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Cardiac Services Strategy for Coronary Heart Disease,
Heart Failure and Rheumatic Heart Disease for Queensland 2005–2015
The development of the Statewide Cardiac Services Plan for Queensland (July 2005) and this
Cardiac Services Strategy for Coronary Heart Disease, Heart Failure and Rheumatic Heart
Disease for Queensland 2005–2015 was guided by a Steering Committee comprised of key
Queensland Health representatives. Invaluable assistance was also provided by reference
groups involving representatives from:
n
Queensland Health (Northern, Central and Southern Areas, and Public Health Branch)
National Heart Foundation (Queensland Branch)
n
Cardiac Society of Australia and New Zealand (Queensland Branch)
n
Private sector clinicians
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University of Queensland (School of Population Health)
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Diabetes Australia (Queensland Branch)
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Queensland Divisions of General Practice
n
Suggested citation:
Queensland Health: Copeland K, Jen C, McCosker C, Kidby K, de Souza H, Perina H.
Cardiac Services Strategy for Coronary Heart Disease, Heart Failure and Rheumatic Heart
Disease for Queensland 2005–2015. Queensland Health. Brisbane. 2006.
For further enquiries regarding this document please contact:
Queensland Health
Cardiac Networks
Central Area Health Service
Lobby 1, Level 2 – Citilink Business Centre
153 Campbell Street
Herston QLD 4029
An electronic copy of this document is available from:
www.health.qld.gov.au
ISBN 1 9 21021 29 2
Cardiac Services Strategy for Coronary Heart Disease, Heart Failure and Rheumatic
Heart Disease for Queensland 2005–2015
© The State of Queensland, Queensland Health, 2006
Copyright protects this publication. However, Queensland Health has no objection
to this material being reproduced with acknowledgment, except for commercial purposes.
Permission to reproduce for commercial purposes should be sought from the Policy
and Quality Officer, Queensland Health, GPO Box 48, Brisbane Q 4001.
Cardiac Services Strategy for Coronary Heart Disease,
Heart Failure and Rheumatic Heart Disease for Queensland 2005–2015
Contents
Foreword.................................................................................................. 2
1. Introduction............................................................................................. 3
1.1 Background...................................................................................................3
1.2 What are the Issues?......................................................................................5
1.3 Where are we at?............................................................................................6
1.4 Recent investment in cardiac services...........................................................7
1.5 Other considerations.....................................................................................8
1.5.1 New and Emerging Technology............................................................8
1.5.2 Other Cardiac Conditions....................................................................9
2. Cardiac Services Strategy for Queensland 2005–2015........................... 10
2.1 Developing the Cardiac Services Strategy....................................................10
2.2 The Cardiac Services Strategy......................................................................10
2.3 Principles.....................................................................................................11
2.3.1 Person-centric service provision.......................................................11
2.3.2 Clinician led service provision...........................................................11
2.3.3 Access...............................................................................................11
2.3.4 Equity................................................................................................11
2.3.5 Safety and quality.............................................................................11
2.3.6 Principles governing Indigenous health............................................11
2.4 Goal of the Cardiac Services Strategy..........................................................12
2.5 Objectives of the Cardiac Services Strategy.................................................12
2.6 Governance..................................................................................................12
2.6.1 Clinical Networks..............................................................................13
2.6.2 Cardiac Collaborative for Healthcare Improvement...........................13
2.7 Reporting, Monitoring and Evaluation..........................................................14
2.7.1 Reporting..........................................................................................14
2.7.2 Monitoring.........................................................................................14
2.7.3 Evaluation.........................................................................................14
3. Working Plan.......................................................................................... 15
3.1 CHD, HF, RHD and Quality and Performance – Standards, Objectives,
Initiatives, Key Activities and Performance Measures..................................15
3.1.1 Coronary Heart Disease.....................................................................16
3.1.2 Heart Failure..................................................................................... 28
3.1.3 Rheumatic Heart Disease................................................................. 39
3.1.4 Quality and Performance...................................................................43
4. Summary................................................................................................46
5. Glossary................................................................................................. 47
6. References.............................................................................................50
7. Bibliography........................................................................................... 52
Cardiac Services Strategy for Coronary Heart Disease,
Heart Failure and Rheumatic Heart Disease for Queensland 2005–2015
Foreword
Heart disease is the leading cause of death in Australia with Queensland having the highest mortality rate among all Australian states. The goal of the Cardiac Services Strategy
for Coronary Heart Disease, Heart Failure and Rheumatic Heart Disease for Queensland
2005–2015 is to provide the best cardiac care for Queenslanders through a coordinated,
evidence based approach to the implementation of equitable and sustainable cardiac
services along the continuum of care. Heart attack remains the most common cause of sudden death, and there are a significant
number of avoidable hospital admissions for both heart failure and unstable angina.
A large proportion of heart disease can be prevented by modifying risk factors that are
lifestyle related. These lifestyle risk factors include overweight and obesity, tobacco
smoking, physical inactivity and a diet high in energy and fats. The Cardiac Services Strategy for Coronary Heart Disease, Heart Failure and Rheumatic Heart
Disease for Queensland 2005–2015 provides a coordinated approach to care for people with
coronary heart disease, heart failure and rheumatic heart disease.
The Queensland Government has embarked on a major transformation of the public health
system.
In October 2005, significant additional funding was announced to allow the implementation
of the Cardiac Services Strategy for Coronary Heart Disease, Heart Failure and Rheumatic Heart
Disease for Queensland 2005–2015 commencing in 2006, including:
n
Investment in regional areas to assist people to access services as close as possible to
where they live and work. This includes increased funding for recruitment of skilled
doctors, nurses and allied health professionals in regional locations.
Investment in additional equipment to enhance existing services and establish new
services in regional areas.
n
Investment in our tertiary facilities to increase the availability of services for both the
local metropolitan population, and those referred from regional and rural locations.
n
Across the state, investment in secondary prevention through early detection and
diagnosis with the recognition that cardiac rehabilitation is an integral part of secondary
prevention.
n
Investment to address the particular needs of our Indigenous population, who have lower
rates of interventional services despite higher rates of heart disease. Responses include
consideration of cultural factors, together with a combination of outreach services and
access to diagnostic and interventional services. n
Increased funding for recruitment of skilled doctors, nurses and allied health
professionals across the State.
n
Our injection of funding will help Queensland Health to better promote healthy lifestyles to
prevent or reduce cardiac disease, to identify disease earlier, and to better manage existing
conditions.
In this context the Cardiac Services Strategy for Coronary Heart Disease, Heart Failure and
Rheumatic Heart Disease for Queensland 2005–2015, forms a critical component of the
Queensland public health system’s review.
Cardiac Services Strategy for Coronary Heart Disease,
Heart Failure and Rheumatic Heart Disease for Queensland 2005–2015
1. Introduction
The purpose of this document is to provide key activities, major milestones and performance
measures for implementing the Cardiac Services Strategy for Coronary Heart Disease, Heart
Failure and Rheumatic Heart Disease for Queensland 2005–2015 (from now on referred to as
Cardiac Services Strategy). It provides a clear picture of the way forward for clinicians,
administrators and other relevant agencies and organisations involved in care of people with
heart disease. The document describes the planning process and framework underpinning
the development of the strategy. It also provides an overview of the background, issues and
current status of cardiac services in Queensland.
Heart disease is the leading cause of death in Australia with Queensland having the highest
mortality rate among all Australian states. Heart attack remains the most common cause
of sudden death. Approximately 25% of people who have a heart attack die within an hour
of their first symptom, and 40% die within five years1.
Heart disease is predominantly a disease of middle age and older Australians. This is a
significant issue given the increasing longevity of older people and the current and expected
population growth in Queensland. Additionally, the number of people surviving heart attacks
is increasing. This means there are more people living with heart disease which adds to the
large burden on the health system2,3.
Heart disease is the most costly individual disease in Australia and most of the expenditure
occurs in the acute setting4,5. A large proportion of heart disease can be prevented by
modifying risk factors that are lifestyle related. These lifestyle risk factors include overweight
and obesity, tobacco smoking, physical inactivity and a diet high in energy and fats.
In recognition of these issues, in October 2004 the Queensland Government committed to
continuing to improve cardiac services by delivering services in a planned and coordinated
way, thereby providing the best possible care for people with heart disease across the State.
1.1 Background
In April 2005 the Statewide Health Services Planning Branch of Queensland Health published
an issues paper, The Development of a Statewide Cardiac Services Plan 2005–20156. This
paper substantiated the need for a statewide cardiac services plan which would set the
strategic direction for the management of cardiac services across the State.
The issues paper focused on the two most prevalent and most costly forms of heart disease,
namely coronary heart disease (CHD) and congestive heart failure (from now on referred to as
heart failure (HF)). The paper described the epidemiology of these diseases in Queensland.
It examined the prevalence of risk factors for CHD and highlighted the significant variations
between Queensland and other states in Australia7. The paper quoted the most recent data
that showed Queensland has the highest rate of overweight and obesity and tobacco smoking
in Australia7 along with the second lowest rate of revascularisation for all Australian states8.
The paper looked at the overall management of CHD and HF, along the continuum of care
and outlined opportunities for further action including:
n
disease prevention in the well population
n
n
secondary prevention through early detection and diagnosis with the recognition
that cardiac rehabilitation is an integral part of secondary prevention
current management in acute care, tertiary prevention and the impact of new
and emerging technologies on cardiac services
Rheumatic heart disease (RHD) was identified in the issues paper as a significant problem
among the Indigenous population. During consultation, it was emphasised that RHD required
urgent attention in Queensland. Though this disease is almost unknown in developed
Cardiac Services Strategy for Coronary Heart Disease,
Heart Failure and Rheumatic Heart Disease for Queensland 2005–2015
countries, Indigenous Australians have one of the highest levels of RHD in the world.
