HARP PARTNERSHIPS IN HEALTH
INTAKE ELIGIBILITY and PRIORITY SCREEN
Revised November 09
ELIGIBILITY ASSESSMENT
1. CLIENT DETAILS
2.
RMH UR
NAME :
RMH UR :
DOB :
3. PROGRAM ELIGIBILITY
* Must answer YES to 3.1 & 3.2. Consult Team Leader if only YES to 3.3 (only at risk).
3.1 Does client live in cities of Moreland, Moonee Valley or Melbourne?
NOTE 1: Different area for Diabetes Co-management
YES
NOTE 2: Out of area referrals will be accepted if have presented to RMH in last 12mths and majority
of care is provided by RMH)
NO
3.2 Has the client presented twice to RMH or other hospital in the last 12 months OR meet the criteria for
one of the specific service areas (4.1 to 4.4 or 4.6)?
NO
3.3 Is client at imminent risk of presenting to hospital?
YES
Note: If YES contact team leader
NO
3.4 Is client still an RMH inpatient?
YES
Note: If YES, flag with HARP Liaison to monitor progress on ward / support referral.
NO
4. SERVICE COMPONENT ELIGIBILITY
YES
* If program eligible but not service eligible consult Team Leader
4.1a CHRONIC ASTHMA
Have presented 2 or more times to hospital in last 12 months due to symptoms of asthma
4.1b CHRONIC RESPIRATORY
Hospital presentation in the last 12 months due to symptoms of Chronic Respiratory Disease;
AND at least one of the following:
&
Diagnosis of COPD with a Respiratory Function test demonstrating FEV1 <60% or FEV1/FVC ratio
<60%
or
or
Diagnosis of Pulmonary Fibrosis, Asbestosis, Bronchiectasis, Interstitial Lung Disease or Cystic
Fibrosis as demonstrated on CT scan
Diagnosis of Pulmonary Hypertension as demonstrated on Echocardiogram
4.2
CHRONIC HEART FAILURE
Have presented 2 or more times to hospital in last 12 months due to symptoms of asthma;
AND:
&
Are at risk of Hospital presentation due to symptoms of Chronic Heart Failure
AND:
&
Had a hospital admission in the last 12 months with Heart failure
4.3
DIABETES FOOT PROGRAM
Diabetes and at least one of the following:
History of significant diabetic foot related problem
Current foot ulcer
Peripheral neuropathy (as determined by 10g monofilament) in the presence of gross deformity
Peripheral vascular disease (with or without wound)
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4. SERVICE COMPONENT ELIGIBILITY (Continued)
4.4
DIABETES CO-MANAGEMENT
Diagnosis of Type 1 or Type 2 Diabetes
AND one or more of the following:
&
Diagnosis of diabetes for ≥15years
&/or
HbA1c≥9% (test in last 6 months)
&/or
2+ high risk foot factors,
&/or
Microalbuminuria confirmed diagnosis
&/or
History of cardiovascular disease
&/or
Diabetes related hospital presentation/admission in last 12 mths
&/or
Proliferative retinopathy
&/or
NOTE: Must live in geographical area above or be patient of one of participating GPs (see GP list)
4.5
CARE FACILITATION
Have had 2 or more presentations to hospital in the past 12 months AND
&
Have complex issues and / or difficulty engaging with mainstream services AND
&
Require comprehensive assessment and intensive care coordination to address issues effecting
representation to hospital. For example referrals to other services, liaison with existing service
providers, advocacy and support
VINAH Program type (internal use only)
Hospitalisations or presentations to ED are primarily for complex psychosocial reasons such as
homelessness, substance abuse, mental health, social isolation = ISC-P – Psychosocial program.
NOTE: If referral information indicates mental health issues, contact HARP Liaison to check eligibility
so can check if Mental Health already involved
Other complex issues = ISC – Complex Needs Program
4.6.
FALLS PREVENTION
Have had 1 or more falls related hospitalisation or presentation to an emergency department in the
past 12 months
REJECTED, or
ACCEPTED, allocated to:
PRIORITY SCREEN
1. GENERAL RISK SCREENING TO BE ASCERTAINED FROM REFERRER FOR ALL REFERRALS;
These questions are designed to elicit information to answer Q3. The more “YES” the greater the urgency
A.
Does the client live alone?
YES
NO
B.
Is the client likely to have self care problems?
YES
NO
C.
Does the client care for someone else?
YES
NO
D.
Is the client already using community services?
YES
NO
E.
Does the client have difficulty walking?
YES
NO
F.
Does the client have cognitive impairment?
YES
NO
G.
Is the client at risk of self harm?
YES
NO
H.
Is the client medically unstable?
YES
NO
I.
Has client been discharged in the last week?
YES
NO
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2. SPECIFIC URGENCY CRITERIA FOR HEARTWISE CLIENTS
A.
Is the client currently experiencing worsening shortness of breath?
YES
NO
B.
Has the client recently been commenced on a Beta Blocker, ACE Inhibitor or
Diuretic Therapy?
YES
NO
C.
Does the client have worsening peripheral oedema?
YES
NO
D.
Does the client have adequate access to their GP?
YES
NO
Does the client have newly prescribed oxygen therapy?
YES
NO
E.
2.1. SPECIFIC URGENCY CRITERIA FOR MELBOURNE EASY BREATHERS CLIENTS
Priority 1: Urgent
A.
Does the client have acute worsening Shortness of Breath?
YES
B.
Requires immediate home intervention to prevent a Respiratory hospital admission
YES
Priority 2: Semi Urgent
C.
Does the client have newly prescribed home oxygen therapy
YES
D.
Does the client require Airway Clearance
YES
Priority 3: Not Urgent
E.
Does the client require Pulmonary Rehabilitation only
YES
F.
Does the client require Home Exercise and Education program only
YES
NOTE: Melbourne Easy Breathers do not require further Priority Screening (below).
3. PRIORITY
PRIORITY 1: URGENT
PRIORITY 2: SEMI URGENT


Client is not at immediate risk of harm

Client has some supports

There is progressive deterioration in
the client’s physical, mental or
functional status
High risk of presentation to hospital due to sudden
exacerbation of medical condition and/or sudden
decline in functional status / mental status

Sudden Carer Withdrawal

Client is a carer and has significant carer
responsibilities


High Client Safety risk due to conflict or relationship
crisis or threat of self harm or significant hazards in the
home
There is progressive deterioration in
the carer’s physical, mental or
functional status


High risk of homelessness
There is need for self management
education and or early intervention
PRIORITY 3: NOT URGENT

The referral indicates the client has sufficient support
available at present
PRIORITY 1: URGENT Phone area to
enable key worker to respond within
24 hours

Client requires assessment regarding future care
requirements client’s health or social issues
PRIORITY 2: SEMI URGENT Response
required within 3 working days
P2

Some complexity around medical and/ or social factors
however a client is able to comply with
recommendations
PRIORITY 3: NOT URGENT – Response
required within 5 working days
P3
P1
COMMENTS:
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