qi4gp

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qi4gp
Harry Pert
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qi4gp

• a quality and information strategy
• for general practice

Harry Pert
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qi4gp

• GP Leaders Forum
• RNZCGP
• NZMA
• Rural GP Network
• IPAC
• GPNA
• Sponsors
• Karen Thomas, CEO RNZCGP
• Victor Klap, CEO IPAC

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Why has NZ been successful?

• Good software, and connectivity (PMS
  Healthlink)
• Culture early adopters
• Business model
• New support for general practice from the early
  90s
• Bottom up, clinically led, grass roots support
• Clinical leadership
• Management support

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New tier of support for general practice

• Management Support
• Contracting
• Claims processing
• IM/IT
• Analysis and planning
• Practice support

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But there are problems

• Considerable, but disconnected, activity
• Implementation of PHCS faltering
• Patient care suboptimal
• Opportunities and obligations
• Our IT/IM limits progress and potential
• We have outgrown our software
• Rate of change overseas faster than NZ

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qi4gp a proposed solution

• a strategy that focuses on
• Individual care
• Population health
• Patient centredness
• Clinical governance

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National Regional DHB/NGO Network Practice Provide
r Individual
Long Term Conditions Proactive Structured
Perspectives
Individual
Population
Acute Conditions Reactive Unstructured
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Relationship remains vital Reactive care ok for
acute conditions More structure needed for long
term conditions
National Regional DHB/NGO Network Practice Provide
r Individual
Long Term Conditions Proactive Structured
Perspectives
Individual
Population
Acute Conditions Reactive Unstructured
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Visits to general practice 50,000 per day 15m
per annum 80 in 12 months 90 in 24
months Visits to hospitals 1,200 admissions
2,000 to ED 4,000 to OPD
National Regional DHB/NGO Network Practice Provide
r Individual
Long Term Conditions Proactive Structured
Perspectives
Individual
Population
Acute Conditions Reactive Unstructured
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Information collected Demographic Name, Age,
Gender, Ethnicities (affiliations) Address
(standards, geocode) NHI Funding
eligibility Clinical Prevention,
screening Conditions
National Regional DHB/NGO Network Practice Provide
r Individual
Long Term Conditions Proactive Structured
Perspectives
Individual
Population
Acute Conditions Reactive Unstructured
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Population a group of individuals sharing a
particular characteristic eg age, gender,
ethnicity domicile, deprivation index health need
National Regional DHB/NGO Network Practice Provide
r Individual
Long Term Conditions Proactive Structured
Perspectives
Individual
Population
Acute Conditions Reactive Unstructured
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Activities eg children needing
immunisation flu vaccination women needing
mammograms cardiovascular risk assessment new
migrants refugees patients diabetes, copd
National Regional DHB/NGO Network Practice Provide
r Individual
Long Term Conditions Proactive Structured
Perspectives
Individual
Population
Acute Conditions Reactive Unstructured
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opportunity we could measure manage any
health problem access, utilisation outcome
inequalities improve the care of the individual
and inform the sector
National Regional DHB/NGO Network Practice Provide
r Individual
Long Term Conditions Proactive Structured
Perspectives
Individual
Population
Acute Conditions Reactive Unstructured
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National Regional DHB/NGO Network Practice Provide
r Individual
Long Term Conditions Proactive Structured
Perspectives
Individual
Population
Acute Conditions Reactive Unstructured
Patient centred
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National Regional DHB/NGO Network Practice Provide
r Individual
Long Term Conditions Proactive Structured
Perspectives
Individual
Population
Acute Conditions Reactive Unstructured
The practice as custodian of the EHR in
partnership with the patient
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• Increasing role of the patient at the centre of
  health care (cf the provider and organisations)
• For information to follow the patient through the
  health system
• Referrals, status, discharge, shared records,
  interconnectivity

National Regional DHB/NGO Network Practice Provide
r Individual
Long Term Conditions Proactive Structured
Perspectives
Individual
Population
Acute Conditions Reactive Unstructured
The practice as custodian of the EHR in
partnership with the patient
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• Variable quality of information for self
  management
• Patient access to the EHR
• Appointments, results, (parts of) the health
  record
• Information about the provider, performance,
  outcomes

National Regional DHB/NGO Network Practice Provide
r Individual
Long Term Conditions Proactive Structured
Perspectives
Individual
Population
Acute Conditions Reactive Unstructured
The practice as custodian of the EHR in
partnership with the patient
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National Regional DHB/NGO Network Practice Provide
r Individual
Long Term Conditions Proactive Structured
Perspectives
Individual
Population
Acute Conditions Reactive Unstructured
Clinical governance
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• Are we doing as well as we could?
• Is there a gap between current practice and
  'best practice?
• How can we manage this?

National Regional DHB/NGO Network Practice Provide
r Individual
Long Term Conditions Proactive Structured
Perspectives
Individual
Population
Acute Conditions Reactive Unstructured
Clinical governance
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Clinical governance is a system in which NHS
organisations are accountable for continuously
improving quality of their services and
safeguarding high standards of care by creating
an environment in which excellence in clinical
care will flourish
National Regional DHB/NGO Network Practice Provide
r Individual
Long Term Conditions Proactive Structured
Perspectives
Individual
Population
Acute Conditions Reactive Unstructured
Clinical governance
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Clinical governance is a system in which NHS
organisations are accountable for continuously
improving quality of their services and
safeguarding high standards of care by creating
an environment in which excellence in clinical
care will flourish
National Regional DHB/NGO Network Practice Provide
r Individual
Long Term Conditions Proactive Structured
Perspectives
Individual
Population
Acute Conditions Reactive Unstructured
Clinical governance
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New tier of support for general practice

• Quality Health Care Support
• Clinical leaders
• Clinical specialists
• Peer (cell) group
• Quality facilitators
• Pharmacy and lab
• Immunisation child health
• Education organisers

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Quality Improvement
Activities Tools
PSDA cycles Measure performance,
feedback Quality indicators Peer
review Intervention Support, quality education
facilitators
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Quality Improvement
Activities Tools
Environment
Culture, relationships trust Learning, local
and international
Incentives Professional values
vs Contractual obligations
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What we know.

• Organised General Practice is good for your
  health.
• Better outcomes, more satisfaction
• A vehicle for strong clinical governance
• Supported by good IT/IM
• But not good enough!
• We can, and must do better
• We know how to
• We believe qi4gp will allow this

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• The major phases in this general practice
  initiative

Clarify Develop the Vision
An Initial Perspective
Implement the Vision
Apr 07
Dates TBC
Aug 07
Dates TBC
Current Phase
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2
8
1
4
3
7
6
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Broader Stakeholder Engagement
Plan to Implement
Initial Stakeholder Engagement
Agree Projects / Partnerships
Draft Discussion Paper
Plan Next Steps
Final Discussion Paper
Final Strategy Document
Track Progress
The Key Directions Project
Stage 1 Business Case
Consultation Document
Detailed Requirements / Solution
Stage 2 Business Case
High-level Requirements / Solution
Implementation