Development Integrated Model of Care for Neurology Services in Ireland

Abstract

Introduction: To develop a Model of Care for Neurology which would provide a framework for neurology services using international best practice and describes care provision using an integrated service approach. The Framework was developed by a team of multidisciplinary professionals and patient representation to cover the full spectrum of care provided in hospitals (in-patient & out-patient) and make specific recommendations to the type of care considered best practice in the management of patients in the community. Context & Population: Over 700,000 people in Ireland have a neurological illness which accounts for one in five acute medical admissions with one in eight patient attendances to a general practitioner. Many of these brain, spinal, nerve and muscle disorders are increasingly treatable but access to diagnosis and treatment in Ireland presents a significant challenge. Against a backdrop of ever increasing prevalence and service under development, a strategic approach to the development of neurology services nationally was required. Highlights: A review of the current status of neurology services was essential. This was needed from the perspective of service providers, service users, their families/carers and the organisations which represent them. Consultants, nurses and health & social care professionals working in all service delivery environments were engaged. The model of care which arose from this extensive consultative process is one that is relevant and patient centred. The recommendations are also reflective of issues raised by patient and their families and as such are not driven by service delivery priorities but also patient priorities. Comments of Transferability: Any future service developments within the area of neurology services can be aligned with the key recommendations and themes outlined in the model of care thus ensuring an improved patient experience from access to diagnostic services, treatment and interventions, rehabilitation services through to palliation irrespective of individual diagnosis. The process for developing this model of care, the multi-stakeholder engagement and the links between service users and service providers is one that could be applicable to any acute and/or chronic illness management. Conclusions: The Model of Care was launched by the Director General of the HSE, in September 2016, with a commitment to implement the recommendations over a phased basis. The model of care describes; -Clear recommendations on; - Integrated services - Comprehensive MDT & requirements of same - Person centred approach - Staffing & resourcing within neurology in line with best practice - Service configuration and managed clinical networks - Care pathways for MS, Parkinson’s Disease, Motor Neurone Disease, Headache - support for GPs in managing chronic neurological conditions - Education & Training - Research The model of care also has developed proposed programme metrics with respect to quality, access and value. With the development of agreed care pathways, for the first time, parameters are available against which patient pathway/journey can be measured. Proposed metrics include; - Progression through identified care pathways - Improved patient experience - Ensure access to the right service at the right time - Earlier diagnosis - Reduction in unscheduled admissions to acute hospital Measurement of these indicators would not have been feasible without agreed care pathways against which care could be measured.