Managing Increasing Demand for Dr Sherene Devanesen CEO Peninsula Health 1
Increasing Demand: Demographic trends Changes to social infrastructure New technology Consumer Expectations 2
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What Americans want is quite simple; all the health care they or their doctors can imagine, virtually free, without added taxes for health care and without out of pocket costs... That s all. Call it part of the American Dream. - Professor Reinhardt, Princeton University. 5
Implications of poor demand management Financial / economic Poor consumer outcomes Good demand management Effective services Appropriate services Multiple settings 6
Health Care in Australia Commonwealth (Federal) Government - Residential Care Australian Healthcare Agreement - Pharmaceutical Benefits Scheme - Payments to doctors for ambulatory care States - Public hospital services 7
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Access to hospitals Emergency Planned or Elective 9
E6 - ED Presentations Frankston & Rosebud Hospitals Peninsula Health 8,000 7,000 6,000 5,000 4,000 3,000 2,000 1,000 0 Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Actual Prev Yr 10
Emergency Access Growth in ED Presentations: Overcrowding Dysfunction Long waiting times Delays in admission 11
Studies Canberra Hospital Deaths in those who experienced overcrowding Increase in hospital mortality at 10 days Western Australia Deaths of those who experienced overcrowding Longer ED length of stay Longer physician waiting time 12
Studies (cont.) Western Australia Strategies Reduce waste Reduce misuse / overuse Improve chronic disease management Match bed supply with demand Optimise hospital inpatient flow 13
California Studies (cont.) 46% of users of EDs believed the care could have been provided by a primary care practitioner. Key factors in use of EDs by avoidable users: Lack of access to outside EDs Lack of advice Lack of alternatives Positive attitude to EDs Chronic conditions Population 32% ED users 44% 14
Consequence of use of EDs for non-urgent needs Divert / delay resources for acute patients More expensive than other settings 15
Control Measures Prevention of Presentation (minimising Avoidable use) Better care for those with acute conditions requiring Emergency care 16
Prevention of Presentations Population based interventions Smoking Nutrition Alcohol Physical activity Injuries 17
Prevention of Presentations (cont.) Provision of information Nurse-on-call strategy June 2006 18
Patients referred in the following manner: Ambulance 5% ED 19% Primary Care provider 42% Self care 33% Other 1% 19
Better Health Channel Health information internet site 20
Prevention of Presentations (cont.) Primary care interventions: Vaccinations Screening, eg Breast, colonoscopy Acute conditions treated at home, eg Dehydration Cellulitis Pelvic inflammatory disease 21
Prevention of Presentations (cont.) Chronic Disease Management, eg Hypertension Heart Failure Diabetes Chronic Lung Disease Social Issues 22
Chronic Disease management (cont.) Chronic diseases 50% Management requires shift from focus on acute symptoms $515m for 5 years from Australian Government 23
Chronic Disease Management (cont.) Self Management Support Education Planned visits 24
Chronic Disease Management (cont.) WHO Innovative care for Chronic Conditions Framework 25
Prevention of Presentations (cont.) Diversion and Substitution Multidisciplinary teams in EDs 26
Prevention of Presentations (cont.) Diversion and substitution Collocated GP clinics Urgent care centres 27
Better Management of Patients Requiring Emergency Care Ambulance diversion or bypass Less than 3% Assessment and Observation Units Peninsula Health Medical Assessment Unit Only 31% admitted to hospital Length of stay decreased 28
Better Management of Patients Requiring Emergency Care (cont.) Information Technology Tracking systems Workforce roles Physiotherapist in ED Good outcomes Streamlining for lower acuity patients 29
