Kiwis show the way on Health Care Homes

A GP-run network in New Zealand has found a significant fall in hospital visits by patients of practices using a Health Care Home model

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A GP-run network in New Zealand has recorded a significant fall in hospital visits by patients of practices using a Health Care Home model.

The Kiwi version is bolder than the Australian government-backed HCH trial confined to patients with chronic disease, in that it involves whole patient populations.

“Our Health Care Home model is a much broader and radical redesign of general practice,” Helen Parker, Health Care Home strategic development manager at the Pinnacle Inc network, told The Medical Republic.

“It covers a redesign of the whole practice population, regardless of whether they are ill or not.”

Data collected by the GP-owned organisation showed that patients of HCH practices were 16% less likely to be admitted to hospital and 8% less likely to present to an emergency department.

The results will be presented in a report measuring the outcomes and performance of the HCH model, expected to be published next month.

“It is a success not just in terms of hospital visits. That is not our main driver,” Parker said. “It’s a success in terms of being a much more convenient service for patients.”

Since Pinnacle kicked off the HCH model in New Zealand’s Midlands region in 2010, a total of 15 practices, with 101,000 patients, have made the transition.

Exhaustive data collection has enabled the group to compare practices’ performance and outputs on a range of indicators, Parker said.

It includes data on GP consultation types and rates, ethnicity and demographic data, email consults, and activity through patient portals where patients can check health records.

“We also collect the outcomes of GP triage consultations, and we’ve also got ED presentation and hospitalisation information, and more.”

The raw data does not show precisely why hospital visits are reduced at HCH practices.

“We have yet to do analysis as to why that is so. But we can see that at the Health Care Home practices, the GPs and nurses see more patients,” Parker said.

“It’s important to remember there are many reasons why people present to ED, such as cost. But at the Health Care Home practices, we’ve got actually have a higher proportion of lower socio-economic patients.”

On the other hand, it’s clear that the model is more efficient for doctors and patients.

“Patients registered with a traditional practice would have to go in for a face-to-face consultation if they felt ill or wanted some advice or treatment,” Parker said.

“In the HCH practice, they can speak to a GP on the phone first.  We know that one-third to 50% of patients who ring for a same-day appointment don’t need to come in. The GP can manage them over the phone.”

“This saves the face-to-face appointments for the people who need them most and gets the practice away from being a mini ED service where it’s first-in, first-served, regardless of what they need.”

The non-profit GP network is now supporting other practices and primary care organisations around New Zealand to roll out the model.

Although the New Zealand context is different from Australia’s, with a long history of patient enrolment at general practices, Pinnacle is also sharing its expertise with Australian colleagues.