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Kristine Battye, Peter Stanley-Davies and Elaine Ashworth

Evaluating a new model of Primary Health Care service delivery in remote Queensland: Lessons Learned. Kristine Battye, Peter Stanley-Davies and Elaine Ashworth. Outline. Describe NWQAHS to provide context for evaluation Structural issues encountered

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Kristine Battye, Peter Stanley-Davies and Elaine Ashworth

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  1. Evaluating a new model of Primary Health Care service delivery in remote Queensland: Lessons Learned Kristine Battye, Peter Stanley-Davies and Elaine Ashworth

  2. Outline • Describe NWQAHS to provide context for evaluation • Structural issues encountered • Difficulties in establishing a system to “measure” process and impact of PHC • Type of data available for planning and evaluating PHC services

  3. North West Qld Allied Health Service Operational Hub and Spoke Model • Key Features • Functional teams • 6 month calendar • 6 weekly rotations • 2-3 days in each community • Primary health care • Centralized booking system • Therapy assistants in each community • Videoconference follow-up • Case conference with resident health professionals Gulf precinct 5 communities Mt Isa Hub Highway precinct 3 communities Mt Isa precinct 3 communities

  4. NWQPHC Board Chief Executive Officer Executive Officer Operations & Outcomes Executive Officer Admin & Finance Area Manager Area Manager Area Manager Area Manager NWQAHS Manager

  5. Initial Management Structure (1.5 Years) NWQPHC Board CEO Community Panel Advisory NWQAHS Service Manager 9 AHPs 1 Admin

  6. Domains of the Evaluation • Recruitment and retention strategy • Management and operation of service • Service delivery – access and PHC • Impact – community and individual • Integration with other service providers • Comparative cost effectiveness with alternate models

  7. Methodology Proposed • Qualitative - Direct intermittent information gathering • Quantitative - Indirect and continuous monitoring, data collection, surveillance and use of sentinel communities, and health issues

  8. Difficulties encountered • Shared perspective of purpose of evaluation • Time frame • Information Mx system relevant to PHC activity • Recognition of complexity of PHC service delivery • Management capacity and multiple demands • Are we trying to collect the right data anyway?

  9. Shared purpose of evaluation Management Capacity – Multiple demands Time frame Structural Issues impacting on Evaluation

  10. Shared purpose of evaluation Management Capacity – Multiple demands Complexity of service delivery model Info Mx system that captures complexity Is it the “right” data? Time frame PHC paradigm but what data set?

  11. Purpose of Evaluation

  12. Shared purpose of evaluation Management Capacity – Multiple demands Time frame Structural Issues impacting on Evaluation

  13. Structural issues: Lessons Learned and Implications for Policy • Realistic timeframes for service establishment and realistic expectations of deliverables in first 3 years • Adequate resource allocation to management in the service establishment phase (service and auspice) • Greater emphasis on formative evaluation by funders and service providers • Broader performance indicators for primary health care services – reduced emphasis on occasions of service

  14. Practical Issues around “Measuring” Primary Health Care

  15. Shared purpose of evaluation Management Capacity – Multiple demands Complexity of service delivery model Info Mx system that captures complexity Is it the “right” data? Time frame PHC paradigm – How is it measured?

  16. Information Management System Specifications: Client demographics and indigenous identifier Clinical treatment records Time use data – activities in conjunction with treatment - community focused activities Client outcomes/ client centred goals

  17. Quantitative data • Referrals as a proxy for occasions of service • Used to measure access to service by indigenous and non-indigenous people at a community level (2nd yr) • Management capacity increased – development of chart system

  18. Analysis of Referrals by community 2002/03

  19. REAL LIFE Data Collection Issues • AHPs record info/data relevant to their job, or see the value of it – data quality is better • Outreach service - client info maintained in a number of places • Reason for referral not “centralized” but recorded in client notes • Centralized data base – maybe need a data “enterer” • Coding? ICPC developed by WONCA

  20. Do we collect the right data to evaluate and plan for PHC? • Measure what we can measure • Occasions of service – proxy for workload? • How do you evaluate the number of oldies you keep out of institutions because they have had access to allied health interventions? • How do you measure the impact of early intervention in services that operate across the age continuum? • Risky!! Why do we try and plan PHC (wellness) services at a local level using secondary care (sickness) data? Because that’s all there is!?

  21. PHC: More Lessons Learned • Need a mix of qualitative and quantitative measures to evaluate PHC – perhaps with equal emphasis • Development of information management and evaluation processes need to be staged, and recognized in contracts with funders • We need to re-think the data set and data collection processes we use to plan and evaluate primary health care services

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