RHD can be minimised through early diagnosis and successful treatment of Acute Rheumatic
Fever (ARF), which in turn, can be prevented by attention to socio-economic conditions such
as appropriate housing, education, employment and other social justice issues9, 10, 11, 12, 13.
The issues paper informed the development of a Statewide Cardiac Services Plan for
Queensland 2005–201514 [the Plan]. The Plan outlined a good practice framework for CHD, HF and RHD which was based on related successful work undertaken in national
and worldwide jurisdictions including:
n
the National Health Service (United Kingdom (UK))15
n
Cardiac Care Network of Ontario (Canada)16
n
British Columbia Cardiac Services (Canada)17
n
n
n
New South Wales Health, New South Wales Clinical Service Framework
for Heart Failure18,19
the Draft National Service Improvement Framework for Heart, Stroke and Vascular
Disease20 and
Queensland Health (Health Outcome Plan: Cardiovascular Health: Coronary Heart Disease
2000–2004)21
In March 2000 the National Health Service (UK) published a National Service Framework
for CHD articulating twelve standards for good practice and spelt out immediate priorities
for action. It summarised ways to make progress and set out milestones and goals for
achievement over the following few years. In recent years (200422and 200523) the National
Health Service (UK) has reported on significant progress and achievements in addressing
the burden of heart disease in the United Kingdom. These achievements include:
n
decrease in time to treatment for people experiencing heart attack
n
reduction in waiting times for cardiac patients to see a specialist
n
reduction in waiting times for cardiac surgery
n
reduction in prevalence of adult smoking
n
increase in number of cardiologists
n
increase in number of cardiac surgeons
n
reduction in death rates from heart disease
The Cardiac Care Network of Ontario24, 25 and British Columbia Cardiac Services have
also published their relevant service plans and provided review publications identifying
achievements over the last 10 years. The Statewide Cardiac Services Plan for Queensland
2005–2015 was developed with these achievements in mind.
The Plan was developed in consultation with a wide range of stakeholders representing
professional and consumer groups across the State.
In developing the Plan consideration was given to related Queensland Health initiatives
to ensure synergy and avoid duplication. These initiatives aim to address chronic diseases
(including cardiac diseases) and the associated risk factors. The initiatives include:
n
Queensland Tobacco Action Plan
n
n
n
Eat Well Queensland: Smart Eating for a Healthier State
Implementation Initiative for the Prevention and Management of Chronic Disease
2005–2015
Strategic Policy for Aboriginal and Torres Strait Islander Children and Young People’s
Health 2005–2010
n
Cardiac Collaborative for Healthcare Improvement
n
the State Budget election commitments, 2004 for Cardiac services
Cardiac Services Strategy for Coronary Heart Disease,
Heart Failure and Rheumatic Heart Disease for Queensland 2005–2015
The Plan addresses the relevant recommendations of the Maher report entitled Report
of investigation into circumstances surrounding deaths awaiting cardiac services at
The Prince Charles Hospital26. These recommendations include:
n
statewide planning for cardiac services
n
access to tertiary care for people with coronary heart disease
n
new and emerging technologies
n
selection and funding for implantable cardiac defibrillators
n
coordination and sustainability of services
n
workload distribution
n
referral practices
n
clinical leadership
n
waiting list management
n
data management
1.2 What are the issues?
The issues facing cardiac services in Queensland are numerous but not insurmountable.
It is well documented that heart disease is:
the biggest killer and the most expensive of all diseases in Australia and Queensland
n
n
largely a disease of middle aged and older Australians
n
increasing as the population is living longer
n
predicted to increase with the exponential growth in Queensland’s population
n
currently a significant burden on the health system
n
largely preventable by modifying lifestyle risk factors, such as, overweight and obesity,
tobacco smoking and physical inactivity
Additionally, coordination of cardiac services within the three Area Health Services and
across the State has been suboptimal and has hindered access to basic and specialist cardiac
services in some areas. Contributing factors include the concentration of these services in
Brisbane, limited specialist positions across the State, a lack of skilled staff and the limited
availability of specialised equipment. In comparison to other Australian states, Queensland
has fewer specialised medical staff 27, 28 , interventional facilities and secondary prevention
programs per capita.
Equity of access for disadvantaged groups is another area requiring attention. People with
socioeconomic disadvantage, Indigenous people and rural populations are known to have
disproportionately high levels of heart disease and reduced access to cardiac treatments
and services compared to the rest of the population7. To date, efforts to address these
issues have not produced broadly effective results; for example, cardiac intervention rates
for Indigenous people remain lower than expected.
Recruitment and retention of staff has been identified as an issue. The limited availability
of training positions, support for training and development and forward planning have been
highlighted as some of the causal factors resulting in high staff turnover and low recruitment
rates. The ability to recruit and retain staff remains a risk in the future.
Monitoring the clinical practice and performance of cardiac services across the State has
been undertaken in the last few years by the Cardiac Collaborative for Healthcare
Improvement. This, however, has been limited in its application and has not included all
Queensland Health service providers.
Cardiac Services Strategy for Coronary Heart Disease,
Heart Failure and Rheumatic Heart Disease for Queensland 2005–2015
1.3 Where are we at?
To gain an accurate picture of the level and extent of current cardiac services in Queensland
a number of activities have been undertaken.
A comprehensive review of existing initiatives, internal and external to Queensland Health,
was undertaken to identify current cardiac related activities, the gaps in cardiac service
delivery and areas of opportunity for improvements along the continuum of care.
A cardiac services survey was administered to 32 public hospitals in Queensland including
tertiary, secondary and regional facilities in all three Area Health Services. The survey asked
each facility to identify:
n
cardiac services provided across the continuum of care
n
resources and dedicated beds available
n
cardiac specific equipment
n
cardiac staffing levels, all disciplines, including funded positions and vacant positions
n
services provided by other facilities (private providers/outreach)
n
transport and inter-facility transfer issues
n
perceived service gaps and priorities for enhancement of services
The responses were collated and data analysed providing baseline information to determine
gaps and inequalities within and between facilities, Health Service Districts and Area Health
Services. Based on this information, potential solutions such as, system changes, increased
staff numbers and new equipment, were developed.
Additional detailed analysis of health information data was undertaken. Data sources
included:
n
the Australian Institute of Health and Welfare (AIHW)
– Summary Report Australian Hospital Statistics 2003–2004
n
Queensland Hospital Admitted Patient Data Collection
– admitted patient episodes of care for ischaemic heart disease and heart failure
2000–2004
– admitted patient episodes of care for cardiovascular disease by Indigenous status
2003–2004
– age adjusted rates of cardiac procedures for the Queensland total population
and the Queensland Indigenous population 2000–2004
n
2001 census population counts by Indigenous status
The results of this analysis confirmed that Queensland had lower rates of cardiac intervention
compared to other States. There is considerable variation in intervention rates between Area
Health Services and between Indigenous and non-Indigenous people in Queensland. There
are a significant number of avoidable hospital admissions for both heart failure and unstable
angina. The survey identified facilities with high, moderate and low admission rates for
coronary heart disease and heart failure and referral patterns across the State.
Analysis of projected population growth for Queensland from the Health Service District
Population Growth Update, Health Determinants Queensland 20047 provided direction
for the planning of specialised cardiac services based on where people will be living as
Queensland’s population grows.
Consultations were held with clinicians and executive staff at tertiary, secondary and regional
facilities involved in the provision of cardiac services. Information from all data sources was
verified and cardiac service needs identified by each Health Service District were prioritised.
The service capacity of each District was also discussed in line with potential enhancement
of services.
Cardiac Services Strategy for Coronary Heart Disease,
Heart Failure and Rheumatic Heart Disease for Queensland 2005–2015
The Cardiac Services Strategy was developed with reference to the Queensland Health
Systems Review: Final Report (Forster, 2005), Action Plan: Building a Better Health Service for
Queensland (2005) and Queensland Public Hospitals Commission of Inquiry (Davies, 2005).
The Cardiac Services Strategy supports and is aligned with the recommendations made in
each of these reports.
1.4 Recent investment in cardiac services
Recent investment in cardiac services has already had a positive effect on service delivery.
The 2004–05 State Budget (including May election commitments) provided $7.5 million for
the provision of a number of cardiac services in 2004–05. This included funding to enhance
existing cardiac rehabilitation services, develop new programs and explore the viability
of alternative models of delivering cardiac rehabilitation. An Indigenous specific cardiac
rehabilitation program and a telephone based service are currently being trialled. Funding
was provided to employ extra cardiac staff and to provide more cardiac procedures including
coronary angiograms and stent procedures in tertiary hospitals. Funds were also made
available to enable more patients to have cardiac defibrillators implanted to reduce the risk
of sudden death.
Two and a half million dollars ($2.5M) in capital funding was also provided through this
budget for a new cardiac diagnostic laboratory which has been built and is now operational
at the Gold Coast Hospital.
In December 2004 Queensland Health committed funds to The Prince Charles and the
Royal Brisbane and Women’s Hospitals to increase the number of cardiac interventions and
to implement a Hospital to Home Heart Failure Program. Funds were also provided to
Townsville Hospital to address avoidable admissions due to HF.
The recent 2005–06 State budget committed an additional $60 million over four years
from 2005–06 for the improvement of cardiac services. These funds will initially be used
for cardiac intervention procedures and to enhance HF and cardiac rehabilitation services.
