Tuesday: Oral Poster Walk, Evaluation, Monitoring and Quality Improvement
| Tuesday, November 12, 2019 |
| 1:20 PM - 1:30 PM |
Speaker
A/Professor Carmel Martin
Senior Medical Advisor
Monash Medical Centre
202 Multimorbidity and Acute Potentially Preventable Diagnoses in HealthLinks Chronic Care (HLCC) Dandenong Cohort. A work in evolution
Abstract
Multimorbidity and Acute Potentially Preventable Diagnoses in HealthLinks Chronic Care (HLCC) Dandenong Cohort. A work in evolution.
Context
Potentially Preventable Hospitalisation (PPH) is an admission for a condition where hospitalisation might have been prevented through provision of appropriate and timely community support and/or medical intervention. PPH have been historically categorised as vaccine-preventable infections, chronic diseases and acute conditions.
The Victorian Department of Health and Human Services (DHHS) state-based public hospitals database HealthLinks Chronic Care (HLCC) uses a scoring algorithm to identify the adult cohort at heightened risk of 3 emergency hospitalizations in the subsequent 12 months. A funding model intended to incentivise Health Services to develop community care models, is applied to these patients. HLCC enrolled patient profiles included: prior unplanned admissions and ED visits; smoking; select conditions including digestive disorders, kidney disease, asthma, COPD, diabetes, pancreatic conditions, cirrhosis/alcoholic hepatitis; excluding cancer, dementia and serious mental illness. MonashWatch (MW) commenced an HLCC enrolled service trial in Dandenong Hospital catchment, a low socio-economic, ethnically diverse area of Melbourne from December 2016.
Objective
1) To describe hospital admissions via an Emergency Department into Monash Health hospitals by patients in the Dandenong HLCC cohort, in the 5 years, July 2015 – July 2019. 2) Describe chronic disease and acute and vaccine preventable conditions PPH based upon AIHW categories. 3) Explore the relationship between acute and chronic diagnoses in HLCC cohort.
Design
Descriptive statistics in the HLCC data base.
Measures
Victorian Admitted Episode database codes.
Results
2500 persons Dandenong HLCC cohort were profiled. Based upon AIHW categories, there were 3262 emergency PPH admissions, 87 (2.5%) were for vaccine preventable conditions; 2115 (65%) were for chronic conditions and 1060 were for acute conditions (32.5%).
All emergency admissions care totalled 17,178. These admissions spread across 20+ units – General Medicine, Emergency, and Cardiology being the top three units.
In 2500 person sample, AIHW PPH chronic admissions included: Angina 306; Asthma 235; Bronchiectasis 81; Chronic Heart Failure 616; COPD 699. Average age was 71 and 50.6% were female. Average LOS 4.0 days. Acute conditions included Cellulitis 322 and Urinary Tract Infections 398. Using AIHW classification pneumonia only identified 5 admissions. Pneumonia unspecified and viral pneumonia , the vast majority, were not included. Acute mean admission age for acute was 67, and average LOS 3.7 days.
26% persons of 2500 had 1 or more PPH emergency chronic disease admissions, 25% had 1 or more acute admissions. 7% of persons had one or more of both chronic and acute PPH emergency admissions. 49% had 1 or more admissions that was neither PPH acute nor chronic conditions.
Conclusion
Categories of acute and chronic PPH based on AIHW categories do not explain 50% of emergency admissions in this cohort. In addition, infection/sepsis may be significantly under-represented in the chronic cohort, because for example, COPD and heart failure are often triggered by acute infections. Acute infections on chronic conditions may underpin many admissions and will be further discussed. We are currently undertaking research into pre-hospital health journeys for sub-set of this cohort.
Context
Potentially Preventable Hospitalisation (PPH) is an admission for a condition where hospitalisation might have been prevented through provision of appropriate and timely community support and/or medical intervention. PPH have been historically categorised as vaccine-preventable infections, chronic diseases and acute conditions.
The Victorian Department of Health and Human Services (DHHS) state-based public hospitals database HealthLinks Chronic Care (HLCC) uses a scoring algorithm to identify the adult cohort at heightened risk of 3 emergency hospitalizations in the subsequent 12 months. A funding model intended to incentivise Health Services to develop community care models, is applied to these patients. HLCC enrolled patient profiles included: prior unplanned admissions and ED visits; smoking; select conditions including digestive disorders, kidney disease, asthma, COPD, diabetes, pancreatic conditions, cirrhosis/alcoholic hepatitis; excluding cancer, dementia and serious mental illness. MonashWatch (MW) commenced an HLCC enrolled service trial in Dandenong Hospital catchment, a low socio-economic, ethnically diverse area of Melbourne from December 2016.
