Building systems Vermont to reduce health disparities: April 17, - - PowerPoint PPT Presentation

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Building systems Vermont to reduce health disparities: April 17, - - PowerPoint PPT Presentation

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Building systems Vermont to reduce health disparities: April 17, 2015 Lessons from remote health in Australia Paul Burgess Outline Where I come from Progress on health equity Key Demographics: 21.5 million people 550,000 Indigenous

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Building systems to reduce health disparities: Lessons from remote health in Australia Vermont April 17, 2015 Paul Burgess

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Outline

  • Where I come from
  • Progress on health equity
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Key Demographics:

  • 21.5 million people
  • 550,000 Indigenous (2.5%)
  • 99.3 million sheep
  • 625,000 New Zealanders (15% of NZ)

Health Score Card Life expectancy: 83Y (#10) Spend: 3,800 pp ($USD) 9.5% of GDP

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Where I’m from

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The The wo world’s wo worst rst new newspaper paper

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NT Health Providers

Private GPs NT Government Aboriginal Controlled

Shared health information

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Clinical context – tough job

  • 34,000 mobile patients over 1.4 million Km2
  • Triple whammy: IFD/Low SES/Chronic diseases
  • Nurse led primary care + Aboriginal workers
  • High staff turnover (non‐Aboriginal)
  • Language/Cultural barriers
  • Evolving IT
  • Distance!
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Indigenous Demography

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Social Determinants of Health dominate

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NT Trends in avoidable hospitalisation 1998-2006

NT Indigenous

2000 4000 6000 8000 10000 12000 14000 16000 18000

Hospital separations per 100 000 NT non-Indigenous

2000 4000 6000 8000 10000 12000 14000 16000 18000

Hospital separations per 100 000 Vaccine Vaccine Acute Acute Chronic Chronic Li SQ et al. (2009) Avoidable Hospitalisation in Aboriginal and non-Aboriginal people in the Northern Territory MJA

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Medical/Nursing Workforce

 Multiple strategies implemented over decades

 Undergraduate

 Rural Health clubs, Rural training schools, Rural student intake  Bonded medical school placements  Rural training rotations, John Flynn Scholarships

 Prevocational

 Electives  Placements in rural medicine

 Vocational

 Regional training providers  Flexible training, Incentives

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February 13, 2008

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Sign Signific ificant Health Health Impr provem emen ents ts

Figure A.6 Death rates per 100 000 standard population, 1998–2031, Northern Territory

Source: ABS and AIHW—see Appendix D. 500 1000 1500 2000 2500

1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031

Rate per 100 000

Actual Indigenous Projected Indigenous rate Indigenous variability bands Actual non-Indigenous Projected non-Indigenous rate Indigenous trend 2006-2011 Indigenous trend 1998-2011

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Take‐home Messages?

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Policy & Community Environment

  • Free healthcare
  • Free medication
  • Aboriginal governance
  • Local health networks
  • Hospital + PHC
  • Primary Health Care
  • NGO collaborations
  • Specialist integration &
  • utreach
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IT system + Data linkage

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Deci Decisi sion

  • n Support

Support

  • Standard treatment manuals
  • Standing orders
  • EBM – peer reviewed
  • Care plan protocols
  • Electronic prescribing
  • Safety functions
  • Electronic FFS billing
  • 24/7 phone support
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Deliv livery Syst System

  • Team based PHC
  • Womb to grave
  • Cross‐training
  • Care pathways
  • STM – common conditions
  • Integrated specialist care
  • E –consults
  • Outreach support
  • allied health
  • Telemedicine
  • 24/7 access to care
  • Radiology
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Self‐management

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Organisation of Care

  • Strong leadership
  • Strategic policy work
  • Collaborations
  • Teaching
  • Data driven improvements

– AHKPIs – CQI – Functional reporting

  • Data linkage/Research
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Key Performance Indicators (N=22)

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Quality Improvement

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Improvement of systems by health centre

  • 1.0

0.0 1.0 2.0 3.0 4.0 5.0 E A H F B D I G C J K L Communities

Levels of system improvement (measured by ACIC scores

  • Intervention group I Group II Group III
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1 2 3 4 5 6 7 8 9 10 11

Organis ational influence E xternal linkages Self-management s

  • pport

D ecis ion s upport D elivery s ys tem des ign Information s ys tems Integration

Baseline Year 1 Year 2

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Functional reporting

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BP control (<130/90) for high CVR

20 30 40 50 60 70 80 Jun‐12 Jul‐12 Aug‐12 Sep‐12 Oct‐12 Nov‐12 Dec‐12 Jan‐13 Feb‐13 Mar‐13 Apr‐13 May‐13 Jun‐13 Jul‐13 Aug‐13 Sep‐13 Oct‐13 Nov‐13 Dec‐13 Jan‐14 Feb‐14 Mar‐14 Apr‐14 May‐14 % CVRA Outcome The Gap Inertia

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1

2 3

4 Ho Hospitalisatio italisations p ns per p r pers rson-year year 10 20 30 40 50

Clin linic ic visits pe visits per r person-year person-year

Population (bubble size-100 persons) Quadratic model

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Acknowledgements

  • Gary Sinclair, Christine Connors, Steve Guthridge,

Mark Ramjan, John Wakerman, Ross Bailie,

  • Remote Medical Practitioners,
  • Remote Area Nurses,
  • Aboriginal Health Workers
  • Aboriginal communities
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Harkness Project

  • How have health organisations extended upon

the medical home to proactively identify and address the needs of vulnerable populations?

  • Multi‐level case study analysis

– Context: policy/funding/ACA – Leadership – Operational – Consumer experience

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Case study sites

  • North Carolina
  • Oregon
  • Vermont
  • Alaska
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Reflections & preliminary findings

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