In this issue
More quality improvement initiatives to come from the Australian Primary Care Collaboratives Program
8,000 Absolute Risk Assessments and counting…
Medicare Local Quality Improvement Partnership
One practice’s formula for successful diabetes management
Six steps towards creating a culturally capable health service
Are you ready for the Closing the Gap: Measure and Act qiConnect dashboard?
Scaling up the focus on improvement at the APAC Forum
Change Day – do something better together!
More quality improvement initiatives to come from the Australian Primary Care Collaboratives Program
The Improvement Foundation (IF) is to deliver a range of new Australian Primary Care Collaborative (APCC) Program Waves as part of the current phase of the Program.
Through these new initiatives, more than 80 general practices and health services across Australia will engage in quality improvement during the health reform process, with a focus on improving the management and/or prevention of chronic disease.
“Maintaining the focus on quality improvement by frontline services has never been more important. During the health reform process, the APCC Program, through these new initiatives, will play a vital role in helping to keep the focus on improving health outcomes for patients and embedding continuous quality improvement into the everyday work of general practices and other primary healthcare services,” says Mr Colin Frick, Chief Executive Officer of IF.
Implementation will take shape in a number of ways – all of which continue to focus on developing and delivering quality improvement programs that support the delivery of measureable, systematic and sustainable improvements to primary health care systems and patient care, in line with IF’s core objectives.
Complex Chronic Disease and Integration Wave
The Complex Chronic Disease and Integration Wave will be delivered in collaboration with the local Health and Hospital Service in Queensland.
This Wave will engage Primary Care Health Services to improve the management of patients with complex chronic disease, and support improved integration between the primary care system and Hospital and Health Service network.
It is expected that a secondary outcome of this work will be a measurable reduction in avoidable hospital admissions and an increase in the use of the national eHealth infrastructure.
National Collaborative Waves
IF will introduce a number of specialised Waves to the Program that focus on greater engagement of practice managers, practice nurses and other primary health care professionals to lead quality improvement work within their organisations.
IF is working closely with national organisations such as the Australian Association of Practice Managers and the Australian Practice Nurses Association to ensure the design and delivery of the Waves adequately support these health professionals to implement quality improvement and improve patient outcomes within their organisations.
IF will continue to deliver the existing Diabetes Prevention and Management Wave (Wave 9) and Cardiovascular Disease and Chronic Kidney Disease Wave (Wave 10) to completion.
During this period of transition in the primary health care sector, IF will be providing direct support to participating general practices and health services to ensure continuity and sustainability of improvements.
IF will soon provide further information about these initiatives through specific recruitment announcements. To register interest in upcoming APCC Program Waves or other quality improvement initiatives, visit the IF website or contact IF direct on 1800 771 522 or firstname.lastname@example.org.
Participants in the Cardiovascular Disease (CVD) and Chronic Kidney Disease (CKD) Wave are achieving some great results to date, namely the recording of almost 8,000 Absolute Risk Assessments, and a steady incline in the number of patients identified as having Chronic Kidney Disease.
CKD and CVD are closely linked. Established CVD is one of the eight major risk factors for CKD, and moderate to severe CKD is a clinical determinant of high CVD risk. Early detection may reduce the rate of progression of kidney failure and cardiovascular risk by 20-50%.
The application of the Absolute Risk Assessment in determining CVD risk and follow-up with evidence-based interventions to manage modifiable risk factors is imperative.
Patients taking the test who are identified as being at risk of developing CVD can then work with their health practitioners to make evidence-based lifestyle changes to enable effective management of modifiable risk factors through lifestyle changes (like weight management, smoking cessation, adequate fruit and vegetable consumption and physical activity) and where appropriate pharmacological therapy. These changes are likely to improve CVD outcomes.
Representatives from Kidney Health Australia provided an informative presentation to participants involved in this Collaborative reinforcing the link between kidney function and Absolute Cardiovascular Risk, followed by important practical strategies for addressing cardiovascular risk in patients with chronic kidney disease.
Participants Dr Margot Woods from Rozelle Total Health and Dr Margaret Lynch from Smith Street Medical Centre, discussed how they manage Absolute Cardiovascular Risk Assessments at their practices, and shared their experiences and ideas with fellow Wave participants. Frequently asked questions relating directly to Absolute Cardiovascular Risk Assessments were addressed in partnership with a representative from the Heart Foundation.
