To read the article in full text, go to: http://www.bpac.org.nz/BPJ/2015/June/tips.aspx

Sixteen randomised and quasi-randomised trials "... compared day hospitals with comprehensive care (five trials), domiciliary care (seven trials) or no comprehensive care (four trials)". 

The authors conclude from their analysis that "there is low quality evidence that medical day hospitals appear effective compared to no comprehensive care for the combined outcome of death or poor outcome, and for deterioration in [activities of daily living ]. There is no clear evidence for other outcomes, or an advantage over other medical care provision".

This article can be read in free full text at:  http://dx.doi.org/10.1002/14651858.CD001730.pub3

Brown L, Forster A, Young J, Crocker T, Benham A, Langhorne P, Day Hospital Group. (2015). Medical day hospital care for older people versus alternative forms of care. Cochrane Database of Systematic Reviews, 6, CD001730. 

Eligible studies required the use of a quantitative method to identify high performing hospitals, and qualitative methods or tools to identify factors associated with high performing hospitals or hospital departments. Practical strategies for achieving high performance were then mapped against the identified themes.

A total of 19 studies from a possible 11,428 were included in the review. A range of process, output, outcome and other indicators were used to identify high performing hospitals. Seven themes representing factors associated with high performance (and 25 sub-themes) emerged from the thematic syntheses: positive organisational culture, senior management support, effective performance monitoring, building and maintaining a proficient workforce, effective leaders across the organisation, expertise-driven practice, and interdisciplinary teamwork. Fifty six practical strategies for achieving high performance were catalogued.

The authors conclude that this review provides insights into methods used to identify high performing hospitals, and yields ideas about the factors important for success. It highlights the need to advance approaches for understanding what constitutes high performance and how to harness factors associated with high performance.

This is an open access article and can be read in free full text at:  http://dx.doi.org/10.1186/s12913-015-0879-z

Taylor, N., et al. (2015). High performing hospitals: A qualitative systematic review of associated factors and practical strategies for improvement. BMC Health Services Research, 15:244.

The Commission invites patients and interested health professionals to give feedback on the draft survey by 24 June 2015. All feedback is anonymous.

To find out more, go to:  http://www.hqsc.govt.nz/news-and-events/news/2196/

To find out more about this event, go to:  http://www.kingsfund.org.uk/events/integrated-care-summit-2015

Nineteen papers were identified as relevant for this review (3 randomised control trials; 4 cross-sectional, 5 cohort and 3 qualitative studies, and 3 systematic reviews). "The reviewed studies indicated that providing general practitioner-led supportive interventions for post-treatment care of cancer patients is feasible and acceptable to patients. General practitioner involvement resulted in improved physical and psychosocial well-being of patients and continuity of care, especially for patients with concomitant health conditions".

The authors discuss the implications of these findings.

This article is available to read in free full text at:  http://www.ijic.org/index.php/ijic/article/view/1987/2983

Ngune, I., et al. (2015). Do patients with long-term side effects of cancer treatment benefit from general practitioner support? A literature review. International Journal of Integrated Care, 8 June.

The Congress is a partnership between The International Foundation of Integrated Care (IFIC), the Inter-ministerial Health and Social Care and Interaction Plan of the Government of Catalonia and Hospital Clínic Barcelona.

To find out more about this event, go to:  http://integratedcarefoundation.org/events/icic16-16th-international-conference-on-integrated-care

Health Minister Jonathan Coleman says good progress is being made towards accurately measuring patient flow from GPs to hospital based specialists and the outcome of those referrals.

“The Government is focused on delivering better and faster access to health services, including more elective surgeries,” says Dr Coleman.

“We’ve backed that up in Budget 2015 with a further $98 million for increased access to elective surgery. This comes on top of the $110 million committed in Budget 2014.

“The number of patients receiving surgical first specialist assessments has significantly increased over the last six years, from around 260,000 patients a year, to over 315,000 patients assessed each year.

“However there have always been an uncounted percentage of patients who are returned to the care of their GPs.”

The previous Government in 2006 estimated around 25 percent of all GP referrals to specialists were returned to GP care. This would mean that of the 260,000 patients seen each year under Labour, at least 65,000 patients were being referred back to their GPs for care.

“Generally we know that patients can be referred back to their GP for a variety of reasons in addition to not meeting the threshold,” says Dr Coleman. 

“These may be cases where management in primary care is more appropriate such as if the patient has been referred for tests that primary care can access. Patients may also have been referred with incomplete information or to the wrong DHB.

“We are keen to better understand the exact outcomes of GP referrals.

“It is a significant undertaking to standardise the way this data is recorded by different DHBs and to understand referral outcomes. New Zealand will be one of a few countries to be collecting information of this kind at a national level.

“The Ministry of Health is working with DHBs to collect data in a comparable way.

“Ultimately this data will provide more comprehensive information for primary care on their patients.”

The project is on track to release the first set of reliable information in early to mid-2016.

Notes:

The National Patient Flow project has a three year implementation plan, with preliminary data expected to be available in early to mid-2016

The first phase being the collection of information on referrals received by DHBs for first surgical assessments. This has been underway since July 2014.

The second phase will commence in October 2015 and will include information on referrals for elective surgery, and some other procedures, including colonoscopy.

The third phase of the collection will commence in July 2016, and will include the full scope of the collection.  This will encompass a wider range of services, including diagnostics, and will allow linking of related referrals, and capture of a clinical classification of referral reason. This will allow more defined understanding of outcomes for patients

To download the toolkit, go to:  http://www.health.govt.nz/publication/lung-cancer-multidisciplinary-meeting-toolkit

National Lung Cancer Working Group (2014). Lung Cancer Multidisciplinary Meeting Toolkit. 

http://www.healthpolicyjrnl.com/article/S0168-8510(15)00117-7/fulltext

They present three themes: "decision hierarchy in health care, meanings of ‘home’, and late recognition of dying. Based on the detailed findings, this paper suggests that important insights into the broader goals of advanced cancer patients are offered by allied health staff, and that more effective use of the multidisciplinary team may support endeavours to achieve more home deaths for cancer patients who want this outcome. The analysis also provides new insights into the meaning of ‘home’ in interactions between advanced cancer patients and health professionals. The wish for ‘home’ appears bound up with other patient goals and the implications of this are discussed".