In addition, components of the chronic disease funding package of $151 million over the
four years, and the Indigenous health budget of $68.8 million over four years, both also
announced in the 2005–06 State Budget, will assist in the implementation of the health
promotion and prevention of chronic disease. Both initiatives overlap with the health
promotion and disease prevention components of the Cardiac Services Strategy.
Following the release of the Queensland Health Systems Review Interim Report (July 2005)
the government allocated $1.08 million for three multidisciplinary teams to help people with
heart failure and to employ two additional registrar positions at The Prince Charles Hospital,
one each in paediatric cardiology and adult congenital heart disease units.
In October 2005, $5 million in recurrent funding was provided as a Cardiac Relief Package –
the first allocation supporting a statewide approach to enhancing cardiac services. This
included $0.3 million in capital funding for the purchase of equipment. This allocation
provides for the employment of more cardiac staff, undertaking more cardiac procedures and
procuring essential equipment. These funds will increase the use of existing tertiary facilities
and expand the existing base of cardiac services by building up services at secondary
facilities. This funding increases to $6.375 million recurrent from 2006–2007 onwards.
Cardiac Services Strategy for Coronary Heart Disease,
Heart Failure and Rheumatic Heart Disease for Queensland 2005–2015
The Special Fiscal and Economic Statement, released in October 2005, committed an
additional $174 million in new funding from 2005–2006 to 2010–2011 for both new
($163.1 million) and existing ($10.9 million) services. This will:
n
improve access to:
– interventional cardiac services
– cardiac surgery
– cardiac services in rural and remote areas, including Indigenous communities
n
build a skilled cardiac workforce
n
improve provision of HF and cardiac rehabilitation services
1.5 Other considerations
1.5.1 New and emerging technology
New and emerging technologies will play an integral role in the future provision of
cardiac services in Queensland and timely consideration and appropriate funding
of such technology is essential.
A Queensland Health horizon scan29 for cardiac devices/new technology was undertaken in
February 2005 to inform the cardiac services issues paper. This is not a definitive summary
and is based upon a limited literature search that may not have captured all emerging
technologies. A list of items from this summary follows.
Bioabsorbable/biodegradable coronary artery stents
Bioabsorbable coronary artery stents comprise material which is intended to be totally or
partially absorbed by the patient’s body over a period of time. The purpose of bioabsorbable
stents is to support the arterial wall during healing after angioplasty while avoiding the longer
term complications associated with permanent stent implantation.
Left ventricular assist devices (LVAD) for destination therapy
New versions of the left ventricular assist device have been developed for use as destination
therapy – implanted permanently for end stage heart failure. Patients who participated in
trials were considered eligible for implantation of a LVAD when they met the transplantation
criteria but were over 65 years of age, had renal failure or insulin dependent diabetes mellitus
with end-stage organ damage. For these patients transplantation would have been
contraindicated.
Multi-detector computerised tomography (MDCT)
MDCT can be used for detecting coronary calcium and for coronary angiography. MDCT
angiography has been found to have high sensitivity and specificity for detecting high grade
coronary artery stenosis. However, imaging of smaller sections of coronary arteries provides
a challenge for MDCT due to their small size and the necessity for motion free imaging.
Suboptimal images of the three major coronary arteries during the cardiac cycle can be
produced due to movements of these vessels.
Hyperoxemic perfusion for treatment of microvascular ischaemia in patients
with acute myocardial infarction (AMI)
The purpose of hyperoxemic perfusion is to treat damaged myocardial tissue arising from
oxygen loss during or after AMI. The therapy is used as an adjunct to the initial interventions
that restore blood flow to cardiac tissue. Successful re-opening of blood vessels through
angioplasty does not necessarily lead to recovery of left ventricular function. Post AMI
patients commonly experience a reduction in contractile function which can result in
heart failure.
Cardiac Services Strategy for Coronary Heart Disease,
Heart Failure and Rheumatic Heart Disease for Queensland 2005–2015
Robotic surgery
Current uses of robotic surgery are mostly confined to smaller surgical procedures but it has
been used in a number of trials and case studies involving coronary artery bypass and mitral
valve procedures.
Gene therapy for heart disease
Over twenty genes have been used in trials involving patients with cardiac ischaemia
or for ischemia-reperfusion. These therapies have taken several forms. These therapies
are generally aimed at finding a treatment alternative for patients with severe end-stage
heart disease, whose options are limited by shortages of donor organs. Most trials reported
are at lower phases with very limited evidence based on randomised controlled trials.
B-type Natriuretic Peptide (BNP) measurement
BNP is a vasoactive peptide that is synthesized and released in response to increases in
ventricular wall stress. It is an indicator of the presence and severity of haemodynamic stress
occurring in the setting of acute myocardial ischaemia and adds to tools for risk stratification.
BNP was initially used in diagnosis of heart failure and now in acute coronary syndromes.
An increased concentration of BNP is associated with ventricular systolic dysfunction and
a greater likelihood of mortality or onset of heart failure30.
These and other new technologies will be monitored and reviewed regularly through horizon
scanning and provision made to implement any of these technologies that are demonstrated
to improve the treatment and management of people diagnosed with CHD, HF or RHD.
1.5.2 Other cardiac conditions
The Cardiac Services Strategy addresses CHD, HF and RHD which are high volume and high
cost health issues. There are a number of other cardiac conditions that require a similar level
of review and planning from a statewide perspective. These conditions include congenital
cardiac anomalies, valvular heart disease, cardiomyopathy and cardiac arrhythmia. The
development of strategies for these conditions will occur in line with the Queensland Health
Statewide Services Plan and the establishment of Cardiac Clinical Networks in 2006.
A review is currently underway within Queensland Health in regard to paediatric cardiology
and paediatric cardiac surgery.
Cardiac Services Strategy for Coronary Heart Disease,
Heart Failure and Rheumatic Heart Disease for Queensland 2005–2015
2. Cardiac Services Strategy for Queensland
2005–2015
2.1 Developing the Cardiac Services Strategy
The Statewide Cardiac Services Plan for Queensland 2005–2015 (July 2005) provides
a framework for a coordinated and integrated system of care for people with coronary
heart disease, heart failure and rheumatic heart disease.
To further define standards and priorities several expert consultation groups were
established from the initial reference group involved in the development of the Plan.
The groups reviewed material on their area of expertise, which included health promotion
and primary prevention of heart disease, coronary heart disease, heart failure, cardiac
rehabilitation, palliative care, workforce and resourcing, Indigenous issues, and quality
of service and data. For RHD, two consultation workshops were held that attracted
representation from across the State.
Information collected from these consultation groups is reflected in the CHD, HF and RHD
standards, objectives, initiatives and key activities in the Cardiac Services Strategy.
The framework covers the whole continuum of care from health promotion through primary,
secondary and tertiary prevention. It was identified that a number of initiatives, particularly
health promotion and primary prevention, in the Cardiac Services Strategy were being
progressed by other Queensland Health programs. These include the Queensland Strategy
for Chronic Disease 2005–2015, Strategic Policy for Aboriginal and Islander Children and
Young People Policy 2005–2015. To avoid duplication, these ‘shared’ initiatives will not be
directly actioned by the Cardiac Services Strategy, but supported through partnership with
other programs.
The Cardiac Services Strategy was developed to address issues from a statewide perspective.
This will be achieved by working in partnership with related programs, for example, the
Queensland Strategy for Chronic Disease 2005–2015 and the Strategic Policy for Aboriginal
and Islander Children and Young People Policy 2005–2015, contributing to a whole of
government approach to address CHD, HF and RHD.
2.2 The Cardiac Services Strategy
The Cardiac Services Strategy is ambitious but realistic, and supports the need for systemic,
sustainable change. People from all areas of health care, such as public health services,
primary care teams, hospital staff, community care, government departments and the private
sector, as well as community groups and consumers, will be involved in working together to
introduce or enhance systems that enable high quality services to be delivered to all people
in Queensland.
The Cardiac Services Strategy provides a coordinated approach to care for people with CHD,
HF and RHD. The evidence based standards have been developed to achieve key objectives
that strive for best practice care for all people in Queensland. Another component of the
Cardiac Services Strategy addresses monitoring of quality and performance indicators.
Key activities were developed in conjunction with the best practice standards. The tables
commencing on page 16 detail the standards, objectives initiatives, key activities and
associated milestones and performance measures for the Cardiac Services Strategy.
10
Cardiac Services Strategy for Coronary Heart Disease,
Heart Failure and Rheumatic Heart Disease for Queensland 2005–2015
2.3 Principles
The broad principles that underpin the Cardiac Services Strategy include the drive to promote
health and reduce inequalities, raise the quality of clinical care and reduce variations in
access to, and the quality of, services. More specifically, the following principles underpin
the Cardiac Services Strategy.
2.3.1 Person-centric service provision
n
n
n
Care is person centred, accommodating the needs, capacity and preferences of
individuals thereby ensuring that people are treated with respect, dignity and autonomy
and are able to make informed decisions.
Effective programs and treatments are provided that have the capacity to delay
progression of disease, complications and disabilities, reduce admissions to hospital,
improve quality of life and maintain functional capacity and independence.
Individuals are supported in self management, enabling them to maintain their
independence and control in a spirit of mutual obligation. Family, carer and the
community are supported.
2.3.2 Clinician led service provision
n
n
Through the Cardiac Clinical Networks, clinicians will drive statewide cardiac service
planning, including the allocation, placement and prioritisation of cardiac resources to
match areas of greatest need and potential health gain.
Clinicians are responsible for the standards of clinical practice.
2.3.3 Access
n
Services are delivered in a timely fashion regardless of age, gender, disability, ethnicity,
or residential location in Queensland.