To view this webinar – click the link to log into qiConnect – CVD & CKD Workshop 3 recording
There have been some impressive results achieved in the Medicare Local Quality Improvement Partnership (QI Partnership) to date. With 79 of the 119 participating general practices and health services focusing on improving the management and prevention of chronic obstructive pulmonary disease (COPD), some great achievements in this topic area are rapidly becoming visible.
In the five months from April to August 2014, the following improvements have been made:
- 38 general practices have recorded spirometry results for 1,258 of their patients diagnosed with COPD. This is a significant increase from the baseline figure of 543
- 9 general practices have 40% of their patients with COPD on a GP Management Plan
- 9 general practices have undertaken 555 episodes of screening for COPD with a Piko-6 screening device
- 14 pharmacies have undertaken 280 episodes of screening for COPD with a Piko-6 screening device and referred 74 individuals for follow up with a GP, which is more than one quarter of all people screened.
The other participating general practices and health services are implementing changes to enhance the management and/or prevention of CKD, CVD and diabetes. These changes include improving data cleansing processes to ensure there are accurate and up-to date registers of patients diagnosed with these chronic diseases, streamlining recall and reminder systems and targeting patients for care planning.
September 13th saw the final workshop for the most recent Wave on Diabetes Prevention and Management. This Wave has achieved outstanding results including improved patient outcomes through the enhanced delivery of the annual cycle of care, improved glycaemic control and proactive prevention activity with over 5,000 Diabetes Risk Assessments performed.
The Wave’s most outstanding results were achieved by Western Road Medical Centre in Victoria, who managed to have an astonishing 70% of their diabetic patients with a recorded HbA1c of less than or equal to 7%.
In the tradition of the APCC Program, the final workshop provides an opportunity for the high achievers to share their stories with colleagues at the Innovation Showcase breakout sessions. In this speed dating style table-top format the presenting practices generously discuss their real world tips and tricks for others to ‘steal shamelessly’, enabling innovation to spread rapidly amongst the Collaborative community. It was in this session that Eileen Dana, Practice Nurse and Diabetic Educator, co-presented with solo GP, Dr Guy Campbell, to reveal their formula for success:
- A whole of team approach with clear roles and responsibilities for reception, nurses, diabetes educators and the GP ensured a coordinated and systematic pathway of care.
- A passion and commitment to improving outcomes for their patients.
- A focus on relevant and consistent education using visual aids to highlight the future impact of diabetes.
- The utilisation of health coaching and motivational interviewing to empower chronic disease patients to take greater control, as they are the ones who will manage their condition day to day for the long term.
Eileen and Guy believe that this honest and persistent ‘coach and clinician’ approach, laced with appropriate humour, is the key to improving self-management. Ultimately the legacy of this approach is far greater than the relatively short amount of time that patients will spend in the clinic.
To view workshop recording from the APCC Diabetes Prevention and Management Wave or the resources used by this Medical Centre, visit qiConnect.
Two years ago Emma Pullen, Practice Manager at Walkerston and Marian GP Superclinics, took the first steps to ensure significant changes occurred in her practice.
“Our most important step towards ‘Closing the Gap’ was to identify our Aboriginal and Torres Strait Islander patients so we could provide them with culturally capable healthcare,” said Emma.
To achieve this objective, Emma and the team undertook the following steps:
- Focused on improving systems and processes within the practice including:
– processes used to identify their patients
– ensuring their policies and procedures were correct and up to date
– examining if they provided culturally capable healthcare; and
– asking why they had so few recorded Aboriginal & Torres Strait Islander patients.
- Sought feedback via community meetings with Aboriginal and Torres Strait Islander representatives, patient questionnaires and an anonymous feedback suggestion box to highlight areas for quality improvement.
- At monthly meetings and through regular email updates and informal conversations, they created a safe ‘no judgement’ environment which opened up communication to address issues, ask questions and provide solutions.
- Made a commitment to staff education by providing training during rostered hours and providing mandatory cultural awareness training.
- Worked with Aboriginal and Torres Strait Islander representatives to find new ways for the practice to identify ethnicity. This included training the staff in communication techniques, displaying culturally appropriate material and rewording of the ethnicity question on the patient information forms.
- Regularly extracting data to chart quality improvement efforts enabling the team to identify what changes were having the most effect.
The changes to their processes around ethnic identification have resulted in a significant increase in the number of clients who are recorded as being of Aboriginal or Torres Strait Islander origin.
The graph above shows improvements in recording of ethnicity between Sept 2012 and Sept 2013, which corresponded to cultural Awareness training, meetings, education and other efforts implemented to identify patients’ ethnicity. The subsequent increase in recording of ethnicity from Sept 2013 to Oct 2013 was a result of updating patient information by asking their ethnicity, and the move from their existing data extraction tool to the Pen Clinical Audit Tool, which more accurately identified this patient data.
