The Victorian Government established the Hospital Admission Risk program (HARP) in 2001-02 to develop preventive models of care involving hospitals and community agencies which focused on people with chronic and complex conditions and gave priority to high volume and/or frequent users of the acute public hospital system.

Background

HARP was created to address sustained increases in demand on the hospital system. The factors contributing to demand include:

• an ageing population;
• new treatment options;
• reduced General Practitioner (GP) availability;
• residential care bed shortfalls;
• workforce shortages; and a
• reduction in the capacity of informal carers.

HARP successfully reduced the growth rate in demand for acute services. Achievements have included:

• improved identification and proactive management of a risk patients;
• increased health system capacity; and
• greater collaboration between services.

For the clients, some of the benefits have been:

• improved health outcomes;
• empowerment through education and self-management strategies;
• individually tailored care; and the
• chance to stay at home for longer.

HARP CDM will focus on continuing to improve the management of people with defined chronic diseases and complex needs who frequently use hospitals or who are at risk of hospitalisation. HARP CDM involves embedding the models of care that have emerged through HARP since 2001 into the Victorian service system.

Key Objectives

The objectives of HARP CDM are to:

• Improve patient outcomes;
• Provide integrated seamless care within and across hospital and community sectors;
• Reduce avoidable hospital admissions and Emergency Department presentation; and
• Ensure equitable access to healthcare.

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Target Population

The target population for HARP CDM are frequent hospital attendees who are most likely to benefit from integrated care and have the potential to reduce avoidable hospital use. This includes:

• People with chronic heart disease;
• People with chronic respiratory disease;
• People with Diabetes
• Older people with complex needs; and
• People with complex psychosocial needs.

Evidence shows that these groups are ‘people who frequently use hospitals or who are at risk of hospitalisation’.

Key Values and Principles

Eight core principles underpin the key values central to HARP CDM. They are considered essential to establishing an effective services system.

1. Client-centred
2. Carer involvement
3. Collaboration
4. Integration
5. Leadership
6. Workforce Development
7. Evidence based practice
8. Quality

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Levels of care

DHS has identified varying levels of care and intensity of service provision for people with chronic and/or complex needs as outlined by Table 1. Key elements of the model of care for HARP CDM are based on the needs of Level 1 and Level 2 service users. These people require intensive community care coordination. This will continue to enhance the usual care they receive from existing community services.

Funding made available through HARP CDM will be aimed at establishing HARP CDM across the state. DHS is currently working toward a funding model.

Efficiencies of scale will be brought about from combining small individual projects into HARP CDM based around a health service. This will allow for greater proportional spending for direct client intervention.

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Early Intervention in Chronic Disease in Community Health Services

The Early Intervention in Chronic Disease in Community Health Services (EIiCDiCHSs) initiative will target people at level 3 of the chronic disease hierarchy, in 9 community health services throughout the state. It is acknowledged that the health situation of people with chronic diseases and complex needs will fluctuate. It is imperative that HARP CDM and EIiCDiCHSs initiatives complement each other and have established protocols for collaboration.

Federal and State Policy Environments

HARP CDM will be developed to complement the rich and overlapping policy environment of both the Victorian and Australian Governments’ health care reform. Directions for your health system: Metropolitan Health strategy identifies an expanded role for ambulatory care services as a cornerstone in the configuration of health care services. Primary Care Partnerships (PCP) are collaborating to improve the health and well being of their catchment’s population through improved coordination of planning and service delivery. Other relevant state policies or initiatives include Community Health Services: creating a healthier Victoria, Improving Care for Older People: a policy for Health Services, New Directions for Victoria’s Mental Health Services: the next 5 years and HealthSMART.

More broadly, a number of Australian Government initiatives provide the opportunity to integrate with HARP CDM, including the Coordinated Care Trials, Enhanced Primary Care, the Strengthening Medicare Initiative, the National Medicines Policy, the Asthma 3+ Visit Plan and the National Health Priority Areas Initiative.

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Contact: Sian Reilly 9096 1331, Chelsea Simpson 9096 7138

This web site is managed and authorised by: the Ambulatory and Continuing Care Unit, Metropolitan Health & Aged Care Services Division of the Victorian State Government, Department of Human Services, Australia