GVGPs

"The Collaboratives has provided a means in our practice for bringing together doctors, practice nurses and reception / management staff in designated teams to brainstorm problems and ideas for developing the changes we wished to see..."....Dr Rob Brun, Kyabram Regional Clinic

"As a practice we obtained significant benefit in the process of the Collaboratives and would like to maintain the momentum into the future."....Dr David Ball,  Mooroopna Medical Centre

Background

The Australian Primary Care Collaboratives (APCC) program is funded by the Department of Health and Ageing, and delivered by the Improvement Foundation (Australia) (IF).  It is based on the model for quality improvement designed by the Institute for Healthcare Improvement (IHI) in the United States, where small, incremental and rapid changes are initiated at a local level to achieve improvements across a wide range of clinical and business systems.  It began in Australia as a $14.6m (Phase 1) project in 2003 and has been so successful that Phase 3 is now in operation.

This model for quality improvement has national and international significance in healthcare system reform and has been adapted and used in a number of countries including the USA, UK, and Australia.  It has currently been used in over 1000 general practices throughout Australia.

About the APCC Program

This program is designed to assist GPs, Practice Nurses, and other primary health care workers to develop an environment for quality improvement within their clinics and therefore improve the clinical outcomes and management of their patients with two of the most common chronic and complex diseases in diabetes and heart disease.  It has been able to do this using the "Collaborative Methodology" that was adapted from the quality improvement model that was developed by the IHI in the USA.

How A Collaborative Works

The Collaborative program runs over a period of around 18 months.  Participants from the clinics involved initially attend an Orientation Workshop, then a series of three "Learning Workshops" over a 6 month period where they learn about the "Improvement Model", ie. change management principles and practical skills for ensuring quality improvement can occur; discuss and share ideas for improvement; and share their experiences (good and not so good). 

Between each workshop is an "Activity Period" where participants implement, test, analyse ideas they have developed in the workshop using PDSA (Plan, Do, Study, Act) cycles. (More information about the Improvement Model from the APCC website)

Additionally, between each workshop, and on a continuing monthly basis, clinics need to upload data to the APCC/IF web portal which is obtained easily through the use of the CAT (Pen Computer Systems-Clinical Audit Tool), (click here for more information about the CAT).

After the first 6 months, participants generally have a substantial understanding of the Improvement Model and their monthly reporting obligations, and for the following 12 months work hard to apply the principles and implement change within their clinics.

Click here for more detailed information about the Collaboratives program from the APCC website.

"...using this concept has enabled significant improvements with our clinical outcomes, particularly with our diabetic patients." ...Michelle Keady, Practice Nurse, Murchison Medical Clinic

APCC Objectives, Topics, Aims and Measures

"The objective of the APCC Program is to encourage and support general practices throughout Australia in delivering rapid, measurable, systematic and sustainable improvements in the care they provide to patients, through the sound understanding and effective application of quality improvement methods and skills."

"The APCC Program has focused its efforts on three topics: diabetes, secondary prevention of coronary heart disease (CHD) and access and care redesign. To build on this work, the APCC Program has introduced two new topics: Chronic Obstructive Pulmonary Disease (COPD) and Chronic Disease Prevention and Self Management (CDPSM)."

The aim for Access and Care Redesign:

• 90% of patients should be able to access their primary healthcare professional of choice on the day of their choice.

The aim for Diabetes:

• 50% of patients with diabetes type 1 or diabetes type 2 within participating practices should have a HbA1c of 7.0% or less.

The aim for CHD:

• 30% reduction in the mortality of patients with CHD in three years.

The aim for COPD:

• To reduce by 30% the number of hospital admissions (compared to the previous 12 months) for respiratory illness in patients with COPD.

The aim for CDPSM:

• Increase the identification of those with risk factors for chronic disease and implement strategies to mitigate these risks, including self management. Through this we aim to assess risk factor status in 50% of those for whom it is recommended and reduce the number of risk factors that are not at target by 20%.

"Each topic in the Program has a specific aim.  Aims are targets that will assist in achieving the overall objective for the Program.  For example, one of the aims for the current Australian Collaborative is to achieve 50% of patients with diabetes type 1 or diabetes type 2 within participating practices should have an HbA1c of 7.0% or less.  This is directly measured through one of the topic measures.  The aims usually involve a 'stretch' goal, which is not necessarily easy to achieve and will require significant improvement work to meet."

"Measures are data collected specifically to help a participating practice track their improvement, and should be as simple to collect as possible."

^{Source: APCC website: http://www.apcc.org.au/images/uploads/Objective_and_Aims_ofthe_APCC.pdf}

"...work has allowed us to surpass the Collaboratives targets for our Diabetic patients and we continue to push our targets ever higher."....Dr Rob Brun, Kyabram Regional Clinic

Closing the Gap Collaboratives Wave

The Closing the Gap Collaboratives Wave has been specifically designed to support clinics and Aboriginal Medical Services to improve access to services and health outcomes for Aboriginal and Torres Strait Islander people.  The health services involved in this wave will initially work on the Access and Care Redesign topic with, naturally, an emphasis on our ATSI people.  Once the organisation has a better understanding of the demand for services from Aboriginal and Torres Strait Islander patients in their community, a priority area from existing topics (above) will be selected to begin the improvement work within the practice.

Benefits to Participating Practices

• Team approach created within the practice
• More clearly defined roles for practice staff
• Improved staff morale
• Improved systems within the practice
• Improved use of Information Systems within the clinic
• Improved patient access to GPs and Practice  Nurses
• Move from being reactive to proactive
• Learning from others encouraged
• Improved data quality
• Improved and more accurate chronic disease registers within the clinic
• Improved patient outcomes and patient satisfaction
• Improved practice income
• Professional development opportunities for GPs and staff
• Risk of failure reduced
• Fear of change reduced

"Being involved with the Collaboratives, has helped us improve our patient care. It has taught us the process to enable change, by utilising small manageable steps."....Connie Fairmaid, Practice Nurse, Mooroopna Medical Centre.

"...most valuable of all the Collaboratives has given us a change model that we can apply to ongoing improvement to patient care. Particularly important is that it gives us, as a practice, the confidence to take on what may initially appear to be problems too big to tackle and just chip away at them 'til almost without knowing it you have achieved your goals."...Dr Rob Brun, Kyabram Regional Clinic.

Resources

Website: Australian Primary Care Collaboratives
Website: Improvement Foundation (Australia)

Click on the link  GVGPs-The Australian Primary Care Collaboratives (1.24 MB) to view an introductory Powerpoint Slideshow with some local data.

Click on the link   Collaborative Storyboard (512 kB) to view our entry (awarded 2nd place), in the "Our Collaborative Journey" for Learning Workshop 3 (Melbourne: 14-16 May 2009).  (Needs sound.)

 APCC Brochure (662.3 kB)
 Collaborative Methodology (1.99 MB)
 How Collaboratives Operate (1.33 MB)
 Measuring For Improvement (1.29 MB)
 Phase 1 Results (385.5 kB)
 Time Committment for Clinics (48.82 kB)
 Practice Case Studies (378.87 kB)
 APCC Closing the Gap Brochure (1.44 MB)  ***New***

Contact

Collaboratives Program Manager: Rob Fairmaid.  This e-mail address is being protected from spambots. You need JavaScript enabled to view it

Practice Support Services : Sally Coates.  This e-mail address is being protected from spambots. You need JavaScript enabled to view it

Closing the Gap Collaboratives Wave: Tanya Garling.  This e-mail address is being protected from spambots. You need JavaScript enabled to view it