In 2001, the Victorian Department of Human Services allocated funding to the Hospital Admission Risk Program (HARP) in an endeavour to arrest the growth in emergency department presentations. The HARP model targeted clients at risk of hospitalisation and provided a thorough assessment, planning, management and monitoring service delivered by a multidisciplinary team. Fourteen diverse projects, from five auspicing agencies, were funded in the Northern Region of Melbourne. Initially projects were functionally independent and relatively isolated, with different models of care, target groups, and management structures. Evaluation of the projects was inconsistent, and in many cases lacking altogether.
As HARP progressed, the Department of Human Services commissioned an evaluation and the outcomes of this evaluation were released in 2005.' The main findings were that HARP was successful in reducing hospital demand and in building relationships across the care continuum. The Department of Human Services decided to mainstream HARP, with a commitment to ongoing ftinding. Consequently, HARP projects from the same health region were required to form a single program with unified governance and reporting.
In 2006 projects in the north of Melbourne moved to operating as one Northern Alliance HARP-Chronic Disease Management (HARP-CDM) Program. The 13 remaining services, from four auspicing agencies, were integrated under a single program with three 'streams': Complex Needs, Chronic Disease and Psychosocial Needs. In parallel with this came several changes to the collection and storage of patient information - the largest of which were the move to the HealthSmart patient management system and mandatory reporting to Department of Human Services on the Victorian Integrated Non-Admitted Health (VINAH) minimum dataset. In mid 2006, the Northern Clinical Research Centre, based at The Northern Hospital saw this as a unique opportunity to align the evaluation of HARP-CDM within an integrated patient management system and mandatory data collection requirements.
Integrated data collation and reporting was expected to facilitate evidence-based policy and planning by the HARPCDM governance group. At the individual service level, comprehensive evaluation was expected to support service sustainability through ongoing quality improvements, increased project efficiency and the development of innovations in evidence-based care.
The objectives of this project were to develop a system-wide evaluation approach for the Northern Alliance HARP-CDM program that would:
* Contribute to evidence-based policy and planning at a regional and state level.
* Support local, clinician-led improvements and innovations in patient care.
* Maximise return on data collection and reporting with minimal burden on clinicians.
* Assist with the integration and coordination of services through performance monitoring and benchmarking.
* Generate further research questions and contribute to the evidence on disease management.
All existing, routinely collected administrative data items (especially emergency department presentations, hospital admissions and financial) and the VINAH minimum dataset items were audited by the evaluators. The VINAH minimum dataset contains 52 fields built around the client's 'episode of care' within the HARP program. Comprehensive data inchiding demographic, referral and service activity information is collected to describe each 'episode of care'.
Following the audit the evaluators developed a list of analyses that could be performed with the available data. These analyses were compared with the HARP-CDM program objectives and evaluation gaps were identified. Measures of client specific, generic and disorder outcomes were identified as missing from the evaluation dataset, and a strategy to include them was developed.
To measure quality of life broadly across the entire Northern Alliance HARP-CDM program, the evaluators sought a validated, generic tool that calculated utility scores and was sensitive to a range of patient conditions and care models. …