Gray Jane S, Swan Judith R, Lynch Margaret A, Tay Tracey M, Mackenzie Marika-Jane, Wiggers John H, Harrison Karen A, McDonald Robert C, O'Dea Ian P, Harrigan Louise M, Fitzgerald Sandra M
Partnerships, Innovation & Research, Hunter New England Local Health District, 56 Stewart Avenue, Hamilton East, NSW 2303, Australia. Email: ; ; ; ;
Hunter New England Central Coast Primary Health Network, Suite 11, 125 Bull Street, Newcastle West, NSW 2302, Australia. Email: ;
Aust Health Rev. 2018 Feb;42(1):66-71. doi: 10.1071/AH16197.
Objective This paper describes the 4-year journey of Hunter and New England HealthPathways - a password-protected web-based portal designed to provide localised evidence-informed clinical and referral information to support general practice at the point of care. Methods A process evaluation was conducted in 2013, with a case study comparison performed in 2014 to assess impact of HealthPathways on patient referral and access to specialist care, followed by a review in 2016 of utilisation of the online portal to assess whether healthcare providers continued to access HealthPathways. Results Increased utilisation was correlated with an increase in the number of pathways published online. Clinical leadership and the process of developing pathways built relationships between primary care and specialist teams. Case studies indicated that a comprehensive approach to pathway implementation accompanied by service redesign resulted in higher pathway use and improved access to specialist care. Senior management support and a formal partnership between major health care providers led to strong governance of HealthPathways and the delivery of other integrated care initiatives. There was significant growth in utilisation over the 4 years, increasing to an average of 6679 sessions per month in 2016 and more general practices reported use of HealthPathways. Conclusions HealthPathways is a vehicle for building strong foundations to support system change and integrated care. The critical elements for acceptability, growth and sustainability are the strong relationships between primary care and specialist clinicians, as well as formal partnerships that are built from the processes used to develop HealthPathways. What is known about the topic? HealthPathways and similar web-based evidence-informed guidelines aimed at improving system integration are increasing in Australia. There are few published papers that describe approaches to inform the ongoing implementation of such programs. What does this paper add? This paper describes iterative methodology for evaluating complex programs, such as HealthPathways, that identifies the critical factors required to build sustainable models of integrated care. What are the implications for practitioners? The 4-year experience of Hunter and New England HealthPathways provides an approach to improve the implementation, sustainability and spread of similar programs and associated integrated care initiatives.
目的 本文描述了亨特与新英格兰健康路径（Hunter and New England HealthPathways）的4年历程，这是一个受密码保护的基于网络的门户，旨在提供本地化的循证临床和转诊信息，以在医疗点支持全科医疗。方法 2013年进行了过程评估，2014年进行了案例研究比较，以评估健康路径对患者转诊和获得专科护理的影响，随后在2016年对在线门户的使用情况进行了审查，以评估医疗服务提供者是否继续访问健康路径。结果 利用率的提高与在线发布的路径数量增加相关。临床领导力以及路径开发过程在初级保健和专科团队之间建立了关系。案例研究表明，采用全面的路径实施方法并辅以服务重新设计，可提高路径使用率并改善获得专科护理的机会。高级管理层的支持以及主要医疗服务提供者之间的正式伙伴关系，促成了对健康路径的有力治理以及其他综合护理举措的实施。4年间利用率显著增长，2016年平均每月达到6679次访问，更多的全科医疗诊所报告使用了健康路径。结论 健康路径是建立坚实基础以支持系统变革和综合护理的一种手段。可接受性、增长和可持续性的关键要素是初级保健和专科临床医生之间的牢固关系，以及从健康路径开发过程中建立的正式伙伴关系。关于该主题已知的信息是什么？在澳大利亚，健康路径和旨在改善系统整合的类似基于网络的循证指南正在增加。很少有已发表的论文描述为指导此类项目的持续实施而采取的方法。本文补充了什么？本文描述了评估复杂项目（如健康路径）的迭代方法，该方法确定了建立可持续综合护理模式所需的关键因素。对从业者有何影响？亨特与新英格兰健康路径的4年经验提供了一种方法，可改善类似项目及相关综合护理举措的实施、可持续性和推广。