As Emma states, “If we can ask all health centres to adopt and participate in similar quality improvement activities, then health equality to all Australians could be accomplished.”
Imagine the potential of identifying any gaps relating to Aboriginal and Torres Strait Islander health in your general practice. You can join other practices like Walkerston and Marian GP Superclinics in an upcoming qiCommunity webinar to discuss specific activities that can be undertaken to improve health outcomes for Aboriginal and Torres Strait Islander patients.
Register here to join Emma in IF’s free qiCommunity webinar – ‘Closing the Gap’ on the 22 October.
We know that to achieve better outcomes in Aboriginal and Torres Strait Islander chronic disease we need better systems for the delivery of primary care.
IF is inviting general practices and health services to join the Closing the Gap: Measure and Act program
Your practice or health service will be able to submit data, identify any gaps, and participate in virtual workshops to better understand specific activities that can be undertaken to improve the health outcomes of Aboriginal and Torres Strait Islander patients.
How to access your Closing the Gap: Measure and Act data via qiConnect
You can track clinical measures over time on the qiConnect portal under the My Health Service tab from 3 October 2014. The quality indicators are drawn from a range of quality indicators extracted by the PEN Clinical Audit Tool (CAT).
If you’re already submitting data to qiConnect you can use this guide to ensure you’re collecting all measures via CAT.
If you do not currently have access to qiConnect you can register here.
Register here to join the free qiCommunity Webinar – ‘Closing the Gap’ on 22nd October. Facilitated by Dr Tony Lembke with guest speaker Emma Pullen, Practice Manager at Walkerston GP Superclinic, you’ll hear about Walkerston’s first steps in their ‘Close the Gap’ work. You’ll also hear how your practice can make a difference by participating in the Closing the Gap: Measure and Act Program.
Closing the Gap: Measure and Act is supported by:
Between 1-3 September, over 1,500 healthcare professional from across Australia and New Zealand came together to share their knowledge and expertise about quality improvement.
The Improvement Foundation was a key sponsor of the Forum and our clinicians Dr Dale Ford, Dr Andrew Knight and Dr Tony Lembke delivered presentations on quality improvement in primary health care, with a focus on moving towards integrated care.
As the event came to a close, Professor Jonathon Gray, Director – Ko Awatea, left us with four challenges:
- We must scale up the focus on improvement – our challenge is that we now need to do it for whole populations and countries.
- We must be transformational leaders – we know the challenges and pressures on our systems and tinkering around is no longer enough.
- We must make the frontline our main focus – creating the opportunities and environments for staff to deliver outstandingly.
- We must continue working together – innovation is happening but we’ve got to find ways to share it.
Through our quality improvement programs, IF have been steadily working at meeting Jonathon’s challenges, with the introduction of qiCommunity playing a pivotal role in sharing innovation across Australia.
APAC keynote speaker Dr Doug Eby was our guest speaker for the recent qiCommunity webinar, which was held during the APAC Forum. Dr Eby discussed healthcare system design and quality improvement implementation as part of his role as VicePresident of Medical Services for Southcentral Foundation in Alaska.
The Doug Eby podcast will be available shortly to all qiCommunity members. If you are not a qiCommunity member, join online for free at www.improve.org.au/qiconnect
The IF team enjoyed meeting all the quality improvement enthusiasts who attended the event and would like to congratulate C.Wilde from Tasmania, the winner of our APAC Forum FitBit competition.
If you missed us at the APAC Forum, you can say hello to the IF team at the following upcoming conferences:
- RACGP 9 -11 October, Adelaide
- AAPM 21- 24 October, Adelaide
Change Day was first held in Australia in March this year, mobilising the collective energy, creativity and ideas of more than 15,000 Australians who pledged to improve the health and wellbeing of others.
Now held in nine countries around the world Change Day is a growing global movement and IF is once again proud to be adding our pledge to Change Day, 11 March 2015.
We will be joining thousands of others to demonstrate how we can take a simple action or idea to make a difference and improve outcomes for clients, consumers and patients, their families and their carers.
Mary Freer, Founder, Change Day (second from left) with Change Day supporters.
On 11th November 2014 Change Day will begin collecting pledges for 2015.
Now is the time to start thinking about how your organisation or service can join in to make Change Day 2015 a great success. What pledge can you make to improve patient, client and consumer health outcomes?
See example pledges, find out more and download the brochure at http://changeday.com.au/