Objective
1) To describe hospital admissions via an Emergency Department into Monash Health hospitals by patients in the Dandenong HLCC cohort, in the 5 years, July 2015 – July 2019. 2) Describe chronic disease and acute and vaccine preventable conditions PPH based upon AIHW categories. 3) Explore the relationship between acute and chronic diagnoses in HLCC cohort.
Design
Descriptive statistics in the HLCC data base.
Measures
Victorian Admitted Episode database codes.
Results
2500 persons Dandenong HLCC cohort were profiled. Based upon AIHW categories, there were 3262 emergency PPH admissions, 87 (2.5%) were for vaccine preventable conditions; 2115 (65%) were for chronic conditions and 1060 were for acute conditions (32.5%).
All emergency admissions care totalled 17,178. These admissions spread across 20+ units – General Medicine, Emergency, and Cardiology being the top three units.
In 2500 person sample, AIHW PPH chronic admissions included: Angina 306; Asthma 235; Bronchiectasis 81; Chronic Heart Failure 616; COPD 699. Average age was 71 and 50.6% were female. Average LOS 4.0 days. Acute conditions included Cellulitis 322 and Urinary Tract Infections 398. Using AIHW classification pneumonia only identified 5 admissions. Pneumonia unspecified and viral pneumonia , the vast majority, were not included. Acute mean admission age for acute was 67, and average LOS 3.7 days.
26% persons of 2500 had 1 or more PPH emergency chronic disease admissions, 25% had 1 or more acute admissions. 7% of persons had one or more of both chronic and acute PPH emergency admissions. 49% had 1 or more admissions that was neither PPH acute nor chronic conditions.
Conclusion
Categories of acute and chronic PPH based on AIHW categories do not explain 50% of emergency admissions in this cohort. In addition, infection/sepsis may be significantly under-represented in the chronic cohort, because for example, COPD and heart failure are often triggered by acute infections. Acute infections on chronic conditions may underpin many admissions and will be further discussed. We are currently undertaking research into pre-hospital health journeys for sub-set of this cohort.
Biography
Carmel Mary Martin is an Adjunct Associate Professor at Monash University and Visiting Consultant to Monash Health and the East Grampians Health Service as well as a part-time General Practitioner (GP). She is active and has always been grounded in clinical general practice with a particular interest in chronic disease and illness, patient centred care and complex systems.
Carmel is the Principal Health Services Researcher to PHC Research Pty Ltd, a research and development company, focussed on developing software to improve the care of unstable patient journeys in a biopsychosocial context. She has considerable evaluation experience in the area of Primary Care transitions in Australia, Canada and Ireland. Carmel is the chair/convenor of the Special Interest Group on Complexity in Health(Care) in the World Organization of Family Doctors, and a member of the Special Interest Group on Complexity in Health(Care) North American Primary Care research Group.
She is a co-editor, with A/Prof Joachim Sturmberg, of the Forum on Systems and Complexity in Medicine and Healthcare in the Journal of Evaluation in Clinical Practice, and many publications including the Handbook on Systems and Complexity in Health (Springer Verlag). She has published widely on complex adaptive systems in health and chronic illness experience.
Carmel is working to improve the experience of illness and the experience of care through supporting the human capacity to heal, and the human capacity to care and support others with the developing roles of community health workers, care managers, primary care nurses and care guides and GPs. Her current vision is to continue to centre care on dynamic systems that represent changes in health experiences including pain and illness into health systems design and evaluation.
Miss Ashlea Hambleton
Implementation Research Officer
Innowell & University of Sydney
209 Technology-enabled service models for quality improvements in Australian mental health care delivery
Abstract
An introduction (comprising background and problem statement): New health information technologies (HIT) are being rapidly developed to support the transformation of mental health services. The InnoWell Platform is a configurable and customisable digital tool that assists in assessment, monitoring and management of mental ill health and maintenance of wellbeing. Importantly, the InnoWell Platform is not just installed into a service, rather implementation is informed by participatory design methodologies, including service modelling to understand and map clinical pathways (both pre- and post-implementation), relationships to external mental health and social services, and key performance indicators related to safety and service quality.
