The Southern NSW Local Health District (SNSWLHD) Osteoarthritis Chronic Care Program (OACCP) provides access to conservative care for people with osteoarthritis, before or while they wait for elective joint replacement surgery.
It services the Bega Valley area and operates out of the South East Regional Hospital in Bega. The program aims to optimise the health and physical condition of the individual before surgery. It is delivered by a multidisciplinary team, led by physiotherapists. It includes exercise and nutrition education sessions that can be delivered:
- individually
- in a group setting
- with virtual care support.
The OACCP captures feedback from patients via patient-reported measures (PRMs) surveys. 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 measures workflow
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Allied Health Assistant (AHA) registers patient via the Health Outcomes and Patient Experience (HOPE) platform.
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AHA allocates survey set to patient.
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AHA completes surveys with patient.
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AHA documents patient's survey results in eMR.
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Clinician reviews the patient's survey results.
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Clinician discusses survey results with patient.
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Clinician works with patient to define patient goals.
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Clinician provides patient with a referral via the relevant referral pathways.
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PRMs are repeated every three months.
Consumer story
Fran*, a 62-year-old female with rheumatoid arthritis, was waiting for a total right knee reconstruction. Fran’s treating team collected the Oxford Knee Score (OKS) and PROMIS-29 surveys every three months.
Early results and clinical assessment indicated a requirement for surgery. However, Fran didn’t want surgery due to family commitments and existing co-morbidities. She decided to focus on lifestyle improvements such as healthy eating, exercise and weight reduction.
Over 12 months, the outcomes of these goals were highlighted by the PROMIS-29. It identified that her pain was decreasing and that her physical function, anxiety, depression and fatigue were improving. Fran’s OKS dropped from severe to moderate.
*Name has been changed for patient privacy.
Benefits of patient-reported measures
Benefits for the patient
- By tracking longitudinal PRMs data measures over time, clinicians can identity patient progress, assess the need for surgery or help support the use of exercise, good nutrition and weight management, if more appropriate.
- Patients that access the OACCP often present with high stress, high pain and low function. PRMs surveys help to identify patient expectations and facilitate conversations about wholistic care.
- The health domains within the PROMIS29 survey provide a great conversation starter between patients and the clinicians. The PROMIS29 provides a gentle way of initiating conversations that have the potential to be hard or confronting for the patient.
Benefits for the service
- The use of PRMs within SNSWLHD is driving a culture of partnering with patients. PRMs ensure consumers are involved in the planning, design, delivery and evaluation of systems and services.
Benefits for the organisation
- OACCP coordinators present annually to the district Patient Safety and Quality Committee and share learnings at multidisciplinary team meetings.
Helpful tips for other services
Identifying key roles and responsibilities across the team is a critical enabler for leveraging a whole-of-team approach when embedding PRMs into the service.
Clinician knowledge of local referral pathways is vital to ensuring patients receive the right care, at the right time.
Investing in the education of administration teams improves the uptake of PRMs. These teams can help patients to understand the purpose of the PRMs program and the ‘what’s in it for me’.
Clinical engagement approach
In 2020, PRMs Program Managers within SNSWLHD engaged OACCP clinicians to support them with service mapping and the implementation of PRMs. The OACCP collected PRMs on paper before moving to HOPE in September 2021. As the program evolved, the PRMs program managers continued to support the OACCP to embed PRMs within their care model.
The OACCP clinicians have continued to collaborate with the PRMs program managers since implementation in 2021. The clinicians have optimised survey tools with their clients to develop appropriate and individual goal setting within the program.
The AHAs were fundamental to establishing a clear and consistent workflow where patients completed the surveys as part of their initial assessment and at ongoing appointments. Clinicians were then able to access and review the information to provide appropriate advice and clinical support.
Organisational structure
Governance
The PRMs Project Officers work within the SNSWLHD’s Clinical Governance Unit as part of the Patient Experience Team . There are several regular district level meetings that require updates and reports connected to PRMs, including the SNSWLHD Patient Safety and Quality Committee. A bi-monthly SWSLHD and Agency for Clinical Innovation PRMs steering committee governs the PRMs program. The regular meetings enable active input from committee members including consumer representation.
PRMs project officers use regular opportunities within the LHD to provide updates, reports and education to a variety of stakeholders. These initiatives provide insight into the PRMs program and showcase the benefits the program may provide to clinicians and services throughout the district. There is a dedicated PRMs myHub page available to all staff in SNSWLHD that provides necessary information on the program and contact details of the PRMs project officers.
Acknowledgements
We acknowledge and thank the following for their participation in this project:
- Monique Strelnikow, Osteoarthritis Chronic Care Program Coordinator
- Emily Guy, Patient Reported Measures Program Manager
- Narelle McDevitt, Patient Reported Measures Program Manager
- Peter Leach, District Director Nursing, Midwifery and Clinical Governance
- Kate Carpenter, Deputy District Director Clinical Governance
- Terence Joe, Patient Experience Manager
- Natalie Nicholls, Patient Reported Measures Project Officer