To read the full abstract, and for information on how to access the full text, go to: http://dx.doi.org/10.1111/ecc.12295 or contact your DHB library, or organisational or local library for assistance.

Bostanci, A., Horey, D., Jackson, K., William, L., Pittmann, L., Ward, J., Moore, G., Martin, P., Hudson, P. and Philip, J. (2015), Insights into hospitalisation of advanced cancer patients: A study of medical records. European Journal of Cancer Care, 22 April [Epub before print] 

The aim of this conference is to exchange knowledge, experience and new ideas in the design and delivery of integrated health and social care.

To find out more about this event, go to:  http://integratedcarefoundation.org/events/wcic3-3rd-world-congress-on-integrated-care

Inclusion criteria were a clearly described primary care intervention, model of care or service, delivered to Indigenous adults with type 2 diabetes reporting a program impact on at least one quantitative diabetes-related health outcome, and where results were reported separately for Indigenous persons.

Thirteen studies were included. Three levels of primary care initiatives were identified: 1) addition of a single service component to the existing service, 2) system-level improvement processes to enhance the quality of diabetes care, 3) change in primary health funding to support better access to care. Initiatives included in the review were diverse and included comprehensive multi-disciplinary diabetes care, specific workforce development, systematic foot care and intensive individual hypertension management. Twelve studies reported HbA1C, of those one also reported hospitalisations and one reported the incidence of lower limb amputation. The methodological quality of the four comparable cohort and seven observational studies was good, and moderate for the two randomised control trials.

The authors conclude that the current literature provides an inadequate evidence base for making important policy and practice decisions in relation to primary care initiatives for Indigenous persons with type 2 diabetes. This reflects a very small number of published studies, the general reliance on intermediate health outcomes and the predominance of observational studies. Additional studies of the impacts of primary care need to consider carefully research design and the reporting of hospital outcomes or other primary end points. 

This is an open access article and is available to download and read in free full text at:  http://dx.doi.org/10.1186/s12913-015-0803-6

Gibson, O.R. & Segal, L. (2015). Limited evidence to assess the impact of primary health care system or service level attributes on health outcomes of Indigenous people with type 2 diabetes: A systematic review. BMC Health Services Research, 15:154.

Making the decision to upgrade Bay of Islands Hospital has also made way for an opportunity to partner with Ngāti Hine Health Trust in the development of a new Whānau Ora Centre (Integrated Family Health Centre) adjacent to the hospital.

To read the full media release from Northland DHB, go to:  http://www.scoop.co.nz/stories/GE1504/S00042/partnership-in-healthcare-for-the-mid-north.htm

To read the article, go to:  http://www.cdhb.health.nz/About-CDHB/staff-resources/Documents/Canterbury%20DHB%20CEO%20Update%20Tuesday%207%20April%202015.pdf

Social Development Minister Anne Tolley has announced that the Social Sector Trials taking place in 16 communities around New Zealand are being extended for a year from 1 July.

The trials involve a number of agencies working together on the ground in communities to produce better results in delivering social services.

“The Social Sector Trials are demonstrating that a community-based approach can better coordinate Government resources to the people who need them,” says Mrs Tolley.

“With a view to adopting permanent structures, over the next twelve months we will take a close look at what is effective in the trial areas and analyse how the trials can work alongside other initiatives such as Children’s Teams and Whānau Ora, in the changing social sector landscape.

“Feedback over the next year from those involved in the trials will be extremely important, and I want to thank those communities who are embracing this new way of working together.”

Health Minister Jonathan Coleman says Southern DHB has now completed the South Island’s rollout of eReferrals, enabling faster more accurate transfer of patient information.

“West Coast, South Canterbury and Nelson Marlborough DHBs replaced paper-based referrals with electronic referrals, and now Southern DHB has begun introducing the system,” says Dr Coleman.

“More than half a million patient referrals from a GP to a hospital specialist have been sent electronically since Canterbury DHB launched the eReferrals system in 2012.

“Replacing hand-written referrals with electronic referrals reduces inaccuracies and saves time for doctors.

“Patients can get through the system faster, and clinicians receive better quality information on which to base their decisions. eReferrals also allow doctors to see where the most convenient healthcare provider is for a patient.”

eReferrals have been launched through the South Island Alliance, a collaboration of the five South Island DHBs, with support from the National Health IT Board. eReferral systems are also available in most DHBs in the North Island.

The system is being developed further to enable doctors to track the progress of their referrals. In future, doctors will also be able to make eReferrals not just externally but within DHBs – for example, between hospital departments.

To find out more about this event, go to:  http://www.ihi.org/education/Conferences/Summit2016/Pages/default.aspx

The open access journal publishes research papers, literature reviews and letters from both researchers and practitioners in the fields of social care, health and clinical informatics. Its focus is on informatics research from the front lines of health care and how informatics can support innovation in health and health care.

Fewer patients are presenting at emergency departments across the Waikato as health organisations focus on working together to provide more integrated health care.

Both Tokoroa and Thames emergency departments recorded significantly less presentations for the 2014 calendar year.

Tokoroa had 667 fewer patients come through ED in 2014 which could correlate to the 766 more patients seen at Tokoroa Medical Centre in the same period.

Midlands Health Network chief executive John Macaskill-Smith said the organisation had been seeing more patients overall in primary care.

“Also in Tokoroa the PAs (physician assistants) have played a massive part, seeing over 6000 patients as drop-in-acute-casuals,” he said.

Macaskill-Smith also attributed the change to the how the organisation manages patients with long term conditions in the community.

At the end of 2013, Midlands Health Network opened a new onsite medical centre attached to the Tokoroa Hospital campus.

In Thames 525 less people required treatment at emergency department which again could be correlated to efforts in community and primary care health services.

Hauraki Primary Health Organisation chief executive Hugh Kininmonth said these changing patterns would raise many questions for the future of health services

“I absolutely agree that these (and other) initiatives are showing the fruits of collaborative efforts,” he said.

However he also suggested both community and health care work closely together to understand the changing trends.

“The marvellous developments at Tokoroa have taken 20 years to implement, [so] it is not premature to begin strategic development discussions now,” said Kininmonth.

Waikato District Health Board last month appointed Dr Damian Tomic as clinical director primary care; he said the statistics were encouraging but more work needed to be done to understand the decline.

“We need to monitor the trends over a longer term to truly understand why they have dropped and how we can maintain them,” he said.