Better Management of Patients Requiring Emergency Care (cont.) Bed management practices Better management of Mental Health patients in EDs Triage tool at PH Length of stay decrease 30
ED1 - % Time on Bypass (DHS KPI 1) 12.0% 10.0% 8.0% 6.0% 4.0% 2.0% 0.0% Jul A ug Sep Oct No v Dec Jan Feb M ar A pr M ay Jun Actual (%) Prev Yr DHS Target 31
ED2 - % Patients Admitted within 8 Hours (DHS KPI 2) 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Jul A ug Sep Oct No v Dec Jan Feb M ar A pr M ay Jun Actual Prev Yr DHS Target 32
ED3 - % Non Admitted Patients with LOS < 4 Hrs (DHS KPI 3) 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Jul A ug Sep Oct No v Dec Jan Feb M ar A pr M ay Jun Actual Prev Yr DHS Target 33
ED4 - Patients LOS > 24 Hours (DHS KPI 4) 80 70 60 50 40 30 20 10 0 Jul Aug Sep Oct Nov Dec Jan Feb M ar Apr M ay Jun Actual Prev Yr DHS Target 34
Planned or Elective Presentations Pre and post hospital care in Outpatients Introduction of Allied Health practitioners in Outpatient Clinics, eg Physiotherapists in Orthopaedic Clinic Planned admission for medical care in stand-alone centre 35
Planned or Elective Presentations (cont.) Procedural (Surgical) Services Categorisation Waiting list Minimisation of cancellations Day of surgery admissions 36
Planned or Elective Presentations (cont.) Other strategies Other public hospitals New centre for State-wide access Use of private sector Medihotels 37
EL1 - Total Patients on Waiting List (DHS KPI 7) 3,400 3,200 3,000 2,800 2,600 2,400 2,200 2,000 Jul A ug Sep Oct No v Dec Jan Feb M ar A pr M ay Jun Actual Prev Yr DHS Target 38
EL5 - Hospital Initiated Postponement (HIPs) per 100 W/L Admissions (DHS KPI 8) 25 20 15 10 5 0 Jul Aug Sep Oct Nov Dec Jan Feb M ar Apr M ay Jun Actual Prev Yr DHS Target 39
W1 - Average Waiting Time - Category 1 (Days) 35 30 25 20 15 10 5 0 Jul A ug Sep Oct No v Dec Jan Feb M ar A pr M ay Jun Actual Prev Yr DHS Threshold 40
W2 - Average Waiting Time - Category 2 (Days) 250 200 150 100 50 0 Jul Aug Sep Oct Nov Dec Jan Feb M ar Apr M ay Jun Actual Prev Yr DHS Threshold 41
W3 - Average Waiting Time - Category 3 (Days) 400 350 300 250 200 150 100 50 0 Jul Aug Sep Oct Nov Dec Jan Feb M ar Apr M ay Jun Actual Prev Yr PH Threshold 42
D2 DOSA General Surgery 100% 90% 80% 70% 60% 50% Jul A ug Sep Oct No v Dec Jan Feb M ar A pr M ay Jun Actual Prev Yr PH Target 43
Example of Performance thresholds used to allocate bonus funding points Percentage of operating time on hospital bypass Bonus Points Criteria Bonus Points Less than or equal to 3.0% 3 3.1% to 4.0% 2 4.1% to 5.0% 1 Greater than 5.0% 0 44
DHS - KEY PERFORMANCE INDICATORS & BONUS FRAMEWORK 2005/2006 Target Emergency ED1 - % Time on Bypass (DHS KPI 1) 3% ED2 - % Patients Admitted within 8 Hours (DHS KPI 2) 80% ED3 - % Non Admitted Patients with LOS < 4 Hrs (DHS KPI 3) 80% ED4 Patients LOS > 24 Hours (DHS KPI 4) 0 ED5 Category 1 - % Patients Seen Immediately (DHS KPI 9) 100% Elective Surgery EL1 Total Patients on Waiting List (DHS KPI 7) EL3 - % Category 2 Waiting more than 90 Days (DHS KPI 5) 0% EL4 - % Category 3 Waiting more than 365 Days (DHS KPI 6) 0% EL5 Hospital Initiated Postponement (HIPs) per 100 W/L Admissions (DHS KPI 8) 15 EL2 - % Category 1 Admitted within 30 Days (DHS KPI 10) 100% 45
Other Strategies Service integration to improve patient journeys Good forecasting and planning Role delineation Development of clinical networks New workforce strategies New workforce roles Defining a queuing strategy Good discharge planning 46
Consumers - 3 segments Healthy population Information or health promotion, disease prevention Early intervention strategies At risk population Identification Self management support High acuity patients Appropriate and effective hospital care 47
Conclusion Collaboration Stronger relationships between sectors Changed relationships Shift to community models of care 48
Conclusion (cont.) Shift: From To Episodic care Continuums of care Provider focus Consumer focus Acute care settings Multiple care settings 49