8. Quality - Ambulatory Services Development

8.1 Post Acute Care

The recurrent budget for this program is $6.2 million. No major changes are proposed to the operation of the program during 1998 - 99, apart from statewide adoption of a scientifically trialled and validated risk screening tool for patients being considered for the service. An evaluation of the program has been tendered. This evaluation will include: health outcomes and cost benefits; patient and carer perceptions and satisfaction; and impact on acute and community care sectors, particularly with respect to service integration and coordination. The outcomes of the evaluation projects will inform future policy and purchasing arrangements.

8.2 Hospital in the Home

The 1998 - 99 budget for this program is $5 million. No major changes are proposed for 1998 - 99. Emphasis will continue to be on growth - encouraging health care providers to recognise the merits of home based acute care as a substitute to hospital care. There are two elements to the program: incentive funding ($4 million); and service development funding ($1 million). The emphasis for service development funding will be on: clinical and/or treatment areas currently under-represented in HITH; and rural (provincial) service development and access.

To continue the focus on quality improvement of home based acute care service provision, the Department will commission an independent audit of HITH. This will focus on: clinical conditions and nature of treatment for which patients are transferred to HITH; patient assessment, referral, care planning and discharge procedures; protocols for dealing with emergencies; recording of adverse incidents and variations to care plans; and recording of HITH patients on VIMD (Victorian Inpatient Minimum Database).

8.3 Home Enteral Nutrition (HEN)

The 1998 - 99 Budget for this Program is $2 million. In 1997 - 98, funding was allocated to 45 provider hospitals. As a means of encouraging professional collaboration and streamlining administration and reporting, funds will now be allocated on a Network or regional basis.

Major developmental projects are:

• Development and implementation of the minimum data set;
• Four research and development projects into outcomes and development of best practice service models; and
• Professional education and development support.

Details will be provided to Networks and hospitals in July 1998.

8.4 Continuous Positive Airways Pressure (CPAP)

The 1998 - 89 Budget for this Program is $0.5 million. The clinical criteria have been expanded to include patients who have 15 apnoea's/hypopnoea's per hour with underlying cardiovascular, neurological or pulmonary disease. Standard reporting formats will also be developed for activity, financial and compliance reporting.

The current term of preferred suppliers of CPAP devices and associated services will expire on 30 June 1998. Suppliers selected through a new tender for preferred suppliers will operate for the next 12 months from 1 July 1998. The Department will invite submissions for research and development projects, the outcomes of which, will inform future policy development and improvements in services.

8.5 Artificial Limbs

Hospital budgets for 1998 - 99 will be capped at previous year's actual expenditure. However, funds will be adjusted to actual activity levels and any surplus redistributed within the Program to agencies with activity levels over target.

Consistent with Government policy directions, hospitals will be required to contest the provision of artificial limb services in the market through a competitive tendering process. The process should meet the requirements of an external audit including accountability, transparency and competitive neutrality. New provider arrangements will be implemented in January 1999. Details will be provided to Networks and hospitals in June 1998.

The Department will evaluate the Program with the aim of improving service delivery and purchasing arrangements.

8.6 Palliative Care Substitution

In 1998 - 99, $3.2 million will be made available to Networks and rural hospitals to develop palliative care services over a six month period. The objective of the Palliative Care Substitution Project is to provide public hospitals with incentives and a framework to develop and test palliative care services delivered in non-acute settings as an alternative to care provided in acute health settings.

An amount of funds equivalent to the cost of operating the required number of palliative care beds based on Aged, Community and Mental Health (ACMH) prices will be identified as a specified grant for each hospital which participates in this project. The total WIES for those hospitals will be reduced by the WIES equivalent of that grant. This grant will be linked to performance indicators on the provision of substituted palliative care services. These performance indicators will be developed and tested during the course of the project.

8.7 The Family Choice Program

The Family Choice Program provides support to families of children and young people aged between 0 - 17 years inclusive with high medical needs and/or dependence on bio-medical technology to enable a child to live at home. The support provided by the program will be flexible, individualised and tailored to particular families based on a case management approach. One type of care provided to a number of children in this program (overnight awake attendant care) is equivalent to admitted patient care.

Current funding for the children receiving overnight awake attendant care, including funding received by specified payments or WIES payments, will be transferred to the Hospital in the Home Program. Funding for growth will be from WIES substitution and these funds will also be transferred to the Hospital in the Home Program. Special funding arrangements incorporated into a daily rate of reimbursement will be negotiated for this group of children. Negotiations regarding the transfer of funds and the appropriate daily rate for treatment will be undertaken in June 1998. Modelling in this document is in accordance with current funding arrangements.

8.8 Service Development Projects and Reviews

A number of major service reviews are currently underway. These include

Review of Radiotherapy Services: This Review has aimed to provide Government with an analysis of options for the future development of radiotherapy services in Victoria. A consultant's report was released in May for industry comment. Final recommendations will be confirmed by the Department and implementation will commence in 1998 - 99.

Ministerial Taskforce on Trauma and Emergency Services: This Taskforce is reviewing the structure and the coordination of trauma and emergency services in Victoria. It will report and provide advice to the Minister in late 1998.

Breast Care Reform Project: Following the report of the Breast Diseases Working Group, the Department has established a Breast Care Implementation Advisory Group which is responsible for developing the implementation strategies for restructuring breast care services in Victoria. A report from the Group is anticipated in late 1998, with implementation of purchasing and reform policy to begin in the third and fourth quarters of 1998 - 99. One million dollars has been committed to the program in 1998 - 99.

Review of the HIV/AIDS and Infectious Diseases Services: HIV/AIDS and Infectious Diseases Services successfully tendered to the Alfred and Royal Melbourne/Western Hospitals respectively will be reviewed. The review is expected to be completed by August 1998.