“Improvements in community care is like a jigsaw… e-referrals, physician assistants, models of care, public health nurses, primary options, general practice services, school-based health services – they are all part of [it]….which leads to patients staying out of hospital.”

Tomic said the only major influence in reducing emergency department patients is by improving the care of patients in the community.

“The challenge is ensuring all those jigsaw pieces continue to fit together and provide patients with the most effective care.”

They conclude that "discharge planning and transitional care for patients with dementia are not adequate and are likely to lead to readmission and other poor health outcomes".

This article is available to read in free full text at:  http://dx.doi.org/10.1111/ajag.12205

Chenoweth, L., Kable, A. and Pond, D. (2015), Research in hospital discharge procedures addresses gaps in care continuity in the community, but leaves gaping holes for people with dementia: A review of the literature. Australasian Journal on Ageing, 34: 9–14. 

To read the full story in the Nursing Review, go to: http://www.nursingreview.co.nz/issue/february-2015-vol-15-1/balancing-the-e-and-health-in-e-health/#.VPdywS5sjb4

The aim of this conference is to exchange knowledge, experience and new ideas in the design and delivery of integrated health and social care.

For further information about this event, go to:  http://www.integratedcarefoundation.org/conference/1630

Using examples from organisations and systems in other countries (including Counties Manukau Health) that are making this shift, "... the authors argue that improving population health is not just the responsibility of health and social care services or of public health professionals – it requires co-ordinated efforts across population health systems".

To read this report, go to:  http://www.kingsfund.org.uk/publications/population-health-systems

To read te case study, go to:  http://www.kingsfund.org.uk/publications/population-health-systems/counties-manukau-new-zealand

• Faster Cancer Treatment: Development of New Zealand tumour standards 
• Faster Cancer Treatment: Implementing the 62-day faster cancer treatment health target 
• Faster Cancer Treatment: The New Zealand cancer nurse coordinator initiative 
  

These poster presentations can be viewed on the Ministry of Heath website at: http://www.health.govt.nz/our-work/diseases-and-conditions/cancer-programme/faster-cancer-treatment-programme 

"Patients receiving the integrated model of care had a reduction in the number of hospitalizations when the principal diagnosis for admission was a diabetes-related complication. Integrated models of care for people with complex diabetes can reduce hospitalizations and help attempts to curtail increasing demand on finite health services".

To read the full abstract, and for information on how to access the full text, go to: http://dx.doi.org/10.1111/dme.12705 or contact your DHB library, or organisational or local library for assistance.

Zhang, J., et al. (2015). Impact of an integrated model of care on potentially preventable hospitalizations for people with Type 2 diabetes mellitus. Diabetic Medicine, 32(7), 872–8807.

To read the full story, go to:  https://www.midlandshn.health.nz/news/online-health-portal-empowers-patients

Participants were 387 patients with a record of diabetes or heart disease, or both, who had depressive symptoms for at least two weeks. Mean age was 58.5 (SD 11.7). General practices were randomised to collaborative care or usual care.

Collaborative care included patient preference for behavioural activation, cognitive restructuring, graded exposure, and/or lifestyle advice, management of drug treatment, and prevention of relapse. Up to eight sessions of psychological treatment were delivered by specially trained psychological wellbeing practitioners employed by Improving Access to Psychological Therapy services in the English National Health Service; integration of care was enhanced by two treatment sessions delivered jointly with the practice nurse. Usual care was standard clinical practice provided by general practitioners and practice nurses.

After adjustment for baseline depression score, mean depressive scores were 0.23 SCL-D13 points lower (95% confidence interval −0.41 to −0.05) in the collaborative care arm, equal to an adjusted standardised effect size of 0.30. Patients in the intervention arm also reported being better self managers, rated their care as more patient centred, and were more satisfied with their care. There were no significant differences between groups in quality of life, disease specific quality of life, self efficacy, disability, and social support.

The authors conclude that collaborative care that incorporates brief low intensity psychological therapy delivered in partnership with practice nurses in primary care can reduce depression and improve self management of chronic disease in people with mental and physical multimorbidity. The size of the treatment effects were modest and were less than the prespecified effect but were achieved in a trial run in routine settings with a deprived population with high levels of mental and physical multimorbidity.

This is an open access article and can be read in free full text at: http://dx.doi.org/10.1136/bmj.h638

Coventry, P., et al. (2015). Integrated primary care for patients with mental and physical multimorbidity: Cluster randomised controlled trial of collaborative care for patients with depression comorbid with diabetes or cardiovascular disease. BMJ, 350:h638.

They conclude from the results that "peer review of cancer MDTs is feasible and acceptable. We describe valuable lessons learnt and recognise that further development of the proposed peer-review model and national benchmarking of MDTs against established outcome measures is required if this process is to be widely implemented".

This article is available to read in free full text at: http://dx.doi.org/10.5694/mja14.00768

Slavova-Azmanova, N. S., et al. (2015). Peer review of cancer multidisciplinary teams: Is it acceptable in Australia?  Medical Journal of Australia, 202 (3), 144-147.

"Eighteen systematic reviews from countries with developed health systems comparable to Australia were included ... [M]ulti-strategy and multidisciplinarity made it difficult to isolate which were the most effective strategies and disciplines. Nurses required specific training for these roles, but performed co-ordination more often than any other discipline. There was, however, no evidence that discipline had a direct impact on clinical or service outcomes, although specific expertise gained through training and workforce organisational support for the co-ordinator was required. Hence, skill mix is an important consideration when employing care co-ordination, and a sustained consistent approach to workforce change is required if nurses are to be enabled to perform effective care co-ordination in CD management in primary care".

This article is available to read in free full text at:  http://onlinelibrary.wiley.com/doi/10.1111/hsc.12194/abstract

Parker, S. and Fuller, J. (2015), Are nurses well placed as care co-ordinators in primary care and what is needed to develop their role: A rapid review? Health & Social Care in the Community, 9 February [Epub before print]. 

Several families in Taumarunui are receiving help from community organisations and the Waikato District Health Board (DHB) to try and reduce environment-induced asthma in children.

Patients’ access to quality health care in rural parts of Waikato DHB has long been a concern for the DHB, but the roll out of a new ‘model of care’ which is linking community and hospital services in Taumarunui looks to be the new benchmark.

Click to enlarge

Integral to the implementation of theTaumarunui Integrated Health Care Model is the development of a number of referral pathways for local services.

