Community and Primary Health Division Aged Care Stream YOU WANT IT WHEN?! Priority Matrix Tool

1. Community and Primary Health DivisionAged Care StreamYOU WANT IT WHEN?!Priority Matrix Tool Brisbane South Aged Care Assessment Team Monica Barrett

2. PRESSURE ON THE TIME POOR ACAT ASSESSOR…

3. WHAT DOES PRIORITY CATEGORY MEAN? • The length of time within which the person needs contact of a clinical nature • May be used as a measure of the appropriateness of the length of time the person waits – can be used to set performance targets • Based on information available to ACAT at referral ACAP Data Dictionary 2002 p. 95

4. NATIONAL REVIEW • Reported that for ACAT, there is no defined process for determining the priority level of a referral (p.41)…there is scope to standardise and formalise the questions asked and the decision making trees to support the triage process (p.44) National ACAT Review Final Report June 2007

5. DEVELOPMENT OF TOOL • 4 domains identified that fit with the definitions as contained in the data dictionary: • Living Arrangements / Carer Issues • Change in Physical / Cognitive Function • Behaviours of Concern • Elder Abuse • Indicators within each domain developed that clearly articulated its meaning

6. HOW DID WE MEASURE ACCURACY? • Allocated priority category at intake • Staff recorded what the category should have been at completion of comprehensive assessment • Pre Ax and Post Ax category compared • Category 4 was recorded for those who did not receive allocated priority

7. RESULTS

8. OUTCOME PRIORITY FOR ALLOCATED 1 • 2 of 5 referrals allocated category 1 were actually category 1 • 1 changed to category 2 - category 1 was correct at time of referral but situation changed in 2 days • 2 changed to category 3 due to referral not reflecting wishes of client and for renewal only

9. OUTCOME PRIORITY FOR ALLOCATED 2 • 55 of 107 allocated category 2 were appropriately prioritised • 32 were found to be category 3. Reasons included: improvement since referral; client and carer differing ideas of what wanted; placement in next 12 months but not immediately; not eligible • 20 did not require ACAT assessment, reasons being rehabilitation, not wanting care, needs being met, HACC referral only

10. OUTCOME PRIORITY FOR ALLOCATED3 • 25 of 31 were appropriately allocated • 1 became very urgent – referral did not indicate urgency • 2 became category 2 due to changes in client circumstances while waiting • 3 did not proceed to assessment as not required

11. CONCLUSIONS • In only 56.2% of cases was the allocated priority the most appropriate category according to assessed needs • On review, allocated priority was accurate based on information on referral • In 43.8% of cases, reasons for urgency were not able to validated at assessment ie. Information collected did not support the information on the referral

12. CONCLUSIONS 2 • Carer stress and ability to continue caring appear to be subjectively measured by referrers

13. CONCLUSIONS 3 • Community agencies sometimes refer for residential care and/or respite as they feel it is required, but clients do not wish to access this kind of care

14. CONCLUSIONS 4 • Community agencies sometimes refer for increased services but clients do not wish to change level of service or are not eligible for packaged care ie. Do not have complex care needs that cannot be met through existing services

15. CONCLUSIONS 5 • 23 referrals (14.9% of the sample) did not proceed to ACAT assessment • Inappropriate referrals increase waiting lists – we all know this!

16. CONCLUSIONS 6 • That when priority category is correctly applied, there is a more even spread between category 2 and 3, thus reducing pressure on ACAT Allocated Outcome Priority 3 20.8% (32) 37.7% (58) Priority 4 6.5% (10) 21.4% (33)

17. LIMITATIONS OF TRIAL • Short time frame (7 weeks) of data collection limited data for those allocated a 3 • Referrals for those to be assessed in the acute setting excluded as all these are allocated a 2 therefore any inappropriate referrals from this source not captured • Return of scoring sheets from assessors not 100% therefore risk of bias

18. RECOMMENDATIONS 1 • Development of National intake models with associated training packages to ensure consistency in application of priority

19. RECOMMENDATIONS 2 • In the meantime, where referrals are not taken by ACAT members, assessors should screen for appropriateness and priority prior to offering appointments

20. RECOMMENDATIONS 3 • Utilise matrix as an educational tool for referring agencies

21. RECOMMENDATIONS 4 • To engender consistency, consideration should be given to the adoption of the matrix as a standard decision making tool for use nationally

22. RECOMMENDATIONS 5 • Introduce a priority category between the current 2 and 3 that has the client contact between 14 and ?30 days to reduce the pressure on category 2 assessments – this is especially important when non-urgent wait times are extended

23. QUESTIONS? ACKNOWLEDGEMENTS: Alison Mott Crystal Aitchison Teresa Chorazyczewski Kim Hogan Leena Rautio Linda Reid Maria Sucharsky Therese Mitchell Jan Coad Kristine McKenzie Angela Dahm Leesa Elliott Sandra Williams Mary Neil Lois Eastgate Sarah Arndt Mylynda Miller Merryl Matheson Diane Bale Rachel Issell Robyn Reid Anne Jacobs Ann Walker