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Integrated Diabetes Services

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Deirdre Panapa

on 2 April 2014

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Transcript of Integrated Diabetes Services

Integrated Diabetes Services
Developing patient-centred diabetes care
Agreed Pathways
Targeted primary and secondary integration
begins through Canterbury Initiative

Care delivery must change!
We are getting older.
More people with chronic conditions. (500,000 believed to have Pre-diabetes in NZ)
Use of health services about to zoom!
Integration: the
key to higher
performance and future sustainability
At its heart, integration:
“seeks to improve the quality of care for individual patients, service users and carers by ensuring that services are well co-ordinated around their needs.”
(Kings Fund 2012)
In 2007 the health system was fragmented
The Canterbury story towards
integrated diabetes care
Diabetes care 5 years ago,
a bit more "conservative"
Medical, hierarchical influenced model
Reactive in nature
High dependency on specialist services
Growing waiting times
Communication and coordination difficulties
General practice works in isolation
"Get checked" (controversial and not supported)
Diabetes care 5 years ago,
a bit more "conservative" - cont
5 different PHO’s with different priority areas and funding models
Two diabetes nurse specialist doing case management in the community
Little capability and capacity in primary care, very few practices supported nurse led diabetes care
Rigid funding models
LDT with little influence
A vision started
To transform the system
A connected system
Centred around people
Three strategic goals
We launched a series of initiatives
31 July '12 –
1 August '13
Vision 2011
Vision 2020
In June 2011 the
Integrated Diabetes Service (IDS)
was established
The concept
Canterbury wide approach to better integrate diabetes services to:

Build a sustainable system that meets the needs of the community
Improve access to health services
Increase the coordination of services
The Health Pathways
Technology and information systems
Clinical leadership and alliances
Workforce development
Governance and structure
Education for Nurses and GP’s
Targeted subsidies
General practice teams access subsidies to support the delivery of care and education to:
1. people with Type 2 diabetes
who are newly diagnosed
2.those who are starting insulin.
Community-Based Diabetes Nurse Specialist and Dietitian services.
Promotes a systematic approach to complication screening which meets the minimum standards of care
DCIP is a flexible funding model which supports individual care planning
DCIP Funding model provides the opportunity to develop innovative models of care
Accurate coding is essential to ensure adequate ongoing practice funding and meet future reporting requirements

Achieving real inroads towards shared care across the system
Retinal Screening
During 2012, a workgroup of the IDS established a community-based diabetes retinal screening programme, which aims to improve access and better meeting the needs of the population with diabetes
And more
Process improvements such as referral management and triaging
Diabetes content for HealthInfo and HealthPathways
Stronger consumer input
(Agreement on) Data Sharing
Patient education classes in community
Improvements on information sharing and communication

Podiatry services for high risk foot patients in the community
Observations +ve
The vertical integration is well advanced
The development of the community based roles with focus on upskilling has been key to the success
Overall positive feedback from consumers
Compared with NZ rates, Canterbury continues to have low rates for people with diabetes as well as growth
DCIP overall well received
Setting something right!
Observations -ve
The development of new, agreed and system-wide approach is hard work and takes time
By default many don't like change ......and can be tribal
The development of measures that are suitable to monitor progress, but also acceptable to all parties continues to provide challenges.
Clinical Outcomes in a fee-for-service model doesn’t reward primary care for prevention
Going forward
The vision remains intact
Challenges and opportunities
Expand and support DCIP with additional funding
Continuing to implement and design clinical/patient education tools and models for improving and supporting self-management of diabetes
Opportunities to use existing shared care platforms to manage and coordinate care for the high risk/high need patient group
Flexible services to address variability in primary care
Horizontal integration - Towards a LTC model
Risk stratification of the diabetes population
Challenges and opportunities -cont
Ongoing nursing workforce development - be aware of potential inefficiencies with role overlap
Transition of care from hospital
Capacity in primary care (room, time, resources)
Real-time feedback of data on the diabetes population to primary care
Strengthening of MDT services to our children with Type 1
Further collaboration and engagement with Maori, Pacific and Asian health providers
All of this without losing sight of
the patient!
How are we doing it?
But fewer young people working and paying taxes to support the pensions and healthcare of older generation
Newly diagnosed:
for 2012/2013
up from
previous year

Starting insulin:
for 2012/2013
up from
previous year
Ten Key Principles for Successful Health Systems Integration
Esther Suter, Nelly D. Oelke, Carol E. Adair, Gail D. Armitage
Healthc Q. Author manuscript; available in PMC 2010 December 20.
Published in final edited form as: Healthc Q. 2009 October; 13(Spec No): 16–23.
Ten Key Principles for Successful Health Systems Integration
How do we stack up against the Ten Key Principles for Successful Health Systems Integration?
CDHB adopts the
NZSSD guidelines
Estimates based on the number of treatments provided in the 1 July 2012-31 December 2012 period for Pegasus Health
Incentives Matter
Two Bedouins are riding their camels through the desert side by side. One of them starts complaining about how slow their camel is. The other Bedouin responds that theirs is slower still – the slowest camel in Arabia.

They get into an argument, and finally make a bet on which camel is slower. The oasis is three miles off and the Bedouins agree that whoever’s camel gets to the oasis last wins the bet. If you think about it you can see what happens.

One of the Bedouins goes slowly, the other goes more slowly because they do not want to lose the bet, the first one goes more slowly still.

An hour later there are the two Bedouins sitting on their camels, stock still in the middle of the blazing hot desert, with the oasis still two miles off.

At this point, a wise man comes by and asks them why they are sitting stock still in the hot sun when the oasis is only two miles off. The Bedouins get off their camels to explain the situation to him.

The wise man whispers two words to them – and the Bedouins leap back on the camels and race for the oasis as fast as they can.

The riddle is: what are the two words?

Incentives Matter - cont
Review of a small 'claim' cohort
Similar average HbA1c value decrease at one year
Less secondary care outpatient contacts per patient for the claim group
Similar inpatient contacts per patient
Results suggest the Starting Insulin Subsidy is providing adequate care for patients.
Oct 12 - June 13
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