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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
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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
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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
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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
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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
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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)
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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
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