PENINSULA HEALTH COMMUNITY HEALTH
Review of the Peninsula Health Hospital
Admission Risk Program (HARP)
Presenter: Belinda Berry
HARP Redesigning Care
Before redesign HARP services had evolved to:
Community Based
 Residential Outreach Support Service ROSS
Team
 Peninsula Complex Care Team
 MI Health
 SHARPS
 Hospital Based
 Response Assessment & Discharge RAD Team
 Drug & Alcohol Liaison
HARP Redesigning Care
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Concerned over time there had been a:
Shift in focus away from Frequent Presenters
Limited Pathways to Community HARP
HARP Services spread over 5 program areas
Need for review of our HARP Governance in
light of revised HIP Guidelines
Evidence to support intensive care coordination
model for this target group
Need to clarify outcomes for HARP Service
HARP Redesigning Care
HARP Redesigning Care
Issue 1 – Focus on Ambulatory Sensitive
Conditions
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Stream % Breakdown by Episode
120%
100%
80%
60%
40%
20%
0%
Peninsula Health
Peer Grp
State
Diabetes
Heart Disease
Other
People with Complex Needs
People with Psychosocial Needs
Respiratory Disease
HARP Redesigning Care
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Issue 2 – Focus on Care Coordination
Episode Duration (Closed Episodes)
120%
100%
80%
60%
40%
20%
0%
<=1
Month
1-3
Months
3-6
Months
6-9
Months
Peninsula Health
9-12
Months
Outer Melb
1-2
Years
State
>2 Years
HARP Redesigning Care
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Issue 3 – Focus on Frequent Presenters
Presentations to the Frankston Emergency Department
09/10 Financial Year
5000
4500
4000
3500
3000
2500
2000
1500
1000
500
0
Jul-09
Aug-09
Sep-09
Oct-09
3+ 09/10
Nov-09
Dec-09
All 09/10
Jan-10
Feb-10
3+ Prev. Yr.
Mar-10
Apr-10
All Prev. Yr.
May-10
Jun-10
HARP Redesigning Care
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Issue 3 – Focus on Frequent Presenters
Seasonal Breakdown of DRG's 2009-2010
250
150
100
50
Winter
Autumn
Spring
Summer
he
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Ch
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Presentations
200
HARP Redesigning Care
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Issue 4 - Where do our Frequent Presenters go?
Discharge Destinations from the
Frankston Emergency Department January to June 2010
60.00%
51.78%
50.00%
47.59%
43.68%
39.40%
40.00%
30.00%
20.00%
10.00%
3.85% 3.38%
1.66% 2.00%
Left at OWN RISK, no
treatment
Left at OWN RISK after
treatment started
0.00%
Ward
Home
All
3+
HARP Redesigning Care
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Issue 5 – Outcomes & Deliverables
• HARP criteria not consistent within HARP programs
• Lack of unified focus on frequent presenters & ACSC
• Core HIP Guidelines not met;
–
–
–
–
–
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Lack of Care Coordination
Multiple access points for HARP contact
Medical support lacking from interdisciplinary approach
Marginalised groups who meet HARP criteria not well engaged
Self Management Support not implemented across HARP
Lack of focus on Advanced Care Planning
HARP Redesigning Care
Framework for future HARP Service Delivery
Delivery System
Design
-Regular, proactive
visits
- Multidisciplinary
- Targeted recruitment
- Responsive to patient
needs
- Integrated throughout
settings
Decision
Support
Clinical
Information
Systems
-Evidenced based
practice
- Risk calculating tools
- Self Management
- Consistent with
ACCESS
- Utilise blackberry for
frequent presenters
-IPM alert system to
Support frequent
presenters & ED
management plans
-PJB data management
system
-VINAH reports
generated
Community
Resources
-Engaged & utilised to
support clients
-Involved & active in
the community
-Develop partnerships
for service delivery
-Right place
-Right time
Self
Management
Support
-Support clients to
Educate & self manage
themselves
-Tailor strategies
- Educate carers & family
- Symptom diaries
- Action plans
-Document & Record
- Measure
improvement
Hospital
Early
Linkages &
Discharge
Clinical
Response
Immediate post
d/c support
Medical
HARP
Support
Secondary
Consultation
Care Coordination
HARP Redesigning Care
Immediate Risk of Hospitalisation
- Ambulance
ACUTE
SERVICES
COMMUNITY
HARP
Clinical
Response
Service
HARP HELD
Outreach
&
Care
Coordination
HARP Care Coordination &
Coaching Program
SAACS
GP care
Self Management Programs
Community Health
- RCF’s
- GP’s
High Need Frequent
Hospital Visits
- 6+ Presentations
- Diabetes, COPD, CHF
- Homelessness, D&A, Mental Health
Planned Managed Proactive Care
-Access to mainstream
community services
SERVICES
Health Promotion & Prevention
Go for Your Life Programs
• Obesity Reduction
•Smoking cessation
•Health promotion
Whole Population Health
Promotion Services
HARP Redesigning Care
CLINICAL RESPONSE
SERVICE
COMMUNITY CARE
COORDINATION
HARP SUPPORT
____________
HOSPITAL EARLY
LINKAGES &
DISCHARGE
STREAM
_____________
____________
_______________
Functions:
Functions:
Functions:
Functions:
•Community based
outreach to RCFs and
Patient’s homes.
• Focus on preventing
Presentation to ED
•Facilitating direct
Transfers to sub-acute
•Partnership with
Ambulance Victoria
•Targeted risk
•screening
of frequent presenters
•Diabetes, COPD
& CHD
AOD, mental health &
Homelessness
•ED Management
Plans
•ED, Wards & Subacute
•Outreach from ED
•Provision of
Evidenced Based
self management
Interventions
•Care Coordination
•Community Linkages
Admin
• Dietetics
• Pharmacy
• CNC’s
• Physio
• Data Specialists
• Adavanced Care
Planning
•Medical Support
•Accessible across
streams
•
HARP Redesigning Care
Before
HARP Redesigning Care
After
HARP Redesigning Care
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Revised Model Based on
Population Health
Targeted Recruitment
Medical Support
Timely notification of presentation to ED
Self Management
Evidenced Based Standards Of Care
HIP Guidelines