Continuity of care in the Wollondilly Integrated Health Neighbourhood

Project Status
Current

Chief Investigator
Siaw-Teng Liaw

Research Team
, Bin Jalaludin (Population Health SWSLHD), Justin Duggan (Community Health SWSLHD), Keith McDonald (SWSPHN)

Research Staff
Jitendra Jonnagaddala, Guan Guo, Kha Vo

Background

The Wollondilly Health Alliance (Wollondilly LGA, SWSLHD, SWSPHN) commissioned the initial establishment of the Wollondilly ePBRN in 2016, incorporating all the general practices in the region. The initial focus was on data quality reports and feedback. This next phase is the use of the ePBRN methodology to evaluate the Oran Park integrated primary care centre and to examine continuity of care in the integrated health neighbourhood. 

Objective

To examine continuity of care in the Wollondilly and Fairfield Health Neighbourhoods and to correlate it with the use of SWSLHD services (Community Health, Emergency Department and Admissions) by patients with ambulatory care sensitive conditions.

Methodology

  1. Link the ePBRN and SWSLHD data sets, with a common date for data extraction:
  2. Assess and manage accuracy of the data and linked data repository;
  3. Identify the cohort of patients with ambulatory care sensitive conditions
  4. Calculate the patient’s Usual Provider of Care (UPC) ratio in the practice and neighbourhood; (Ref: BMJ 2017;356:j84 | doi: 10.1136/bmj.j84)
  5. Correlate the UPC with use of LHD services and assess the model using logistic regression and machine learning methods*.
  6. Analyse and report on the findings in peer-reviewed journals.

Progress

The ePBRN data repository has been extracted and will be updated at a common index date with the extraction of SWSLHD data (5-year period). The SWSLHD data extraction has been delayed for months; however, the planned common index date is planned for 31 March 2019.

* Ambulatory care sensitive (ACS) or potentially preventable hospitalisation (PPH) conditions include asthma, atrial fibrillation, cancer, coronary heart disease, chronic kidney disease, chronic obstructive pulmonary disease, dementia, depression, diabetes mellitus, epilepsy, heart failure, hypertension, rheumatoid arthritis, learning disabilities, mental health, stroke or transient ischaemic attacks, and peripheral arterial disease. Admissions associated with ACS will be compared with those not associated with ACS conditions.