Study protocol: primary healthcare transformation through patient-centred medical homes—improving access, relational care and outcomes in an urban Aboriginal and Torres Strait Islander population, a mixed methods prospective cohort study
Abstract:IntroductionFor over 40 years, Aboriginal and Torres Strait Islander Community-Controlled Health Services (ACCHS) in Australia have led strategic responses to address the specific needs of Aboriginal and Torres Strait Islander populations. Globally, there has been rapid growth in urban Indigenous populations requiring an adaptive primary healthcare response. Patient-centred medical homes (PCMH) are an evidenced-based model of primary healthcare suited to this challenge, underpinned by principles aligned with t… Show more
“…Given the pilot and preliminary nature of the study, comparison to standard care sites was beyond the scope of the present study. Leveraging from findings of this pilot study, a further study is underway to expand the implementation of the PCMH model to a second site within the IUIH network and compare outcomes to standard care clinics over a five-year period [ 12 ]. There were limited data available on important cultural, social and economic determinants of health and wellbeing.…”
Section: Discussionmentioning
confidence: 99%
“…Patients and their families are assigned to a core multidisciplinary care team – a “Pod”– which includes an Aboriginal or Torres Strait Islander Health Worker (AHW), an administrative coordinator, a registered nurse and a general practitioner (GP, Australia’s primary care physician) working collectively to lead and coordinate care based on the patient’s identified health and wellbeing priorities (Fig. 1 adapted from [ 12 ]). Fig.…”
Section: Methodsmentioning
confidence: 99%
“…Since its establishment in 2009, IUIH has been responsive to community needs in the context of a rapidly growing Aboriginal and Torres Strait Islander population in SEQ. IUIH routinely reviews their clinical care systems, as well as implements continuous quality improvement initiatives and evaluations to ensure quality comprehensive primary care is delivered to their clients [ 12 ]. Where required, changes in service delivery are implemented.…”
Section: Introductionmentioning
confidence: 99%
“…The defining features of a PCMH include: health care delivered by a team of multidisciplinary clinicians; the voluntary enrolment of clients to the program; a focus on patient education and self-management; the use of technology to support client care (including data-driven improvement), and service planning and co-ordination [ 17 ]. ISoC2 represents many of these key features, but with innovation and adaptation to strengthen access, client-provider relationships, and client engagement and agency [ 12 ]. This includes assignment to a core multi-disciplinary team, who have an expanded and intersecting scope of practice and work collectively throughout a care episode to meet patient needs.…”
Background
The patient-centred medical home (PCMH) is a model of team-based primary care that is patient-centred, coordinated, accessible, and focused on quality and safety. In response to substantial population growth and increasing demand on existing primary care services, the Institute for Urban Indigenous Health (IUIH) developed the IUIH System of Care-2 (ISoC2), based on an international Indigenous-led PCMH. ISoC2 was piloted at an urban Aboriginal and Torres Strait Islander Community-Controlled Health Service in South-East Queensland between 2019–2020, with further adaptations made to ensure its cultural and clinical relevance to local Aboriginal and Torres Strait Islander people. Little is known on the implementation and impact of PCMH in the Australian Indigenous primary care setting. Changes in implementation process measures and outcomes relating to engagement and quality-of-care are described here.
Methods
De-identified routinely collected data extracted from electronic health records for clients regularly attending the service were examined to assess pre-post implementation changes relevant to the study. Process measures included enrolment in PCMH team-based care, and outcome measures included engagement with the health service, continuity-of-care and clinical outcomes.
Results
The number of regular clients within the health service increased from 1,186 pre implementation to 1,606 post implementation; representing a small decrease as a proportion of the services’ catchment population (38.5 to 37.6%). In clients assigned to a care team (60% by end 2020), care was more evenly distributed between providers, with an increased proportion of services provided by the Aboriginal and Torres Strait Islander Health Worker (16–17% versus 10–11%). Post-implementation, 41% of clients had continuity-of-care with their assigned care team, while total, preventive and chronic disease services were comparable pre- and post-implementation. Screening for absolute cardiovascular disease risk improved, although there were no changes in clinical outcomes.
