Case Studies

As part of our annual reporting to the Department of Health, we were required to write two ICDM case studies.

The annual case studies for ICDM highlight the impacts of the partnership work to improve the care of people with chronic disease and illustrates progress against the expectations outlined in the DH 2009-2012 PCP Program Logic.

The summaries/abstracts section from all case studies will be published on the Department of Health website.  A selection of complete case studies will also be published.

The two case studies submitted were:

 

PCP Role in Chronic Disease Management

The WPCP is committed to improving the quality of care and quality of life of people living in Gippsland through a coordinated, collaborative region wide approach to Integrated Chronic Disease Management (ICDM).

The ICDM program supports the development of an integrated community-based and person centred approach to the prevention and management of chronic disease, based on the Chronic Care Model developed by Ed Wagner and colleagues at the McColl Institute for Healthcare Innovation. The Wagner model proposes a proactive approach to chronic disease, focusing on keeping clients as healthy as possible. It advocates for healthcare systems improvements, community involvement in planning, and the development of self management support for clients.
http://www.ihi.org/IHI/Topics/ChronicConditions/AllConditions/Changes/

The PCP’s support for ICDM builds on the earlier work of the Better Healthcare in Gippsland (BHCiG) Project (2004-2006). This project adopted a coordinated regional approach to improving services for people at risk of or experiencing chronic disease, piloting a chronic disease management care pathway protocol in three Gippsland sites. A key resource, the BHCiG Chronic Disease Management Resource Kit https://www.dhs.vic.gov.au/communityhealth/cdm/res_bhig.htm was developed as a result of the successful partnerships and collaboration between the project partners and staff from the various agencies that participated in the project.

The PCP aims to contribute to improvements in chronic disease care by:

  • Promoting and supporting the implementation of the Wagner Model of Chronic Illness Care
  • Facilitating and supporting Working Groups and other ICDM networking activities.
  • Actively promoting and providing training in the use of the Better Health Care in Gippsland (BHCiG) Chronic Disease Management Resource Kit and training package.
  • Building the capacity of health care providers to deliver improved care to people with a chronic illness, by providing training, networking and mentoring support in all aspects of the chronic care model.
  • Participating in the ongoing development of a Gippsland Regional ICDM Training Plan.
  • Supporting the development, implementation and ongoing review of the early intervention projects at both Central Gippsland Health Service and Yarram and District Health Service.

Wellington Health and Community Services Directory

Our latest directory is now available Wellington Health and Community Services Directory March 2010

CDM Network Terms of Reference:
WCDM Network Terms of Reference March 2011

 CDM Network Meeting Minutes 2011:
Minutes WCDM Network 050411

ICDM/SC Survey

The state-wide service coordination and integrated chronic disease management (ICDM) surveys are part of the Primary Care Partnership (PCP) annual reporting requirements for the Department of Health (www.health.vic.gov.au/pcps/about/prr.htm). This process provides an opportunity for PCP member agencies to reflect on their current practice and facilitates discussions to implement service coordination and ICDM practice.

The survey results provide an opportunity for PCPs to identify areas requiring further resources and development and may be included in reviewed PCP strategic and operational plans. The survey results identifies the agencies who require further support and those that have well developed service coordination to lead or model practice. In addition, the surveys provide evidence of PCPs as a platform to deliver service system improvements and creates a benchmark for PCPs to measure the effectiveness of future strategies and interventions to further strengthen service coordination and ICDM.

At an agency level the surveys provide a vehicle to review their current practice, identify the areas that need improving and benchmark their practice against previous results and other agencies. The results also produce evidence for existing quality assurance systems and accreditation processes within the agencies.

The survey is now available via http://www.health.vic.gov.au/pcps/coordination/cqi.htm  and needs to be completed by the 31st of October 2011.

 The PCP is available to support agencies with the survey and to assist agencies determine the best approach. The completion of the survey will be extended this year to include more program areas such as dental, family and children’s services etc.