Clinical Prioritisation Criteria (CPC)

and HealthPathways

Jody Paxton, Manager, Surgical and Outpatient Reform Team

24 March 2017

http://qheps.health.qld.gov.au/cpc/home.htm

https://cpc.health.qld.gov.au/

• Transparent minimum criteria, applied state-

wide, to support equitable and appropriate

prioritisation of access to public specialist

outpatient services

CPC

Diabetes &

endocrinology (including paediatric)

Ear, nose & throat (including paediatric)

Gastroenterology General paediatrics

General surgery Gynaecology Hepatology Neurology

Neurosurgery (including paediatric)

Oncology & malignant

haematology

Ophthalmology (including paediatric)

Orthopaedics

Paediatric surgery Plastic & reconstructive

surgery (including paediatric)

Urology Vascular

• 186,638 patients on a specialist

outpatient waiting list (source: MIS, 22/3/17)

• 75% from General Practice

• Variability in categorisation

• Variability in local guidelines

• Variability in referral completeness

Current challenges for public hospitals

• 10% did not meet criteria

• 15% did not have enough information to

categorise

Desktop audit - results

Current

challenges

for GP’s

Chronic constipation HHS H = not accepted HHS I = >40 yrs HHS J = >5% body weight loss in 6

mths

Cataracts HHS A = BCVA worse than 6/12

better eye HHS B = BCVA worse than 6/12

worse eye HHS C = BCVA worse than 6/12

both eyes

Abdominal aortic aneurysm HHS F = >5cm (Cat 1) HHS G = >6cm (Cat 1) Interstate = 3-3.9cm (Cat 1)

Tonsillitis (adults) HHS D = 4-6/yr HHS E = 5+/ yr International = 7/yr

• What about the social impact (driving rules?)

• Are the Queensland thresholds too low?

• What’s the impact on activity volumes and cost?

• Are the Queensland thresholds too high?

• What impact does this have on patient health?

• What is best managed in primary care?

• When is a specialist best placed to diagnose/manage?

Current challenges – for everyone

• “knee injury few years ago. Has been getting

increasing locking, giving way and intermittent

pain. Young man also morbidly obese”

• “8 year old with wrist injury ? cause”

• “patient has crusty eyes. Please see for

treatment”

Stages of CPC implementation

• CPC embedded

• Local service directory

• Minimise inappropriate referrals – able to see the true demand

• Better quality referrals – less returns for further information,

or not ready for care

CPC + HealthPathways

“Was able to draw on CPC to explain referral decision with patients”

“I use HealthPathways to see if I need to refer and to gain clinical advice. This minimises my need for referrals”

“It’s really freed up my time. I’ve been able to create a new scoping list in procedural suites” – SMO Gastroenterology

Improving referral quality

Source: Mackay HHS – CPC Proof of Concept interim evaluation report

Before CPC Source: CPC Project Referral Audit – November 2015

After CPC Source: Mackay HHS – CPC Proof of Concept interim evaluation report - January 2017

Decreasing variation in

categorisation

0% 10% 20% 30% 40% 50% 60%

Unable to categorise

Did not meet criteria

Cat3

Cat2

Cat1

Orthopaedics Mackay HHS

Outcomes of Referral Audit n=184

Current OPD Cat CPC Cat

Source: Mackay HHS – CPC Proof of Concept interim evaluation report

The right pathway

• Clinicians

• Proof of Concept teams

• HIU leadership team

• CPC/HealthPathways team

Acknowledgements

Contact Jody Paxton at:

jody.paxton@health.qld.gov.au

CPC@health.qld.gov.au

or 3328 9337

Questions?