In 1995, the future imperative was shared care (P. Pritc). It still is!  The Danish Quality Programme for General Practice presents a set of shared care indicators  Lars Rytter, Copenhagen

Danish Quality Programme for General Practice – 4 projects  Indicators - Poul Brix  IT - Henrik Schroll  Patient perspective – Peder Olesgaard  Shared care – Lars Rytter  Manager - Søren Friborg and Tina Eriksson

Facilitator organisation  Since 1992, an organisation of GP facilitators – coordinate the work of GPs and hospitals  Almost 10% of all GPs have joined the organisation  The organisation focus on the interface between primary and secondary care

Main tasks  Quality of referrals  Quality of discharge letters  Joint local policies for most important disease areas –Who is responsible for what?  Standards for communication`?  Quality tests through local audits  Accessibility – both directions  Joint vocational meetings

The national quality organisation focus on the quality of the ”patients voyage” through the health care system

“Patients voyage” – 10 stops Afd. Hospital Alm. praksis Special- læge- praksis Hjem- me- plejen Alm. praksis Organisational qualityt KliniskClinical quality Patitinetspercieved quality

Main ”elements” in the traditional voyage  F1: Access to GPs –Access to GPs by telephone –Emergency appointments –Planned appointments with transferred responsibility when practices are closed

F2: Referral –Generally accepted standards for quality of referral letters –Shared local policy for the major disease areas (70% of flow of patients) –Accessibility for advice – “move the problem – not the patient. PP”

F3 - visitation  Visitation on a daily basis  Return / dialogue on incomplete referrals (ex. patient not sufficiently evaluated before referral)  Accessibility to appointments with short waiting times – alternatives to emergency referral

F4 – Agreement on placement of responsibility during waiting time “left in limbo”  A clear responsibility  The GP is responsible in case of worsening and unacceptable waiting times  Information to patient within 8 days concerning the time of first appointment and the waiting time in alternative treatment facilities

Hospital standards  F5 - A treatment plan is available within 24 hours  F6 – A personal responsible person is allocated within 24 hours  F7 – GPs are informed, when patients are transferred between hospitals or hospital departments

F8 – Information to GPs when patients are discharged  Diagnose  Short medical history  Medical treatment status  Information given to patient  Planned interventions after discharge (for GP offices / municipality staff / hospital out patients clinics)

Home care and rehabilitation  F9 - Plan for rehabilitation  F10 –Plan for the municipality staff: –home nursing –meals brought to patients home –necessary changes in patients home –equipment needed

Indicators for all standards  Structure indicators: ex. Is a written policy present?  Process indicators: ex. Number of referrals according to the policy  Result indicators: ex. patient satisfaction

Standards are currently being tested  Are standards clearly described?  Are standards readily accessible?  Is the time consumed reasonable?  Is quality improved?

Next challenge  Making standards/indicators for the increasing number of outpatients with chronic health problems  We need policies for –Communication –Deciding on which patient can be cared for by GPs and which by the hospital staff –Teams working in the patients homes