McNab Justin, Gillespie James A
Menzies Centre for Health Policy, The University of Sydney, Sydney, Australia.
Int J Integr Care. 2015 Sep 23;15:e015. doi: 10.5334/ijic.2243. eCollection 2015 Apr-Jun.
HealthOne was part of a state-wide initiative to invest in new community-based facilities for collocating services. The HealthOne Mount Druitt is a virtual hub and spoke organisation established in 2006 in a socially disadvantaged part of Western Sydney based out of a new community health hub. The model is based on 'virtual' care planning and aims to improve coordination of care for older people with complex health needs, reduce unnecessary hospitalisations and ensure appropriate referral to community and specialist health services. General practitioner liaison nurses (GPLNs) work closely with clients as well as general practitioners (GPs) and other health care providers. Primary health care providers reported improved communication and coordination of services, and there have been lower levels of utilisation of the emergency department (ED) for patients following enrolment in the programme. HealthOne provides an example of how a virtual organisation together with highly skilled care coordinators can overcome some of the barriers to providing integrated care created by fragmented funding streams and care delivery systems.
“健康一号”是该州一项全州范围倡议的一部分，该倡议旨在投资建设新的社区设施以整合服务。“健康一号”德鲁伊特山分部是一个虚拟中心及分支组织，于2006年在悉尼西部一个社会经济地位不利的地区成立，依托一个新的社区健康中心开展工作。该模式基于“虚拟”护理计划，旨在改善对有复杂健康需求的老年人的护理协调，减少不必要的住院治疗，并确保适当转诊至社区和专科健康服务机构。全科医生联络护士（GPLN）与客户以及全科医生（GP）和其他医疗服务提供者密切合作。初级卫生保健提供者报告称服务的沟通和协调得到了改善，并且在患者加入该项目后，急诊科（ED）的利用率有所降低。“健康一号”提供了一个范例，展示了一个虚拟组织与高技能护理协调员如何能够克服由分散的资金流和护理提供系统所造成的提供综合护理的一些障碍。
