Transcript Enabling quality and information in primary care

Enabling quality in primary care
The purchaser role
ACC’s Primary Care Programme
• ACC purchasing of primary care is changing
• Current purchasing methods (fee for service)
are passive and enable few incentives for
greater quality or innovation
• Primary care chief executives met with ACC
last year to agree a programme of change
• Pilots will test opportunities for improvement
New purchasing framework
• The ACC purchasing framework will define the
type of change:
• Relationship based
• Mutually beneficial
• Cooperative, based on agreed outcomes, service
development and risk sharing
• Value driven
• Based on both cost and quality
• Accountability/Development
• Provider monitoring and evaluation
• Performance feedback
• Timeliness
• Every day off work means payment for income
replacement
Purchasers can play a major role
in the search for quality
• Four step cycle
Two examples
• ACC has recently worked with anaesthetists to
co-design a pre-operation assessment process
to improve quality.
• Problem raised in ACC/Anaesthetists liaison
meetings
• Patient co-morbidities, medications, allergies,
lifestyle issues relevant information for
improving quality of service
• Questionnaire use now mandatory for ACCcontracted anaesthetists
Time off Work Certification
• ACC has been working with Lake Taupo PHO to
review certification patterns by local general
practitioners and to design a way to improve
them
• Use of clinical evidence about benefits of
recovery of work, support for liaison with
employers and performance based contract
with incentives for quality practice
Clinical Evidence
• COHE Initiative Washington State – 2004
• 33% less likely to miss work
• Systematic Review of Quantitative Literature –
2005 Canada
• work based RTW interventions can reduce
work disability duration
Clinical evidence
• Vocational Rehabilitation – What Works, for
Whom, and When?
Waddell, Burton, Kendall 2008:
• “The advice and management given in primary
care has a major and lasting impact on the
individual’s (and their family’s and employer’s)
beliefs about the health condition and how it
should be managed”
General Practice
General practitioners:
• Play a key role in advising and supporting
patients about return to work
• Need to understand their patients’ work
situation
• Should appreciate that return to work is an
important outcome for clinical management
Data-based targets
Data based targets
Monitoring and evaluation
• New focus on the monitoring of provider
performance through data collection and analysis
• ACC has used payment data in the past
• Not fit for purpose
• Designing monitoring frameworks with providers
in the future will enable ACC to better provide
feedback and support quality improvement in
general practice