Implementing value‐based health care at scale: the
            <scp>NSW</scp>
            experience

Koff, Elizabeth; Lyons, Nigel

doi:10.5694/mja2.50470

Medical Journal of Australia

2020

DOI: 10.5694/mja2.50470

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Implementing value‐based health care at scale: the NSW experience

Elizabeth Koff

Nigel Lyons

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Cited by 39 publications

(59 citation statements)

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“…4 In New South Wales (NSW), Australia, clinical leadership and engagement are central to health system transformation. 5 However, the breadth, scale and pace of engagement has increased in response to the pandemic. The NSW experience is a model for system-wide crisis management and provides practical strategies for clinical engagement.…”

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confidence: 99%

Value of clinical engagement in the NSW Health response to COVID-19

Lyons¹,

Cox²,

Clements³

2020

Aust. Health Rev.

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Clinical engagement has been critical to the NSW Health response to COVID-19, with clinicians across the state working together at a scale and pace not seen before. Since mid-March 2020, 30 COVID-19 Communities of Practice (COPs) have been established, bringing together over 3500 clinicians and other members across 30 different clinical specialties to inform and support a consistent statewide response to the pandemic. COPs share issues, escalate priorities and develop evidence-based guidance on a range of topics. This article provides practical insights into the value of clinical leadership and engagement in a time of crisis. It describes the role of COVID-19 COPs, what they have achieved and their importance in supporting the ongoing pandemic response in New South Wales.

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confidence: 99%

Value of clinical engagement in the NSW Health response to COVID-19

Lyons¹,

Cox²,

Clements³

2020

Aust. Health Rev.

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“…To the Editor : We read with interest the article by Koff and Lyons and agree that there is a need to develop, implement and evaluate health systems around patient needs and wishes. Implementing value‐based health care is an excellent initiative to address sustainability and patient‐centred care .…”

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confidence: 99%

“…Implementing value‐based health care is an excellent initiative to address sustainability and patient‐centred care . Genuine reform requires a transition away from volume‐based service contracting towards a multidisciplinary approach focused on evidence of improved outcomes . This would reward doctors and the system for keeping patients healthy and independent in their own homes, with community support, for as long as possible…”

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confidence: 99%

“…The Leading Better Value Care initiative (2016–2020) may be misinterpreted as another set of top‐down policies. It may also have unintended consequences such as reinforcing the silo approach to disease states, diverting finite hospital and local health district resources, such as staff and expertise, to these 13 policy‐driven priority projects.…”

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confidence: 99%

“…In our work in perioperative health care, we have identified some concerns. First, the sustainability of our health systems is tested by patients who are frailer, who have chronic diseases, and who present for high risk surgery . Second, these patients have a higher incidence of post‐operative complications and are more likely to be discharged to a higher care facility, rather than back to their home .…”

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confidence: 99%

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Implementing value‐based health care at scale: the NSW experience

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Forero

Greenfield

et al. 2020

Medical Journal of Australia

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An 11-year longitudinal analysis of refracture rates and public hospital service utilisation in Australia’s most populous state

et al. 2022

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Summary This detailed 11-year longitudinal analysis calculated the public health cost of managing refractures in people aged ≥ 50 years in Australia’s most populous state. It provides current and projected statewide health system costs associated with managing osteoporosis and provides a foundation to evaluate a novel statewide model of fracture prevention. Purpose The purpose of this longitudinal analysis was to calculate current and projected refracture rates and associated public hospital utilisation and costs in New South Wales (NSW), Australia. These results will be used to inform scaled implementation and evaluation of a statewide Osteoporotic Refracture Prevention (ORP) model of care. Methods Linked administrative data (inpatient admissions, outpatient attendances, Emergency Department presentations, deaths, cost) were used to calculate annual refracture rates and refracture-related service utilisation between 2007 and 2018 and healthcare costs between 2008 and 2019. Projections for the next decade were made using ‘business-as-usual’ modelling. Results Between 2007 and 2018, 388,743 people aged ≥ 50 years experienced an index fracture and 81,601 had a refracture. Refracture was more common in older people (rising from a cumulative refracture rate at 5 years of 14% in those aged 50–64 years, to 44% in those aged > 90 years), women with a major index fracture (5-year cumulative refracture rate of 26% in females, compared to 19% for males) or minimal trauma index fracture and those with an osteoporosis diagnosis (5-year cumulative refracture rate of 36% and 22%, respectively in those with and without an osteoporosis diagnosis). Refractures increased from 8774 in 2008 to 14,323 in 2018. The annual cost of refracture to NSW Health increased from AU$130 million in 2009 to AU$194 million in 2019. It is projected that, over the next decade, if nothing changes, 292,537 refracture-related hospital admissions and Emergency Department presentations and 570,000 outpatient attendances will occur, at an estimated total cost to NSW Health of AU$2.4 billion. Conclusion This analysis provides a detailed picture of refractures and associated projected service utilisation and costs over the next decade in Australia’s most populous state. Understanding the burden of refracture provides a foundation for evaluation of a novel statewide ORP model of care to prevent refractures in people aged ≥ 50 years.

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Implementing value‐based health care at scale: the NSW experience

Cited by 39 publications

References 4 publications

Value of clinical engagement in the NSW Health response to COVID-19

Value of clinical engagement in the NSW Health response to COVID-19

Implementing value‐based health care at scale: the NSW experience

An 11-year longitudinal analysis of refracture rates and public hospital service utilisation in Australia’s most populous state

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