THE IMPROVEMENT CHALLENGE

How local health performance information creates opportunities to improve rural and remote health outcomes

Real Results: Meeting the challenge in Primary Health Care

Sharon Sweeney and Sue Scheinpflug West Moreton-Oxley Medicare Local Using data to prioritise efforts and resources to improve health outcomes in the West Moreton-Oxley region

West Moreton-Oxley Medicare Local’s Comprehensive Needs Assessment

 methodology – data and other evidence  prioritising needs  identifying strategies  planning and implementation – whole of organisational approach About WMOML The West Moreton–Oxley Medicare Local region is located in the western corridor of South East includes the local government areas of Ipswich, Lockyer Valley and parts of the Our region Scenic Rim, Somerset and local government areas.

Brisbane Using data to prioritise efforts and resources to improve health outcomes in the West Moreton-Oxley region CNA project stages

Assess Establish Plan Confirm need priorities priorities

Demography and Groups of Special Need Issues and Options Who’s in the region? - Impact of need - Options for addressing

Health Status Set Priorities How well are we? - In context of resources & likely effect – rank order response to need Health Services How many and where? CNA project stages

Assess need

Assess inequalities, demographic trends, special needs groups

Current health status/outcomes and health service utilisation

Service and capacity mapping

Stakeholder views on health concerns and capacity issues

Demography and Groups of Health Services Health Status Special Need How many and where? How well are we? Who’s in the region? Concepts and data from a variety of sources allows us to zoom in on specific locations and specific sub-groups

PHIDU Benchmarking our region

the West Moreton Oxley region was evaluated by comparison to either • all Medicare Locals (61 in total) • other similar Medicare Locals (seven that are referred to as Metro 3 Medicare Local peer group) • Queensland and Australian averages, and • (where available) trend data about the region.

PLUS: information from extensive consultations with stakeholders including community members, consumers and private, public and non-government service providers undertaken in February and March 2014. Benchmarking our region

less desirable

How do we compare on eighteen indicators against similar Medicare Local cohort (Metro 3)?

lower use less desirable

lower use less desirable

lower use less desirable

lower use less desirable

lower use Higher potentially avoidable deaths Lower life expectancy Higher barriers to seeing specialists less Adults overweight desirable Obese adults Adults who smoke daily

Higher rate of avoidable hospitalisations Lower rates of GP attendances Higher rate of adult admissions to hospital lower use Lower rates of specialist attendances Higher rate of adults visiting hospital Higher rates of allied health attendances A quick snapshot - Rapid population growth

• The current estimated resident population is 379,765 (30 June 2013) • It is projected to grow by more than 90% to 721,107 residents by 2031 – an annual rate of growth well above the projected Queensland rate. • Much of this growth will be in Ripley, Rosewood and the Ipswich eastern corridor (Bellbird Park- Brookwater, Springfield Lakes and Redbank Plains). Areas of socio-economic disadvantage

• a Indexkey of Relative determinant Socio-economic Disadvantage of health

51.7% of the WMOML region is categorised in the two lowest quintiles for socio-economic disadvantage. (Qld average is 40%) Developmentally vulnerable children

The AEDC results for children in the region are poorer compared to Queensland and Metro 3 Medicare LocalHigher peer group on the average negative percentages. indicators Most notably when looking at the proportion of children developmentally on track compared to the other 61 Medicare Locals nationally, children in the region rank very low in: • Physical health and wellbeing – 53rd • Social competence – 57th • Emotional maturity – 59th Lower on the positive • Language and cognitive skills – 61st. indicators WMOML chronic disease profile

There are specific locations with above average chronic disease indicators • Ipswich-Central • Ipswich East • Laidley • Darra-Sumner/Wacol Emergency Department presentations Identifying areas of greatest need Regionally specific understanding Qualitative data collection Quantitative data collection Population health data, service Interviews and focus groups utilisation data, capacity mapping

Qualitative data analysis Quantitative data analysis • Thematic analysis • Data analysis to identify hotspots, • Summary of consultation disease patterns and service gaps themes • Summary of data

Integrate information and compare results • Synthesis of information • Cross-checking and comparing data • Population profile

Confirm needs assessment findings and results • Key themes, needs and service or capacity issues identified and confirmed • Shortlist of needs Shortlist of needs/issues

Health condition/issue Vulnerable populations • Mental health • Aboriginal and Torres Strait Islander peoples • Child development • Areas of chronic disadvantage • Obesity (nutrition and physical inactivity) • Refugees and humanitarian entrants Smoking • • People with a disability • Premature death: heart • Health services for older people disease • Health of children and young • Premature death: chronic people obstructive pulmonary disease Health system • Premature death: lung cancer • Service coordination and integration Type 2 diabetes • • Substantial population growth CNA project stages