Currently paediatric asthma patients that present at Taumarunui’s Emergency Department are offered the opportunity for referral onto this pathway.

Project coordinator Penny Neal said the approach is about working collaboratively with local organisations to try and improve the overall health of the community.

“It is the start of transformation; we have gone from a culture of working in silos to now working collaboratively,” she said.

The asthma referral pathway identifies children that present at the hospital or GP with asthma and refers them on for assessment and treatment.

They are then asked if they would like to enrol with the Whanau Ora programme delivered by Taumarunui Community Kokiri Trust which involves a Whanau Ora assessment and holistic approach to improving social, physical and spiritual wellbeing. For the asthma pathway this includes being referred to a public health nurse for a home visiting programme

“It is important that we engage with families/whanau on an aspirational level not just physical health one – it is the only way we will help change that environment,” said Neal.

Currently the asthma programme is working with a number of families/whanau.

This year a number of other pathways using the same integrated model of care will be rolled out including pathways for the frail elderly, vulnerable children, and a generic referral pathway that facilitates smooth referral for patients who may need several organisations help.

The purpose of this review is to synthesise findings of studies that implemented the CCM in primary care, in order to identify facilitators and barriers encountered during implementation.

This review identified barriers and facilitators of implementation across various primary care settings in 22 studies. The major emerging themes were those related to the inner setting of the organisation, the process of implementation and characteristics of the individual healthcare providers. These included: organisational culture, its structural characteristics, networks and communication, implementation climate and readiness, presence of supportive leadership, and provider attitudes and beliefs.

The authors conclude that these findings highlight the importance of assessing organisational capacity and needs prior to and during the implementation of the CCM, as well as gaining a better understanding of health care providers' and organisational perspective.

This is an open access article and is available to read in free full text at:  http://dx.doi.org/10.1186/s12875-014-0219-0

Kadu, M. & Stolee, P. (2015). Facilitators and barriers of implementing the chronic care model in primary care: A systematic review. BMC Family Practice, 16:12.

This one-stop-shop approach brings together a multi-disciplinary team who can carry out all required lung cancer assessments in one day.

To read the full story on the Ministry of Health website, go to:  http://www.health.govt.nz/our-work/diseases-and-conditions/cancer-programme/cancer-stories/multi-disciplinary-approach-fast-tracks-lung-cancer-diagnosis

Public comment on this standard closes 5 pm, Friday 27 February 2015.

To read the draft standard, go to:  http://ithealthboard.health.nz/standards/health-information-standards-open-public-comment

This article is available to download and read in free full text at:  http://dx.doi.org/10.1093/intqhc/mzu068

Manojlovich, M., et al. (2014). Achieving a climate for patient safety by focusing on relationships. International Journal for Quality in Health Care, 26(6), 579 - 584.

Ten English National Health Service hospitals were identified with the shortest length of stay after elective colonic surgery between January 2011 and December 2012. Semi-structured telephone interviews were conducted with a senior colorectal surgeon and ward nurse at each site. 

These units standardised clinical care based upon an Enhanced Recovery Program. Beyond this, they organised the clinical team to efficiently and reliably deliver this package of care, with the majority of day-to-day care delivered by consultants and nurses. Patients were closely monitored for postoperative deterioration, using a combination of early warning scores, nurses’ clinical judgement and regular senior medical review. Of note, operative volume and laparoscopy rates in these units were not statistically significantly different from the national average. The postoperative analgesic strategy varied widely between units, from routine epidural use to local anaesthetic infiltration or patient-controlled analgesia.

The authors conclude that the Enhanced Recovery Program may be seen as necessary but not sufficient to achieve the best length of stay results. In the study units, consultants and nurses led and delivered the majority of patient care on the ward. High quality teamwork helped detect and resolve clinical issues promptly, with nurses empowered to contact consultants directly if needed. Other units may learn from these teams by adopting protocol-based, consultant- or nurse-delivered care, and by improving coordination and communication between consultants and ward nurses.

This is an open access article and can be read in free full text at:  http://dx.doi.org/10.1186/s13037-014-0050-5

Byrne, B.E., et al. (2015). Understanding how colorectal units achieve short length of stay: An interview survey among representative hospitals in England. Patient Safety in Surgery, 9:2.

Quantitative and qualitative evidence of MDT models of care for the management of pregnant/postnatal women with pre-existing diabetes and cardiac disease was considered, and 19 papers were included from UK, Canada, USA, the Netherlands and Singapore.

No studies were found which had compared MDT models for pregnant/postnatal women with pre-existing diabetes or cardiac disease. Two small retrospective studies reported better outcomes for women with cardiac disease if an MDT approach was used, although evidence to support this was limited. Due to study heterogeneity it was not possible to meta-analyse data. No evidence was identified of MDT management in the postnatal period or impacts of MDT working on healthcare resources.

The authors conclude that despite widespread promotion of MDT models of care for pregnant and postnatal women with pre-existing diabetes or cardiac disease, there is a dearth of primary evidence to inform structure or working practices or beneficial impact on maternal and infant outcomes or healthcare resources. They go on to say that primary research into if or how MDT models of care improve outcomes for women with complex pregnancies is urgently needed.

This is an open access article and can be read in free full text at:  http://dx.doi.org/10.1186/s12884-014-0428-5

Bick, D., et al. (2014). Management of pregnant and postnatal women with pre-existing diabetes or cardiac disease using multi-disciplinary team models of care: A systematic review. BMC Pregnancy and Childbirth, 14:428.

Each overview covers health insurance, public and private financing, health system organization and governance, health care quality and coordination, disparities, efficiency and integration, use of information technology and evidence-based practice, cost containment, and recent reforms and innovations.

In addition, summary tables provide data on a number of key health system characteristics and performance indicators, including overall health care spending, hospital spending and utilization, health care access, patient safety, care coordination, chronic care management, disease prevention, capacity for quality improvement, and public views.

To read the report in full text, go to: http://www.commonwealthfund.org/publications/fund-reports/2015/jan/international-profiles-2014

They find that "... social network attributes of degree centrality, connectedness and tie strength impact on coordination performance for PCCN. We further note that socio-demographic characteristics of patient age, patient sex and hospital type (ie, private versus public) moderate the relation between independent and dependent variables for PCCN. We argue that the proposed research framework of this study could be applied in various healthcare settings (eg, inter-departmental collaboration within hospital and Intensive-Care Unit coordination) to explore and model coordination performance".