2.3.4 Equity
n
n
Policies are enacted that aim to reduce inequalities in health for disadvantaged groups,
for example, Indigenous people, rural and remote populations, and low socioeconomic
groups.
There is a commitment to an equitable statewide distribution of services with resources
targeted at people in greatest need and with greatest potential to benefit.
2.3.5 Safety and quality
n
n
n
Services are safe, of high quality, evidence based, and are outcome focused, delivered
by highly trained, competent staff.
Services reflect efficiency, achieving desired results with the most cost effective use
of available resources.
Services are sustainable, that is, they are designed to meet the current needs of
Queenslanders with consideration given to the emerging needs of the population
into the future.
2.3.6 Principles governing Indigenous health
n
The Indigenous health components of the Cardiac Services Strategy are guided by the
principles articulated in the Cultural Respect Framework for Aboriginal and Torres Strait
Islander Health 2004–2009.
11
Cardiac Services Strategy for Coronary Heart Disease,
Heart Failure and Rheumatic Heart Disease for Queensland 2005–2015
2.4 Goal of the Cardiac Services Strategy
The goal of the Cardiac Services Strategy is to provide the best cardiac care for Queenslanders
through a coordinated, evidence based approach to the implementation
of equitable and sustainable cardiac services along the continuum of care.
2.5 Objectives of the Cardiac Services Strategy
The following reflect the overall objectives of the Cardiac Services Strategy.
1. To increase health promotion and primary prevention activities to reduce the incidence
of behavioural risk factors and the prevalence of heart disease in the community.
2. To improve access to, and equity of cardiac services throughout the State by appropriate
distribution and coordination of services.
3. To improve service delivery in all sectors of cardiac care for the community, with
consideration for people with special needs, for example, people living in rural and
remote areas, Indigenous people and people with socio-economic disadvantage.
4. To provide highly trained, competent cardiac staff along the continuum of care by
supporting competence-based training and effective recruitment and retention initiatives.
5. To ensure clinical practice is safe and of a high standard by implementing evidence based
clinical guidelines and procedures, through expanding the role of the Cardiac
Collaborative for Healthcare Improvement and establishing Cardiac Clinical Networks.
6. To expand service delivery models including innovative and flexible ways of allocating
financial and human resources.
7. To acquire and distribute appropriate funding and resourcing based on equity, access
and outcomes, to achieve the initiatives within the Cardiac Services Strategy.
8. To integrate health services to improve communication between health providers along
the continuum of care of cardiac services.
9. To monitor and review performance, at specified intervals, to improve clinical practice
and service delivery.
10.To decrease morbidity and mortality rates associated with cardiac conditions.
2.6 Governance
A number of overarching strategies need to be in place in order to implement the Cardiac
Services Strategy. The identified strategies facilitate all actions proposed in the Cardiac
Services Strategy. These include the establishment of a Statewide Cardiac Clinical Network,
Area Health Service Cardiac Clinical Networks and the expansion and evolution of the role
and functions of the existing Cardiac Collaborative for Healthcare Improvement.
These groups will oversee clinical leadership and workforce development, service planning
and coordination, coordination of clinical information, and implementation of the Cardiac
Services Strategy.
Underpinning these strategies are the following principles of clinical governance31, 32
n
quality of patient care and safety of patients,
n
n
12
equity of access and equity of outcome within the health care system incorporating
population-based planning
clinician/consumer driven planning
Cardiac Services Strategy for Coronary Heart Disease,
Heart Failure and Rheumatic Heart Disease for Queensland 2005–2015
2.6.1 Clinical Networks
Clinical leadership is seen as a fundamental driver for improved professional practice32.
Clinical networks offer an opportunity to standardise care, make the best use of scarce
resources, improve equity of access and equity of outcome, and reduce the effect of specialist
services being concentrated in large centres33.
The networking of cardiac services will provide greater opportunities for improved
communication, the development of evidence-based treatment guidelines leading to
standardised approaches to care, and create links to encourage clinicians to work together
across facility, geographical and discipline boundaries.
A Queensland Statewide Cardiac Clinical Network and three Area Health Service Cardiac
Clinical Networks will ensure a coordinated, representative, accountable, outcome-oriented,
clinically driven cardiac service in Queensland. It will improve accessibility, equity and
accountability while providing a standardised high quality of care for all Queenslanders.
2.6.2 Cardiac Collaborative for Healthcare Improvement
The aim of the Cardiac Collaborative and its subset the Cardiac Rehabilitation Collaborative
is to facilitate clinicians working together to improve care for people with heart disease by
identifying and addressing evidence-practice gaps in care. This includes:
n
sharing innovative service improvement activities
n
development, implementation and evaluation of clinical process and outcome indicators,
development of data collection, review and feedback systems
n
profiling current practice
n
reduction of variations in practice
The provision of shared, useful, accurate, timely and reliable information is essential.
The development, implementation and maintenance of clinical information systems and
decision support mechanisms remain challenging.
The current scope of responsibilities of the Cardiac Collaborative limits its impact. Expanding
the role of the current Queensland Health Cardiac Collaborative for Healthcare Improvement
will improve administration, guidance, communication of data, clinical training and
coordination of cardiac services in Queensland.
To improve care and inform future planning, the Cardiac Collaborative will ensure the
following:
n
performance indicators are evidence-based and useful
n
Clinical Information Systems are selected to be broadly applicable, user-friendly
and connect with other systems within the organisation
n
appropriate training and resources support the process
n
data is collected, entered and managed efficiently and accurately
n
data is transformed into useable information
n
information is shared in a timely manner
n
information is used to improve practice
An expanded Cardiac Collaborative will support the Area Health Services, Health Service
Districts and clinical networks with evaluation of services, clinical practice and education and
training. It will also take an active role in the implementation and monitoring of the Cardiac
Services Strategy.
13
Cardiac Services Strategy for Coronary Heart Disease,
Heart Failure and Rheumatic Heart Disease for Queensland 2005–2015
2.7 Reporting, monitoring and evaluation
2.7.1 Reporting
Reporting will occur through a number of avenues. These include:
n
expenditure report through Finance Branch to the Executive Management Team monthly
n
n
n
n
n
n
n
clinical and outcome reporting through the Cardiac Collaborative for Healthcare
Improvement to area Health Services bi-annually
annual cardiac services report from all Health Service Districts providing cardiac services
to Area Health Services
a Cardiac Services Strategy review and report based on milestones and performance
measures described in this document to Cabinet, after June 2007
report by the Chronic Disease Implementation Team on the health promotion and disease
prevention component of the Cardiac Services Strategy
report by the implementation team for the Aboriginal and Islander Child and Young
Peoples Strategic Policy on related Indigenous issues
the election commitment initiatives will be reported through the Area Health Services
monthly
reporting requirements of the Health Action Plan
2.7.2 Monitoring
Monitoring will occur by the Area Health Service Cardiac Clinical Networks and the Statewide
Cardiac Clinical Network. Following the review of the implementation after June 2007, a report
will be submitted to Cabinet.
2.7.3 Evaluation
Existing state and national data sources will be accessed, where possible, to inform
milestones and performance measures. The evaluation will track changes across time
in key areas and will allow comparisons within the State and other jurisdictions.
The Assessing Cost Effectiveness (ACE) Prevention Study, conducted through the School
of Population Health, University of Queensland will provide additional information for
consideration in evaluating the Cardiac Services Strategy. The aim of this study is to establish
objective evidence on the benefits and costs of health intervention options whilst taking into
account the need for greater health equity, transparency of decision making and stakeholder
acceptability.
The Evaluation Framework for the Queensland Strategy for Chronic Disease 2005–2015 which
will be undertaken by the School of Population Health, University of Queensland has seven
key components. These include:
n
an annual survey of key stakeholders
n
interviews with key Indigenous representatives
n
a computer assisted telephone interview (CATI) survey of people with a chronic disease
n
a CATI survey of the general population
n
interviews with clinicians
n
random survey of service providers and a cohort study of people with chronic disease,
including cardiac disease
This evaluation will also provide important information for consideration in relation to
evaluation of the Cardiac Services Strategy and future planning for cardiac services.
14
Cardiac Services Strategy for Coronary Heart Disease,
Heart Failure and Rheumatic Heart Disease for Queensland 2005–2015
3. Working plan
3.1 CHD, HF, RHD and quality and performance
– standards, objectives, initiatives, key activities
and performance measures
The Cardiac Services Strategy working plan is outlined in the following tables.
The four tables, CHD, HF, RHD and Quality and Performance, detail the standards, objectives
and planned activities, milestones and performance measures for the period 2005–2007.
The activities undertaken during this period form the basis for the ongoing expansion of
cardiac services across the State. Therefore, the key activities, milestones and performance
measures listed for 2005–2007 will remain the priority for 2007–2010. In addition, the
outcomes and evaluation of the 2005–2007 working plan will be used to further develop
activities planned for 2007–2010. The same process will follow for 2010–2015.
It is recognised that many of the key milestones and performance measures in the period
2005–2007 are process orientated. During the initial phase of implementing the Cardiac
Services Strategy baseline data will be established allowing more outcome-focused measures
to be developed over time.
15
Cardiac Services Strategy for Coronary Heart Disease,
Heart Failure and Rheumatic Heart Disease for Queensland 2005–2015
3.1.1 Coronary Heart Disease
Objectives
Initiatives and Key Activities
Key Milestones and
Performance Measures
Key
Stakeholders
To be determined by
Chronic Disease Strategy
Implementation Team
and Indigenous Health Unit
Chronic Disease
Strategy
Implementation
Team
Standard 1: Promote cardiac health in the population
1.1 To implement
and evaluate, through
effective partnerships,
health promotion
approaches that ensure
attention to the social
determinants of cardiac
disease.
