Care Coordination Service Centre and Priority Patient Dashboard

Overview

Initiative type

Model of Care

Status

Deliver

Published

03 March 2022

Summary

The Care Coordination Service Centre in Torres and Cape HHS is a comprehensive patient-assistance initiative designed to deliver the logistical and wraparound, “at-the-elbow” care support needed by priority patient cohorts, such as First Nations people. A key component is the Priority Patient Dashboard—a risk prioritisation tool that enhances visibility and coordination of care for high-priority patients.

Key dates

Mar 2020 - Dec 2021

Implementation sites

TCHHS and CHHHS

Partnerships

Queensland Aboriginal and Islander Health Council

Aim

To provide greater visibility of priority patients, enabling coordinated management of care and a single point of reference for providers across the system.

Outcomes

Priority patient cohorts in the Torres and Cape HHS will receive more coordinated care.

Background

There is currently an opportunity to improve coordination of health care services across the care continuum in Queensland. This is a result of the fragmentation (and often duplication of services) between Queensland Health, Hospitals and Health Services (HHSs), the Australian Government Department of Health, Primary Health Networks (PHNs), Non-Government Organisations (NGOs), private practice, and community-controlled organisations. Whilst significant work has been done in Far North Queensland around improving collaboration between the different providers (such as, but not limited to, the Better Health North Queensland Plan and the Stronger Mob Living Longer Plan), these relationships need to continue to be built upon and leveraged in order to improve integration and continuity of care.

Methods

Colocation of services has commenced into the Care Coordination Service Centre.

Discussion

Far North Queensland face a number of unique problems due to the demographic, social, economic, cultural and geographical factors of the region. Patients often face barriers to accessing the right care, in the right place at the right time. This has led to inequity in health outcomes throughout the population. The region also has a large number of priority patients and communities. This in part is due to the region having a significantly higher proportion of First Nations people (14.2 per cent compared to the state average of 4 per cent).

Key contact

Lucy Pullen

Director of Nursing - Clinical Projects

Torres and Cape Hospital and Health Service

Email:  carecoordinationhub@health.qld.gov.au