This article is available to download and read in free full text at:  http://www.achsm.org.au/DownloadDocument.ashx?DocumentID=1915

Uddin, S. & Hossain, L. (2014). Social networks in exploring healthcare coordination. Asia Pacific Journal of Health Management, 9(3).

They identify a number of major themes: barriers included the culture of the unit, communication, and a lack of resources. Themes associated with facilitating early mobilisation included organisational change, improved communication between medical units, and improved resources.

Based on their analysis, the authors suggest that a dedicated mobility team led by physiotherapists may help address the barriers related to mobility.

To read the full abstract, and for information on how to access the full text, go to: http://dx.doi.org/10.1016/j.aucc.2014.11.001 or contact your DHB library, or organisational or local library for assistance.

Barber, E. A., et al. (2014). Barriers and facilitators to early mobilisation in intensive care: A qualitative study. Australian Critical Care, 19 December [Epub before print]

Now available to read in free full text at: http://dx.doi.org/10.1093/ageing/afu180 

Philp, I. (2014). The contribution of geriatric medicine to integrated care for older people. Age and Ageing, 44(1), 11-15.

The report is available to read in free full text at:  http://www.pickereurope.org/wp-content/uploads/2014/10/Developing-measures-of-IC-report_final_SMALL.pdf

King, J., et al. (2013). Developing measures of people’s self-reported experiences of integrated care.  Oxford: Picker Institute Europe & University of Oxford.

Health Minister Jonathan Coleman has welcomed the rollout of a new national IT system aimed at improving the quality of maternity care for women and their babies.

“The new Maternity Clinical Information System (MCIS) is a secure online system which brings together all the information collected on different systems in hospitals and in the community,” says Dr Coleman.

"Having all the relevant information available in one place will make it easier for midwives, GPs, hospital specialists and other health professionals to work together as a team to care for women during pregnancy and labour, and after their babies are born.

“The system will be developed further so the 60,000 women who have babies each year can access their own maternity information through an online portal.

“Strengthening our maternity services has been a priority for the Government, that’s why we’ve invested over $100 million extra into a range of improved maternity services for parents, including longer stays for mothers in hospitals and birthing facilities.”

The MCIS programme is being progressively rolled out across all DHBs, with MidCentral, South Canterbury, Whanganui, Tairawhiti and Counties Manukau DHB the first to sign on.

The system has been developed in collaboration with the colleges of midwives, GPs and obstetricians and gynaecologists. The work has been supported by the Ministry of Health, the National Health IT Board and DHBs.

The authors report on health and health care use; health care costs and access; timeliness of care; care coordination and safety; doctor-patient relationship; health promotion; end-of-life planning; and management of chronic conditions and caregiving.

The article is available to read in free full text at:  http://dx.doi.org/10.1377/hlthaff.2014.0947

Osborn, R., et al. (2014). International survey of older adults investigates access, coordination, and patient-centered care. Health Affiars, 33(12), 2247-2255

It concludes by highlighting four lessons that CCGs, other commissioners and providers should keep in mind as they embark on new models of commissioning and contracting to support integrated care".

The report is available to download and read in free full text at:  http://www.kingsfund.org.uk/publications/commissioning-contracting-integrated-care

Addicott, R. (2014). Commissioning and contracting for integrated care. London: King's Fund.

Implementation of ERAS  will lead to the delivery of safe, effective, and patient and family centred care for elective patients undergoing primary total hip or knee joint arthroplasty (TJA) and acute patients with fractured neck of femur (#NOF).

This Collaborative Change Package is designed for use by all health professionals in District Health Boards (DHBs) that are responsible for the planning and delivery of care for patients undergoing TJA or with #NOF. For DHB teams, the adoption of ERAS will lead to a more integrated, team based approach to patient care.  By adopting and implementing ERAS principles patients and their families will:

• Be more educated and engaged in their care and recovery
• Experience improved functional outcomes and reduced length of stay, complications and readmissions
• Be more satisfied with their care experience

The Change Package is available to download below.

New Zealanders suffering from chronic fatigue syndrome (CFS) are getting a greater chance to fight the illness in Wellington.

Now a new pathway developed by clinicians at Capital & Coast District Health Board (CCDHB) will allow separate specialties to work closely together to help the patient recover.

CFS affects between 10,000 and 20,000 people of all ages, socioeconomic and ethnic groups in New Zealand, on average it effects a patient’s life for between three and five years.

“It’s an overwhelming sense of fatigue, where a person’s everyday function is impacted,” clinical psychologist Matthew Leaver says.

The new pathway allows physiotherapists and psychologists to work separately with the patient, but each is then able to share relevant information with the other.

Leaver says the specialties work well together to speed up the recovery process.

“We deal with the psychological effects of having CFS and motivate people to get involved with physiotherapy,” Leaver says.

The physiotherapy programme involves stabilising the patients physical activity, followed by gradual planned increases which extends their physical functioning beyond their current ability Physiotherapist Vanessa Simpson says the new plan is helping patients feel stronger and healthier and more in control of their situation.

“One patient said to me following completion of the programme she now likes exercise as opposed to fearing it.”

One patient said she could really see the benefits and can now “walk for thirty minutes”, whereas five minutes was a major struggle before.

Physiotherapy clinics are being run in Wellington, Kenepuru and Kapiti.

The DHB has a number of initiatives in place to help ensure Lakes patients get the coordinated and timely care they need throughout the cancer pathway.

To read the full case study on the Ministry of Health website, go to:  http://www.health.govt.nz/our-work/diseases-and-conditions/cancer-programme/faster-cancer-treatment-programme/faster-cancer-treatment-case-studies/systems-improvement-faster-cancer-treatment-lakes-dhb

The authors draws on three years' development work with leaders in health care systems in north-west England, which has adopted a 'discovery' approach to developing integrated care and the leadership capabilities supporting it.

The paper is available to download and read in free full text at: http://www.kingsfund.org.uk/publications/system-leadership

Fillingham, D. & Weir, B. (2014). System leadership: Lessons and learning from AQuA's Integrated Care Discovery Communities. London: King's Fund.

He thought it was probably piles or something minor but decided to see his GP, who referred him for a sigmoidoscopy which could show what was going on in his lower bowel. The investigation at Princess Margaret hospital 2 weeks later confirmed a rectal tumour and was the beginning of Norm’s ‘cancer pathway’ – a journey that would continue for the rest of the year.

