Community Health Quality Improvement Initiatives Tony Triado, Department of Health Julie White, Monash Health and Convenor, Quality Indicators Pilot Working Group Alison Brown, Lead Consultant, Australian Centre for Healthcare Governance
Session Outline Discussion of: 1. National accreditation standards for communitybased programs 2. Client and carer experience survey 3. Community Health Quality Indicator Project:
National accreditation standards & Experience Survey National Accreditation for community-based services The programs that are participating The work Final decisions Client Experience Survey The project Time lines for developing an instrument for CHSs
Community Health Quality Indicator Project Project Vision: Improve the quality & safety of care provided by Statefunded community health agencies and the evidence for the effectiveness and appropriateness of care Project Purposes: To further strengthen the culture of reflective practice and continuous quality improvement To have quantitative evidence to demonstrate high quality services and systems To evaluate the impact for clients of the services To report to the community and stakeholders e.g.in the annual quality of care report
FRAMEWORK FOR INDICATORS Health conditions Prevalence of disease, disorder, injury or trauma or other health related states Health Status How healthy are Australians? Is it the same for everyone? Where are the best opportunities for improvement? Determinants of Health Are the factors determining good health changing for the better? Where and for whom are these factors changing? Is it the same for everyone? Environmental factors Physical, chemical and biological factors such as air, water, food and soil quality Health System Performance How does the health system perform? What is the level of quality of care across the range of patient care needs? Is it the same for everyone? Does the system deliver value for money and is it sustainable? Effectiveness Care/intervention/action provided is relevant to the client s needs and based on established standards. Care, intervention or action achieves desired outcome Human function Alterations to body, structure or function (impairment), activity limitations and restrictions in participation Community and socioeconomic Community factors such as social capital, support services, and socioeconomic factors such as housing, education, employment and income Wellbeing Measures of physical, mental, and social wellbeing of individuals Health behaviours Attitudes, beliefs, knowledge and behaviours such as patterns of eating, physical activity, smoking and alcohol consumption Safety The avoidance or reduction to acceptable limits of actual or potential harm from health care management or the environment in which health care is delivered Deaths Mortality rates and life expectancy measures Bio-medical factors Genetic-related susceptibility to disease and other factors such as blood pressure, cholesterol levels and body weight Responsiveness Service is client orientated, Clients are treated with dignity, confidentiality, and encouraged to participate in choices related to their care Continuity of Care Ability to provide uninterrupted, coordinated care or service across programs, practitioners, organisations and levels over time Accessibility People can obtain health care at the right place and right time irrespective of income, physical location and cultural background. Community and Health System Characteristics Efficiency & Sustainability Achieving desired results with most cost effective use of resources. Capacity of system to sustain workforce and infrastructure, to innovate and respond to emerging needs
Community Health Practice Indicators (CHPI s) Working Group Membership Name Organisation Julie White Manager HARP / Chronic & Complex Care Monash Health Dr Jen Bichel-Findlay and or Ms Kylie Mercer ACHS EQUIP Dr Andrea de Silva-Sanigorski Barb Bell Mark Plamigale Ms Alison Brown Governance Consultant Ms Anne Cox Director, Community Health Services Ms Antoinette Mertins Dr Paul Ireland Manager Ms Sue Medson CEO Mr Tony Triado Senior Project Officer Ms Phoebe Zhang Dental Health Services Victoria (DHSV) and The University of Melbourne Quality Improvement & Community Services Accreditation (QICSA) Quality Improvement & Community Services Accreditation (QICSA) Victorian Healthcare Association (VHA) and ACHG Isis Primary Care Merri Community Health Service Commission for Hospital Improvement Gippsland Lakes CHS and East Gippsland PCP Department of Health Partnerships and Primary Health ACHS-EQuIP
The Indicators
Community Health Practice Indicators (CHPIs) Deliverables 1. Community health practice indicators (CHPI) Resources and training for community health staff Project Methodology: 1. Trialling the sector wide implementation of community health practice indicators (CHPI) to commence in the second half on 2014 in all CH agencies
Community Health Practice Indicators (CHPI s) Work to date Operational Manual 22 indicators for future benchmarking purposes 11 for internal quality improvement purposes Trial of 22 indicators in second half of 2014 to test robustness of indicators for future benchmarking Data collection processes Data storage for all indicators Benchmarking in future Communication Training and support during data collection
Community Health Impact Indicators (CHII s) Karen Ridgway Kate Astbury/Jill Miller Sally Mitchell/Lorraine Nicholas Christopher Turner Margaret McDonald Shane Richardson Samantha Park Rosalind Nixon Erica Ruck David Whitrow Angela Miezis Melinda Charlesworth Naomi Kubina Barb Bell Sue Gilham Alex Phillips Tony Triado Alison Brown Peninsula Health Community Health Grampians Community Health North Yarra Community Health Western Regional Health Centre Cobaw Community Health Hepburn Health Service South Gippsland Hospital Central Bayside Community Health Ovens & King Community Health Bendigo Community Health Service Doutta Galla Community Health Bendigo Health Inner East Community Health Service Quality Innovation Performance (QIP) The Australian Council on Healthcare Standards EQuIP Banyule Community Health Department of Health ACHG
Background CHII s VHA CG in CH project Latrobe Literature review Impact Indicator Working group Initial Pilot Second Pilot
CHII s Domain Smoking risk factor Nutrition risk factor Physical Activity Risk Factor Alcohol Risk Factor Quality of Life Wellbeing/Life Satisfaction Avoidable Admissions to ED and/or Hospital Chronic Disease Self-Management Weight Diabetes` Cardiovascular disease - hypertension Cardiovascular disease Cholesterol Client profile Question On average how many cigarettes do you smoke daily? In the past four weeks, how many serves of vegetables did you usually eat each day? In the past four weeks how many serves of fruit did you usually eat each day? In the past week, on how many days have you done a total of 30 minutes or more of physical activity, which was enough to raise your breathing rate? How often do you usually drink alcohol? On a day you drink alcohol, how many standard drinks do you usually have? How often did you have 6 or more drinks on one occasion in the last 3 months? EQ-5D-5L Multiple choice questions All things considered, how satisfied are you with your life? Have you had any visits to the hospital emergency department in the last 12 months? Have you been admitted to hospital overnight or for a longer stay in the last 12 months? Stanford Self-Efficacy for Managing Chronic Disease 6-Item Scale Waist circumference HbA1c Systolic and diastolic blood pressure Measurement of blood levels of LDL and total cholesterol Literacy Co morbidity Highest education level Demo age, gender, postcode HCC status
Impact Indicators Pilot in 15 agencies: Baseline (Feb), 3 months(may) and 6 months (Aug) Purpose: The sensitivity of the measures to inform indicators of change: Has there been any change?: Indicator format for detecting change: The percentage of clients in the target group whose smoking has increased, stayed the same or decreased. What is the extent of change?: The percentage of clients in the target group whose smoking has increased, stayed the same or decreased.
Community Health Quality Improvement Initiatives 1. Introduction of national accreditation standards for community-based programs Community Health Quality Indicator Project: 2. Community Health Practice Indicators (CHPI s) 3. Community Health Impact Indicators (CHII s) Questions?