The Respiratory Ambulatory Care (RAC) at Western Sydney Local Health District (WSLHD) is a multidisciplinary, multisite service, providing care for patients with chronic respiratory disease.
The service provides:
- comprehensive multidisciplinary assessment clinics
- pulmonary rehabilitation
- ongoing support for patient self-management, including a 24-hour helpline, weekly text message service and monthly newsletter.
Pulmonary rehabilitation is an outpatient service that includes an initial assessment followed by a course of 16-24 outpatient treatment sessions. Patients then attend a follow-up clinic prior to discharge. Pulmonary rehabilitation services are provided in WSLHD at Westmead, Blacktown and Mt Druitt hospitals.
The service has been collecting patient-reported measures (PRMs) on paper since it was established in 2001. This includes patient-reported outcome measures (PROMs) that help to inform consultations and care planning, response to treatment regimens and when patients require referrals to the multidisciplinary team and other services.
Patient-reported experience measures (PREMs) help to identify any areas for further review and improvement, and aid in the evaluation of service delivery. The service moved to the Health Outcomes and Patient Experience (HOPE) platform in March 2021 and added the Patient Reported Outcomes Measurement Information System 29-item Health Profile (PROMIS-29) quality of life tool.
Patient-reported measures workflow
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PRMs are assigned to patients at the time of registration to the service.
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Surveys are completed at the initial clinic visit on a paper form.
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Survey results are discussed in a multidisciplinary team meeting at the conclusion of clinic.
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Care planning is based on the survey results (aided by a decision support tool).
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Service contacts patient to discuss care planning and interventions based on survey results.
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Results and interventions are documented in a letter to patient's general practitioner (GP).
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PRMs are repeated at the conclusion of pulmonary rehabilitation.
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Results are discussed in a multidisciplinary team meeting at the conclusion of the clinic.
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Service contacts patient to discuss care planning and interventions based on survey results.
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Results and interventions are documented in a letter to patient's GP.
Consumer story
Irene*, a 76-year-old female, attended the RAC service for her initial assessment. She had a history of COPD, minor coronary artery disease and hypertension. Irene completed HOPE surveys at her initial clinic visit (PROMIS 29, SGRQ and CAT). High scores on questionnaires included a physical function score of 9 and pain interference score of 8 on the PROMIS 29; and symptoms score of 57.7 and activity score of 92.5 on SGRQ. CAT was also noted to be 17 (higher scores in breathlessness, limited activities and low energy).
Irene was enrolled in pulmonary rehabilitation, which is known to improve health-related quality of life and physical function. Staff also concentrated on helping Irene develop skills to manage breathlessness and fatigue. Irene completed 18 exercise sessions and nine education sessions. Irene completed surveys (along with other outcome measures) post-program. The service was able to easily document Irene's improvements using her outcome measures, show them to her, and report them to her GP, referring respiratory physician and cardiologist.
*Name has been changed for patient privacy.
Irene’s quality of life has improved as shown by a reduction of more than 4 points on her St George Respiratory Questionnaire. Irene’s other PROMs showed an improvement in fatigue and pain interference, including an improvement of 1 standard deviation of 5 points on the PROMIS-29. Irene also achieved her personal goal of improving her breathlessness level.
Benefits of patient-reported measures
Benefits for the patient
- PRMs improve patient care by allowing patients to tell clinicians what matters to them. Clinicians are then able to pinpoint areas of concern for patients and provide proper support and referrals.
- Although RAC's comprehensive assessment process has always included PRMs, formalising and embedding PRMs in the clinic process by contacting patients to discuss results has reassured both patients and staff that the assessment process is identifying issues. The clinician addresses these issues throughout the treatment sessions.
- This also leads to better communication with GPs, as the clinician documents the results of PRMs in patient clinic letters, ensuring continuity of care.
Benefits for the service
- PRMs have confirmed that our treatment model is addressing patient issues (improving symptoms, mood, social functioning etc). We will continue to monitor results and if we see new trends, we could potentially change our model to address issues as they arise, and/or use results to strengthen business cases to address shortfalls (e.g. funding for a clinical psychologist if anxiety is not responding to our treatments).
Benefits for the organisation
- The primary focus of PRMs data at WSLHD is at the patient level. In the RAC service, the team uses results to inform suggested treatment options, which are discussed with the patient over the phone. The results are also sent to the referring doctor and other members of the health care team, in addition to being included in progress notes in eMR.
- Experience measures data has been used to improve patient experience, an example being the provision of new bariatric treatment chairs in the High Risk Foot Clinic at Westmead as a result of patient feedback provided on experience surveys.
- The use of PRMs has grown steadily at WSLHD with strong engagement across Leading Better Value Care and Integrated Care services. The PRMs Leads approach eligible services and provide information sessions to encourage participation in the program. Leads present and provide reports to various forums and committees, providing visibility of program and encouraging involvement. Targeted information sessions on new features of HOPE as well as refresher drop-in sessions are run for existing HOPE users. Information is also available on the WSLHD intranet as well as a local PRM SharePoint site.
Helpful tips for other services
Adapt your standard processes to suit the individual service and patients.
Not all patients are able to manage the technology, so provide a flexible approach to survey collection.
Celebrate successes, no matter how small.
Clinical engagement approach
The WSLHD PRMs leads took a collaborative approach to the rollout of PRMs in the RAC service. They developed a close working relationship with the respiratory team pre and post launch to provide the following support:
- Engagement with clinical leads to highlight the advantages of HOPE, emphasising its potential to enhance patient care, streamline pathways, facilitate benchmarking, and pave the way for future integration with the Electronic Medical Record (eMR).
- Analysing workflows and collaborating to design a new process that incorporates PRMs into existing processes.
- Documenting business rules and workflows in a Quick Reference Guide, ensuring clarity and consistency in implementation.
- Providing just-in-time training through education sessions on PRMs, HOPE and using PRMs data effectively.
- Developing a tailored PROMIS-29 decision support tool for clinicians, including local referral pathways and valuable insights.
Organisational structure
Governance
The PRMs Steering Committee oversees the rollout of PRMs, headed by the PRMs Executive Sponsor and Sponsor, with representation from multicultural health, the patient experience team, analytics, digital health solutions and other key stakeholders from across the district. The PRMs Leads report bi-monthly to this committee on activity, successes and risks. Raising awareness of PRMs is achieved through networking with stakeholders across the endorsed cohorts. We also celebrate successes in district and facility publications and broadcasts.
Acknowledgements
We acknowledge and thank the following for their participation in this project:
- Mary Roberts, RAC Clinical Nurse Consultant
- Christiane Boehm, RAC Clinical Nurse Specialist
- Jasmin Ellis, Executive Sponsor, General Manager Integrated and Community Health
- Luke Taylor, Sponsor, A/District Director Allied Health
- Faiza Wajahat, District Manager, Value Based Healthcare
- Alison Warhurst, PRMs Project Lead
- Vanda Leonardo, PRMs Project Lead
- Leanna Chow, PRMs Project Officer