On Friday 18 July 2003, the Premier Hon Steve Bracks, MLA and the Minister
for Health Hon Bronwyn Pike, MLA, launched the 2003-04 Hospital Demand
Management Strategy funding allocations, including 2003-04 HARP funding
allocations.
Twenty-nine projects have been approved through the 2003-04 HARP funding
round, making a total of 100 projects currently funded through HARP.
The initiatives funded in 2003-04 will contribute to integrated systems
of care for people, taking account of the range of services across the
care continuum. The projects build on the existing prevention base that
exists within health services participating in HARP. Nine (31%) of the
projects extend existing initiatives that have demonstrated their effectiveness.
There has been strong collaboration across the service system with 22
(76%) of the initiatives involving funds being channelled into primary
care services. A number of mechanisms have been used to achieve this
including six projects (21% of the organisations) where primary care
agencies are the fund holder.
| NAME OF PROJECT |
PROJECT OBJECTIVE |
2003/04 FUNDING |
PROJECT CONTACT |
| AUSTIN HEALTH |
Community Link Rapid Response Service Enhancement
|
This project enhances an existing initiative
which caters for the needs of older people presenting to the Austin
Health emergency department by providing an alternative for older
people through the provision of a comprehensive assessment of a person's
medical condition and their home environment. Following assessment
services are provided in a timely manner, responding to a persons
immediate needs. The project is a joint partnership between GPs,
the Royal District Nursing Service, hospital and community-based
services and local councils. This initiative builds on relationships
between these services to enhance continuity of care for older people
and integrated service responses. |
$679,194 |
Bernadette
McDonald
Bernadette.McDonald@austin.org.au
9496 5343
|
| Respecting Patient Choices |
To assist individuals their families, doctors
and other health care providers to discuss preferences about end
of life care. This enables people to work together to understand
and clarify individual wishes, and appoint another person to follow
through on expressed wishes if an individual becomes unable to make
decisions for themselves. |
$318,481 |
| Out of Area Bed Coordination |
Provides for an "Out Of Area Bed
Co-ordinator to assist people urgently in need of inpatient treatment
within an Acute Psychiatric Unit when other hospitals are unable
to accommodate these patients and they come from another catchment
area. |
$112,688 |
| BARWON HEALTH |
| Integrated Disease Management of Chronic Heart
Failure (CHF) |
This initiative will provide an integrated comprehensive
service to a person with CHF and to his/her family. The program involves
maintaining strong links with the person's GP as the cornerstone
of care, and will include a comprehensive package of specialist nursing,
physiotherapy, medical, occupational therapy, pharmacy, complex care
coordinators, social work, rehabilitation services, education and
leisure support. Simultaneously, generalist community health staff
members will be trained so they can continue the work with the person
and the family, to maintain the gains made. |
$179,712 |
Anna Fletcher
annaf@barwonhealth.org.au
5226 7573
|
| BAYSIDE HEALTH |
| Medication Alert Project |
Patients at risk of medication misadventure whilst
attending The Alfred, Austin Health, The Royal Melbourne and/or Southern
Health hospitals will be stratified into high medium and low risk
groups. Those identified as high risk, will receive a visit from
pharmacist within a week of discharge to discuss and resolve medication
issues. Contact will be made with the patients GP and Community Pharmacist,
detailing medication changes made during the hospitalisation, with
a rationale where possible, and any identified issues. Patients identified
as medium risk, will be referred to their GP for follow up in the
community by Home Medication Review. Patients identified as low risk
and who are visited by RDNS or other community supports, will be
assessed and referred to their GP if necessary. |
$521,147 |
Jenny Woodgate
jenny.woodgate@austin.org.au
9496 5000
|
| BENDIGO HEALTH CARE GROUP |
| Improved Management of Care for People with Congestive
Heart Failure |
The initiative involves a multidisciplinary team
offering expertise and implementing interventions across the continuum
of care for patients with CHF. The model of care has a particular
focus on empowering patients with CHF to better manage their own
care. |
$144,877 |
Janice Osteraas
josteras@bendigohealth.org.au
54546410
|
| CITY OF PORT PHILLIP |
| Care Coordination for Mental Health & Complex
Psychosocial Needs |
This project aims to improve the health and wellbeing
of people with mental health and complex psychosocial needs who are,
or are likely to become, frequent users of hospital emergency and
inpatient services. It does this through the development of a coordinated,
comprehensive response to client needs, between the hospital and
