1. In 1995, the future imperative was shared care (P. Pritc). It still is! • The Danish Quality Programme for General Practice presents a set of shared care indicators • Lars Rytter, Copenhagen

2. Danish Quality Programme for General Practice – 4 projects • Indicators - Poul Brix • IT - Henrik Schroll • Patient perspective – Peder Olesgaard • Shared care – Lars Rytter • Manager - Søren Friborg and Tina Eriksson

3. Facilitator organisation • Since 1992, an organisation of GP facilitators – coordinate the work of GPs and hospitals • Almost 10% of all GPs have joined the organisation • The organisation focus on the interface between primary and secondary care

4. Main tasks • Quality of referrals • Quality of discharge letters • Joint local policies for most important disease areas • Who is responsible for what? • Standards for communication`? • Quality tests through local audits • Accessibility – both directions • Joint vocational meetings

5. The national quality organisation focus on the quality of the ”patients voyage” through the health care system

6. Patitinetspercieved quality Hospital Alm. Hjem - Alm. Special - praksis læge - me - praksis praksis plejen KliniskClinical quality Afd. Afd. Afd. Afd. Organisational qualityt “Patients voyage” – 10 stops

7. Main ”elements” in the traditional voyage • F1: Access to GPs • Access to GPs by telephone • Emergency appointments • Planned appointments with transferred responsibility when practices are closed

8. F2: Referral • Generally accepted standards for quality of referral letters • Shared local policy for the major disease areas (70% of flow of patients) • Accessibility for advice – “move the problem – not the patient. PP”

9. F3 - visitation • Visitation on a daily basis • Return / dialogue on incomplete referrals (ex. patient not sufficiently evaluated before referral) • Accessibility to appointments with short waiting times – alternatives to emergency referral

10. F4 – Agreement on placement of responsibility during waiting time “left in limbo” • A clear responsibility • The GP is responsible in case of worsening and unacceptable waiting times • Information to patient within 8 days concerning the time of first appointment and the waiting time in alternative treatment facilities

11. Hospital standards • F5 - A treatment plan is available within 24 hours • F6 – A personal responsible person is allocated within 24 hours • F7 – GPs are informed, when patients are transferred between hospitals or hospital departments

12. F8 – Information to GPs when patients are discharged • Diagnose • Short medical history • Medical treatment status • Information given to patient • Planned interventions after discharge (for GP offices / municipality staff / hospital out patients clinics)

13. Home care and rehabilitation • F9 - Plan for rehabilitation • F10 –Plan for the municipality staff: • home nursing • meals brought to patients home • necessary changes in patients home • equipment needed

14. Indicators for all standards • Structure indicators: ex. Is a written policy present? • Process indicators: ex. Number of referrals according to the policy • Result indicators: ex. patient satisfaction

15. Standards are currently being tested • Are standards clearly described? • Are standards readily accessible? • Is the time consumed reasonable? • Is quality improved?

16. Next challenge • Making standards/indicators for the increasing number of outpatients with chronic health problems • We need policies for • Communication • Deciding on which patient can be cared for by GPs and which by the hospital staff • Teams working in the patients homes