash, March 2014.

“By continuing to implement National Collaborative Waves, the government is sending a strong message to health professionals about the central role of continuous, quality improvement in primary health care.” Senator for New South Wales, Australia and Assistant Minister for Health, Fiona Nash, March 2014.