key community agencies. The project will bring together a multi disciplinary
team of workers from key agencies with expertise in working with
the target group, who will be able to identify services required,
share information, develop skills and promote the coordinated care
of clients. |
$463,911 |
Jackie Beckmann
JBeckman@portphillip.vic.gov.au
9209 6485
|
| DAREBIN COMMUNITY HEALTH
SERVICE |
| Integrated Chronic Disease Management - COPD & CHF |
This project targets people with COPD and CHF,
providing them with rehabilitation and treatment in line with individualised
care plans. It will involve coordinating the services provided by
hospitals, GPS and community service providers. Within the project
people's self-management of their conditions will be enhanced. |
$338,851 |
Robyn Bradley
robyn.bradley@dch.org.au
8470 1807
|
| DIANELLA COMMUNITY HEALTH
SERVICE |
| A Comprehensive Community Approach to Asthma
Management for Children and Families - Phase 2 |
This extends an existing project which provides
intensive support to children with asthma. A particular emphasis
is placed on families from culturally and linguistically diverse
and low socio-economic statue backgrounds in the north and west of
Melbourne. The initiative will involve education and support on asthma
management for GPs participating in the project and facilitate linkages
and interface between other paediatric asthma programs provided in
the community. Opportunities tor support parental smoking cessation
and family based physical activities will be provided along with
a written asthma management plan developed with the family/child
and translated if required. Home visits and follow up will be undertaken
as appropriate. |
$187,054 |
Debra O’Connor
Debra.oconnor@dianella.org.au
8345 5450
|
| EASTERN HEALTH |
| Integrated Response to Complex Needs in the Community |
Focuses effort across sectors of the health service
system by enhancing the capacity to respond in the community to conditions
for which presentations and admissions to hospital can be avoided.
In addition to building a substantial 'Community Response Capacity',
this model intends to create a culture shift for service providers
in the health sector to reinforce the view that trips to hospital
can be avoided, and that the capacity of hospitals to provide optimal
responses to urgent acute needs must be preserved by ensuring non
urgent and chronic conditions are well managed in the primary care
and community support setting. |
$1,113,400 |
Andrew Crow
andrew.crow@angliss.org.au
9764 6150
|
| Respecting Patient Choices |
To assist individuals their families, doctors
and other health care providers to discuss preferences about end
of life care. This enables people to work together to understand
and clarify individual wishes, and appoint another person to follow
through on expressed wishes if an individual becomes unable to make
decisions for themselves. |
$168,530 |
Jennifer Evans
Jennifer.evans@maroondah.org.au
0408 135 246
|
| GOULBURN VALLEY HEALTH |
| Goulburn Valley Admission Risk Program: Strengthening
Acute and Community Partnerships |
A new allied health team will be established
to work with people with diabetes, older people waiting for a bed
in residential care and people with mental health problems who are
at risk of hospital admission. Entry to the service and co-ordination
of care will be provided through specialist nurses working with Shepparton
ACAS and the Diabetes Education and Support Service. A nurse consultant
in mental health will work within Goulburn Valley Health's emergency
department to provide consultation for patients presenting with mental
health problems and provide referral to more appropriate services. |
$213,710 |
Leigh Gibson
leigh.gibson@gvh.humehealth.org.au
58 322 700
|
| MELBOURNE HEALTH |
| Comprehensive Community Care Service |
The Comprehensive Community Care Service will
provide integrated service for older people living in the community
with one or more chronic conditions and complex care needs. It will
provide earlier intervention to prevent avoidable hospitalisation
by increasing both the level of support services available, and integration
between services. The service will be predominately community based
and will comprise two teams working together as an integrated service.
The Community Response Team operating extended hours, 7 days a week,
will provide a single point of entry, same or next day home assessment
and a short term service coordination role and the Specialist Care
Team will provide specialist interventions for clients with chronic
conditions such as diabetes, COPD, CHF, arthritis complicated by
factors associated with older age. |
$675,684 |
Jane Gilchrist
Jane.Gilchrist@mh.org.au
9342 7820
|
| METROPOLITAN AMBULANCE SERVICE |
| Medical Deputising Service link with MAS Referral
Service |
This project supplements a pilot project that
links two services for greater coordination and better patient care.
The first service is the MAS Referral Service. The Referral Service
will divert callers with certain low acuity problems away from automatic
ambulance attendance by proffering appropriate alternative services.