Queensland Strategy for Chronic Disease 2005–2015
1.1.1 Consolidate partnerships with non-government
organisations to progress health issues of the general
population in relation to CHD
1.1.2 Ensure consistent, accurate and clear information for
the community about the prevention of CHD is easily accessible
1.1.3 Provide an effective range of health promotion
programs and guidelines based on good practice which can be
utilised across the life course to impact on cardiac health
1.1.4 Provide support to address the underlying social
determinants of cardiac health through effective cross sectoral
partnerships (eg. housing; education; employment; transport)
Indigenous Health Unit
Indigenous
Health Unit
1.1.5 Increase uptake of cross cultural education programs
to ensure a more informed workforce with regard to Indigenous
health issues
Queensland Strategy for Chronic Disease 2005–2015
1.2 To provide a
realistic and appropriate
approach to the
implementation
of cardiac health
promotion policies and
programs in different
geographic and
socioeconomic areas.
To be determined by
1.2.1 Assess, develop and coordinate policies and programs Chronic Disease Strategy
for the general population, with special attention to the specific Implementation Team
and Indigenous Health Unit
needs of sub-groups and those at high-risk, in particular the
Aboriginal and Torres Strait Islander population, that raise
community awareness of the need to assess and manage
hypertension, hypercholesterolaemia, healthy eating, physical
inactivity, overweight and obesity, safe alcohol use, smoking
and mental health issues.
Chronic Disease
Strategy
Implementation
Team
1.3 To implement and
evaluate policies that
reduce the prevalence
of coronary risk factors
in the population, and
reduce inequalities in
the risk of developing
CHD.
Queensland Strategy for Chronic Disease 2005–2015
To be determined by
Chronic Disease Strategy
Implementation Team
and Indigenous Health Unit
Chronic Disease
Strategy
Implementation
Team
To be determined by
Chronic Disease Strategy
Implementation Team
Chronic Disease
Strategy
Implementation
Team
1.3.1 Increase awareness and up-take of current guidelines
for the assessment and management of hypertension,
hypercholesterolaemia and other cardiac risk factors among
relevant clinicians throughout Queensland.
1.3.2 Encourage all health care professionals to screen,
identify and provide advice and support to individuals who
are at risk from unhealthy lifestyle choices and behaviours
and refer to specialised services where indicated.
1.3.3 Identify effective health promotion approaches and
personnel in relation to the reduction in the prevalence of
smoking, enhancing optimal nutrition and increasing physical
activity across the State.
1.3.4 Recognise and support the different requirements
in rural and remote areas in the implementation of health
promotion programs that address behavioural risk factors.
1.4 To contribute
to a reduction in the
prevalence of smoking
in the population.
16
Queensland Strategy for Chronic Disease 2005–2015
1.4.1 Ensure smoking cessation programs are in place in
all major hospitals.
1.4.2 Ensure QH smoke free policies are instituted and
monitored.
Cardiac Services Strategy for Coronary Heart Disease,
Heart Failure and Rheumatic Heart Disease for Queensland 2005–2015
3.1.1 Coronary Heart Disease (continued)
Objectives
Initiatives and Key Activities
Key Milestones and
Performance Measures
Key
Stakeholders
1.5 To ensure
appropriate policies
and cardiac health
programs reach the
Indigenous population.
Queensland Strategy for Chronic Disease 2005–2015
To be determined by
Chronic Disease Strategy
Implementation Team
and Indigenous Health Unit
Chronic Disease
Strategy
Implementation
Team
1.5.1 Implement Indigenous specific tobacco cessation
programs in partnership with local Indigenous health groups.
Indigenous
Health Unit
Standard 2: Prevent CHD in high risk people
Queensland Strategy for Chronic Disease 2005–2015
2.1 To instigate
widespread education
of the community on
the signs and symptoms
of angina, unstable
angina and heart attack,
and the appropriate
actions to be taken by
the consumer.
To be determined by
Chronic Disease Strategy
2.1.1 Develop and provide culturally relevant education
to the community through various avenues (community groups, Implementation Team
and Indigenous Health Unit
schools, sporting entities) utilising all forms of media and
communications on the signs and symptoms of heart attack,
cardio-pulmonary resuscitation training and the importance
of seeking medical help early.
Chronic Disease
Strategy
Implementation
Team
2.2 All health service
providers across the
continuum will identify
people at significant
risk of CHD and offer
them appropriate
referrals, advice and
treatment to reduce
their risks factors.
Queensland Strategy for Chronic Disease 2005–2015
To be determined by
Chronic Disease Strategy
Implementation Team
Chronic Disease
Strategy
Implementation
Team
To be determined by
Chronic Disease Strategy
Implementation Team
and Indigenous Health Unit
Chronic Disease
Strategy
Implementation
Team
2.2.1 Increase capacity for screening of hypertension, renal
failure, hypercholesterolaemia, insulin resistance, abdominal
adiposity (increased waist measurements), physical inactivity,
alcohol consumption, and nutrition.
Indigenous
Health Unit
2.2.2 Monitor, detect and manage cardiac risk factors in the
community.
2.2.3 Support screening of risk factors within the context
of local communities.
2.2.4 Increase education to health providers to recognise
seriousness of conditions.
2.2.5 Provide risk factor advice and support to individuals
to assist them to modify unhealthy lifestyle choices and
behaviours (smoking, physical activity, diet, alcohol
consumption and weight).
2.2.6 Identify people with diabetes as a secondary condition.
2.3 To develop links
and maintain a high
level of communication
between all health
service providers
across the continuum.
Queensland Strategy for Chronic Disease 2005–2015
2.3.1 Develop patient register and recall systems for use
in primary care environments to enable early diagnosis and
follow up of CHD risk factors.
2.3.2 Address systemic issues affecting cardiac health,
for example, communication shortfalls between all health
service providers across the continuum, fragmentation of
service delivery and service duplication.
Indigenous Health Unit
2.3.3 Consolidate partnerships with Community Controlled
Health Services to progress Indigenous health management
in relation to CHD.
Indigenous
Health Unit
2.3.4 Improve access to mainstream services for Indigenous
people by addressing local barriers, employment of Indigenous
people and ensuring good practice care is delivered.
2.3.5 Increase availability of Indigenous Health Workers
(IHW) to facilitate education and treatment of CHD among the
Indigenous population.
17
Cardiac Services Strategy for Coronary Heart Disease,
Heart Failure and Rheumatic Heart Disease for Queensland 2005–2015
3.1.1 Coronary Heart Disease (continued)
Objectives
Initiatives and Key Activities
Key Milestones and
Performance Measures
Key
Stakeholders
Standard 3: Recognition, treatment and management of CHD (angina, unstable angina and heart attack)
3.1 To promote
and provide training
programs for health
professionals involved
in the care of people
with CHD.
3.1.1 Provide training for health professionals in recognition,
assessment, treatment, education and management of people
with CHD.
n
n
n
n
n
n
Support health professionals to undertake training and
education relevant to CHD
Investigate other modes of delivering training and education
3.2 To accurately
and promptly diagnose
people suspected of
having CHD.
Establish positions at tertiary facilities for short term clinical
placement for nurses from rural and remote centres
n
18
n
Support the release of nursing staff, particularly from rural
and remote facilities, to undertake clinical placements
Partner with National Heart Foundation (NHF), Cardiac
Society of Australia and New Zealand (CSANZ) and other
relevant organisations to provide training
Develop and deliver an Indigenous-specific CHD
management training program, particularly for Indigenous
health workers
3.2.1 Promote the availability and understanding of
recognised guidelines for the treatment of cardiac risk factors,
Reducing Risk in Heart Disease, 2004, NHF & CSANZ.
n
n
Support health professionals to undertake post graduate
qualifications
3.1.2 Develop and implement a training program for IHW
targeting CHD management of the Indigenous population.
n
n
Ensure guidelines, Reducing Risk in Heart Disease,2004,
NHF & CSANZ available on Queensland Health Electronic
Publishing Service (QHEPS)
Provide outreach education on the guidelines targeting
staff in hospitals, primary health care, Divisions of General
Practice, community health, aged care facilities and nursing
homes
n
n
n
n
n
n
Number of health
professionals funded to
participate in education
and training relevant to
CHD increased
Increased number of health
professionals funded to
undertake tertiary
postgraduate education
relevant to CHD
Area Health
Services
Districts
Education
providers eg. NHF, CSANZ,
Universities
One (1) nursing position for
short term clinical placement
per tertiary facility established
Number of staff accessing
clinical placement
Indigenous-specific CHD
management training
program developed
Number of staff accessing
training program
Process agreed within
Queensland Health (QH) for
endorsement of guidelines
Indigenous
Health Unit
Workforce Units
Education
providers
Area Health
Services
Districts
100% of eligible facilities
Cardiac
offered education on each
of the relevant CHD guidelines Collaborative
Chief Health
Extent to which guidelines
Officer’s Office
have been adopted
Statewide
Cardiac Clinical
Network
Cardiac Services Strategy for Coronary Heart Disease,
Heart Failure and Rheumatic Heart Disease for Queensland 2005–2015
3.1.1 Coronary Heart Disease (continued)
Objectives
Initiatives and Key Activities
3.2 To accurately
and promptly diagnose
people suspected of
having CHD.
