Data and quality improvement in primary care

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Joanna Coutts and Joanne Dean
By
Hunter New England and Central Coast Primary Health Network
Joanna Coutts,
Integrated Care Manager;
Joanne Dean,
Senior Project Officer, BEAP project lead
Issue
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Allied health professionals make significant contributions in the care of patients with type 2 diabetes mellitus (T2DM). However, the value of this care is not well known due to limited access to collective data sets.

While allied health is a growing professional group, and as the population and rates of chronic disease increase in Australia, it is likely the demand for allied health services will continue to increase, especially in regional, rural and remote areas. Solutions to meet this demand will increasingly require evidence-based information to plan for delivery of equitable and accessible value-based care.

The Hunter New England and Central Coast Primary Health Network (The PHN) developed a quality improvement pilot project aiming to demonstrate the value of allied health care to patients with a chronic disease (T2DM).

The pilot tested the concept that current software technology can be used to aggregate allied health clinician- and patient-reported disease measures from various sources.

The pilot was conducted with five allied health practices from various professions (physiotherapist, podiatrist, exercise physiologist, dietitian and accredited diabetes educator) and locations, including regional and rural practices.

A technical and process workflow was developed to collect clinician-reported clinical measures (CM), patient-reported outcome measures (PROM) and patient-reported experience measures (PREM) from T2DM patients. The PROMIS Scale v1.2 Global Health measures were collected via a digital patient survey. Both the CM and the PROM were collected at the initial and final stages of client intervention. The data was de-identified and aggregated for reporting from a central data repository (PHN Insights).

It was shown that existing software could be used to collect and store de-identified, aggregated allied health data from various practices and professions in a central data repository, from which evidence-based reports could be developed.

BEAP Key reporting areas

Modifiable risk factors such as smoking status, alcohol consumption, weight and body mass index (BMI), and certain clinical monitoring indicators such as HbA1C and blood pressure, were able to be benchmarked against dashboard reports on general practice T2DM clinical measures for the same region, to allow for analysis.

Data output indicated trends that demonstrate allied health intervention and quality improvement opportunities for practices.

The pilot demonstrated advanced digital capacity by linking both the CM and PROM data. This linkage is an innovative approach and has the potential to provide new opportunities to measure clinician intervention and patient experience alongside each other. Development of evidence-based reports can potentially quantify the value of allied health care in the management of chronic disease.

Clinicians surveyed agreed that access to ongoing reports, such as those developed in the pilot project, would enable the practice to use data and clinical systems more effectively. Activities may include progressing clinical improvement and improving the patient and clinician experience. Clinicians also agreed that the model is likely to be successfully adaptable to capture different chronic disease indicators.

It is hoped, in the longer term, that this pilot may lead to the development of, and access to, evidence-based reporting data sets to demonstrate the impact of various allied health interventions when treating patients living with chronic disease and to support quality improvement in primary health care. Findings would first need to be validated with a larger cohort and the burden of clinical data entry needs to be overcome.

Knowing the value of care provided, matched to patient outcomes, will help plan for primary healthcare services into the future, ensuring more sustainable, equitable and affordable care for patients in all geographical areas.

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