Establish priorities

Issues and options analysis

Priority Setting and validation CNA project stages

Issues and options analysis

Impact Severity and size of the problem

Potential strategies Drawn from a review of published literature and and interventions programs and initiatives currently being delivered by West Moreton-Oxley Medicare Local and other Medicare Locals Analysis Critical analysis of the strategies and interventions – included consideration of evidence of effectiveness, health gains, appropriateness and acceptability, equity, cost effectiveness, and feasibility, sustainability, consistency with health policy, alignment with Medicare Local key results areas and impact on service coordination and integration CNA project stages

Priority Setting and validation

Criteria Description Effectiveness Identified evidence suggests the intervention will result in improved health of target group and/or improvement in health services for consumers

Cost effectiveness The intervention is affordable and can deliver results at a reasonable cost

Feasibility The intervention can be managed or delivered by WMOML or by WMOML in association with other organisations

Confirm priorities Our nine priority areas

• disease or health condition issues • health inequities or service gaps • health system improvements Our 19 strategies health inequities or service gaps

health system improvements disease or health condition issues Our 19 strategies WMOML structural logic

WMOML Board Planning and Performance Vision Management Board Meetings and Annual Board Retreat CEO and Purpose Strategic Leadership Plan Annual Staff Team Planning Goals Day Operational Plan Quarterly Reviews Strategies Our people Budget Team Annual Meetings Work/ Work Project Plans Plans Staff Performance Activities Strategies/interventions

Chronic diseases Obesity (nutrition and physical - Life expectancy in WMOML is low inactivity) compared to peer Medicare Locals and - The obesity rate (38%) for WMOML is the Medicare Locals nationally (46th of 61) highest in its Medicare Local peer group - Diseases which cause greatest numbers - Rates of adequate fruit and vegetable of premature deaths in the region are heart intake and physical inactivity in the region disease, lung cancer and COPD are worse than Qld rates

Support general Promote practices in targeted Short term lifestyle opportunities for communities to and self- Deliver community participation in implement best management based healthy living healthy eating practice in support programs and lifestyle physical activity and prevention, for people with programs healthy lifestyle screening, early Strategies diabetes programs in the intervention and region management Strategies/interventions - implementation

• Intensive program of • In partnership with education and practice Diabetes Queensland: Regional support to six General Educational • Workshops conducted Practices for a period of six Events for people living with months Diabetes – Diabetes – • Initial full day workshop What Now? – • Monthly education sessions delivered by diabetes Intensive educator and dietitian via webinar (Improvement Practice Foundation, PenCS) Support • Workshops for health • Two practice visits per professionals – e.g. month from WMOML and Insulin Administration Credentialled Diabetes (Practice Nurses); Educators from Diabetes webinars – Diabetes Queensland Management Strategies/interventions Diabetic Screening • • • • AUSDRISK e.g. tool based population a using years 3 last the in diabetes for screened 40 over % pts of regionour practicesfurther participate. as of Longerplan term practicediscuss improvementsanalyse and to Used Data collected on • Fasting• • Blood Glucose to 30kg/m2 to equal or over BMI recorded a with Patients age of years 35 over adults Indigenous glucose blood had afasting have factors following risk the of anywith patients % of - the begin getting aggregated an understanding each month - implementation • • HbA1c using 7% to equal or than results less HbA1c % of months 6 last the in test HbA1c recorded a with patients diabetic % all of PenCAT /PatCAT

Blood Pressure• months 3 last the within Pressure Blood recorded a have patients diabetic % all of Our Team

Acknowledgement Luke Passfield, Strategic Insights Consulting Dr. Remo Ostini, University of Queensland Where to find WMOML’s CNA

West Moreton-Oxley Medicare Local website www.westmoretonoxley.com.au

»About »Publications »Comprehensive Needs Assessment http://www.westmoretonoxley.com.au/about/publications/ The new Primary Health Network

Includes, but is not limited to the following locations: • Dalby • Goondiwindi The new Darling • Ipswich Downs and West • Kingaroy Moreton PHN • Miles • Toowoomba • Warwick

West Moreton PHN Performance Management

PHN Performance Framework The PHN Performance Framework contains three tiers of performance: i. national ii. local; and iii. organisational Possible PHN Performance Framework The ten least healthy locations in Australia

Top 10 unhealthiest areas 1.1. -Maranoa, QLD 6. South Australian Outback, SA 2. Limestone Coast, SA 7. Riverina, NSW 3. Shepparton, VIC 8. Fitzroy, QLD 4. Ipswich, QLD 9. Ballarat, VIC 5. Mackay, QLD 10. Toowoomba, QLD DARLING DOWNS WEST MORETON PRIMARY HEALTH NETWORK THE IMPROVEMENT CHALLENGE

How local health performance information creates opportunities to improve rural and remote health outcomes

Real Results: Meeting the challenge in Primary Health Care

Sharon Sweeney and Sue Scheinpflug West Moreton-Oxley Medicare Local