Thread by @WePublicHealth

I'm joining breakout session 3 with Susan McKee CEO @VicDental up first with her presentation titled: 'You know the drill - Putting patient experience and value first in dental care' #GiantSteps

For those that don't know, oral health is not part of Medicare, for a very long and painful reason. They are working with govt to include oral health as part of universal healthcare - McKee #GiantSteps22
cc @LRussellWolpe

Firstly acknowledges, We've got a lot of work to do to improve the gap in health for Aboriginal and Torres Strait Islander people - McKee #GiantSteps22

What is value-based healthcare? "It is not values, it is about value". It's looking at the outcomes that are important to patients, over the cost of delivering those services - McKee #GiantSteps22

How do we do this in the most efficient way? Care is designed with and around the person, right care provided to the right person at the right time, prevention & early invention, integrated & based on risk (ie who's the most at risk) - McKee #GiantSteps22

Why do we need to change?
Oral disorders are one of the biggest preventable disorders in Australia - McKee #GiantSteps22

More than 2 million Australians report avoiding or delaying going to the dentist because of the cost. - McKee #GiantSteps22

On a side note, last week I learned that my grandad had false teeth because when he was 16 he decided to have all his teeth removed so he didn't have to go to the dentist anymore. 🤯. #GiantSteps22

Why is it important? ageing population, greater expectations from people, consumers want to enjoy good health - McKee #GiantSteps22

Current system is very siloed, fee for service, disease focused, clinicians in control, demand management and about controlling wait list - McKee #GiantSteps22

Vic Dental based their model on Michael Porter's model of value based healthcare, but tailored it, with consumer and workforce engagement and co-design at its centre - McKee #GiantSteps22

A lot of training was done to create a workplace culture that embraces change - McKee #GiantSteps22

Developed measuring outcomes to identify those most at risk, following 'ICHOM - International Consoritum for health outcomes measurement' -McKee #GiantSteps22
ichom.org

Lessons learned - leadership is critical, it is a long journey, outcome measurement (that are important to the person), collaboration is fundamental, co-creation with consumers needs skills & practice - McKee #GiantSteps22

Q - are we at war with our health system? A - I think we should be, because the current system is not working -McKee #GiantSteps22

Q- profits are often easy to measure & often equated with value, how do we measure value-based healthcare? A- measure patient outcomes (before & after intervention) & short-term behavioural changes (ie teeth-brushing habits). Aiming for generational change - McKee #GiantSteps22

Our mantra is "how do we get the mouth back in the body?" in terms of ensuring oral health becomes part of conversation about overall health - McKee #GiantSteps22

Next presentation in this session is by Dr Katherine Harding, Research Fellow & Manager of the Allied Health Clinical Research Office, Eastern Health & Annie Lewis, Project Officer and PhD Candidate, Eastern Health and La Trobe University @easternhealthau #GiantSteps22

Their presentation is titled 'Patients over patience: Reducing wait times at specialist clinics' - #GiantSteps22

600 people on epilepsy outpatient clinic waiting list, some have been on the wait list for 6 years!!! - #GiantSteps22

A systematic review found that seizure control outcomes are better if patients are seen more promptly, confirming their hypothesis - #GiantSteps22

An alternative model of access = STAT, not unlike what is going on the dental services, they said - #GiantSteps22

Evidence on STAT in other settings - e.g. community rehab, qualitative interviews, research translation. Research question - can wait lists for an epilepsy clinic be reduced by implementing STAT? - #GiantSteps22

Eliminating a wait list of 600 was really daunting, limited budget, resistance, etc. They undertook a thorough audit of the 600 patients on the waiting list - #GiantSteps22

Audit found 35% had been offered appointments & failed to attend, 38% on waiting list in error (ie duplicate referral). At the end of audit, only 11% needed to stay on list. "The longer your list is, the harder it is to clean." - #GiantSteps22

Analysed demand - # new patients / # clinicians. "Often services don't know what their demand is" - #GiantSteps22

At first appointment, doctor can think about how they're going to triage ongoing service (ie let's not go with a just in case appointment) - #GiantSteps22

STAT model prompts discussions about service efficiencies - #GiantSteps22

Results - backlog reduced during implementation. Post-intervention - a small increase in backlog but not statistically significant, however something they will continue to monitor - #GiantSteps22

Implementation tips - during implementation stage they're absorbing an increased load, communication is vital during this stage. STAT needs to be continually monitored - #GiantSteps22