1. Improving Population Health through technology and culture OR “How to turn reluctant travelers into excited globetrotters” Ian Landreth Feb 2009

2. Claimer/Disclaimer  This is NOT: Rocket science Efficiency personified Cutting edge IT Clever in its simplicity  This IS: Effective in improving indigenous health Effective in engaging GPs in population health Progress on a shoe string Frustrating Brave

3. Our Population  Located on Sunshine Coast SE QLD  Population approx 350,000  Main Towns: Maroochydore, Caloundra, Noosa, Nambour, Gympie  Growing by 800 permanent residents every week in last 5 years

4. Our General Practice Population  475 GPs (272 FTEs); 128 Practices  256 General Practice Nurses (32% increase)  108 Practice Managers (24% increase)  GPs younger than national average  Fastest uptake in technology initiatives  Opinionated  29% Female  25% International Medical Graduates

5. What do we do?  Funded by DoHA (55%); QldHealth (35%); Other (10%).  Pursue improved health for our communities through the support of General Practice  Chronic Disease, Palliative Care, Aged Care, Mental Health, Practice Nursing, Business and Systems Support, Education and Training, Health Promotion, Preventive Health, Indigenous Health  Employ 30 staff and 9 contractors in program management and direct service delivery from 11 sites

6. Conundrum  General Practice focuses on individuals  Systems, software, funding supports this  Population Health requires GPs to: Adjust Clinical Practice and Business Practice Plan and deliver at Practice or Local level Overcome lack of tech support Commit to change at own cost (time & $)

7. Conundrum gets worse  Research shows that GPs will change their behaviour and sustain this change when 3 conditions are in place: 1. Must be good for their Patients 2. Must be at least financially neutral 3. Must be simple

8. Our Solution  Show quantifiable benefits to patients through APCC database  Compensate for change management, absorb development costs, build value proposition around MBS item numbers  Use existing technology where possible so Practices do not have to change their PMS &  Leverage off existing programs where trust relationships already exist

9. Key Principles 1. Know your population 2. Leverage off existing program funding and objectives 3. Don’t force technology change – support diversity 4. Active recruitment of targeted Practices 5. Keep Patient outcomes to the front 6. Don’t listen to others who say you can’t

10. Step 1Find the target!  Scope a manageable population  Must be: Identifiable Locatable Trackable in regard to services accessed

11. Step 2Build on success  Leverage off existing programs Brokerage Model of North Coast Aboriginal Corporation for Community Health (NCACCH) Australian Primary Care Collaboratives Australian Better Health Initiatives (ABHI)

12. Step 3Use existing technology  Extraction from whatever practice software is being used  De-identify and Re-identify patient information at the Practice end  Create a new Patient record in real time linked to the indigenous data-base

13. Step 4Go get them!  “Tag” all Indigenous patients within the Practice systems  Gather Baseline data  Recruit targeted Practices and create future recruitment pool  Support Information Management in the Practices with education around data cleaning and coding  Participation fee and information payments

14. Step 5Patients to the front!  Reports showing health improvement at individual, Practice Population level and will Indigenous Population level  Benchmarking drives change through comparative feedback  Support for Practices to design clinical improvement processes  Health system design (Brokerage)

15. Step 6Ignore the doubters…Do It  Whatever knowledgeable people say in criticism, they are probably right… but The important thing though is not to let this prevent you moving forward.  In Population Health, doing nothing is not an option!

16. Summary 1. Know your Population Local indigenous community 2. Leverage off existing funding and programs NCACCH Brokerage; DoHA Core Grant; ABHI; Chronic Disease initiatives 3. Don’t force technology – support diversity Kept tech development issues on our side of the fence and worked (where possible) with what was already in place

17. Summary ctd 4. Active recruitment of targeted Practices Used APCC practices and larger “indigenous” practices 5. Keep patient benefits to the front and data only a means to an end  Reports and analysis to support practices/GPs in quality improvements and service planning 6. Don’t listen to nay-sayers! No IM funding but prioritise it over other things and use what we have