Access for Older People’s complex care close to home A rural and Metro partnership model Debra Tooley - District Manager Aged Care Services John Cullen - Geriatrician
Western NSW … Where are we? Population: 277,353 18% Aged over 65 yrs 2
Our Services …
Why Telehealth Enhanced Model? Data Analysis Project Design Implement & Test Increased demand Collaborative solution Honorary medical design contracts Pt complexity Technology Service Agreement Funding source Purchase of Telehealth No Geriatrician devices Leadership Development of Clinical – pt selection Increased waiting times protocols Patient engagement Data collection – Role clarity Increased travel for activity & cost services Quality & Audit process Rostering of staff No funding for Geriatric Staff Education Medicine services Communication strategy 4
Principles Person Centred, Primary care directed and Targeted based empowered Collectively Continuously accountable and Shared improved mutually information beneficial
Enablers Engagement Governance Partnerships Funding Leadership Capability Culture Technology Information
Telehealth Model – a component of a comprehensive geriatric model of care Clinics Workforce Scheduling Metro: Equipment, Geriatrician Patients and Geriatrician Local: Booking Clinician Transcription Liaison with service GP Patients Technology Evaluation Clinical Booking Quadruple assessment Aim Equipment & reports testing Continual collated improvement Education Mgt plans Health Governance Record & Funding Shared Clinical gov. clinical notes Local leadership Audit process
What Works Well • Well accepted by patients and carers • Family patient education and care • Telehealth is not “instead of” face to planning discussions face clinics - complimentary • Cognitive Assessments and diagnosis • Capacity Assessments • The Medicare model rather than ABF • Comorbidities / Chronic disease funding model assessment ( and management) • The enterprise has had the support • Medication reviews of both CEs of both LHDs • Driving assessments • • The network has been reliable and General healthy ageing advice the equipment continues to improve • Advanced care planning discussions • Gait, Falls and Bones evaluation
What Doesn’t Work • Patient characteristics – severe deafness • Non-cooperation – extremely rare • Assessments requiring hands on physical examination - (undertaken at face to face clinics)
Measuring Success Improved experiences for Improved experiences for people, families and clinicians and service carers providers QUADRUPLE AIM Improved health Improved Health outcomes for the Systems population
Measuring Success Improved Patient & Improved Clinician Carer Experience Experience “Excellent team work – felt “Great service in our own supported” town” “Technology easy to use” “No different to a face to face appt ” “Very organised clinic” “Great not having to travel to “Feel connected to the patients Sydney (6- 10 hours)” and carers” “Felt like I had specialists’ full “I can do clinics from my own attention the whole time” office” “Perfect for country people” Decreased waiting time for patients – less stress
Measuring Success & Sustainability WNSWLHD Geriatric Medicine Program 300 250 200 160 150 Consults via Telehealth 110 138 180 132 150 100 160 140 140 50 120 55 85 76 52 55 56 40 100 36 22 14 5 0 0 80 2010 2011 2012 2013 2014 2015 2016 2017 2018 60 Consults FTF Consults via Telehealth 40 20 0 2010 2011 2012 2013 2014 2015 2016 2017 2018 Consults via Telehealth
Outcomes People, families and carers • I can access specialist services in my own town • I don’t have to re -tell my story • I know that there are a team of skilled staff that assist with my health and social care needs Service Providers and clinicians • I can access all relevant information about the patient so I can provide high quality care (comprehensive assessment, restorative care, GP collaboration) • I work in an efficient system that supports me to provide high quality care • I collaborate and communicate effectively with other providers to deliver the best care possible Population • Care addresses the social determinants of health • Care for people with long term conditions is improved Health Care System • The system is efficient and results in timely and appropriate management • Health care service in NSW connected with social care • IT systems and processes are integrated across the health system • Financially viable
Where to from Here? • WebRTC – using the web to connect to patients and carers on their own devices in locations that are convenient to them (including RACFs) • Use of wearable devices - Embedded into clothing • In home monitoring • Linking outside the health network e.g. with AMSs
Quote for John Cullen ‘ The Geriatric Medicine Service is one of the more worthwhile and satisfying things I do as a clinician and a service manager’ 15
Where to from here? Thank you! Debra Tooley - District Manager Aged Care Services email: Debra.Tooley@health.nsw.gov.au
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