Please use this identifier to cite or link to this item:
http://hdl.handle.net/11054/2935
Title: | Adopting a metropolitan case management model for implementation in a rural setting. |
Author: | Malakellis, Mary Wong Shee, Anna Alston, Laura Odgers, Jade Versace, Vincent McNamara, Kevin Griffith, P. |
Issue Date: | 2024 |
Conference Name: | Western Alliance Annual Symposium |
Conference Date: | November 11-12 |
Conference Place: | Lorne, Australia |
Abstract: | Background/aim: Emergency Department (ED) overcrowding is a global public health concern and there has been increasing focus on improving the care for individuals with frequent potentially avoidable presentations to the ED, who generate a disproportionately high number of ED presentations and health resource utilisation. Patient Watch, a program utilising a case management model of care, and modelled on metropolitan model was implemented in a rural context to address frequent potentially avoidable presentations to the ED. We aimed to understand how contextual factors influenced the implementation and scale-up of Patient Watch in a rural region. Population/setting: Members of the Patient Watch steering committee involved in the planning, implementation and scale-up of the program including representatives from health services across the region (e.g. project leads, executive and assistant directors, clinicians, the Hospital Admission Risk Program manager, lead health coach, and tele-navigator support workers). Methods: A mixed methods approach was used to collect and synthesise data from the following sources: qualitative interviews, document review, and observation. The data were categorised into themes using thematic analysis and data source triangulation applied to enhance understanding and trustworthiness of findings. Results/findings: Three themes were constructed from the data characterising the implementation of Patient Watch in a rural context. (1) Context drives adaptation: adaptation of the metropolitan model was essential to fit Patient Watch to the rural context and promoted novel innovation; (2) health system complexity: external factors supported implementation (e.g., funding) and influenced the delivery of Patient Watch (e.g., system integration, workforce capacity); and (3) centralised governance: provided benefits for rural areas (e.g., administrative support, training) with local autonomy important to address local needs. Conclusion: The findings emphasised how rural contextual factors influenced the implementation and scale-up of Patient Watch and provide a greater understanding of implementing and adapting a metropolitan model in a rural context. Adaptation was an important focus to address sustainability, external factors such as funding, system integration, and workforce capacity positively and negatively influenced implementation processes, and findings highlighted the need to balance centralised governance and local autonomy. An agile rural workforce successfully implemented Patient Watch challenging the ‘deficit’ perspective of rural health and highlights the strengths of a rural context to achieve spread, scale-up and sustainability. Translational impact/implications for future practice: Although, evidence-based case management models have been shown to improve care for people who have frequent potentially avoidable ED presentation, few have been adapted or developed for a rural context. Further, evidence of implementation processes for evidence-based interventions to address frequent presentations to the emergency department are scarce in rural settings. This represents a considerable evidence gap for a vulnerable population with low levels of health service access. |
URI: | http://hdl.handle.net/11054/2935 |
Internal ID Number: | 02846 |
Health Subject: | CASE MANAGEMENT RURAL HEALTH EMERGENCY DEPARTMENT |
Type: | Conference Presentation |
Appears in Collections: | Research Output |
Files in This Item:
File | Description | Size | Format | |
---|---|---|---|---|
Malakellis_Mary_Western_Alliance_121124.pdf | 559.62 kB | Adobe PDF | ![]() View/Open |
Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.