Evaluation of Hunter & New England HealthPathways

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1 Evaluatin f Hunter & New England HealthPathways

2 2

3 General Practice & Ambulatry Care Activity General Practice MBS data: In 2013 there were 3.3 millin patient attendances t 730 GPs in the HML regin, a 5.6% increase n 2012, cmpared t a 2.8% increase acrss Australia. BEACH data suggests that in the HML regin each year: GPs manage arund 5.1 millin prblems, with 36% f these fr chrnic disease; There wuld be arund 290,000 referrals t medical specialists and 155,000 referrals t Allied Health prfessinals. Each GP wuld make arund 400 new referrals t specialists. Example: Jhn Hunter Hspital Ambulatry Care Centre Average f 150 referrals a day 760+ sessins run daily 45+ different specialties 250+ different clinicians

4 Ambulatry Care Driver Diagram

5 The three phase apprach t H&NE HealthPathways evaluatin

6 Phase 1 HealthPathways Evaluatin: Partnerships 1) Phase 1 examined the initial develpment and implementatin prcesses f HealthPathways, stakehlder perceptins f the frmatin f partnerships, and early indicatins f clinical pathways utilizatin. 2) Fund that the cllabrative develpment prcess f HealthPathways imprved partnerships between primary care and specialist clinicians. Hunter & New England HealthPathways Prcess Evaluatin available at: data/assets/pdf_file/0012/122070/phase_1_healthpathways_ Prcess_Evaluatin_Final.pdf).

7 Phase 2: Aims Phase 2 Evaluatin T describe the impact f HealthPathways n patient referrals and access t specialist care T describe the implementatin f assciated clinical redesign initiatives T describe the change ver time in HealthPathways usage

8 Phase 2: Methds Mixed methds descriptive apprach Case studies 3 clinical pathways: Rutine Antenatal Care, Persistent Nn-cancer Pain, Suicide Risk Patient referral audit (quality f referral infrmatin, 3 pathways as abve) Analysis f HNE service data relating t case study pathways (timeliness f patient accessing specialist care, 3 pathways as abve) Dcument reviews and stakehlder interviews t describe pathway implementatin and assciated clinical redesign initiatives Analysis f webpage utilisatin data (Ggle analytics) Telephne survey f general practices in regin re reprted use f pathways

9 Phase 2: Key Findings There were indicatins that: 1)Overall use f the H&NE HealthPathways site by the target audience f general practice increased 2)Quality f referrals imprved 3)Patient access t specialist care increased 4)Clinical redesign initiatives accmpanied pathway develpment

10 Quality f referrals imprved 40%f the randm sample f referrals t JHH Maternity services utilised the Antenatal pathway s referral frm fllwing its implementatin. Recrding items f clinical infrmatin imprved Naming f a specialist n referrals imprved in all three case studies: Pre HealthPathways Pst HealthPathways JHH Antenatal Services 54% 78% (95% fr thse using the specific HealthPathways referral frm Hunter Integrated Pain Service 52% 94% HNE Mental Health 18% 62%

11 Patient access t specialist care increased Frm a small sample f referrals t JHH Maternity, it was fund that: 80% f wmen referred using the pathway referral frm were assessed within the target timeframe, cmpared t 57% wh were referred using ther types f referral frms. 92% f wmen were seen by the maternity services by 25 weeks gestatin pst implementatin f the pathway cmpared t 74% prir t implementatin. The bjective f increasing the prvisin f shared antenatal care was nt achieved. The median patient waiting time t first cntact with HIPS reduced frm 56 days t 41 days.

12 Clinical redesign initiatives accmpanied pathway develpment Clinical redesign Rutine antenatal care: develpment f explicit triage categries, referral criteria & level f risk; intrductin f new electrnic referral management system Pain: redesign f clinical prcesses, discharge letters, pain Mx plans; review f triage criteria and estimated waiting times; patient questinnaire & assessment prcedures mdified t reduce delay in accessing specialist care; changes made t apprach t piid management Suicide: n redesign Implementatin f pathways Rutine antenatal care: mst extensively supprted, prmted and reinfrced Suicide: nt supprted nr systematically prmted r reinfrced.