(continued)
3.2.2 Promote the availability and understanding of
recognised guidelines for the assessment and management
of patients with:
– Acute Coronary Syndromes (ACS), Management of Unstable
Angina, 2000; Addenda 2001, 2002; and Management of
non-ST elevation chest pain/discomfort, NHF & CSANZ
Key Milestones and
Performance Measures
n
n
n
– ST Elevation Myocardial Infarction (STEMI), Reperfusion
Therapy for Acute MI and Reperfusion Therapy Algorithm,
NHF & CSANZ.
Source updated guidelines, Management of Unstable Angina,
and Management of non-ST elevation chest pain/discomfort,
when published
n Source updated guidelines, Reperfusion Therapy for Acute
MI and Reperfusion Therapy Algorithm, when published
n
n
n
Provide outreach education on the guidelines targeting
staff in hospitals, primary health care, Divisions of General
Practice, community health, aged care facilities, and nursing
homes
n
Endorsed guidelines to be available on QHEPS
n
n
n
‘Quick Reference’ clinical
guide developed and
distributed to 100% QH
facilities
Districts
Cardiac
Collaborative
Chief Health
Officers Office
Statewide
Minimum standard guidelines Cardiac Clinical
Network
developed
Minimum standard guidelines Pathways
to assist with CHD pathway
development and distributed
to 100% of facilities
Extent to which guidelines
have been adopted
Liaise with universities, NHF, National Health and Medical
Research Centre (NHMRC) and other bodies to ensure
emerging evidence is incorporated into planning for services
and clinical practice
Assist facilities to translate guidelines into practice, for
example, application in rural setting different to tertiary
hospital
3.2.3 Promote the availability and utilisation of protocols
and guidelines for pre-hospital care of people suspected
of having CHD.
n
n
100% of eligible facilities
offered education on each of
the relevant CHD guidelines
Develop minimum standard guidelines, from the recognised
clinical guidelines, to assist in future development of CHD
pathways and have available on QHEPS
Apply to QH to endorse recognised guidelines
n
n
Area Health
Process agreed within QH
for endorsement of guidelines Services
Develop and distribute a ‘Quick Reference’ clinical guide
from the guidelines for clinical use
n
n
n
Key
Stakeholders
Promote the use of the Primary Clinical Care Manual, 4th Ed,
2005, Queensland Health and Royal Flying Doctor Service
(Queensland Section) where applicable
n
n
100% of facilitates with
access to relevant guidelines
Area Health
Services
100% of eligible facilities
offered education on prehospital care guidelines
Districts
Cardiac
Collaborative
Ensure clinical guidelines and practice manuals are updated
regularly, for example, regular review and/or sending alerts
to facilities about practice changes
Liaise with Queensland Ambulance Service (QAS) and
Royal Flying Doctor Service (RFDS) to ensure clinical
practices are current and evidence based
Educate relevant health workers about the pre-hospital
care guidelines
19
Cardiac Services Strategy for Coronary Heart Disease,
Heart Failure and Rheumatic Heart Disease for Queensland 2005–2015
3.1.1 Coronary Heart Disease (continued)
Objectives
Initiatives and Key Activities
3.2 To accurately
and promptly diagnose
people suspected of
having CHD.
(continued)
3.2.4 Promote that all people suspected of having CHD have
access to non-invasive diagnostic tests as outlined in the
guidelines.
n
Explore best option for accessing exercise stress testing
services in areas of low activity – Queensland Health service
or purchase service from private provider
3.2.5 Establish Chest Pain Assessment Units (CPAU) in major
hospitals to better risk stratify patients with chest pain.
n
n
n
n
Expand the number of facilities with CPAUs based on
episodes of care
Develop standardised criteria for patient admission to
CPAU and minimum standard guidelines for the management
of this patient group
Key Milestones and
Performance Measures
n
n
n
n
n
Support staff to undertake training in exercise stress testing
(EST)
Increase availability of EST equipment as required
n
n
3.3.1 Ensure patient information regarding the balance
3.3 To ensure that
of risks and benefits for treatment options are available
people with CHD are
appropriately educated, across the State.
investigated and offered n Provide education and dissemination of patient teaching
treatments of proven
material across the State
clinical and cost
n Promote use of National Heart Foundation (NHF) literature
effectiveness.
n Promote the use of QH patient information consent forms to
assist patients in decision making about treatment options
n
n
20
Waiting times for EST services
within recommended time
frames:
– Inpatient
– Outpatient
Number of facilities with
CPAU increased
Area Health
Services
Districts
Area Health
Services
Standardised criteria for
Districts
admission to CPAU and
minimum standard guidelines Health
Information
for management developed
Branch
100% of eligible facilities
Cardiac
receive standardised criteria
Collaborative
for admission and minimum
standard guidelines
Number of CPAU staff trained
to perform EST increased
Reduced length of stay of low
risk cardiac patients
100% of eligible facilities
have access to relevant
patient teaching material
Area Health
Services
Districts
Cardiac
Collaborative
Update Queensland Health procedure specific patient
information consent forms in line with changing practices
3.3.2 Ensure recognised guidelines outlining the indications
for coronary angiography are available across the State.
n
n
Number of secondary and
regional facilities with EST
services increased
Key
Stakeholders
Develop guidelines outlining indications for coronary
angiography to ensure open and transparent communication
Provide outreach education on indications and referral
processes for coronary angiography to staff in hospitals,
Divisions of General Practice and primary health care
n
Have guidelines available on QHEPS
n
Apply to QH to endorse recognised guidelines
n
n
n
Coronary angiography
guidelines developed
Area Health
Services
100% of eligible facilities
educated on guidelines
Districts
Cardiac
Process agreed within QH
Collaborative
for endorsement of guidelines
Chief Health
Officer’s Office
Cardiac Services Strategy for Coronary Heart Disease,
Heart Failure and Rheumatic Heart Disease for Queensland 2005–2015
3.1.1 Coronary Heart Disease (continued)
Objectives
Initiatives and Key Activities
3.3.3 Ensure people with symptoms of angina, unstable
3.3 To ensure that
angina or heart attack are referred to a Cardiologist in a timely
people with CHD are
appropriately educated, fashion utilising standardised risk stratification tools.
investigated and offered n Implement a risk stratification tool to help determine
treatments of proven
each patient’s relative priority for treatment
clinical and cost
n
Provide
education about risk stratification targeting staff
effectiveness.
in
hospitals,
Divisions of General Practice and primary
(continued)
health care
n
Key Milestones and
Performance Measures
n
n
n
Support development of a web-based system for triage
of interfacility transfers
n
3.3.4 Establish routes of referral for coronary angiography
within local areas.
n
n
n
n
n
Establish protocol for referral to physician and then
onto tertiary facility, using hub and spoke model
n
Formalise documentation of referral routes to ensure
open and transparent communication
n
Develop standard referral information requirements
and make available to GPs, primary health professionals
and other referring bodies
Investigate the benefits of major centres having dedicated
interfacility transfer beds
n
Key
Stakeholders
Standardised risk
stratification tool for people
with CHD developed/chosen
Statewide
Cardiac Clinical
Network
100% of eligible QH facilities
offered education on risk
stratification tool for people
with CHD
Area Health
Services
Web-based system for triage
of cardiac patients requiring
inter-facility transfer
developed
Cardiac
Collaborative
100% of eligible facilities
offered education on webbased system for triage
Protocol for referral to
specialist/tertiary care
developed
Protocol distributed to
100% of facilities
Standard referral information
requirements developed
100% of eligible facilities
and Divisions of GP receive
standard referral information
Districts
Health
Information Branch
Area Health
Services
Districts
Cardiac
Collaborative
Health
Information
Branch
Statewide
Cardiac Clinical
Network
21
Cardiac Services Strategy for Coronary Heart Disease,
Heart Failure and Rheumatic Heart Disease for Queensland 2005–2015
3.1.1 Coronary Heart Disease (continued)
Objectives
Initiatives and Key Activities
3.3 To ensure that
people with CHD are
appropriately educated,
investigated and offered
treatments of proven
clinical and cost
effectiveness.
(continued)
3.3.5 Establish target activity for coronary angiography,
percutaneous transluminal coronary angioplasty (PTCA)
and stenting (including drug eluting stents) and coronary artery
bypass grafting (CABG) based on age-standardised rates per
100, 000 population.
n
n
n
n
n
n
n
n
n
n
Agree on State target for coronary angiography
Develop strategy to increase coronary angiography activity
over time to address current shortfalls
Key Milestones and
Performance Measures
n
n
n
n
Agree on State target for coronary angioplasty
Develop strategy to increase coronary angioplasty activity
over time to address current shortfalls
n
Agree on State target for CABG
Develop strategy to increase CABG activity over time
to address current shortfalls
n
Review funding allocation for drug eluting stents
Develop strategy to allocate funding for drug eluting stents
including regular review
n
Review bed allocation in facilities and adjust to
accommodate planned activity
Review staffing resources in facilities and adjust
to accommodate planned activity
n
n
n
n
n
n
22
Key
Stakeholders
State target for coronary
angiography established
Area Health
Services
State target for PTCA
established
Districts
State target for CABG
established
Number of coronary
angiograms performed
by State, Area and facility
increased
Cardiac
Collaborative
Health
Information
Branch
Statewide
Cardiac Clinical
Number of coronary
angioplasty/stents performed Network
by State, Area and facility
increased
Number of CABGs performed
by State, Area and facility
increased
Number of coronary
angiograms per 100,000
population by State and Area
increased
Number of coronary
angioplasty/stents per
100,000 population by State
and Area increased
Increased number of CABGs
per 100,000 population by
State, Area and facility
Improved rates of coronary
intervention compared with
those undertaken in other
Australian States
Increased number of
Indigenous people having
cardiac procedures per
population
Number of drug eluting
stents used by facility
Increased number of
cardiology beds per Area
and facility
Cardiac Services Strategy for Coronary Heart Disease,
Heart Failure and Rheumatic Heart Disease for Queensland 2005–2015
3.1.1 Coronary Heart Disease (continued)
Objectives
Initiatives and Key Activities
3.3.6 Ensure waiting times for specialist appointments,
3.3 To ensure that
PTCA and stenting, and CABG are consistent with national
people with CHD are
appropriately educated, and international guidelines.
