Implementation and evaluation of a novel integrated care program in South Eastern Sydney, Australia

Abstract

Background: Integrated Care in Australia has mostly been implemented as micro-level initiatives rather than systemically, which has challenged its sustainability [1]. South Eastern Sydney Local Health District (SESLHD) and the Central and Eastern Sydney Primary Health Network (CESPHN) have sought to scale the benefits of existing micro-level strategies, such as inter-disciplinary coordination, coordination, and person-centred care, in order to increase population-level impacts and enhance sustainability. The focus of their joint Integrated Care Strategy has shifted towards implementation of meso- and macro-level integrated care programs [2]. This paper presents an overview of the evolution, implementation and evaluation of this novel program. About the IC Program: The centrepiece of the revamped Strategy is three interlinked programs, based on Bodenheimer’s 10 building blocks [3]: 1) General Practice 2020:a quality improvement activity in general practice involving practice teams. 2) Care Coordination: a model of service involving Clinical Nurse Consultants and a social worker. 3) Talking Wellbeing:a co-produced salutogenic initiative based in general practice. Th objectives of these programs are to: Strengthen partnerships and integration. Support general practice to transition towards a person-centred medical neighbourhood (PCMN) model. Establish a sustainable, localised care coordination model. Build connections and experiences that enhance individual and collective wellbeing. The PCMN model is an Australian federal government initiative, similar to the health care home concept [4]. Desired outcomes of the PCMN are aligned with the quadruple aim [5]. Evaluation: The three programs will be evaluated at: (i) consumer, (ii) provider, and (iii) service levels. The overall analytic approach is informed by Normalisation Process Theory [6], with emphasis on the impact, acceptability, feasibility, sustainability, and scalability of the Strategy. Data will be collected at 6, 12 and 18 months points following implementation. Implications for Integrated Care: Lessons learnt from the evolution and and implementation of the three programs that make up the Strategy will have relevant to integrated care in other settings. References: 1- Angus L and Valentijn PP (2018). From micro to macro: assessing implementation of integrated care in Australia. Australian Journal of Primary Health. 24;59-65. 2- Stewart G, Bradd P, Bruce T, et al (2017). Integrated care in practice – the South Eastern Sydney experience. Journal of Integrated Care. Vol.25;No.1:49-60. 3- Bodenheimer T, Ghorob A, Willard-Grace R and Grumbach K (2014). The 10 building blocks of high-performing primary care. Annals of Family Medicine. Vol.12;No.2;166-171. 4- Grant R and Greene D (2012). The Health Care Home Model: Primary Health Care Meeting Public Health Goals. American Journal of Public Health. Vol.102;No.6:1096-1103. 5- Bodenheimer T and Sinsky C (2014). From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider. Annals of Family Medicine. Vol.12;No.6;573-576. 6- May CR, et al (2018). Using Normalization Process Theory in feasibility studies and process evaluations of complex healthcare interventions: a systematic review. Implementation Science. 13(1):80.

Keywords

• implementation
• care coordination
• general practice
• quality improvement
• co-design