Integrated Comprehensive Care – A Case Study in Nursing Leadership and System Transformation

Usherwood

et al. 2020

BMC Health Serv Res

Background In Australia and other developed countries, chronic illness prevalence is increasing, as are costs of healthcare, particularly hospital-based care. Integrating healthcare and supporting illness management in the community can be a means of preventing illness, improving outcomes and reducing unnecessary hospitalisation. Western Sydney has high rates of diabetes, heart and respiratory diseases and the NSW State Ministry of Health funded a range of key strategies through the Western Sydney Integrated Care Program (WSICP) to integrate care across hospital and community settings for patients with these illnesses. Complementing our previously reported analysis related to specific WSICP strategies, this research provided information concerning overall experiences and perspectives of WSICP implementation and integrated care generally. Methods We administered 125 in-depth interviews in two rounds over 12 months with 83 participants including patients and their carers, care facilitators, hospital specialists and nurses, allied health professionals, general practitioners and primary care nurses, and program managers. Half of the participants (n = 42) were interviewed twice. We conducted an inductive, thematic analysis on the interview transcripts. Results Key themes related to the set-up and operationalising of WSICP; challenges encountered; and the added value of the program. Implementing WSICP was a large and time consuming undertaking but challenges including those with staffing and information technology were being addressed. The WSICP was considered valuable in reducing hospital admissions due to improved patient self-management and a focus on prevention, greater communication and collaboration between healthcare providers across health sectors and an increased capacity to manage chronic illness in the primary care setting. Conclusions Patients, carers and health providers experienced the WSICP as an innovative integrated care model and valued its patient-centred approach which was perceived to improve access to care, increase patient self-management and illness prevention, and reduce hospital admissions. Long-term sustainability of the WSICP will depend on retaining key staff, more effectively sharing information including across health sectors to support enhanced collaboration, and expanding the suite of activities into other illness areas and locations. Enhanced support for general practices to manage chronic illness in the community, in collaboration with hospital specialists is critical. Timely evaluation informs ongoing program implementation.

Section: Discussionmentioning

confidence: 99%

Key stakeholder experiences of an integrated healthcare pilot in Australia: a thematic analysis

Usherwood

et al. 2020

BMC Health Serv Res

“…Patient centred approaches are important in joining up health care and can reduce hospital admissions and costs (41,42). Facilitators of patient-centredness identified in other settings such as better communication across sectors (43,44) and with patients (6), enhanced multidisciplinary collaboration (45,46) and a focus on prevention and patient self-management (47,48), were identified by our participants as key priorities of the WSICP.…”

Section: Discussionmentioning

confidence: 99%

Key stakeholder experiences of an integrated healthcare pilot in Australia: A thematic analysis

USHERWOOD

et al. 2020

Preprint

Background In Australia and other developed countries, the prevalence of chronic illness is increasing, as are costs of healthcare, particularly hospital-based care. Integrating healthcare and supporting illness management in the community are seen as a means of preventing illness, improving outcomes and reducing unnecessary hospitalisation. Western Sydney has high rates of diabetes, heart and respiratory diseases and the NSW State Ministry of Health funded a range of key strategies through the Western Sydney Integrated Care Program (WSICP) to integrate care across hospital and community settings for patients with these illnesses. Methods We aimed to explore how different stakeholders experienced the WSICP and investigate their broader perspectives on the care delivered. We administered 125 in-depth interviews in two rounds over 12 months with 83 participants including patients and their carers, care facilitators, hospital specialists and nurses, allied health professionals, general practitioners and primary care nurses, and program managers. Half of the participants (n=42) were interviewed twice. We conducted a thematic analysis on the interview transcripts. Results The key themes related to the set-up and operationalising of WSICP; challenges encountered; and the added value of the program. Implementing the WSICP was a large and time consuming undertaking but challenges including those with staffing and information technology were being addressed. The WSICP was considered to have value in reducing hospital admissions due to improved patient self-management and a focus on prevention, greater communication and collaboration between healthcare providers across health sectors and an increased capacity to manage chronic illness in the primary care setting. Conclusions Patients, carers and health providers experienced the WSICP as an innovative integrated care model and valued its patient centred approach. Long term sustainability of the WSICP will depend on more effectively sharing information including across health sectors to support enhanced collaboration, continuing its suite of strategies and expanding them into other illness areas and locations, and ongoing capacity building of primary health care. Funding reform of the current fee-for-service payment system was recommended to facilitate high quality management of chronic illness in the community.

“…Patient centred approaches are important in joining up health care and can reduce hospital admissions and costs (43,44). Facilitators of patient-centredness identi ed in other settings such as better communication across sectors (45,46) and with patients (6), enhanced multidisciplinary collaboration (47, 48) and a focus on prevention and patient self-management (49, 50), were identi ed by our participants as key priorities of the WSICP.…”

Section: Discussionmentioning

confidence: 99%

Key stakeholder experiences of an integrated healthcare pilot in Australia: A thematic analysis

USHERWOOD

et al. 2020

Preprint

BackgroundIn Australia and other developed countries, chronic illness prevalence is increasing, as are costs of healthcare, particularly hospital-based care. Integrating healthcare and supporting illness management in the community can be a means of preventing illness, improving outcomes and reducing unnecessary hospitalisation. Western Sydney has high rates of diabetes, heart and respiratory diseases and the NSW State Ministry of Health funded a range of key strategies through the Western Sydney Integrated Care Program (WSICP) to integrate care across hospital and community settings for patients with these illnesses. Complementing our previously reported analysis related to specific WSICP strategies, this research provided information concerning overall experiences and perspectives of WSICP implementation and integrated care generally.MethodsWe administered 125 in-depth interviews in two rounds over 12 months with 83 participants including patients and their carers, care facilitators, hospital specialists and nurses, allied health professionals, general practitioners and primary care nurses, and program managers. Half of the participants (n=42) were interviewed twice. We conducted an inductive, thematic analysis on the interview transcripts.ResultsKey themes related to the set-up and operationalising of WSICP; challenges encountered; and the added value of the program. Implementing WSICP was a large and time consuming undertaking but challenges including those with staffing and information technology were being addressed. The WSICP was considered valuable in reducing hospital admissions due to improved patient self-management and a focus on prevention, greater communication and collaboration between healthcare providers across health sectors and an increased capacity to manage chronic illness in the primary care setting.Conclusions Patients, carers and health providers experienced the WSICP as an innovative integrated care model and valued its patient-centred approach which was perceived to improve access to care, increase patient self-management and illness prevention, and reduce hospital admissions. Long-term sustainability of the WSICP will depend on retaining key staff, more effectively sharing information including across health sectors to support enhanced collaboration, and expanding the suite of activities into other illness areas and locations. Enhanced support for general practices to manage chronic illness in the community, in collaboration with hospital specialists is critical. Timely evaluation informs ongoing program implementation.