investigated and offered n Develop consistent and appropriate categorisation system
treatments of proven
for waiting times for each cardiac activity
clinical and cost
n Establish target waiting times for cardiology outpatient
effectiveness.
appointment
(continued)
n Establish target waiting times for cardiac surgery outpatient
appointment
n
Establish target waiting times for coronary angiogram
n
Establish target waiting times for coronary angioplasty
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
Utilise Elective Admission Module for all appointments/
procedures to enable review of waiting times and numbers
Increase number of specialist staff in facilities with
intervention in line with planned activity
3.3.7 Improve availability of consultant cardiac services
(cardiology and cardiac surgery).
n
Key Milestones and
Performance Measures
Enhance and/or introduce general cardiology services at
major and secondary facilities based on episodes of care
Increase number of Cardiologists in major facilities based
on activity patterns
Increase number of Cardiologists in secondary facilities
based on episodes of care
Establish/increase number and location of outreach
cardiology outpatient clinics including outreach services
to Indigenous communities
Enhance and/or introduce cardiac surgery services at
facilities based on projected demand and service delivery
models
Explore re-profiling workforce in line with types of patients
accessing facilities
Enhance cardiac catheter laboratories (CCL) services in
facilities with existing capacity
Waiting times for coronary
angiogram within target
time frame
Area Health
Services
Districts
Cardiac
Collaborative
Waiting times for coronary
angioplasty within target
time frame
Health
Information
Branch
Waiting time for CABG within
target time frame
Statewide
Cardiac Clinical
Network
All facilities using Elective
Admission Module for
interventional cardiology
procedures
Number of full-time equivalent Area Health
(FTE) interventional
Services
cardiologists employed
Districts
by QH increased
Cardiac
n Number of FTE cardiac
Collaborative
surgeons employed in QH,
Health
by Area and facility, increased Information
n Number of cardiac surgery
Branch
beds per Area and facility
Statewide
increased
Cardiac Clinical
Network
n Number of admitted episodes
of care for CHD by State, Area, QAS
District and Indigenous status CCC
n Mortality rates for the State
and by Indigenous status
n
n
n
Identify districts where CCL could be established based
on demand and population growth
Establish scope of practice, credentialing and procedures
for establishment of new and existing CCLs
Target waiting times for
coronary angiogram and
PTCA established
Key
Stakeholders
n
Length of stay for CHD
monitored
Acute coronary interventional
service (primary coronary
angioplasty) established in
South East Queensland
Existing CCL services
functioning at capacity
Utilise CSANZ guidelines Policy on support facilities
for coronary angiography and percutaneous coronary
intervention,2005, to assist decisions regarding new
services
Establish a plan for acute coronary interventional services
(primary and rescue angioplasty) within Areas in
consultation with QAS and Queensland Clinical Coordination
Centre (CCC)
Establish lead up plans (12 -24 months prior) for introduction
of new CCL/cardiac surgery services including training of staff
Explore opportunities for public/private partnerships for
interventional cardiology and/or cardiac surgery
23
Cardiac Services Strategy for Coronary Heart Disease,
Heart Failure and Rheumatic Heart Disease for Queensland 2005–2015
3.1.1 Coronary Heart Disease (continued)
Objectives
Initiatives and Key Activities
3.3.8 Improve access rates for disadvantaged groups
3.3 To ensure that
(low socioeconomic and Indigenous people).
people with CHD are
appropriately educated, n Identify and address obstacles related to referral, treatment
investigated and offered
and ongoing management of disadvantaged groups
treatments of proven
n
Improve education for disadvantaged groups and health
clinical and cost
care workers in these areas
effectiveness.
(continued)
3.3.9 Ensure patient transport networks optimise patient
treatment, enable timely investigation and support ongoing
management.
n
n
n
n
Ensure all service users have knowledge of processes,
for example, Interfacility transport operational guidelines
Liaise with QH Transport Coordination Team regarding
patient transport, for example, a non-emergency air service
n
n
n
3.4 To ensure
appropriate systems
are in place for optimal
long term management
of people with CHD.
n
n
n
n
n
24
n
n
100% of eligible facilities
provided with education on
patient transport procedures
Standardised system for
measuring inter-facility
transfer times established
Waiting times for inter-facility
transfer reduced against
baseline
Support development and ongoing maintenance of a web-based triage system for interfacility transfers
Explore use of telehealth for specialist consultations,
preadmission, outpatient clinics and secondary prevention
for regional areas
Provide education and dissemination of patient teaching
material
Utilise telehealth links with pharmacists to provide
discharge counselling on medications as needed
Work with community Pharmacists for medication review
(Medicare referral)
Pursue joint project with NHF to provide standardised
patient information, for example, “My Heart, My Life”
Develop/source patient education tools, for example,
videos and compact discs
Provide culturally and linguistically diverse educational
material
Area Health
Services
Districts
Transport
Coordination
Team
QAS
RFDS
CCC
n
Investigate existing telehealth facilities available to districts
3.4.1 Ensure that all patients with CHD, their families and
carers, receive multidisciplinary education regarding their
treatment and ongoing care, and a clear discharge plan.
n
n
Liaise with QAS and RFDS on all related issues
Establish regional infrastructure and data links where
necessary
Key
Stakeholders
Refer to 3.3.7
Liaise with Clinical Coordination Centre (CCC) for interfacility
transport
3.3.10 Consider increased utilisation of information
technology and telehealth to support service delivery.
n
Key Milestones and
Performance Measures
n
n
n
n
n
Number of facilities with
access to telehealth services
increased
Number of facilities using
telehealth for specialist
consultations or outpatient
clinics increased
Number of facilities using
telehealth for preadmission
increased
Area Health
Services
Districts
Information
Technology
Statewide
Telehealth
Service
Number of facilities using
telehealth for patient
education increased
Current, standardised patient
education material
developed/sourced
100% eligible facilities have
access to patient education
material
Area Health
Services
Districts
Cardiac
Collaborative
National Heart
Foundation
Cardiac Services Strategy for Coronary Heart Disease,
Heart Failure and Rheumatic Heart Disease for Queensland 2005–2015
3.1.1 Coronary Heart Disease (continued)
Objectives
Initiatives and Key Activities
3.4 To ensure
appropriate systems
are in place for optimal
long term management
of people with CHD.
(continued)
3.4.2 Ensure that the community based doctor/health care
provider receives a discharge summary that outlines
suggested management.
n
n
n
Develop and implement comprehensive electronic medical
and nursing discharge summaries in all hospitals across
the State
n
n
n
n
Explore the benefits of a single medical record number
across the State
n
Increase/introduce cardiology outreach clinics outside
major facilities, especially in disadvantaged areas
Increase/introduce cardiology outreach clinics in Indigenous
communities in consultation with community leaders and
local health services
n
n
3.4.4 Develop and implement systems for IHW and/or
Community Controlled Health Services (CCHS) to be involved
in coordination of follow up care and secondary prevention
strategies for Indigenous patients.
n
n
n
Electronic medical and
nursing discharge summaries
developed
Number of avoidable hospital
admissions for CHD reviewed
Key
Stakeholders
Area Health
Services
Health
Information
Branch
Increased number of referrals
received by outpatient CR
programs
Develop formal referral procedures to Outpatient Cardiac
rehabilitation and Community nurses and include on
pathways
3.4.3 Improve access to specialist outpatient appointments
for people with CHD.
n
Key Milestones and
Performance Measures
Establish communication networks with CCHS and
IHW within Districts
Utilise Indigenous Patient Liaison Officers (PLO),
where available, to assist in coordination of care
n
Increased number, locations
and frequency of outreach
cardiology clinics in rural and
remote areas
Increased number, location
and frequency of outreach
cardiology clinics in
Indigenous communities
Waiting time for cardiology
clinics, including outreach
clinics, within target time
frame
Indigenous representation on
all cardiac clinical networks
Area Health
Services
Districts
Indigenous
Health Unit
CCHS
Health
Information
Branch
Area Health
Services
Statewide
Cardiac Clinical
Network
Indigenous
Health Unit
Incorporate referral to CCHS, IHW and PLO into pathways
Queensland Strategy for Chronic Disease 2005–2015
3.4.5 Implement or enhance multidisciplinary Community
and Hospital Interface Program (CHIP) (CHIP+) program across
Health Service Districts.
To be determined by the Chronic Chronic Disease
Disease Strategy
Strategy
Implementation Team
Implementation
Team
3.4.6 Introduce Multidisciplinary Chronic Disease Primary
Health Care teams in the community that support and work
with existing primary health care delivery systems
25
Cardiac Services Strategy for Coronary Heart Disease,
Heart Failure and Rheumatic Heart Disease for Queensland 2005–2015
3.1.1 Coronary Heart Disease (continued)
Objectives
Initiatives and Key Activities
Key Milestones and
Performance Measures
Key
Stakeholders
Standard 4: Cardiac Rehabilitation (CR) for people with CHD (secondary prevention and disease management)
4.1 To provide
evidence-based
CR programs that
will reduce the risk
of subsequent cardiac
events and monitor
ongoing management.