13 Clinical redesign initiatives accmpanied pathway develpment

14 General Practice use f HealthPathways increased A phne survey f use in general practice shwed that: 63% f all practices and 83% f large practices in the HML regin reprted that they used HealthPathways; Cmpared t a similar survey in 2013, use f HealthPathways by medium and large practices increased by 74% (frm 37% t 65%), Ggle analytics data indicated that frm 100 General Practices in the regin, HealthPathways was accessed mre than 1,000 times in the three mnth perid Jan-March 2014

15 Key Learnings HealthPathways: prvides an excellent fundatin fr achieving the gal f imprving patient access t the right care at the right time in the right place, and t better integrate primary and specialist systems f care; is being increasingly used by general practice with 83% f large practices in the Hunter regin reprting that they use HealthPathways; can help imprve the quality f referrals t specialist services and patient access t specialist care; supprts redesign initiatives. Pathways assciated with clinical redesign initiatives and invlving a cmprehensive apprach t pathway develpment and implementatin were mre likely t result in increases in access t specialist care and greater website usage.

16 Other measures (i) Paediatric Orthpaedics Develpmental Dysplasia f the Hip Impact n service delivery: Over the perid 1 Jan 2014 t 28 Feb 2015 there have been an average f 25 pageviews per mnth f the Develpmental Dysplasia f the Hip (DDH) HealthPathways 16% reductin in patients n waitlist (currently 563pts as f March ) New appintments available t mre urgent patients Clinics n lnger duble bked imprving patient safety and clinic wait times Increased capacity f 134 new appintments each year $20,100 saved in avidable cst f Orthpaedic Surgen time ($150/hr fr Orthpaedic surgen at 20 min appintments fr patients wh are seen up t three times) Valuatin methdlgy: Increased capacity f 134 new appintments each year $20,100 saved in avidable cst f Orthpaedic Surgen time ($150/hr fr Orthpaedic surgen at 20 min appintments fr patients wh are seen up t three times) Cst t implement = within existing resurces

17 Other measures (ii) Surgery / Gastrenterlgy - +ve FOBT Impact n service delivery: T date, the Psitive Faecal Occult Bld Test (FOBT) HealthPathway had an average f 59 pageviews per mnth since ging live n 1 July Gastrenterlgists and General Surgens reduced need t see patients fr assessment prir t clnscpy has freed up time t see ther patients in clinics Valuatin methdlgy: Pilt data results: Median waiting time fr GP referral t clnscpy reduced frm 82 days t 42 days Avidable number f clinic visits t Gastrenterlgists and General Surgens patient visits being measured Cst f Service = Clrectal Crdinatr

18 Other measures (iii) Autmated Ggle analytics reprts - usage

19 Acknwledgements Hunter & New England Evaluatin Steering Cmmittee: Dr Jhn Wiggers (Chair) (Directr Ppulatin Health, HNE LHD) Mr Ian O Dea (HealthPathways Prgram Manager, Hunter Medicare Lcal) Ms Jane Gray (Directr Research, Innvatin and Partnerships, HNE LHD) Dr Margaret Lynch (GP, Clinical Lead - Hunter Medicare Lcal / HNE LHD Dr Tracey Tay (Clinical Lead, HNE LHD / Agency fr Clinical Innvatin) Ms Liz Hay (Manager, Health Ecnmics and Evaluatin Team, Agency fr Clinical Innvatin) Ms Marika Mackenzie (Prgram Manager, Hunter Medicare Lcal) Ms Karen Harrisn (Prgram Manager, HNE LHD) Ms Judith Swan (Knwledge Manager, HNE LHD)

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