A case study of reducing avoidable

hospitalization due to chronic disease through health

promotion in health services and health workforce planning

David Limc113.lim@qut.edu.au

ReconciliationIn keeping with the spirit of Reconciliation, I acknowledge the traditional owners of the land on which we are meeting today, and acknowledge the important role Indigenous people continue to play within the community.

www.reconciliation.qut.edu.au

“avoidable hospitalization”• Rosana, A., Abo Loha, C., Falvo, R., van der Zee, J., Ricciardi, W., Guasticchi, G., and de Belvis, A. G. (2012) The relationship between avoidable hospitalization and accessibility to primary care: a systematic review.

European Journal of Public Health, 23(3), 356-360.

– “possible measure of the performance of primary health care”– “significant inverse association between the indicator of PHC [primary health

care] accessibility and rates of AH [avoidable hospitalization]”

• National Health Performance Authority:– Australia has higher rate of hospital admissions c.f. USA, Canada, UK, New

Zealand, Japan costs– Council of Australian Governments– “ambulatory care sensitive conditions” and “potentially preventable

hospitalisations”– Chronic | acute | vaccine-preventable– 2011-12: 7% hospital admissions ≈ 2.5m hospital bed days (9% hospital bed days)

• Rural and remote Australia

Diabetes

• Barriers:– Rural and remote (unemployment, lower SES, distance to travel, …)– Higher representation of Indigenous Australians (4.5% vs. 2.4%

nationally)– Underutilization of general practice and allied health services

• Enablers:– Willingness and relationship

• Wheatbelt Health MoU Group– Low spillage

• Type 2 diabetes in the Wheatbelt (2005):– Prevalence: 7.5% c.f. WA 6.3%– Indigenous: RR 3.67

Respiratory and Cardiovascular• WA Dept of Health, SHRAC Research Translation 2011• Higher prevalence of respiratory disease (290.3 vs. 281.5 per 1,000 population), and cardiovascular

disease (180.7 vs. 175.6 per 1,000 population).• Avoidable hospitalization as compared with WA rates for:

– asthma (306.4 vs. 222.3 per 100,000 population),– chronic obstructive pulmonary disease (COPD; 281.3 vs. 275.9 per 100,000 population), – hypertension (133.5 vs. 29.0 per 100,000 population),– angina (243.0 vs. 198.5 per 100,000 population), and– congestive heart failure (270.8 vs. 202.9 per 100,000 population).

• Respiratory and cardiovascular disease account for the major avoidable hospital admission: 8% and 7% respectively

– Asthma (average 2.2 hospital bed days)– Stroke (average 10 hospital bed days)

• Findings: Lim, D., and Geelhoed, E. (2015) Australasian Medical Journal, 8(7), 249-250

– statistically significant reduction of 10.6 avoidable cardiovascular and respiratory hospital admissions per site (SEM 1.6, p<0.01)– reduction of 19.8 occupied bed days (SEM 9.3) per site– average length of stay per admitted chronic respiratory and/or cardiovascular condition/s was 0.4 bed days– cost saving across the Wheatbelt from this reduction in avoidable hospital admission was between $52,781 and $64,167 per

site, or $1,372,306 and $1,668,342 across Wheatbelt (2013 value). – cost saving from the reduction in total occupied bed days were $46,669 per site or $1,213,384 across Wheatbelt (2013 value)– Returns on investment: 3.52 – 4.28– Lim, D. and Geelhoed, E. (2014) 2nd International Primary Health Care Reform Conference. 17 – 19 March 2014

• Patient engagement, community empowerment:• Sustainability of collaborative model of multi-morbidities care require better primary-secondary integration and

consideration of social determinants of health

Enablers• Focus:

a) patient empowerment and self-management, b) early identification, c) structured intervention, and d) preventative intervention

• Stakeholders engagement in:– Health services planning

• Health promotion• Structured care• Expanded scope of practice• Commitment

– Workforce planning• Recruitment• Training

• Leadership, willingness and ownership• Seedling fund

Alma Ata:• health … is a fundamental human right and … requires the action of many other social and economic sectors. … Governments

have a responsibility for the health of their people which can be fulfilled only by the provision of adequate health and social measures

– Access to high cost pharmaceuticals (biosimilars)

• gross inequality in the health status of people … is politically, socially and economically unacceptable– LGBTIQ health practitioners

• The people have the right and duty to participate individually and collectively in the planning and implementation of health care

– Patient engagement and empowerment (cystic fibrosis and parenthood)– Management of hepatitis C in primary healthcare

• Primary health care is … universally accessible to individuals– Metro North Brisbane EDs and general practice

• QEMRF 2015– Expanded scope of paramedic practice– QUT Health Planning unit