Population Health

Support Health Services - General Practice/ ACCHOs

Improve the Health System - System Integration & Coordination

General Practices and Aboriginal Controlled Health Organisations are supported to improve individual and community health outcomes and experience of health care.

Improve integration of systems and coordination of care across health services for improved individual health outcomes and experience of health care.

Improve integration of systems and coordination of care across health services for improved individual health outcomes and experience of health care.

Facilitate Patient Centred Medical Home model of care coordination across health sector.

Potential Lead

CSAPHN

ACCHOs General Practice

Improve the Health System - Health Technology

Engage with Stakeholders - Health Service Sector

Increase health service implementation and application of technical solutions to improve integration of systems and coordination of care across health services.

Increase knowledge and understanding of local, state and national health service sector to support CSAPHN with effective commissioning of activity and advocacy for primary health care.

Partner with LHNs to improve discharge planning and communication with general practice for post-acute care.

Facilitate capacity building and sharing of information between pharmacy, general practitioners and patients.

Facilitate shared clinical reviews to patients with complex conditions working with multiple health care professionals.

CSAPHN SA Health Regional LHNs General Practice

CSAPHN

CSAPHN

ADHN Chronic disease peak bodies

Reduce potentially preventable hospitalisations

Chronic Disease (Screening/ Management/Coor dination)

Support Access to Care - Health Services

Increase individual and community access to health care services.

Explore opportunities to further develop Stakeholder engagement program – functional relationships with the pharmacy and allied health sectors.

CSAPHN Allied Health Pharmaceutical Society of Australia

Multi-Disciplinary Care Support Access to Care - Health Services

Increase individual and community access to health care services.

Work with RFDS and other providers to enable expansion of services to include chronic disease and mental health nursing services for existing clinics.

CSAPHN RFDS Regional LHNs

Potentially Preventable Hospitalisations (PPH)

Improve the Health System - System Integration & Coordination

System Integration Improve the Health System - System Integration & Coordination

Improve integration of systems and coordination of care across health services for improved individual health outcomes and experience of health care.

Improve integration of systems and coordination of care across health services for improved individual health outcomes and experience of health care.

Delivery of locally based intermediary and home-based care in local areas of need

Facilitate individual alternative care arrangements including for people in palliative stages of life.

Partner with LHN and key stakeholders to address identified risks resulting in preventable Emergency Department admissions and hospital re-admissions.

Partner with LHN and key stakeholders to define a Country SA Primary Health delineation model.

CSAPHN Regional LHNs Palliative Care SA

CSAPHN APHN SA Health Regional LHNs

CSAPHN Regional LHNs

Population Health

Improve the Health System - Health Technology

Access Improve the Health System - Health Technology

Increase health service implementation and application of technical solutions to improve integration of systems and coordination of care across health services.

Increase health service implementation and application of technical solutions to improve integration of systems and coordination of care across health services.

Investigate healthcare needs in small communities where inpatient care best utilises available resources rather than trying to provide an alternative service. Enable multi-party virtual case conferencing with health professionals across primary care and LHNs.

CSAPHN

RDWA Regional LHNs

Improve integration of systems and coordination of care across health services for improved individual health outcomes and experience of health care.

Partner with LHNs to improve discharge planning and communication with patient, general practice, health and wellbeing services.

RACFs

CSAPHN Regional LHNs

CSAPHN

PSA Private

Integrated and coordinated care across the health system

System Integration Improve the Health System - Health Technology

Increase health service implementation and application of technical solutions to improve integration of systems and coordination of care across health services.

Facilitate implementation and promotion of My Health Record ongoing. CSAPHN ADHA

CSAPHN Enable delivery of secure telehealth services for private and public providers and increased promotion and support of telehealth initiatives through direct practice support activities.

Maintain regional service directories.

CSAPHN ADHA Support health service providers to adopt and actively use secure messaging.

CSAPHN Support Web Services Transition through communicating healthcare providers awareness and changing of system. CSAPHN