Quality & SafetyPrimary CareKnowledge Understanding, Discussion and Exchange

Dr Dale Ford Dr Andrew KnightImprovement Foundation AustraliaParis 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?

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

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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

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Collaborative Methodology

Lowitja Institute CQI Conference 201412

• Origins with Deming• Langley, Moen, Nolan,

Norman, and Provost combined the three questions and the PDSA cycle

13Lowitja Institute CQI Conference 2014

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

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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

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Lowitja Institute CQI Conference 201417

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