The Australian College of Nursing (ACN) was invited to the launch of The Second Australian Atlas of Healthcare Variation by the Australian Commission on Safety and Quality in Health Care (the Commission) in Canberra today.
“I would like to congratulate the Commission on the release of The Second Australian Atlas of Healthcare Variation. This is a very important document which paints a picture of healthcare variation that must be acknowledged and addressed,” Australian College of Nursing Chief Executive Officer, Adjunct Professor Kylie Ward FACN stated.
The Second Australian Atlas of Healthcare Variation follows the release of the first Australian Atlas of Healthcare Variation in November 2015. The first Atlas revealed the variation in health care provision across Australia, in fields such as antibiotic prescribing, surgical, mental health and diagnostic services.
At the time of the release of the first Atlas, ACN pointed out that the foundations had been laid for the clinical, social and health workforce issues to be further explored in future editions of the Atlas.
“ACN argued at the time, and continues to express this view today, that opportunities exist to make greater use of our nursing workforce to better meet population health needs. ACN pointed out the importance of incorporating nurse sensitive indicators into the Atlas to realise the full potential of our nursing profession,” said Adjunct Professor Ward.
The Second Australian Atlas of Healthcare Variation examines variation in 18 clinical items and not only identifies issues but also makes recommendations to address them.
“ACN was provided the opportunity to contribute to The Second Australian Atlas of Healthcare Variation by the Commission through a consultation process and I am pleased to see examples of nurse-led care included.
“In particular, it is heartening to see examples of nurse-led coordination of care which has resulted in reduced hospitalisations and improved health outcomes, especially among Aboriginal and Torres Strait Islander Australians.”
An example from Western Australia shows an out-of-hospital health care model led by nurses has resulted in reductions in hospitalisations among Aboriginal and Torres Strait Islander children in both urban and remote areas. Nurses lead care coordination and create partnerships with Aboriginal Controlled Health Services and individual health professionals to better meet the needs of Aboriginal and Torres Strait Islander Australians. This is achieved through organising outreach care closer to home, travel, social support, telehealth services and combining appointments to minimise unnecessary travel.1
Other models of care demonstrate alternatives to hospital care as a way of reducing potentially preventable hospitalisations. These examples show nurse-led coordination of care in the community:
- Increased use of community nursing and hospital-in-the-home (HITH) services
- Multidisciplinary clinics for management of chronic disease
- Aged care emergency services led by nursing staff
The Second Australian Atlas of Healthcare Variation describes the successful trial of in-reach community nursing in Australia. An in-reach nurse identifies emergency department and acute ward patients in hospitals who could be cared for in their home or a community clinic. The nurse facilitates handover and future care coordination of patients. This model reduces healthcare costs and ensures hospital beds are allocated to patients with the most need.
Also explored in the second edition of the Atlas is the significant challenge of managing readmissions for hospitals. Specialist nurses have proven effective in reducing readmissions of chronic obstructive pulmonary disease (COPD) and diabetes patients through effective case management.
Importantly, under an urban-based model, an example of nurses providing home-based case management for Aboriginal and Torres Strait Islander Australians with multiple chronic diseases takes into consideration a holistic view of health, addressing physical health as well as psychosocial factors in a culturally safe way. Improvements in blood pressure levels, glycated haemoglobin (HbA1c) levels and reduced rates of depression have been recorded.2
“Any model that improves health outcomes for our most disadvantaged Australians needs to be encouraged and supported. The Second Australian Atlas of Healthcare Variation supports more effective models of care to reduce potentially preventable hospitalisations. Nurses will continue to play an important role in meeting Australia’s health needs as the population ages and incidences of chronic disease increase,” said Adjunct Professor Ward.
To view the second Atlas click here.
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1 Cresp R, Clarke K, McAuley KE, McAullay D, Moylan CA, Peter S, et al. Effectiveness of the Koorliny Moort out-of-hospital health care program for Aboriginal and Torres Strait Islander children in Western Australia. Med J Aust 2016;204(5):1971e–7.
2 Askew DA, Togni SJ, Schluter PJ, Rogers L, Egert S, Potter N, et al. Investigating the feasibility, acceptability and appropriateness of outreach case management in an urban Aboriginal and Torres Strait Islander primary health care service: a mixed methods exploratory study. BMC Health Serv Res 2016;16(1):178.