Ray Wihapi 14 November 2013

© HHL Group March 2013

Ray Wihapi14 November 2013

Te Whiringa Ora

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Te Whiringa Ora/Care Connections

1. Background2. The model3. The results

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Why we developed Te Whiringa Ora

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Why (continued...)

Te Whiringa Ora

• Chronic health conditions are increasing globally. New Zealand has followed this trend, with an estimated 80% of all deaths resulting from a chronic condition (National Advisory Committee on Health and Disability, 2007).

• Need for a more proactive and responsive approach.

• Current reactive models of health care are failing to meet the needs of some individuals

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Our people

Te Whiringa Ora

• Eastern Bay of Plenty • Population of 50,000 • 48% identifying as Māori (national average is

14%).• The area has high levels of long-term conditions

which are higher than the national average• Clients are those who have been admitted to

hospital two or more times over the past 12 months and/or have had six primary care visits in the past 12 months (including ED visits)

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Te Whiringa Ora approach

Te Whiringa Ora

• Underpinned by the principles of Whānau Ora • Innovative and evidenced-based approach to

addressing long term conditions• The client and their whānau in the driver’s seat• Facilitating interdisciplinary care• Complex health needs and high users of hospital

services• Provide a ‘web of care’ to connect what exists already• Time-limited support phase of three to six months

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What we do

Te Whiringa Ora

• Home visits – CM and KTT• Engage, relate and build trust• Holistic assessment at intake and discharge

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What we do (continued)

Te Whiringa Ora

• Shared support plan• Client prioritised goals • Interventions associated with goals• Linking to the right service at the right time• Enabling people to better understand and

manage their condition - health literacy• Provide information and support• Tele-monitoring

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Linking people to the right service at the right time

Te Whiringa Ora

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Key objectives

Te Whiringa Ora

• Improve access to primary, secondary and community health care to achieve better health outcomes for clients and whānau

• Provide seamless access to quality health services that meet clinical, social and cultural needs

• Reduce disparities in health outcomes • Contribute to improving primary care management of

chronic and long-term conditions • Improve client self-management of long-term

conditions• Support the health outcome priorities for Eastern Bay

of Plenty

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Key objectives (continued)

Te Whiringa Ora

• Reduce preventable hospital admissions and hospital length of stay

• Increase proactive intervention to prevent or delay deterioration which results in increasing levels of care and acute admissions

• Provide a holistic client-centred and whānau ora approach to care

• Educate service users and their whānau in self-management of chronic care and lifestyle changes

• Increase sustainability of future health services by increased use of the unregulated workforce

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Results - Synergia evaluation

Te Whiringa Ora

• SF12 scores - quality of life• Analysis of baseline and follow-up SF-12 data • Physical composite score: bodily pain, physical

functioning, role-limitation physical and general health

• Mental composite score: mental health, energy/vitality, role limitation - emotional and social functioning

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Results - Synergia evaluation

Te Whiringa Ora

• Whose health improved? Māori and non-Māori (approach applies cross

culturally) Males and females All age groups

• All showed a clinically significant increase in their SF-12 scores

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So what does this mean?

Te Whiringa Ora

• TWO assists in the improvement of clients’ quality of life

• Deterioration is typical for clients with multiple long-term conditions

• SF-12 struggles to monitor change in smaller samples

• Many evaluations of other models have found no change in these outcomes

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Use of inpatient services

Te Whiringa Ora

Time in hospital:• A 10% reduction in bed days for TWO clients• A 47% increase in bed days for the control group

Hospital admissions:• A reduction in the use of inpatient services for TWO

clients. No change for the control group• TWO clients were spending more time at home and

using inpatient services less frequently

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Use of outpatient services

Te Whiringa Ora

TWO clients usage of outpatient services decreased in frequency or stabilised:• Decreased for COPD• Stabilised for diabetes• Decreased for heart disease

Control groups’ use of outpatient services:• Increased for COPD• Increased for diabetes• Remained the same for heart disease patients

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Emergency Department presentations

Te Whiringa Ora

• ED presentations occurred less frequently for most TWO clients - especially COPD and diabetes clients.

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TWO potential savings (per client)

Te Whiringa Ora

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Evaluation summary

Te Whiringa Ora

• TWO evaluation findings are very positive• Evidence provides support for TWO and the

model underpinning itTWO supports:• Improvements in service coordination and

access• Improvements in self-management• Improvements in clients’ quality of life• Reductions in clients’ use of hospital services

© HHL Group March 2013 20Te Whiringa Ora

“ People don’t care how much you know until they know how much you care”