Transcript Taylor Myers

New Zealand Cardiology Wards
and Adventures
Taylor Myers Locke
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New Zealand Healthcare System
Cardiovascular care in New Zealand
Identifying cardiovascular at-risk populations
Improvements in the Cardiovascular Healthcare delivery
Comparison to Kansan’s health
Kansas Heart and Stroke Collaborative: understanding,
identifying, and comparison
• New Zealand adventures
Objectives
• Funded by public, private and nongovernmental sectors
• Tax resources provided 83 percent of healthcare
• Improvement needed
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Rural
Asian, Pacific Islander,
Maori adult population
Systematic care
New Zealand Healthcare Model
www.moh.govt.nz
• Non-profit boards made of a combination of elected,
appointed and Maori representatives
• responsibility of healthcare planning, funding and
implementation is broken up geographically
• High degree of autonomy
• Not all created equal
District Health Boards
http://www.whyora.co.nz/Understanding-health/Health-Systems/
Auckland City Hospital
• Heart disease accounts for 30 percent of national
mortality
• Increasing admission rates for ACS and AMI
• Multidisciplinary approach to heart failure treatment
State of New Zealand
Cardiovascular Disease
Elliott J and Richards M.
• Comprise 15% of New Zealand’s population
• CV disease (CVD) is highest
• Coronary Artery Disease Death occurs on average a decade
earlier
• < 65 in 45 % of Maori population vs 11% in non-Maori
• Increased CVD risk factors
• Smoking, hypertension, diabetes mellitus
Maori Population
Whalley GA, et al.
http://www.businessinsider.com.au/jimmy-nelsons-tribal-photos-before-they-pass-away-2014-2
• Started in 2002, aimed to improve ACS outcomes
• Identified weaknesses with rural and Maori populations,
50% less investigations and revascularization procedures
in certain DHBs
• The 2012 audit recognized gaps in access to
echocardiography, cardiac angiography, and delays in
care at non-intervention centers
ACS NZ Audits and
Improvements
NZACS SNAPSHOT Audit Group
• Large rural population resulting in lack of access
• Coronary heart disease mortality rates have decreased at
national and state level
• Highest mortality rates in rural Kansas
• CAD risk factor rates have increased
• Diabetes mellitus, obesity, hypertension
Comparison to Kansans?
Kansas Department of Health and Environment
• Transforming model of care for heart and stroke disease,
in areas traditionally with limited access
• Preventative and post event care managed by care
managers and health coaches within the community
• Developing shared clinical guidelines, and EMRs
Kansas Heart and Stroke Collaborative
Ranney, Dave.
• Combining preventative to quaternary care (like the
DHBs in New Zealand)
• Shared Clinical Guidelines
• Community healthcare providers to help manage patient
with diagnosis and discharge
• Heart failure nurse managers in New Zealand
• No national EMR and poor information exchange
Key Contrasts
• Young Pacific Islander immigrants or Maori population
hospitalized for CV disease
• Reasonable expectations for disease state and end-of-life
• Conscious of ordering unnecessary tests and procedures
• Long wait time for specialist care and work up
• Heavily dependent on general practitioner
Kiwi Healthcare Culture
http://www.kiwibird.org/
• Mr. S had right sided heart failure with subsequent end
stage liver disease requiring Lasix drip, followed by
pressor support
• Family highly involved in care
• Stayed on cardiology ward throughout stay, never in CCU
or MICU
• My work up and management differed
• Maybe less is more?
Clinical Experience
• New Zealand health infrastructure is evolving, but well
managed and providing quality care throughout the nation
• New Zealander’s struggle with cardiovascular risk factors
and disease, especially the Maori population
• Community support and standardization throughout New
Zealand is a model that is loosely reflected in the Kansas
Heart and Stroke Collaborative
• Clinicians should be open to change and challenged to
provide the best care possible
Conclusions
Sometimes, you have to jump
… and enjoy the view
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New Zealand Health System Review. Health Systems in Transition, World Health Organization, Vol.4 No. 2. 2014.
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Whalley GA, et al. Higher prevalence of left ventricular hypertrophy in two Māori cohorts: findings from the Hauora
Manawa/Community Heart Study. Australian and New Zealand journal of public health. 2015-01-05;n-a-n/a.
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Elliott J, Richards M. Heart attacks and unstable angina (acute coronary syndromes) have doubled in New Zealand since 1989:
how do we best manage the epidemic? N Z Med J. 2005;118 (1223).
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New Zealand Acute Coronary Syndromes (NZACS) SNAPSHOT Audit Group. The management of acute coronary syndrome
patients across New Zealand in 2012: results of a third comprehensive nationwide audit and observations of current
interventional care. N Z Med J. 2013 Dec 13;126(1387):36-68.
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Ranney, Dave. "Moser to Lead Heart Disease, Stroke Collaborative at KU Hospital - See More At:
Http://www.khi.org/news/article/moser-lead-heart-disease-stroke-collaborative/#sthash.Zik3k6bG.v6EtJs8Y.dpuf." Kansas
Health Institute. 5 Dec. 2014. Web. 24 Mar. 2015.
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"Working Together for a Healthy Kansas: Kansas Action Plan for Heart Disease and Stroke Prevention, 2012-2017." Kansas
Department of Health and Environment. Heart and Stroke Alliance of Kansas, 1 Apr. 2013. Web. 24 Mar. 2015.
<http://www.kdheks.gov/cardio/download/CVH.pdf>.
References