Aim

To deliver a new program allowing patients the choice of being cared for at home or through a day clinic with a shared care arrangement with the admitting doctor.

Benefits

• Improved patient experience and health outcomes
• Providing people who may have previously been admitted to hospital with the opportunity to receive care in their home or in a day clinic
• Reducing avoidable hospital admissions
• Reduction in cost per capita.

Project status

Pilot commenced August 2014.

Background

Western NSW LHD is working to reduce avoidable hospital admissions, with LHS given a reduction target of 0.8% for the 2013/2014 period. Chronic Obstructive Pulmonary Disease (COPD) is the largest avoidable admission category.

LHS Redevelopment provides the opportunity to co-locate acute, community and allied health services in Forbes and Parkes. Contemporary models of care can result in better health outcomes, improved patient/carer experience and a reduction in cost per capita. It also contributes to the Local Health District Integrated Care Strategy.

Solutions implemented

1. Shared Care Model of Hospital in the Home
2. Patient Management Plans/COPD Guidelines and Action Plans.

Results

1. Auditing of community based nurses with COPD Patient Management Plans. An increase from 28% to 67% of management plans completed
2. Commencement of a Model of Care trial on 4 August 2014
3. Increase in referrals from General Practitioners (GPs) / Visiting Medical Officers (VMOs).

Lessons learnt

• Organisational climate has impacted on the project, due to the momentum of the local health service redevelopment
• Staff acknowledgement of the positive impact of acute and community services working together to improve the patient experience
• Integration of acute and community based services in rural health care setting with limited resources.

Implementation sites

A pilot project commenced in Parkes in August 2014. Future expansion of the project to Forbes by September 2015.

Partnerships

NSW Ministry of Health, Local GPs/VMOs, WNSW LHD Redesign and Innovation Leaders.

Reference

NSW Health. (2013). NSW Hospital in the Home (HITH) Guideline: GL2013_006.

Contact