The second service is offered by Melbourne's two medical deputising
services, Australian Locum Medical Service and Melbourne Medical
Locum Service. The Medical Deputising Services will coordinate the
attendance of a locum doctor within an appropriate time frame. The
funds provided will provide for some of the information technology
requirements of the project. |
$139,580 |
Angela Hodgkinson
Angela.Hodgkinson@mas.vic.gov.au
9840 3717
|
| NORTHERN DIVISION OF GENERAL
PRACTICE |
| An Integrated Holistic Approach to Diabetes Management |
This initiative aims to provide an integrated
and holistic approach to diabetes management, to avoid complications
that lead to patient admission to hospital. There are currently many
services available to diabetic patients in the catchment and this
project will coordinate these services and reduce barriers to access.
The project will develop a single point of entry to community-based
diabetes services, provide a comprehensive package of assessment
and treatment services, support GPs to develop care plans for diabetic
patients and adopt a common chronic disease management approach across
acute and primary health care. |
$345,302 |
Phillip Bain
Phillip.bain@ndgp.org.au
9416 7689
|
| NORTHERN HEALTH |
| Integrated Wound Management Services |
Through a joint partnership between community
health centres, GPs, Royal District Nursing Service and hospitals
in the Northern Region, an integrated approach to wound care in the
community is being developed. This initiative encourages health professionals
to work together to enable people with wounds improved access to
care and ongoing management of their wounds. This approach will facilitate
better treatment and lead to improved healing of wounds for people
who are at hight risk of ongoing problems. |
$392,918 |
Rebecca Jessup
rebecca.jessup@nh.org.au
9495 0400
|
| Community Client Orientated Medication Services
(C-COMS) |
C-COMS has been designed in response to an increasing
awareness of the growing number of older people presenting to EDs
and requiring hospital admission for medication-related problems.
Addressing the medication management needs of older people whilst
they are still in the community, and so reducing the number of presentations
to emergency departments and the number of hospital admissions for
drug-related reasons is a key principle of C-COMS. |
$313,888 |
Samantha Reid
samantha.reid2@nh.org.au
8480 4614
|
| Respecting Patient Choices |
To assist individuals their families, doctors
and other health care providers to discuss preferences about end
of life care. This enables people to work together to understand
and clarify individual wishes, and appoint another person to follow
through on expressed wishes if an individual becomes unable to make
decisions for themselves. |
$91,615 |
Gail Roberts
Gail.Roberts@nh.org.au
0425 745 111
|
| PENINSULA HEALTH |
| Peninsula Residential Outreach Response Team |
A team of health professionals from Peninsula
Health incorporating a Clinical Nurse Specialist in Gerontics, a
Senior Social Worker and an Aged Care Registrar will provide on-site
visits and telephone advice to residential care facilities in order
to support the staff in meeting their residents' needs within the
facility. The team will work with consumers, their carers, the residential
care facility and GPs to provide support for medical management of
residents, behavioural support and planning for end of life decisions
and care. |
$214,454 |
Sue Goonan
sgoonan@phcn.vic.gov.au
9784 7663
|
| ROYAL DISTRICT NURSING SERVICE |
| RDNS Community Nursing Response to Metropolitan
Ambulance Service Referral Service |
Aims to reduce the number of clients being transported
by ambulance to emergency departments by referring non-emergency
'000' callers to a more appropriate health care service provider.
If there is no need for an emergency response, the '000' call-taker
refers the call to a health professional who will ask the caller
more questions, identify if a community nursing service is appropriate,
determine an appropriate response time, obtain the caller's consent
to share health information, and pass on information about the caller's
needs to the RDNS. RDNS will negotiate a home visit time with the
caller to develop a care plan. |
$297,384 |
Martin Wischer
mwischer@rdns.com.au
9536 5222
|
| ST VINCENT'S HEALTH |
| Holding It Together |
The Holding it Together (HiT) expands an existing
program focusing on clients with drug and alcohol problems, issues
related to homelessness, and mental health issues. HiT provides a
service response tailored to each of these groups who are high users
of emergency departments (ED). For patients who are not eligible
for mental health services, but continue to present to the ED with
mental health issues, HiT provides a response in care coordination,
case management, and links patients in with appropriate services
such as GPs and HACC services. For patients who are homeless, and
present to the ED intoxicated with alcohol, HiT will provide a more
appropriate environment in which to sober up and be linked in with
appropriate services. This includes offering options such as crisis
accommodation and advocating for longer-term accommodation needs.
