Health Services Research Unit

Improving access to care

  • How can we improve access to care?

    Every year, RCH outpatient (OP) clinics see in excess of 270,000 children and the number of referrals to RCH OP clinics has increased by 94% over the last six years. 

    Some clinics have wait lists more than 12 months yet many families do not turn up to their booked appointments. Similarly, there have been increasing numbers of children presenting to emergency departments (EDs) across Victoria. Over the last decade, paediatric referrals from general practitioners (GPs) to the ED have increased by 60% in Australia. Children aged zero to four years now make up the largest age category presenting in Victoria, far exceeding adults.

    There is anecdotal evidence that many of these children could be safely managed outside the hospital setting for their diagnosis and/or ongoing management. Directing children away from the ED or OP clinics towards community-based care could improve access to hospital care for children with more complex conditions. However, concern exists regarding the skill level of community providers to manage health conditions.

    The HSRU is conducting a number of studies examining the interface between community care and hospital OP clinics and ED. 

    Current projects

    • Strengthening Primary Care for Children
      In the UK, a new model of care, Connecting Care for Children (CC4C), was implemented to improve GP care for common childhood conditions, and to reduce ED and OP referrals. Within the first 12 months of implementing this model, participating GP practices and hospitals reported a 39% reduction in new patient hospital appointments; a 19% reduction in speciality referrals; and a 22% reduction in ED attendances. In addition, families reported they preferred to see their GP and had increased confidence in doing so. GPs reported improved knowledge of child health and how to navigate the hospital system on behalf of their patients. GPs also reported that the model led to increased trust and collaboration with paediatricians. 
      Based on the model’s success in the UK, we anticipate that comparable outcomes could be achieved in an Australian setting. The HSRU has developed a project plan that will implement a version of this model within six GP practices in partnership with the North Western Melbourne Primary Health Network (NWMPHN); Werribee Mercy Hospital; Sunshine Hospital; and the HaBIC Research Information Technology Unit at the University of Melbourne.

    • Why do outpatient clinic appointments go unattended?
      We know that up to 20% of specialist outpatient clinic appointments are unattended, with families missing their appointment for any number of reasons. This is despite very long wait lists for appointments. We are interviewing families who had an appointment, but did not attend, with the aim to find out why the appointment was missed so that we can increase the efficiency of the outpatient clinics into the future. Through this project, we will determine what we can do to help families get to their appointment or to cancel it in time so that another child can be seen. 

    Completed projects

    • RCH Outpatient Clinic Efficiency
      Over a 12 month period spanning May 2015 to April 2016, we conducted an audit of the efficiency in use of five outpatient clinics at RCH. We looked at differences in the availability of new versus review appointments, and any differences in the proportion of the available appointments that were booked in, and attended, by clinicians and families. We found wide variation in clinic attendance but no seasonable variation. ‘Review’ appointments were less well attended by families than ‘new’ appointments. 

    Related projects

    Prof Hiscock is conducting related projects through the Community Health Services Research Group at MCRI. Project details are listed below.
    You can also read more about projects within the Community Health Services Research Group here. [link to: https://www.mcri.edu.au/research/themes/population-health/community-health-services-research]

    Collaborations

    National: RCH; MCRI; University of Melbourne; Sunshine Hospital; NWMPHN; Werribee Mercy Hospital; HaBIC Research IT Unit (A/Prof Dougie Boyle); Curve Tomorrow.
    International: USA - University of Michigan, Child Health Evaluation and Research Center (Prof Gary Freed) and Stanford University (Dr Lee Sanders); Canada - Toronto Sick Kids (A/Prof Eyal Cohen) and   (Prof Astrid Gutmann); Ireland – Trinity College, Dublin (A/Prof Maria Brenner); UK – King’s College London (Prof Ingrid Wolfe) and University College London (Dr Dougal Hargreaves); Sweden – Karolinska Institute (Prof Anders Hjern).

    Datasets

    Victorian Admitted Episodes Dataset (VAED); The Royal Children’s Hospital (RCH; Epic); Generic Health Network Information Technology for the Enterprise (GRHANITE); Australian Paediatric Research Network (APRN).

    Funding sources

    RCH Foundation; Better Care Victoria (DHHS), MCRI.