To read the full case study on the Ministry of Health website, go to: http://www.health.govt.nz/our-work/diseases-and-conditions/cancer-programme/faster-cancer-treatment-programme/faster-cancer-treatment-case-studies/cancer-pathway-one-patients-experience

New initiatives are improving the timeliness of diagnosis and treatment, as well as improving the support provided to patients and their families.

The introduction of cancer care coordination by a specialist nurse and the implementation of the DHB’s Faster cancer treatment project has allowed a fresh look at systems and clinical pathways.

To read the full case study on the Ministry of Health website, go to: http://www.health.govt.nz/our-work/diseases-and-conditions/cancer-programme/faster-cancer-treatment-programme/faster-cancer-treatment-case-studies/systems-improvement-faster-cancer-treatment-wairarapa-dhb

Ten prospective studies (2286 survivors) were included (5 randomised controlled trials). Several models of survivorship care plans (SCP) were evaluated (paper based/on-line, oncologist/nurse/primary-care physician-delivered and different templates). The authors found very few measurable benefits of SCPs (survivor distress, satisfaction with care, cancer-care coordination or oncological outcomes) in randomised controlled trials. However, survivors reported high levels of satisfaction with SCPs. The authors also note that resource issues were identified as a significant barrier to implementation.

To read the full abstract, and for information on how to access the full text, go to: http://dx.doi.org/10.1038/bjc.2014.505 or contact your DHB library, or organisational or local library for assistance.

Brennan, M.E., et al. (2014). Survivorship care plans in cancer: A systematic review of care plan outcomes. British Journal of Cancer, 111, 1899-1908.

To read the story in full text, go to the Nursing Review website: http://www.nursingreview.co.nz/issue/october-2014-vol-14-5/helping-children-survive-and-thrive/#.VFk2U_mUcXw

Twenty-seven systematic reviews were identified; conditions included chronic heart failure (CHF; 12 reviews), diabetes mellitus (DM; seven reviews), chronic obstructive pulmonary disease (COPD; seven reviews) and asthma (five reviews).

Most reviews covered comprehensive services across the care continuum or standardization of care through inter-professional teams, but organizational culture, governance structure or financial management were rarely assessed. A majority of reviews found beneficial effects of integration, including reduced hospital admissions and re-admissions (in CHF and DM), improved adherence to treatment guidelines (DM, COPD and asthma) or quality of life (DM). Few reviews showed reductions in costs.

The authors conclude that the systematic reviews of integrated care programmes were of mixed quality, assessed only some components of integration of care, and showed consistent benefits for some outcomes but not others.

This is an open access article and is available to read in free full text at:  http://dx.doi.org/10.1093/intqhc/mzu071

Martínez-González, N.A., et al. (2014). Integrated care programmes for adults with chronic conditions: A meta-review. International Journal for Quality in Health Care, 26(5), 561 - 570.

• Publication: National patient survey: Results for patients treated in August 2014 
  

They undertook a mixed-methods prospective observational study of 12 MDTs in the London and North Thames area, covering cancer, heart failure, mental health and memory clinic teams. Data were collected by observation of 370 MDT meetings, completion of the Team Climate Inventory (TCI) by 161 MDT members, interviews with 53 MDT members and 20 patients, and review of 2654 patients’ medical records. 

Based on the results, they conclude that substantial diversity exists in the purpose, structure, processes and content of MDT meetings. Greater multidisciplinarity is not necessarily associated with more effective decision-making and MDT decisions (as measured by decision implementation). Decisions were less likely to be implemented for patients living in more deprived areas.

The authors identified 21 indications of good practice for improving the effectiveness of MDT meetings. These related to the purpose of the meetings (e.g. that agreeing treatment plans should take precedence over other objectives); meeting processes (e.g. that MDT decision implementation should be audited annually); content of the discussion (e.g. that information on comorbidities and past medical history should be routinely available); and the role of the patient (e.g. concerning the most appropriate time to discuss treatment options). 

Priorities for future work include research to examine whether or not the 21 indications of good practice identified in this study will lead to better decision-making; for example, incorporating the indications into a modified MDT and experimentally evaluating its effectiveness in a pragmatic randomised controlled trial. 

This article is available to read in free full text at: http://dx.doi.org/10.3310/hsdr02370

Raine R, Wallace I, Nic a’ Bháird C, Xanthopoulou P, Lanceley A, Clarke A, et al. (2014). Improving the effectiveness of multidisciplinary team meetings for patients with chronic diseases: a prospective observational study. Health Services Delivery Research, 2(37),

Health Minister Jonathan Coleman has announced the formation of a new steering group to explore optimising the role pharmacists play in community health care.

“Pharmacists are highly skilled and I want to ensure we are realising their potential as we move towards a more integrated health service,” says Dr Coleman.

The Pharmacy Steering Group will help develop clear priorities for pharmacy and provide advice to the Ministry of Health on how the role of pharmacists can be maximised.

"This Steering Group will tap into the good work already happening in pharmacy at a local and national level and make sure innovative solutions are widely disseminated,” says Dr Coleman.

“One of the priorities for the group will be to promote integration of pharmacy with other health care services to help cope with the challenges of an ageing population, increased demand for health care and increased prevalence of long term conditions.

“We need to do all we can to ensure coordinated care for patients and to encourage stronger links between services, whether in hospital or in the community. The pharmacist’s expert knowledge in medicine management can play a key part in that.

"This is a hugely positive step for pharmacy as a whole and I look forward to seeing the practical benefits of this work in action.”

The Steering Group, which met for the first time yesterday, includes representatives from community and hospital pharmacists. The group is co-chaired by Cathy O’Malley, the Ministry’s Deputy Director General of Sector Capability and Innovation together with a DHB representative.

Seven articles were included, and a statistically significant decrease in amputation rates following the implementation of an MDFC was reported in five out of the seven studies. However, the authors note that there are "... large flaws in the methodological designs of these studies. The literature does suggest there is a great advantage to using MDFCs to decrease amputation rates in high-risk patients. However, without strong literature to back up this delivery approach, it cannot be regarded as evidence-based. Thus, further study must be performed, focusing on improving research protocols to achieve strong evidence to consolidate the use of MDFCs".

