Redeveloping breast services in Victoria An outline of the Breast Disease Service Redevelopment Stra

1
Redeveloping breast services in Victoria An
outline of the Breast Disease Service
Redevelopment Strategy and the work of
BreastCare Victoria

• Strengthening Support for Women with Breast
  Cancer Workshop
• March 2001

2
Summary of Redevelopment Process

• DHS established a review of breast care services
  in October 1997
• Breast Care Implementation Advisory Committee
  established to guide the review, chaired by Lyn
  Swinburne
• Extensive consultation process involving key
  stake-holders and experts in the field
• Review informed by analysis of existing service
  provision and by current best practice

3
What is best practice for breast care ?
4
Evidence-based best practice

• NHMRC Clinical Practice Guidelines
• timely and accurate diagnosis
• access to specialist multi-disciplinary care
• access to specialist breast care nurses
• psycho-social and community support
• clear, consistent and timely information
• focus on communication skills

5
Best practice continued

• referral for radiotherapy and chemotherapy as
  appropriate
• involvement of patients in the treatment planning
  process
• education and training for health professionals
  across all sectors
• monitoring, evaluation and publication of
  outcomes data

6
Best practice continued

• From a system perspective, best practice
  requires
• integrated and coordinated services across the
  care continuum
• transparent accountability and service monitoring
  to ensure that standards of care are subject to
  continuous quality improvement
• mechanisms to incorporate new research findings
  in to clinical practice
• access to appropriate services at a local level,
  particularly for women living in regional and
  rural areas

7
Key issues for redevelopment arising from the
consultation

• Importance of State-wide coordination
• Importance of developing sustainable improvements
  to breast care services
• Importance of multi-disciplinary care
• Importance of patient-centred care, and
  continuity of care
• Need to improve psychosocial support
• Need to improve information for women

8
Breast Disease Service Redevelopment Strategy

• Developed to provide a framework for the
  redevelopment of breast care services in Victoria
  over five years in line with accepted best
  practice.
• Guide the allocation of available resources to
  enhance breast care services

9
(No Transcript)
10
Breast Disease Service Redevelopment Strategy

• Victoria is currently the only jurisdiction in
  Australia to be adopting a pro-active approach to
  improving breast care services
• Strategy has a strong focus on meeting the needs
  of consumers and working in collaboration with
  all stakeholders

11
Overall direction of the Strategy

• Recognising breast disease as an area requiring a
  level of specialisation.
• Promoting access to high quality services -
  strong focus on needs of women in regional and
  rural Victoria.
• Enhancing the existing service system by
  developing an integrated and coordinated approach
  to service delivery.

12
Key recommendations of the Strategy

• Establishing a Unit to coordinate state-wide
  functions - BreastCare Victoria
• Developing a mechanism to improve quality of care
  and implement best practice - Breast Services
  Enhancement Program
• Facilitating links between service providers to
  maximise access to services and to promote
  continuity of care
• Developing appropriate support services for
  consumers

13
What has been achieved?

• Breast Services Enhancement Program (BSEP)
• Major initiative of BreastCare Victoria
• Provides incentive funding to enhance best
  practice in breast care
• Aims to involve both public and private hospitals
  across Victoria
• Enabled the development of a strong
  infrastructure to facilitate breast service
  redevelopment

14
Breast Services Enhancement Program

• In metropolitan areas, services have formed four
  consortia of public and private providers.
• In rural areas, region-wide demonstration models
  have been established in the five rural regions
  Barwon South-Western, Grampians, Lodden-Mallee,
  Hume and Gippsland.

15
BSEP priority areas

• BSEP aims to trial/pilot and evaluate a range of
  service improvement initiatives based on best
  practice.
• Core initiatives focus on
• multi-disciplinary care
• access to breast care nurses
• communication and information
• continuity and service integration

16
BSEP

• In 1999/2000, BreastCare provided 1.3 m to fund
  the core BSEP initiatives and a range of locally
  identified special projects.
• Funding for the Program has been extended to June
  2002.
• Range of new special projects will be funded this
  year.

17
Other BreastCare initiatives

• Commissioned an intervention study to determine
  criteria for a quality breast prosthesis
• Commissioned a Breast care nursing workforce
  study
• Looking at the roles and practice of breast care
  nurses in Victoria
• Study will inform the development of breast care
  nursing in a range of settings

18
BreastCare initiatives

• Developed an Evaluation framework for the
  Strategy
• Strong focus on participative evaluation and
  documentation of change management process
• Funded a range of consumer support initiatives
  including training, attendance at conferences
• Actively supporting the establishment of a
  Consumer-run Resource Centre

19
BreastCare initiatives

• Joint initiatives with National Breast Cancer
  Centre
• Funded an extra Victorian site for the NBCC
  Multi-disciplinary Care Trial
• Hoping to establish a collaborative project with
  NBCC and BreastScreen Victoria to develop a
  decision aid for women with Ductal Carcinoma in
  Situ

20
BreastCare initiatives

• Strengthening Support for Women with Breast
  Cancer Project
• Focus of our discussions today
• Funded by Commonwealth Department of Health and
  Aged Care, and will be evaluated by the NBCC
• Return to this

21
BreastCare initiatives

• Currently working on a framework to develop a
  Data management system and associated performance
  indicators
• Linked to the development of standards for breast
  care, and the costing and funding of best
  practice
• These will be requirements in the development of
  sustainable change

22
Summary of the strengths of the BreastCare Program

• strong focus on evidence-based practice
• extent of consumer involvement at all levels
• development of services in rural Victoria
• collaborative nature of the program
• work closely with stakeholders on all
  initiatives, through the BreastCare Advisory
  Committee, working groups, and direct consultation

23
Strengthening Support for Women with Breast Cancer

• Arose from a Commonwealth Government commitment
  to improve support for women with breast cancer
  living in rural and remote areas
• 4.1 million over 4 years has been made available
  to develop sustainable improvements in supportive
  care
• Victorian share of this funding is 530,000 over
  four years

24
Strengthening Support for Women with Breast Cancer

• Victoria is in a strong position to participate
  in this program due to the infrastructure put in
  place by the Breast Services Enhancement Program.
• Consultation at a national level was facilitated
  through the NBCC who ran a workshop in November
  1999 to agree objectives for the program.

25
Strengthening Support for Women with Breast Cancer

• 4 models were identified during the national
  consultation
• establishing new specialist BCNs
• upgrading services through audit, training,
  coordination
• extending the role of existing health care
  workers to include BCN tasks
• strengthening access to tertiary referral through
  e-health

26
Strengthening Support for Women with Breast Cancer

• BreastCare Unit discussed the Program with rural
  BSEP Managers and a working group of the
  BreastCare Advisory Committee
• Developed a submission to the Commonwealth that
  combined a number of features of the models
  identified
• Elected to focus on the piloting of e-health as a
  mechanism for improving supportive care

27
Strengthening Support for Women with Breast Cancer

• Recruited a Project Officer with experience in
  the use of e-health technologies.
• Today is the first of a series of consultations
  and workshops which will lead to the
  identification of innovative strategies to
  improve supportive care.
• We decided to carry out the consultations using
  videoconferencing as a way of familiarising
  ourselves with the technology.

28
Strengthening Support for Women with Breast Cancer

• BreastCare Victoria is very keen to ensure that
  the strategies developed under this Program
  complement and build on the overall breast
  service redevelopment agenda.
• We are confident that Victoria will be able to
  make a very significant contribution to this
  Program, and that the strategies developed will
  result in sustainable improvements in supportive
  care for women.