|Implemented in this survey?|
The NSW Chronic Care Collaborative involved 22 teams representing 18 Area Health Services in NSW. Collaborative methodology identified, disseminated and implemented best practice for Heart Failure and Chronic Obstructive Pulmonary Disease. Lessons learned from both successful and unsuccessful interventions have been an important outcome for teams and others undertaking improvement work. A formal evaluation of the Collaborative has been undertaken.
The NSW Chronic Care Collaborative involved 22 teams representing 18 Area Health Services across NSW. These teams were representative of a wide range of health care providers including General
Practitioners and consumers. They used the collaborative methodology to facilitate the identification, dissemination and implementation of best practice for patients with Heart Failure and Chronic
Obstructive Pulmonary Disease in a range of settings over a period of approximately 12 months.
A formal evaluation of the Collaborative has been undertaken. It is anticipated that improvements achieved as a result of collaborative interventions will help to reduce hospital admissions/readmissions for people with these chronic conditions. It is also anticipated that the processes established for enhanced management of people with heart failure and COPD will be transferable for managing other chronic diseases.
The aim of the NSW Chronic Care Collaborative was to implement a collaborative methodology to facilitate the identification, dissemination and implementation of best practice for patients with Heart Failure and Chronic Obstructive Pulmonary Disease in a range of settings over a period of approximately 12 months.
NSW Health provided financial incentives of $26,000 to each Area Health Service (AHS) in the State for project support and GP involvement in relation to the setting up of teams to address AHS-specific issues related to both HF and COPD. All AHS were represented in the Collaborative although not all addressed both health conditions.
Providers of care in NSW, Patients with chronic conditions
|Degree of Innovation||traditional||innovative|
|Degree of Controversy||consensual||highly controversial|
|Structural or Systemic Impact||marginal||fundamental|
|Public Visibility||very low||very high|
As the methodology has been in use in a number of countries, it cannot be considered as particularly innovative. There is evidence that its implementation was consensual. As a local initiative, it is likely to be neutral with regard to its impact on the healthcare system as a whole. Although over time it may have a greater impact than this. It was not visible to the general public and, as is obvious, is transferable between healthcare systems.
This activity reflects initiatives being undertaken at the national level through the National Health Priorities Action Council (NHPAC) which is a sub-committee of the Australian Health Ministers' Advisory Council (AHMAC), established in 2000 and given the responsibility of facilitating improvements in health services to achieve better health outcomes in the national priority areas (which include cardiovascular disease, diabetes, cancer, asthma, mental health, arthritis, musculosketal conditions and injury prevention).
National Health Priorities
|Implemented in this survey?|
The idea was one of a series of initiatives designed by the Department of Health in NSW to address the issue of how the health system will best be able to meet the challange of improving care
provided to people with chronic conditions.
The tool used in this instance was a methodology developed in the USA and used in UK, USA and Scandinavian countries - the Collaborative change management methodology. Thus, although this represents a new approach for NSW, it is not new overall.
The Collaborative methodology, designed by the Institute for Healthcare Improvement in the USA, provides a generic quality improvement model that can be applied to achieve small, rapid and locally relevant improvements across a broad range of clinical and practice business issues. The Collaborative methodology has successfully delivered improvements in care for patients with asthma, diabetes, coronary heart disease and cancer in the primary health care setting in the US, UK and Europe. It represents a successful body of work that can be adapted to achieve the aims of the Australian Primary Care Collaboratives Program. The key topic areas for the Australian Program are diabetes, cardiovascular disease and access to general practice.
The Collaboratives are implemented in "waves", where one "wave" is defined as one orientation session and three learning workshops with periods of participant activity (action periods) between each and followed by activities to spread the learnings to others.
The approach of the idea is described as:
As an initiative of the Health Department, a number of policy and position papers are available which report on the broad policy approach which underpins the Collaborative concept. However, a specific publication about the implementation and evaluation of the program is not yet available. It is not clear that there were any opponents to the idea or that conflicts arose which required mediation.
|Hospital-based providers||very supportive||strongly opposed|
|GPs||very supportive||strongly opposed|
|Consumers||very supportive||strongly opposed|
|Hospital-based providers||very strong||none|
The 22 teams from 18 AHS used the Collaborative methodology as described below. The methodology for this particular use was based on the premise that best practice related to the performance
of a range of diagnostic and management interventions drawn from the NSW Health Respiratory and Heart Failure Clinical Service Frameworks and Aboriginal Chronic Desease Service Frameworks. Teams implemented a range of successful interventions that have been spread more broadly to
achieve statewide improvements in management of those disease groups. Many of the initiatives have application for Chronic Disease Management more generally. Lessons learned from both successful and
unsuccessful interventions have been an important outcome for teams and others undertaking improvement work.
The program involved an orientation session and then four learning sessions held during 2004. At each learning session, the participants presented the results of the processes they had undertaken and received instructions and advice about the next set of processes they would be required to undertake.
A formal evaluation of the Collaborative has been undertaken. It is anticipated that improvements achieved as a result of collaborative interventions will help to reduce hospital
admissions/readmissions for people with these chronic conditions. It is also anticipated that the processes established for enhanced management of people with heart failure and COPD will be
transferable for managing other chronic diseases. The NSW Chronic Care Program, through the Chronic Care Unit at NSW Health, will facilitate the sustainability of improvements made within the
The report detailing the results of the evaluation is not yet available.
Not yet available. However the process of implementation and some self-reflective evaluation of individual projects are available on the dedicated website (see below).
The objective in instigating a Collaborative methodology has been successful as 22 teams from 18 AHS participated in and completed a series of tasks aimed at improving the management of people
with heart failure or COPD.
As this initiative is specific both in terms of the methodology used and the conditions targeted, it is likely that it will achieve its objectives as listed below. The presentations from teams indicated that they were generally successful in increasing the proportion of people with COPD or Heart Failure at a designated community health service point, who have previously had the complete diagnostic bundle and the complete management bundle, increasing the proportion of people with COPD or Heart Failure presenting to Emergency Department, discharged from hospital who have previously had the complete management bundle and with whom advanced care directives have previously been discussed. The extent to which each team was successful varied.
Overall, it is clear that this initiative improved the quality of care. It may also have improved access to care as GPs as well as hospital clinicians were involved from every AHS in NSW. However, it is not clear how widespread the involvement of GPs was. Nor is it clear how long-lasting the changes in clinical practice will be - some teams identified problems in attitudes to change at local clinical levels. There has been no evaluation of the extent to which changes in practice have impacted on the costs of providing care at either the hospital or GP level.
|Quality of Health Care Services||marginal||fundamental|
|Level of Equity||system less equitable||system more equitable|
|Cost Efficiency||very low||very high|
As this methodology seeks to implement changes to practice at the most fundamental level, if successfully implemented, widely adopted and sustained, it is likely to lead to significant improvements in care for people with chronic conditions. If the above conditions (ie successful implementation, widespread adoption and sustained action) are met, it may also have an impact of equity in terms of both access to care and outcomes. There is no evidence available which would allow an evaluation of the probable impact on costs of care or efficiency.
Collaborative methodology: www.npdt.org/scripts/default.asp?site_id=1&Id=9748
NSW Health. Chronic and Complex Care publications: www.health.nsw.gov.au/sd/igfs/hp/resources/
Website for the NSW Health Chronic Care Collaborative: www.health.nsw.gov.au/sd/igfs/hp/ccc/index.html