To read the full abstract, and for information on how to access the full text, go to: http://search.informit.com.au/documentSummary;dn=668262697809950;res=IELHEA or contact your DHB library, or organisational or local library for assistance.

Quinlivan, E; Jones, S; Causby, R and Brown, D. (2014). Reduction of amputation rates in multidisciplinary foot clinics - a systematic review. Wound Practice & Research: Journal of the Australian Wound Management Association, 22(3), 155-162. 

Specialist knowledge is too concentrated in hospitals to the detriment of patients, whose increasingly complex needs should be treated closer to home, a report finds.

The report is based on detailed research with six case studies working in new ways to deliver care outside hospital. It found a pressing need to develop new roles for hospital consultants who should spend more time working outside hospitals in multidisciplinary teams with primary, community and social care colleagues. One of the strongest messages in the report is that this should include supporting and training other health and care professionals to enable them to provide more specialist services closer to people’s homes.

The report found that this approach can lead to better patient experience, improve management of chronic conditions and reduce waiting times, although it is unlikely to deliver significant cost savings. Spreading these ways of working will require significant change and needs commitment across the local health and care system. To make this a reality, the report makes a number of recommendations.

• National and local commissioners must develop new funding models that motivate hospitals to keep activity out of their clinics. Current incentives, like Payment by Results, can act as a barrier to developing integrated care by incentivising activity in hospitals.
• GPs and practice nurses will need to take on extended roles and provide more specialist care in their surgeries. This will require initial investment to increase capacity in primary care but may relieve pressure in the long term by improving diagnosis and treatment.
• Consultants and commissioners should develop strong partnerships to drive forward service change. Commissioners must act as a bridge between local organisations, consult with stakeholders and pilot new approaches. 
• Transition funding should be made available to allow services to be piloted, evaluated and refined. 
• Robust economic evaluation data must be collected on the impact of hospital service models across the whole local health system. 
• New services must provide placements for trainee doctors to prepare them for working in different settings in a more integrated care workforce.

Ruth Robertson, Fellow at The King’s Fund said: ‘Our research uncovered great examples where hospital consultants working with their colleagues outside hospital has improved patient care. Implementing this new way of working is a challenge when budgets are constrained, the acute care workforce is focused on delivering consultant cover in hospital seven days a week and general practice is functioning under severe pressure. However, doing so offers enormous benefits to patients and brings the vision of a more integrated NHS that bit closer.’

The King’s Fund visited six services where consultants are delivering or facilitating care outside hospital. This report presents the findings from those visits as case studies. It identifies key characteristics and challenges to this way of working and seeks out evidence of the benefits to patients and the NHS more broadly".

The case studies are as follows:

• Portsmouth and South East Hampshire diabetes service
• Leeds interface geriatrician service 
• Imperial child health general practice hubs 
• Sunderland dermatology and minor surgery service
• Haywood rheumatology centre
• Whittington respiratory service

The report is available to read in full text at: http://www.kingsfund.org.uk/publications/specialists-out-hospital-settings

Read the related media release: http://www.kingsfund.org.uk/press/press-releases/consultants-need-spend-more-time-outside-hospital-report-finds

Robertson, R., et al. (2014). Specialists in out-of-hospital settings Findings from six case studies. London: King's Fund.

Central PHO and Manawatu Horowhenua Tararua Diabetes Trust have signed a Memorandum of Understanding (MoU) to work together on improving the care of people with pre-diabetes and diabetes across the MidCentral district.

This understanding will help achieve several key goals. It will:

• assist general practice teams with implementing their diabetes improvement plans
• support the development of diabetes Quality Improvement Framework for the district
• support the implementation of Diabetes related Collaborative Clinical Pathways
• streamline the district’s approach to self-management support programmes

Both organisations have a complimentary range of skills and experiences and acknowledge working collaboratively will have positive and desirable impacts on the care of people with diabetes.

Adrian Broad, Trust Manager, MHT Diabetes Trust believes it is important for organisations such as his to be working together to meet the challenges of diabetes.

He said: “Working in isolation is not an option for health providers these days. We’re really looking forward to the benefits of both organisations working closely together, which will result in better outcomes for people with diabetes and their families. It’s a very exciting and positive innovation.”

Chiquita Hansen, CEO Central PHO is delighted to be working in partnership by aligning resources to assist general practice teams to deliver on their recently developed Diabetes Improvement Plans.

She said: “This is a great outcome for everyone. By joining forces we have the best chance of supporting people living with diabetes.”

The theme of the meeting is: Integrated Care: Leading the way in clinical practice. The integrated care theme was conceptualised due to the changing role of the radiologist and radiation oncologist in the clinical setting. 

For further information about this event, go to: http://www.ranzcr2015.com/

“The holistic approach found in Māori understandings of health has major implications for modern societies and the increasing complexities that shape health and wellbeing,” Dr Durie said in his keynote address.

To read the full media release from the Public Health Association, go to: http://www.scoop.co.nz/stories/GE1410/S00026/maori-lead-the-way-with-health-solutions.htm

Based on their findings, the authors conclude that "the presence of an orthogeriatric service was associated with a reduction in 30-day mortality but a longer LOS". They recommend further research to investigate the key aspects of care that determine health outcomes. 

This article can be read in free full text at: https://www.mja.com.au/journal/2014/201/7/orthogeriatric-services-associated-lower-30-day-mortality-older-patients-who

Zeltzer, J., et al. (2014). Orthogeriatric services associated with lower 30-day mortality for older patients who undergo surgery for hip fracture. Medical Journal of Australia, 201 (7), 409-411.

Southern DHB is introducing a District wide Palliative Care Model which means the referral process for palliative care will be the same at Southland Hospital as Dunedin Hospital.

In Dunedin the Palliative Care Advisory Service (PCAS) was established in 2006 and is supported by Palliative Care Clinical Nurse Specialists, Helen Sawyer and Gayle Elliott and Dr Brendon Rae (Palliative Medicine Physician) who are based at Dunedin Hospital.

The service in Southland historically has been a joint model between Hospice Southland and the DHB.

To introduce the new model of care in Southland Hospital, Southern DHB has welcomed Leah Cavanagh into her new role as full time Palliative Care Nurse based at the Hospital.  Leah who was formerly a Cancer Nurse Co-ordinator at Southland Hospital will support palliative care in the inpatient setting in Southland Hospital. Leah will officially begin taking referrals from 6th October 2014.