Conclusions
The increase in the number of regular clients assigned to a team and their even distribution of care among care team members provides empirical evidence that the service is transforming to a PCMH. Despite a complex transformation process compounded by the COVID-19 pandemic, levels of service delivery and quality remained relatively stable, with some improvements in risk factor screening.
“…Given the pilot and preliminary nature of the study, comparison to standard care sites was beyond the scope of the present study. Leveraging from findings of this pilot study, a further study is underway to expand the implementation of the PCMH model to a second site within the IUIH network and compare outcomes to standard care clinics over a five-year period [ 12 ]. There were limited data available on important cultural, social and economic determinants of health and wellbeing.…”
Section: Discussionmentioning
confidence: 99%
“…Patients and their families are assigned to a core multidisciplinary care team – a “Pod”– which includes an Aboriginal or Torres Strait Islander Health Worker (AHW), an administrative coordinator, a registered nurse and a general practitioner (GP, Australia’s primary care physician) working collectively to lead and coordinate care based on the patient’s identified health and wellbeing priorities (Fig. 1 adapted from [ 12 ]). Fig.…”
Section: Methodsmentioning
confidence: 99%
“…Since its establishment in 2009, IUIH has been responsive to community needs in the context of a rapidly growing Aboriginal and Torres Strait Islander population in SEQ. IUIH routinely reviews their clinical care systems, as well as implements continuous quality improvement initiatives and evaluations to ensure quality comprehensive primary care is delivered to their clients [ 12 ]. Where required, changes in service delivery are implemented.…”
Section: Introductionmentioning
confidence: 99%
“…The defining features of a PCMH include: health care delivered by a team of multidisciplinary clinicians; the voluntary enrolment of clients to the program; a focus on patient education and self-management; the use of technology to support client care (including data-driven improvement), and service planning and co-ordination [ 17 ]. ISoC2 represents many of these key features, but with innovation and adaptation to strengthen access, client-provider relationships, and client engagement and agency [ 12 ]. This includes assignment to a core multi-disciplinary team, who have an expanded and intersecting scope of practice and work collectively throughout a care episode to meet patient needs.…”
Background
The patient-centred medical home (PCMH) is a model of team-based primary care that is patient-centred, coordinated, accessible, and focused on quality and safety. In response to substantial population growth and increasing demand on existing primary care services, the Institute for Urban Indigenous Health (IUIH) developed the IUIH System of Care-2 (ISoC2), based on an international Indigenous-led PCMH. ISoC2 was piloted at an urban Aboriginal and Torres Strait Islander Community-Controlled Health Service in South-East Queensland between 2019–2020, with further adaptations made to ensure its cultural and clinical relevance to local Aboriginal and Torres Strait Islander people. Little is known on the implementation and impact of PCMH in the Australian Indigenous primary care setting. Changes in implementation process measures and outcomes relating to engagement and quality-of-care are described here.
Methods
De-identified routinely collected data extracted from electronic health records for clients regularly attending the service were examined to assess pre-post implementation changes relevant to the study. Process measures included enrolment in PCMH team-based care, and outcome measures included engagement with the health service, continuity-of-care and clinical outcomes.
Results
The number of regular clients within the health service increased from 1,186 pre implementation to 1,606 post implementation; representing a small decrease as a proportion of the services’ catchment population (38.5 to 37.6%). In clients assigned to a care team (60% by end 2020), care was more evenly distributed between providers, with an increased proportion of services provided by the Aboriginal and Torres Strait Islander Health Worker (16–17% versus 10–11%). Post-implementation, 41% of clients had continuity-of-care with their assigned care team, while total, preventive and chronic disease services were comparable pre- and post-implementation. Screening for absolute cardiovascular disease risk improved, although there were no changes in clinical outcomes.
