Chronic Disease Clinical Trial
Official title:
Evaluation of Quality of Care - Nurse Allied Health Clinic Programme, HA
In the past two decades, as a result of population aging and shifts in patient needs, we have
seen an increased demand for chronic disease management (CDM) delivered in the community. The
Hong Kong Government introduced six nurse allied health clinics (NAHC) programme to assist
the delivery of care to facilitate the increased demand on chronic disease management (CDM)
in the community, which are currently being piloted within the government funded general
outpatient clinics (GOPC) of the Hospital Authority (HA). These programmes are designed to
enhance CDM in primary care through patient empowerment and use of multi-disciplinary nurse
and allied health led teams, and aim for secondary prevention and treat-to-target for
specific health conditions. This model of care has already been established in a number of
countries, namely United Kingdom, Australia, Canada and United States, where
multi-disciplinary allied-health clinics, nurse practitioners and nurse-led clinics have
already been integrated into routine practice in primary care (Thomas, Cullum et al. 2000;
Laurant, Reeves et al. 2005).
The six NAHC programmes which have been developed to date address falls prevention (FP),
continence care (CC), mental wellness (MW), wound care (WC), respiratory disease management
(respiratory clinic) and medication management and compliance (MMCC). The evaluation on the
QOC is an essential part of the programme in order to inform future policy. he Department of
Family Medicine and Primary Care (FMPC) of the University of Hong Kong (HKU) has been
appointed by the HA to carry out the evaluation of the QOC of the programme.
The Action Learning and Audit Spiral methodologies to measure whether the target standard of
care intended by the NAHC programme is achieved. Each NAHC participating clinic will be
invited to complete a structured evaluation questionnaire. Anonymized data of all patients
who have enrolled into the NAHC programme for more than 6 months will be included in the
evaluation on the process and outcomes of care. Data on the process of care will be retrieved
from the HA medical records.
In-depth study of NAHC CC programme: In order to compare the outcomes over time between
subjects who have and who have not participated in the NAHC Continence Care Programme, three
hundred and sixty control patients who have not been enrolled into the NAHC CC programme will
be selected for the comparison in the outcomes of care. Subjects will be followed up by
telephone to evaluate the effect of the programme in quality of life (QOL), patient
enablement, and global rating of change in health condition at baseline , 12-month and
24-month after enrollment.
Main Outcome Measures: The primary outcomes are the proportion of participants who have
received the planned process of care and have improvement in clinical outcomes.
Data Analysis: Descriptive statistics on proportions meeting the QOC criteria will be
calculated. The changes in clinical, service and patient reported outcomes between baseline
and discharge will assessed by paired sample t-test. The audit cycle will be repeated 4 times
over a period of 5 years.
In-depth study of NAHC CC programme: the clinical outcomes between NAHC CC subjects and
control group will be compared by independent sample t-test or Chi-square test.
Results: The QOC of the NAHC programme will be determined. Areas of deficiency and possible
areas for quality enhancement will be identified.
Conclusion: The results of this study will provide empirical evidence on whether the HA's
NAHC programmes enhance the QOC of their participating patients. This information will be
used to guide service planning and policy decision making.
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