 “The aim of a hospital based specialist palliative care service within the Southern DHB is to incorporate a palliative care approach into the provision of a quality service which meets the needs of the patients, families and staff in all services and departments,” said Southern DHB Palliative Care Clinical Nurse Specialist, Helen Sawyer.

The Palliative Care Advisory nursing teams receive referrals at each site and provide advice on management and care planning as requested by the referring team, and when required Dr Rae and the Hospice medical teams provide assessment support and advice. The focus is on the hospital inpatient population, whilst the Hospices focus on the community.

The service supports integration of pharmacist services for the patient between community pharmacy, community-based services, general practice and secondary care. 

This project is a partnership project with Midlands Health Network and the Midland Community Pharmacy Group (MidCPG) for the development and implementation of the role of the Tokoroa Clinical Pharmacist. 

To read the report for the period 1 February to 31 July 2014, go to: https://www.midlandshn.health.nz/publications/tokoroa-clinical-pharmacists-service-report

In August 2013, the project asked Porirua what activities would make a difference to:

• reduce the number of people being admitted to hospital for Ambulatory Sensitive Conditions (ASH) that could be better prevented or managed in the community; and
• reduce the number of people attending the Wellington Regional Hospital Emergency Department
• (ED).

These activities were set out in the Tumai Hauora ki Porirua Action Plan. This report provides an update
on what where, how and with whom this work has been done. 

The report back to the community on Year One of the Porirua Social Sector Trial can be read in full text at: http://www.compasshealth.org.nz/Portals/0/Publications/Porirua%20SST/PSST_Annual_Update_2014.pdf

To read more about the project, go to: http://www.hiirc.org.nz/page/42337/

The study was undertaken between 2011 and 2013 in two English health-care systems, each comprising an acute health-care provider, community and primary care providers, local authority social services and social care agencies. 

The study involved in-depth ethnographic research in the two sites (combining observations of discharge processes and knowledge-sharing activities, focused ‘patient tracking’ to trace and understand discharge activities across the entire patient journey, and qualitative interviews with 169 individuals working in health, social and voluntary care sectors.

The study reinforces the view of hospital discharge as a complex system involving dynamic and multidirectional patterns of knowledge sharing between multiple groups. The study shows that discharge planning and care transitions develop through a series of linked ‘situations’ or opportunities for knowledge sharing. It also shows variations in these situations, in terms of the range of actors, forms of knowledge shared, and media and resources used, and the wider culture and organisation of discharge.

The study also describes the threats to patient safety associated with hospital discharge, as perceived by participants and stakeholders. These related to falls, medicines, infection, clinical procedures, equipment, timing and scheduling of discharge, and communication. Each of these identified risks are analysed and explained with reference to the observed patterns of knowledge sharing to elaborate how variations in knowledge sharing can hinder or promote safe discharge.

The study suggests four areas of change that might enhance knowledge sharing, reduce system complexity and promote safety. First, knowledge brokers in the form of discharge co-ordinators can facilitate knowledge sharing and co-ordination; second, colocation and functional proximity of stakeholders can support knowledge sharing and mutual appreciation and alignment of divergent practices; third, local cultures should prioritise and value collaboration; and finally, organisational resources, procedures and leadership should be aligned to fostering knowledge sharing and collaborative working. 

To read the report in full text, go to:  http://dx.doi.org/10.3310/hsdr02290

Waring J, Marshall F, Bishop S, Sahota O, Walker M, Currie G, et al. (2014). An ethnographic study of knowledge sharing across the boundaries between care processes, services and organisations: The contributions to safe hospital discharge. Health Services and Delivery Research, 2(29).

Southern nurse-led health clinics are being piloted thanks to Ministry of Health funding (Te Ruinga - spreading proven innovations) combined with Southern DHB and Southern PHO support.

“Everybody is extremely excited that we have been given the opportunity to deliver Nurse-Led clinics. Progress and interest to date is encouraging as we move to providing increasingly integrated and coordinated health services within Māori communities,” said Southern DHB District Manager Māori Health, Pania Coote.

The Clinics will provide and facilitate a range of health and social services for Dunedin, Central Otago, East and North Otago, Bluff, South Invercargill, Gore and Mataura communities, and are being led by Māori Health Providers across the Southern district.

Nadine Goldsmith (Southland based) and Lorna Scoon (Otago based) have been appointed as the nursing leads for the clinics, and both are currently both working towards becoming Nurse Practitioners.

“The funding for these clinics also provides a fantastic opportunity for the nurses in the roles to have the financial, professional and clinical support available to assist them to become Nurse Practitioners. On completion of their training, having two Nurse Practitioners working within the different Māori communities will provide a great opportunity to improve patient outcomes,” said Southern Primary Health Organisation Nurse Director, Wendy Findlay.

What makes these clinics unique is that they are shaped by community needs, they link the whānau into community and GP services whilst responding to the vision of Whānau Ora.

“We are committed (primary, secondary and community) to work effectively together to establish Nurse-Led clinics across the Southern district, utilizing our combined resources to jointly make a difference in reducing health inequalities and enhancing quality of life, ” said Pania.

Māori Health Providers, Kāi Tahu ki Otago Limited and Awarua Social and Health Services are both working in collaboration with the following partners to deliver the community based service:

Tokomairiro Waiora Inc.
Tumai Ora Whānau Services
Uruuruwhenua Health
Te Hou Ora Otepoti Inc.
Waihōpai Rūnaka Inc.
Hokonui Rūnanga Health & Social Services Trust

Chris Rosenbrock, Manager, Kāi Tahu ki Otago Limited, commented that “these partners provide pathways for clinics to happen within their communities and the kaupapa for each clinic is determined by the community.”

The clinics are free and Patricia (Trish) Young, Kaihautu – CEO, Awarua Social & Health Services said that she was “excited about the availability of free Marae based health clinics for whānau in Bluff, Hokonui, Mataura, Waihōpai and South City. Working collaboratively with Rūnanga across Murihiku will ensure that we capture whānau to improve access to health services and develop better pathways for them into other primary health care providers.”

The book is divided into 15 sections, which include: decision support systems and clinical practice guidelines; improved healthcare through informatics; data analysis; mobile health; technology and system evaluation; and text mining. The final two sections present posters from the conference.

This e-book is open access and the content can be downloaded and read in full text at: http://ebooks.iospress.nl/volume/e-health-for-continuity-of-care-proceedings-of-mie2014