Evaluation of HealthOne Mt Druitt

HealthOne Mt Druitt (HOMD) is a system of managing people with chronic illness that integrates primary and community health services. The linchpin of the HOMD model of care is the two GP liaison nurses (GPLNs) who identify the patient’s needs based on referrals received and assessments made and facilitate communication, case conferencing and care coordination between the various health professionals and other providers involved in the patient’s care.

SCIPPS Sydney worked in close collaboration with the Mount Druitt Community Health Centre and HealthOne staff to conduct a mixed method evaluation of HOMD.

The qualitative component of the evaluation commenced in 2010. Interviews with NSW Health and WSLHD decision and policy makers, steering committee members and HOMD staff were completed by the end of 2010. Interviews with patients were completed in March/April 2011. Interviews with these patients’ GPs were completed by end November 2011. A focus group with Mount Druitt Community Health staff was held in November 2011.

Patient emergency department presentations and hospital admissions data were extracted in August 2011. CHIME (Community Health Information Management Enterprise) data were extracted in October 2011. A survey to all service providers with HealthOne enrolled patients was distributed in May 2011.

The Report was finalised in February 2013:

McNab J., Mallit, K., Gillespie J. Report of the Evaluation of HealthOne Mount Druitt, Menzies Centre for Health Policy, February 2013.

Findings

Changes in Patient Outcomes

  • Patient outcome analyses showed that among people with chronic and complex conditions enrolled in the HOMD program the number of emergency department presentations, and length of stay in the emergency department, in the 12 months following enrolment in HOMD was significantly less than in the 12 months prior to enrolment.

Changes in Health Services

  • The pattern of service utilisation changed in the 12 months after enrolment in HOMD, with more referrals to allied health services such as physiotherapy, podiatry, occupational therapy, dietetics and psychosocial services.
  • Source of the referral changed with fewer referrals from the acute care (hospital inpatient) setting and more from other health service providers and families, friends and neighbours.
  • The GPLNs improved coordination and integration of services for clients with chronic and complex illnesses.
  • The GPLNs improved formal and informal communication between community health, general practice and other health and social care providers through care planning, case conferences, and partnership building.

Process Evaluation

  • The process of forming enduring partnerships is a long and difficult one, with unity of vision, trust and leadership at all levels of the partner organisations necessary for the successful implementation of a HealthOne service.
  • GPLNs were crucial to all aspects of the development and implementation of the service, with engagement with clients kicking off the process of forming appropriate relationships and providing care, and where necessary, referral to new services, including social care and psychosocial services.
  • GPLNs needed to be flexible and work with GPs, other providers and partner organisations to add value to the care provided to clients rather than compete by providing duplicate services. Policy and decision makers also needed to remain flexible to allow innovation to occur at the local level, reflecting local needs, while still providing the broader policy framework or management decisions when necessary.
  • The seniority and expertise of individuals in Liaison Nurse roles are critical to earn and maintain respect of health and other professionals, along with leadership skills to initiate a cross-organisational culture change conducive to coordination and integration within the primary health care sector.
  • Sustainability of HealthOne services depended on the continued commitment of leaders at all levels of the partner organisations, and a continued commitment from funding bodies to employ GPLNs and provide wider workplace support.