July 2023 edition
Andrew Davison, NSW Health Chief Allied Health Officer, talks about understanding the different dimensions of value based healthcare at a system and service level, and from his own personal experience.
From the moment I started working as an allied health professional 25 years ago I was told about the importance of ‘patient-centred care’. I aimed to include this in my clinical practice, without really understanding what it meant or how to apply it practically.
When value based healthcare was first introduced it was a little like ‘patient-centred care’ for me. Although I had a general sense of its importance I didn’t yet fully understand the concept, the role it would play or how to use it from day to day.
The priority programs that NSW Health introduced to advance key areas of value based healthcare started to solidify how the concepts could be applied. These included the Leading Better Value Care initiatives, particularly those led by allied health such as High Risk Foot Services, Osteoarthritis Chronic Care Prevention Program and Osteoporosis Refracture Prevention.
It wasn’t, however, until I realised that the underlying principle of value based healthcare was the ‘Quadruple Aim’ of healthcare that the penny dropped.
The Quadruple Aim is that health services and clinicians aim to provide care which:
For me, designing and delivering health services with a focus on achieving the Quadruple Aim provides a clear way to apply value based healthcare in all our work and how NSW Health becomes a value based system.
Value based healthcare is a way of working that we can use to achieve our strategic plans such as Future Health and the Regional Health Plan, and it can also be applied to any service and an individual's clinical practice.
To me, value based healthcare provides a way to design services and to deliver patient-centred care to the person in front of you, on a daily basis.
In 2021, a physiotherapy and occupational therapy led program to prevent chronic lymphoedema in women following surgery for breast cancer was implemented in 13 local health districts.
Chronic lymphoedema is a debilitating lifetime condition which affects many breast cancer survivors. It is a chronic swelling of a limb or body region, and is associated with significant morbidity, pain, loss of function and, on rare occasions, mortality. It is a condition that requires a significant amount of clinician time to manage, with the patient wearing compression garments on a daily basis at a significant cost and discomfort.
To develop the model, we took a value based healthcare approach, applying evidence-based practice to deliver care across the Quadruple Aim. The published research showed that a prevention model using surveillance and early intervention had better patient outcomes and was more cost-effective than treating lymphoedema after it developed.
Patient and clinician experience are regularly monitored to continuously help improve the program.
Since starting in March 2021, more than 4,500 patients have participated in the program with clinicians delivering over 14,000 episodes of care, and both patient and clinician experience has been very positive.
More importantly, it is estimated that this has prevented over 600 patients from developing chronic lymphoedema which will have a dramatic positive impact on their quality of life.