Conclusions
The increase in the number of regular clients assigned to a team and their even distribution of care among care team members provides empirical evidence that the service is transforming to a PCMH. Despite a complex transformation process compounded by the COVID-19 pandemic, levels of service delivery and quality remained relatively stable, with some improvements in risk factor screening.
“…Further given the pilot and preliminary nature of the study, comparison to standard care sites was beyond the scope of the present study. Leveraging from ndings of this pilot study, a further study is underway to expand the implementation of the PCMH model to a second site within the IUIH network and compare outcomes to standard care clinics over a ve-year period (13). There were limited data available on important cultural, social and economic determinants of health and wellbeing.…”
Background
The patient-centred medical home (PCMH) is a model of primary care that delivers patient-centred care by a team of clinicians that is coordinated, accessible, and focused on quality and safety. In response to substantial population growth and increasing strains on existing primary care services, the Institute for Urban Indigenous Health (IUIH) developed the IUIH System of Care-2 (ISoC2), based on an international Indigenous-led PCMH. ISoC-2 was piloted at an urban Aboriginal and Torres Strait Islander Community-Controlled Health Service in South-East Queensland between 2019–2020, with further adaptations made to ensure its cultural and clinical relevance to local Aboriginal and Torres Strait Islander people. Little is known on the implementation and impact of PCMH in the Australian Indigenous primary care setting. Changes in implementation process measures and outcomes relating to engagement and quality-of-care are described here.
Methods
De-identified routinely collected data extracted from electronic health records for clients regularly attending the service were examined to assess pre-post implementation changes relevant to the study. Process measures included enrolment in PCMH team-based care, and outcome measures included engagement with the health service, continuity-of-care and clinical outcomes.
Results
The number of regular clients within the health service increased from 1,186 pre implementation to 1,606 post implementation; representing a small decrease as a proportion of the services’ catchment population (38.5 to 37.6%). In clients assigned to a care team (60% by end 2020), care was more evenly distributed between providers, with an increased proportion of services provided by the Aboriginal and Torres Strait Islander Health Worker (16–17% versus 10–11%). Post-implementation, 41% of clients had continuity-of-care with the care team, while total, preventive and chronic disease services were comparable pre- and post-implementation. Screening for absolute cardiovascular disease risk improved, although there were no changes in clinical outcomes.
Conclusions
The increase in the number of regular clients assigned to a team and their even distribution of care among care team members provides empirical evidence that the service is transforming to a PCMH. Despite a complex transformation process compounded by the COVID-19 pandemic, levels of service delivery and quality remained relatively stable, with some improvements in risk factor screening.
Background Few studies have examined patient experiences of the Patient Centred Medical Home (PCMH). This qualitative study explores the experiences of patients of an urban Aboriginal Community Controlled Health Service during its transition to a model of a PCMH. Methods Twenty-eight community members who were registered as patients of an urban Aboriginal Community Controlled Health Service were purposively recruited to participate in yarning interviews. Yarns were conducted using a guide containing open-ended questions in the same domains as those used in patient satisfaction surveys at the participating clinic. Data from yarns were analysed by Aboriginal and non-Indigenous researchers using thematic analysis. The interpretations of Aboriginal and Torres Strait Islander researchers were privileged in the analysis. Results Key themes highlighted the importance of relationships, connectedness, and personal growth and empowerment to community members’ health and wellbeing, which they described as a journey of healing and recovery. Delays in implementing a process to empanel patients in a care team meant that most community members were unaware a PCMH had been implemented. However, community members commonly reported a more welcoming environment, more contact with the same doctor and more involvement of Aboriginal Health Workers in their care. Conclusions Aboriginal and Torres Strait Islander community members’ narratives of their experiences bear evidence of the acceptability of a PCMH model for delivery in Aboriginal Community Controlled Health Services to improve relational care between patients and health staff. A patient-directed empanelment process has been implemented to better connect patients to their care team in the clinic, and the role of the Aboriginal Health Worker reshaped to strengthen connections between patients and their care team in and outside the clinic.
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