evaluating a new model of primary health care service delivery in remote queensland: lessons learned...
TRANSCRIPT
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Evaluating a new model of Primary Health Care service delivery in remote Queensland: Lessons Learned
Kristine Battye, Peter Stanley-Davies and
Elaine Ashworth
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Outline
• Describe NWQAHS to provide context for evaluation
• Structural issues encountered
• Difficulties in establishing a system to “measure” process and impact of PHC
• Type of data available for planning and evaluating PHC services
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North West Qld Allied Health Service
Operational Hub and Spoke Model
Mt Isa Hub
Gulf precinct5 communities
Highway precinct3 communities
Mt Isa precinct3 communities
Key Features
•Functional teams
•6 month calendar
•6 weekly rotations
•2-3 days in each community
•Primary health care
•Centralized booking system
•Therapy assistants in each community
•Videoconference follow-up
•Case conference with resident health professionals
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NWQPHC Board
Chief Executive Officer
Executive OfficerOperations & Outcomes
Executive OfficerAdmin & Finance
Area Manager
Area Manager
Area Manager
Area Manager
NWQAHS Manager
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NWQPHC Board
CEO
NWQAHSService Manager
9 AHPs1 Admin
Community PanelAdvisory
Initial Management Structure (1.5 Years)
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Domains of the Evaluation
• Recruitment and retention strategy
• Management and operation of service
• Service delivery – access and PHC
• Impact – community and individual
• Integration with other service providers
• Comparative cost effectiveness with alternate models
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Methodology Proposed
• Qualitative - Direct intermittent information gathering
• Quantitative - Indirect and continuous monitoring, data collection, surveillance and use of sentinel communities, and health issues
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Difficulties encountered
• Shared perspective of purpose of evaluation• Time frame • Information Mx system relevant to PHC
activity• Recognition of complexity of PHC service
delivery• Management capacity and multiple demands• Are we trying to collect the right data
anyway?
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Shared purpose of evaluation
Management Capacity – Multiple demands
Time frame
Structural Issues impacting on Evaluation
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Shared purpose of evaluation
Complexity of servicedelivery model
Info Mx system that captures complexity
Is it the “right” data?
PHC paradigm but what data set?
Management Capacity – Multiple demands
Time frame
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Purpose of Evaluation
Management Funder Evaluator
Summative – Did the service do what it said it would do, and do it well enough to be refunded?
Developing internal systems in parallel to the evaluator
Do what it said it would do?Meet objectives of RHS programImprove access – occasions of service
Value for $$
Formative and Summative– Development of systems to support roll-outAspects of model needing modification to achieve goalsImpact on client & communities
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Shared purpose of evaluation
Management Capacity – Multiple demands
Time frame
Structural Issues impacting on Evaluation
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Structural issues: Lessons Learned and Implications for Policy
1. Realistic timeframes for service establishment and realistic expectations of deliverables in first 3 years
2. Adequate resource allocation to management in the service establishment phase (service and auspice)
3. Greater emphasis on formative evaluation by funders and service providers
4. Broader performance indicators for primary health care services – reduced emphasis on occasions of service
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Practical Issues around “Measuring”
Primary Health Care
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Shared purpose of evaluation
Complexity of servicedelivery model
Info Mx system that captures complexity
Is it the “right” data?
PHC paradigm – How is it measured?
Management Capacity – Multiple demands
Time frame
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Information Management System
Specifications:
Client demographics and indigenous identifier
Clinical treatment records
Time use data – activities in conjunction with treatment
- community focused activities
Client outcomes/ client centred goals
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Total community attributable time 2002/2003
0.0
100.0
200.0
300.0
400.0
500.0
600.0
Bur
keto
wn
Cam
oow
eal
Clo
ncur
ry
Daj
arra
Doo
mad
gee
Hug
hend
en
Julia
Cre
ek
Kar
umba
McK
inla
yM
orni
ngto
nIs
land
Nor
man
ton
Ric
hmon
d Community
Ho
urs Client
Community
Travel
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Mornington Island - community attributable time 2002/2003
0.010.020.030.040.050.060.070.080.090.0
Discipline
Ho
urs
Client
Community
Travel
Hughenden - community attributable time 2002/2003
0.020.040.060.080.0
100.0120.0140.0160.0180.0200.0
Discipline
Ho
urs
Client
Community
Travel
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Quantitative data
• Referrals as a proxy for occasions of service
• Used to measure access to service by indigenous and non-indigenous people at a community level (2nd yr)
• Management capacity increased – development of chart system
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Analysis of Referrals by community 2002/03
Community No. Referrals
% Pop referred
No. Indig. Referrals
Est. Indig. Pop
% Indig. Pop referred
Burketown 103 44% 35 94 37%
Camooweal 23 7% 10 145 7%
Cloncurry 172 5% 31 880 4%
Dajarra 20 9% 14 195 7%
Doomadgee 154 11% 103 1,231 8%
Mornington Is 195 16% 107 1,115 10%
Normanton 81 5% 47 866 5%
Richmond 221 24% 5 103 5%
Hughenden 322 12% 45 260 17%
Julia Creek 62 7% 8 30 27%
Total 1,419 11% 409 5,064 8%
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REAL LIFE Data Collection Issues
• AHPs record info/data relevant to their job, or see the value of it – data quality is better
• Outreach service - client info maintained in a number of places
• Reason for referral not “centralized” but recorded in client notes
• Centralized data base – maybe need a data “enterer”
• Coding? ICPC developed by WONCA
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Do we collect the right data to evaluate and plan for PHC?
• Measure what we can measure• Occasions of service – proxy for workload?• How do you evaluate the number of oldies you keep out
of institutions because they have had access to allied health interventions?
• How do you measure the impact of early intervention in services that operate across the age continuum?
• Risky!! Why do we try and plan PHC (wellness) services at a local level using secondary care (sickness) data? Because that’s all there is!?
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PHC: More Lessons Learned
• Need a mix of qualitative and quantitative measures to evaluate PHC – perhaps with equal emphasis
• Development of information management and evaluation processes need to be staged, and recognized in contracts with funders
• We need to re-think the data set and data collection processes we use to plan and evaluate primary health care services