NSW Chronic Care Program
NSW Chronic Care Collaborative (February 2004 - March 2005)
The NSW Chronic Care Collaborative was a statewide improvement program
set up to enhance the implementation of NSW
Clinical Service Frameworks for chronic obstructive pulmonary disease
(COPD) and heart failure. The Collaborative was a joint initative of the
NSW Department of Health and the Clinical Excellence Commission. It used
the Institute for Healthcare Improvement's
breakthrough series methodology, a short-term (usually 6 to 15 months)
learning, implementing and auditing intervention. It brings together a
large number of teams from hospitals and other health facilities to learn
together and then to work for focused improvements in their own health
service. The NSW Chronic Care Collaborative focused on improving the diagnosis
and management of heart failure and chronic obstructive pulmonary
disease.
Achievements
Key achievements of the NSW Chronic Care Collaborative include:
- actively engaged over 300 clinicians and managers from acute and community
health services across NSW in improving care and outcomes for patients
with chronic disease
- saved 25,000 inpatient bed days through decreased hospital admissions
of patients with chronic obstructive pulmonary disease (COPD) and heart
failure
- significantly improved the diagnosis and management of COPD and heart
failure, including increased referral to rehabilitation for patients
with COPD and increased dose titration for patients with heart failure
- improved understanding of clinicians and managers in the principles
of chronic care management
- increased ability of clinicians and managers to implement clinical
practice improvements for patients with chronic disease
- enhanced communication and teamwork across health services
- developed resources
that help health services in improve care for patients with chronic
disease.
Future directions
The NSW Chronic Care Collaborative has demonstrated what can be achieved
when diverse groups come together to achieve a common aim - to improve
the diagnosis and management of patients with COPD and heart failure.
The achievements made within the Collaborative will continue to be built
upon by a range of initiatives led by the Chronic Care Unit including:
- development and implementation of NSW Chronic Disease Strategy Phase
3 (2006 - 2009)
- increased emphasis on self-management and rehabilitation
- identifying and enhancing uptake of models of care coordination, care
planning and multidisciplinary care for people chronic disease
- improving the collection of data to monitor improvement in chronic
care management.
Evaluation of the NSW Chronic Care Collaborative
On completion of the NSW Chronic Care Collaborative, the NSW Department
of Health engaged the Centre for Health Services Research at Westmead
to evaluate the Collaborative. Full details of their work and findings
can be found in Evaluation:
NSW Chronic Care Collaborative or for a general overview please see
the Executive
Summary.
For further information or to subscribe to the Chronic Care Listserve
please contact the NSW Chronic Care Unit on 02 9391 9921 or email chroniccare@doh.health.nsw.gov.au.
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