Enabling quality in primary care

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Enabling quality in primary care

• The purchaser role

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ACCs 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

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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

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Purchasers can play a major role in the search
for quality

• Four step cycle

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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
  ACC-contracted anaesthetists

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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

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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

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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
  individuals (and their familys and employers)
  beliefs about the health condition and how it
  should be managed

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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

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Data-based targets
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Data based targets
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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

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