August project update
Our team has been busy this past month with the transition to the Implementation Phase of the initiative and reaching the midway point of the Winter Strategy. Our focus is identifying how we measure and demonstrate value at each stage of the Care Pathway, monitoring and assessing the patient journey and developing collaborative models of care between MLHD and MPHN.
Winter Strategy reaches midway mark
We’ve now officially hit the halfway point of our Winter Strategy. Building on learnings from the past three years of the Murrumbidgee Winter Strategy and guided by the Living Well, Your Way Care Pathway, this year’s strategy is supporting 19 general practices across the Murrumbidgee Catchment to refocus their approach to more proactive and holistic chronic disease management for patients at risk of deterioration during winter.
Midpoint deliverables were due on 15 August and are important ‘check-ins’ for the Primary Care Engagement team and the practices involved. It’s all about looking at achievements, challenges, goals and the next steps needed to continue and expand services and integrating them into day-to-day practice activities.
Working with Griffith Aboriginal Medical Service (GAMS)
Our Living Well Clinician Lisa Curry has been working alongside staff at Griffith Aboriginal Medical Service (GAMS) to introduce the Living Well care pathway to the community. Lisa has been upskilling staff, providing additional resources, and reviewing treatment plans and progress of patients diagnosed with Chronic Heart Failure.
By working together, Lisa and the GAMS team have put in place formal review and escalation measures for the service that include nursing and medical review, improved processes for completing management plans, and updating educational resources for people living with COPD and CHF.
Lumos rollout taking effect
GPs from across the region continue to sign up to Lumos – the new program using state-of-the-art systems to link deidentified data from general practices to other health databases across the state. Lumos will give a new lease on localised data, and a comprehensive view of patient pathways, and the case for practices to get on board is only getting stronger as new data about the effectiveness of the program comes to light.
One of the largest NSW Health initiatives ever, Lumos is a partnership between the Ministry of Health and the Primary Health Networks. The Lumos collective database spans regional, remote and metropolitan areas across NSW and is continually growing.
We’re delighted to say MPHN ranks first in the state in terms of participating practices, with more than 30% of practices across the region signed up to date.
Some of the great benefits of participating are highlighted in our new factsheet, which shows that, following discharge from an unplanned stay in hospital, a visit to a GP within two days was followed by 32% fewer readmissions within the first week. A visit within the first 4 weeks after discharge was followed by 22% fewer readmissions down the track (1-3 months). Check out more great results on their website.
Needless to say, with such encouraging benefits, our team will continue to work with general practices across the Murrumbidgee to increase Lumos participation.
