History of Improving the Journey
The ItDJ project is a systems change initiative that commenced in 2007. Through a partnership of the Inner East Primary Care Partnership (IEPCP) and Outer East Health and Community Support Alliance (OEHCSA) member organisations, the project supports local partnering agencies to enact change to improve care for people with chronic disease (with a specific focus on type 2 diabetes).
2007-2008
The initial ItDJ project started in 2007 and involved:
- A qualitative research into consumer experiences of diabetes within the region.
- A tabletop review of their services using the National Service Improvement Framework for Diabetes (National Health Priority Action Council, 2005).
From this work, an agreed set of tools to facilitate consistent screening and ensure all consumers had access to consistent packages of care and information across the region, no matter where they initially presented was developed. Tools developed for this purpose included:
- Type 2 diabetes Care Pathway- outlines the services that all consumers in the EMR with type 2 diabetes must have the opportunity to access, at different life or disease stages based on the level of complexity of their condition.
- The type 2 diabetes Priority Pathway Tool - initial screening tool to support categorisation (and prioritisation) of consumers on the basis of their risk of disease progression and/or complications and identify the level of care required.
- The Consumer Information Pack- Type 2 diabetes outlines the minimum data that all people with type 2 diabetes should receive to support provision of credible, current information and consistency across the region.
- The Recall and Reminder Map -provides recommendations for frequency of review for each care pathway.
2009
The ItDJ pilot tested the above tools in 2009. It was a 3 month pilot in the Maroondah local government area with a cluster of health agencies. It was funded through the Department of Human Services, the Lord Mayors Charitable Fund and Eastern Health. A number of recommendations were developed after the evaluation of the pilot.
The Improving the Journey Implementation Group suggest the following recommendations:
- Review the Diabetes Risk Tool in light of suggested changes identified during the pilot, including a change in the name.
- Review the timeframes of services under each APoC category.
- Guidelines to have a list of relevant definitions.
- A change to the name of the Agreed Packages of Care to a name more suitable reflecting service delivery.
- A wider roll out of the Diabetes Risk Tool, Agreed Packages of Care, and the Client Information Pack once appropriate review processes have been undertaken.
- Frequent training for all staff that provide diabetes services as well as part of the induction/orientation of new staff so that ITJ principles gets embedded into normal practice, thereby providing a consistent approach across the EMR.
- Continue to provide client educational information in colour rather than black and white.
- A centralised system such as E-referral or electronic records to allow for a recall/reminders.
- Improve or standardise a common data set that will allow for the monitoring and evaluation of diabetes services as well as for the sharing of relevant data across agencies.
- Embedding systems for recall/reminders across agencies.
- Look at new ways to effectively engage with general practice and private providers.
- To carry out a post implementation review of the ITJ pilot in October/November 2009, to determine whether there has been any lasting change and the impact on the clinicians and organisations practice.
2010-2011
The 2010-11 phase of the project focused on implementing the recommendations of the pilot, one of which was to embed ItDJ within agencies using an eight month program of action oriented workshops as a key strategy for change. The workshops focused on improving those elements of the Wagner model previously listed and aimed to support agencies in the reform process using the ItDJ tools, which were developed by the project partners. Agencies are used the rapid cycle quality improvement model of ‘Plan, Do, Study, Act’ (PDSA) to identify small part(s) of the ItDJ tools, to implement within their organisations. Eight workshops were completed . Click here for the 2011 ItDJ Report.