A GP project officer will focus on improved system linkages between
HiT and GPs, as well as between public mental health clinics and
GPs. |
$481,466 |
Silvio Pontonio
Silvio.PONTONIO@svhm.org.au
9288 2132 |
| Restoring Health |
The Restoring Health Program
aims to deliver improved health outcomes for patients with Chronic
lung disease, heart failure and diabetes. This will be achieved
by providing:
* Tailored care plans between GPs, specialist medical, nursing
and allied health staff at St Vincent's Hospital Melbourne, and
specialist nursing and allied health staff based in the community.
* Outreach services including community nursing and allied health
services.
* Heart failure, pulmonary rehabilitation and diabetes rehabilitation
programs.
* Community supports such as maintenance exercise programs,
support groups and better health self-management courses.
* Flexible access to medical staff via rapid access outpatient
clinics.
Tailored services to carers and CALD clients and their carers.
|
$417,314 |
| Treatment, Response & Assessment For Aged Care |
The Treatment, Response and Assessment for Aged
Care (TRAAC) is an integrated system of care and support between
St. Vincent's Hospital and local community agencies and services.
TRAAC facilitates access to services that provide both clinical and
non-clinical care. In addition to treating clinical symptoms, the
non-clinical services can reduce patient and carer stress that, if
ignored, can often lead to an ED attendance. TRAAC encourages health
and social services in hospital and in the community to work together
to provide services that are most appropriate for the patient and
their families. |
$428,580 |
| The COACH Program in the Community |
This project extends an existing initiative by
establishing a maintenance and relapse prevention/management service
for patients with coronary heart disease who have achieved their
risk factor targets by means of the Coaching Patients On Achieving
Cardiovascular Health (COACH). The COACH initiative is a training
program for patients with CHD whereby a health professional coach
empowers the patient to act in partnership with their treating doctor
to achieve and maintain target levels for their particular coronary
risk factors. The additional position funded will be based within
the Melbourne Division of General Practice. |
$74,241 |
| Respecting Patient Choices |
To assist individuals their families, doctors
and other health care providers to discuss preferences about end
of life care. This enables people to work together to understand
and clarify individual wishes, and appoint another person to follow
through on expressed wishes if an individual becomes unable to make
decisions for themselves. |
$129,223 |
| SOUTHERN HEALTH |
| Care in Context for Mental Health Patients |
Targets people aged 16 to 65 years who are frequent
presenters to the Monash Medical Centre and Dandenong Hospital who
have mental health issues. Patients who present to the ED five or
more times in 6 months will be 'flagged' and assessed for mental
health issues. Those patients who have mental health issues will
have care plans developed by mental health care consultants located
in community health centres. These care consultants will provide
short term treatment and facilitate the implementation of their care
plans in collaboration with other primary care providers. |
$354,335 |
Greg Young
g.young@southernhealth.org.au
9783 8463
|
| Supporting the Improved Management of CHF in
the Community |
This project aims to support management in the
community of people with CHF using processes such as screening /
intake, outreach, a designated heart failure clinic, action care
plan, community services, review and communication between service
providers. Expected outcomes are improved quality of care and reduced
need for hospital admissions, or presentation to the ED for these
people. |
$244,652 |
| Health for Kids in the South East |
The 'Health for Kids' project aims to achieve
the best health outcomes for children in the south eastern suburbs.
The focus of the initiative will be on four particular conditions
asthma, croup, bronchiolitis and gastroenteritis. The aim is to prevent
these illnesses occurring, and when prevention is not possible, manage
them in the best possible way to keep them out of hospital or to
reduce their length of stay. The project is based around two main
strategies assisting health professionals working with children to
practice the highest standards and linking health professionals together
so that children get the best service from the right people. |
$424,764 |
| WESTERN HEALTH |
| An Integrated System for Managing the Care of
Older People with Complex Needs |
Targets people who are 65 years or older who
frequently present to the Sunshine and Western Hospital EDs, and
have one or more identified risk factors. The Project will focus
on identifying and managing people with complex needs across the
continuum of care. Through the use of comprehensive assessment, development
of personalised management plans and continuous evaluation of care,
the initiative will ensure that people with complex needs have immediate
and appropriate access to the services they require. |
$1,113,208 |
Gillian Dickman
Gillian.Dickman@wh.org.au
8345 1179
|
