1 / 26

Topic: Improving Models of Care Stream 1c

Managing Acute Demand Presenter: Allan Moffitt amoffitt@cmdhb.org.nz Hospital: Fury Melbourne 10 th May 2006. Topic: Improving Models of Care Stream 1c. KEY PROBLEMS. High demand for medical admissions Predicted new acute hospital needed by 2010 - $$$

nirav
Télécharger la présentation

Topic: Improving Models of Care Stream 1c

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Managing Acute Demand Presenter: Allan Moffitt amoffitt@cmdhb.org.nz Hospital: Fury Melbourne 10th May 2006 Topic: Improving Models of CareStream 1c

  2. KEY PROBLEMS • High demand for medical admissions • Predicted new acute hospital needed by 2010 - $$$ • High rate of Preventable Hospitalisations • Barriers to access in Primary Care • Barriers to access of diagnostic support in the community • Poor health status - High Health Inequality

  3. Acute Demand Growth at MMH – 1990’s

  4. Evidence of success Synopsis • Admissions reduced <0.5% growth in 2002 yr • EC attendances have reduced or remained static • FAMA – reduction of 5.7 bed days p.p. p.a. • POAC - 85% managed out of hospital (4,600 cases avoided admission last year) • +ve Return on Investment x$1.70

  5. Acute Demand controlled!

  6. POACS Neighbouring DHB Integrated Care Server available 1998 strategic plan - integration CMDHB SA CHF pilot CHF ext. SA COPD trial COPD ext MHRT diabetes pilot South Med diabetes pilot CCM package diabetes module

  7. More up to date – demand = demographic growth

  8. Primary Options for Acute Care(POAC)J.V. with Clinical Assessments Ltd

  9. Primary Options for Acute Care • To reduce demand on Public Hospital acute services by enabling patients to be managed safely in the community. • Access to appropriate community based services which are delivered in a timely manner • Funds to purchase these services • South Auckland Pilot Project • Based upon Pegasus IPA model • Joint Venture • CMDHB • Clinical Assessments Ltd (ProCare Health & EastHealth Services)

  10. POAC - Eligibility Criteria • Any patient who would otherwise be admitted acutely to MMH for • Treatment or • Investigation AND • Can be managed safely in the community for under $300

  11. POAC - How/Why it works • No red tape - minimal bureaucracy!(Whatever it takes to make it happen) • Service Coordinator available 24/7 • Well designed request forms • Sticker with case number • Claim Form with required information • Close oversight/scrutiny • Trust - leap of faith

  12. Therapeutic Medical IV Antibiotics/Fluids Nebulisation Observation Review Social Dinner Bed & Breakfast Personal Care / Home Help Investigative Laboratory Troponin D-dimer Radiology X Rays Ultrasounds Doppler POAC - TYPES OF SERVICES • Logistical • Transport • Service Co-ordination

  13. POAC Referrals by Diagnostic Group – 2005/06

  14. POAC Clinical Oversight Board • Representation • CMDHB • PHOs • Maori Providers • Role • Clinical Governance • Eligibility of claim • Appropriateness of clinical management • Guideline development • Cost control

  15. POAC Evidence of Success PILOT: • Commenced Feb 2001 • 387 claims by 83 GPs costing $85,430 • Average cost $220 • 85% managed out of hospital • Estimated savings to MMH of $265,000 • Deloittes R.O.I. of $1.70 SINCE (to Dec 2004): • Episodes of Care > 10,388 • Average cost ~ $173 • 85% not admitted > 8,834 avoided admissions • No of referring GPs: >300

  16. POAC this financial year: July 05 – Apr 06 • Total referrals = 4,375 (87% avoided admission) • Saved admissions = 3,794 • Average Clinical Cost = $176.67 • Management cost (add) $55.80 • Total annual budget $1.3 million – likely expenditure $1.4M for ~5,000 – 5,500 saved admissions • 100% of GPs referring to programme at least once/year

  17. Frequent Adult Medical AdmissionsProject (FAMA)

  18. Frequent Adult Medical Admissions (FAMA) • Case Management in primary care • Support of Care Coordinator Nurses • Patient Held Care Plans • Monthly Visits to Practice Nurses • Quarterly Visits to GPs • Patients Identified by hospital criteria Adults with 2 or more admissions to medical wards and Totalling more than 5 days in hospital Within the last 12 months

  19. FAMA Enrolment - 2002 • 1541 Patients identified • 1232 (79.9%) Evaluated by GP for Enrolment • 192 (15.6%) found to be deceased • 198 (16.1%) not known to practice • Of the remaining 835 patients • 375 (45%) enrolled • 205 (25%) ‘unlikely to benefit’ • 59 (7%) ‘unlikely to be admitted’ • 58 (7%) ‘declined’ • 75 (9%) ‘unable to comply’ • 63 (6%) ‘other reasons for non-enrolment’

  20. FAMA Hospital Bed Day Usage

  21. FAMA 30 Day Readmission Rates

  22. FAMA Summarised Results • 45% of eligible evaluated people enrolled • Problems with Hospital Data (Dead / Wrong Practice) • 48% reduction in hospital bed day use (5.7 bed days p.p. p.a.) • 40% (or greater) reduction in 30 day readmission rate • Practitioners found extra time with patients particularly useful • 85% of patients felt the project was useful or very useful. • Average Clinical Cost $157.39 p.p. for 6 months(excludes management overhead)

  23. Critical Success Factors • Primary/Secondary Partnership ( &Governance) • Leadership - Chief Executive level! • Clinical Champions • Change management project Lessons Learnt • Multi-dimensional approach to achieve results • Sustainable Funding – economic analysis • Continued promotion important • Capacity of Sector - rate limiting steps

  24. We’re all part of the same health system!

More Related