Theory/Methods: The InnoWell Platform is now being offered as part of standard clinical care in face-to-face and online mental health services across population groups, including young children and their families, young people, adults (including the veteran community) and older adults. During pre-implementation, at least two service modelling workshops are conducted to discover, evaluate and prototype clinical pathways (intake, assessment, treatment planning, treatment, progress monitoring, exit) which can be assessed against safety and service quality domains (i.e. accessibility, acceptability, workforce competence, efficiency, effectiveness, appropriateness and care continuity). The co-designed service models are updated quarterly to reflect changes related to implementation and impacts on workflows by role (i.e. health professional, service management or administration).
Results: To date, service modelling workshops have been conducted in nine primary youth mental health services, a counselling service for veterans and their families, a helpline for individuals affected by eating disorders and negative body image issues, and a primary health network using ‘staged care’ principles across the lifespan. To ensure a comprehensive understanding of each service’s clinical pathway, participants included those with a lived experience (consumer and/or supportive other), health professionals, service management and administration. Key themes explored included: quality in mental health service provision; current clinical pathway(s) with an emphasis on access and delays in service provision; and, how the InnoWell Platform could enhance care and improve outcome monitoring.
Discussion: New HITs, such as the InnoWell Platform, have the potential to realise significant improvements in Australian mental health service quality. Co-designed service models highlight potential points of consumer engagement with the Platform and impacts on service workflows to facilitate successful implementation.
Conclusions (comprising key findings): A thorough understanding of a service’s clinical pathway is essential to determine at which point(s) the InnoWell Platform is best placed to drive person-centred, collaborative care; improve the efficiency and enhance the effectiveness of care provision; and monitor safety and service quality.
Lessons learned: Iterative review of service models is required to track changes associated with embedding the Platform in the service as well as in response to service-level changes (i.e. revised intake procedures).
Limitations: Currently, limited data is available in the Platform to evaluate safety and service quality indicators as they relate to points in the clinical pathways.
Suggestions for future research: Monitoring changes in the service model in association with real-time metrics collected by the Platform will inform and guide service quality improvement.
Theory/Methods: The InnoWell Platform is now being offered as part of standard clinical care in face-to-face and online mental health services across population groups, including young children and their families, young people, adults (including the veteran community) and older adults. During pre-implementation, at least two service modelling workshops are conducted to discover, evaluate and prototype clinical pathways (intake, assessment, treatment planning, treatment, progress monitoring, exit) which can be assessed against safety and service quality domains (i.e. accessibility, acceptability, workforce competence, efficiency, effectiveness, appropriateness and care continuity). The co-designed service models are updated quarterly to reflect changes related to implementation and impacts on workflows by role (i.e. health professional, service management or administration).
Results: To date, service modelling workshops have been conducted in nine primary youth mental health services, a counselling service for veterans and their families, a helpline for individuals affected by eating disorders and negative body image issues, and a primary health network using ‘staged care’ principles across the lifespan. To ensure a comprehensive understanding of each service’s clinical pathway, participants included those with a lived experience (consumer and/or supportive other), health professionals, service management and administration. Key themes explored included: quality in mental health service provision; current clinical pathway(s) with an emphasis on access and delays in service provision; and, how the InnoWell Platform could enhance care and improve outcome monitoring.
Discussion: New HITs, such as the InnoWell Platform, have the potential to realise significant improvements in Australian mental health service quality. Co-designed service models highlight potential points of consumer engagement with the Platform and impacts on service workflows to facilitate successful implementation.
Conclusions (comprising key findings): A thorough understanding of a service’s clinical pathway is essential to determine at which point(s) the InnoWell Platform is best placed to drive person-centred, collaborative care; improve the efficiency and enhance the effectiveness of care provision; and monitor safety and service quality.
Lessons learned: Iterative review of service models is required to track changes associated with embedding the Platform in the service as well as in response to service-level changes (i.e. revised intake procedures).
Limitations: Currently, limited data is available in the Platform to evaluate safety and service quality indicators as they relate to points in the clinical pathways.
Suggestions for future research: Monitoring changes in the service model in association with real-time metrics collected by the Platform will inform and guide service quality improvement.
Biography
Ashlea Hambleton is an early career researcher and registered Clinical Psychologist Registrar. She is currently working as an Implementation Research Officer with InnoWell on the Project Synergy trial. Ashlea carries special interests in eating disorders and body image, youth mental health, technology and telemedicine and the translation of research to clinical practice.