4.1.1 Promote the availability and understanding of
recognised guidelines for the identification, assessment and
management of people who are likely to benefit from CR:
Recommended Framework for Cardiac Rehabilitation, NHF and
Australian Cardiac Rehabilitation Association (ACRA); A
Practitioners Guide, ACRA; Queensland Health Best Practice
Guidelines for Health Professionals – Outpatient Cardiac
Rehabilitation; Nutrition Recommendations for Cardiac
Rehabilitation, NHF; Best Practice Guidelines for Cardiac
Rehabilitation and Secondary Prevention (Goble and
Worcester); and Draft manual for cardiac rehabilitation for
Aboriginal and Torres Strait Islander Peoples, NHMRC.
n
n
n
Endorsed guidelines to be available on QHEPS
n
n
n
n
Promote and provide funding to support staff to attend
existing training programs for CR
Provide support and funding for IHW to complete the IHW
specific NHF training package in the management of
cardiovascular disease, including rehabilitation
Work in conjunction with NHF and ACRA to provide materials
and resources
Liaise with universities to offer post graduate course in
cardiac rehabilitation
Work in collaboration with ACRA and NHF in establishing
and reviewing rehabilitation programs
Review existing programs to ensure they meet recognised
guidelines
Work in collaboration with ACRA to develop specialist
competency standards for Cardiac Rehabilitation Nurses
n
26
100% of eligible facilities
Districts
received education on each
of the relevant CHD guidelines Cardiac
Rehabilitation
Extent to which guidelines
Collaborative
have been adopted
Chief Health
Officers office
Statewide
Cardiac Clinical
Network
Work in collaboration with NHF and ACRA to support
and promote best practice
4.1.2 Ensure CR programs are evidence-based and provided
by appropriately trained staff.
n
n
Area Health
Services
Disseminate recognised guidelines and provide education
targeting staff in hospitals, primary health care, Divisions
of General Practice, community health, aged care facilities,
nursing homes and Aboriginal Community Controlled Health
Organisation.
Apply to QH to endorse recognised guidelines
n
n
Process agreed within QH for
endorsement of guidelines
Source updated guidelines when published
n
n
n
n
n
Area Health
The number of CR programs
that meet minimum standards Services
Number of IHW who have
accessed NHF training
package
Districts
Cardiac
Rehabilitation
Collaborative
Statewide
Cardiac Clinical
Network
National Heart
Foundation
Australian
Cardiac
Rehabilitation
Association
Cardiac Services Strategy for Coronary Heart Disease,
Heart Failure and Rheumatic Heart Disease for Queensland 2005–2015
3.1.1 Coronary Heart Disease (continued)
Objectives
Initiatives and Key Activities
4.2 To ensure that
people with CHD
are actively referred
and have access to
secondary prevention
and CR programs.
4.2.1 Ensure all patients with CHD have access to an
in-hospital CR program.
n
n
n
n
Enhance / establish in-hospital CR programs based on
episodes of care
Ensure systems in place to identify Indigenous people at
entry and through hospitalisation so that CR is relevant
Utilise telehealth links with CR Coordinators to provide
advice and assistance with patient rehabilitation
n
n
n
n
n
n
n
4.3 To investigate
alternative methods
of providing CR,
secondary prevention
and management
programs to the whole
community to increase
participation rates.
Promote availability and understanding of guidelines for
referral of patients to CR
n
n
n
n
n
n
n
n
n
n
n
Provide education on guidelines for referral of patients
to CR targeting staff in hospitals and Divisions of GP
n
Include referral to CR on discharge summary to GP,
regional hospital, primary health care professional
n
Include referral to CR on appropriate pathways
Key
Stakeholders
Increased full-time equivalent Area Health
in-hospital CR staff per District Services
Number of programs with
telehealth facilities increased
Number of facilities with
access to patient teaching
material
Districts
Cardiac
Rehabilitation
Collaborative
Statewide
Increased number of inpatient Telehealth
CR programs
Services
Increased number of
outpatient CR program
places per District
Increased number of referrals
received by outpatient
CR programs
Outpatient CR participation
rates per program increased
Number of programs with
telehealth facilities increased
Utilise telehealth links with CR Coordinators to provide
advice and assistance with patient rehabilitation
Area Health
Services
Districts
Cardiac
Rehabilitation
Collaborative
NHF
Statewide
Telehealth
Services
Pathways
Information
Technology
Enhance/establish and fund outpatient CR programs
based on patterns of activity
Regularly update and disseminate (QHEPS/ NHF/ ACRA
website) a list of CR programs and contacts in Queensland
Investigate benefits of accessing CR services from the
private sector, where public programs are not available
4.3.1 Seek innovation in delivery of rehabilitation to rural and
remote, Indigenous populations and the broader community.
n
n
Ensure multidisciplinary information (as supplied by
dietician, pharmacist, physiotherapist, exercise physiologist,
social worker, occupational therapist, psychologist, cardiac
rehabilitation services and other health providers) is
provided to all patients admitted
with CHD
4.2.2 Support referral practices that promote suitable
patients with CHD being referred to an outpatient secondary
prevention cardiac rehabilitation (CR) program
n
Key Milestones and
Performance Measures
Provide funding to implement recommendations from current
trial of an Indigenous specific cardiac rehabilitation model
n
n
Indigenous-specific model
of CR implemented
Area Health
Services
Telephone model of
CR implemented
Districts
Provide funding for implementation of recommendations
from telephone CR pilot project jointly funded by QH and NHF
Cardiac
Rehabilitation
Collaborative
Support additional trials in alternative service delivery,
for example, care management
NHF
Utilise telehealth links with CR Coordinators to provide
advice and assistance with patient rehabilitation
Ensure consideration is given to level of literacy amongst
the population when information for Indigenous patients
is formulated
Statewide
Telehealth
Services
Liaise with community groups to identify opportunities
Liaise with NHMRC/NHF regarding outcomes of cardiac
rehabilitation for Aboriginal and Torres Strait Islander
people project
27
Cardiac Services Strategy for Coronary Heart Disease,
Heart Failure and Rheumatic Heart Disease for Queensland 2005–2015
3.1.2 Heart Failure
Objectives
Initiatives and Key Activities
Key Milestones and
Performance Measures
Key
Stakeholders
To be determined by Chronic
Disease Strategy
Implementation Team and
Indigenous Health Unit
Chronic Disease
Strategy
Implementation
Team
Standard 1: Reducing HF in the population
1.1 To develop,
implement and evaluate
policies and programs
that reduce the
prevalence of coronary
risk factors in the
population, and reduce
inequalities in risk of
developing HF.
Queensland Strategy for Chronic Disease 2005–2015
1.1.1 Increase awareness and up-take of current guidelines
for the assessment and management of hypertension,
hypercholesterolaemia and other cardiac risk factors among
relevant clinicians throughout Queensland.
Indigenous
health Unit
1.1.2 Monitor and control hypertension,
hypercholesterolaemia and other cardiac risk factors and
detect and manage manifestations of HF.
1.1.3 Ensure consistent, accurate and clear information
for the community about the prevention and management
of HF is easily accessible.
1.2 To prevent
Refer to CHD standards/objectives 1 – 4
myocardial damage
that could lead to HF
(refer to CHD standards/
objectives 1 – 4).
Refer to CHD standards/
Refer to CHD
objectives 1 – 4 and associated standards/
Key milestones and Performance objectives 1 – 4
Measures
Standard 2: Optimise diagnosis, treatment and ongoing management of people with HF
2.1 To promote and
provide training
programs for health
professionals involved
in the care of people
with HF.
2.1.1 Increase access and support for HF training programs
for health professionals.
n
n
n
n
n
n
n
Support attendance at existing HF training programs
for all health professionals
Support existing HF education forums, for example,
QH Cardiac Collaborative, NHF, CSANZ, Heart Failure Nurses
Society
Provide funding for Hospital to Home Heart Failure Program
in all Area Health Services and Districts on an ongoing basis
Provide financial support for all health professionals
undertaking post graduate qualifications
28
n
n
n
Identify and implement other modes of training, for example,
e-based modules
Number of health
professionals, including IHW,
funded to participate in
education and training
relevant to HF increased
Increased number of health
professionals funded to
undertake postgraduate
education relevant to HF
HF training module for
Pharmacists developed
Area Health
Services
Districts
Cardiac
Collaborative
Workforce Units
Education
providers
Number of staff accessing HF
training programs
Develop and implement training module for specialist
HF pharmacists
Assist in the establishment of a Cardiac Pharmacist Support
Group
2.1.2 Develop and implement a training program for IHW
targeting HF management of the Indigenous population.
n
n
Support and provide Indigenous specific advanced training,
for example, the Hospital to Home Heart Failure Program
for IHW
n
n
Education
An Indigenous specific
training program is developed Providers
Number of IHW accessing
training program
Indigenous
Health Unit
Cardiac Services Strategy for Coronary Heart Disease,
Heart Failure and Rheumatic Heart Disease for Queensland 2005–2015
3.1.2 Heart Failure (continued)
Objectives
Initiatives and Key Activities
2.2 To accurately and
promptly diagnose
people with HF.
2.2.1 Promote the availability and understanding of
recognised guidelines, for the assessment and management of
people with HF; Contemporary Management of the Patient with
Chronic Heart Failure in Australia, NHF and CSANZ, 2002;
American College of Cardiology/American Heart Association
2005 Guideline Update for the Diagnosis and Management of
Chronic Heart Failure in the Adult; and National Prescribing
Service “Improving drug use in heart failure” October 2004.
n
n
Provide outreach education on the guidelines, targeting staff
in hospitals, primary health care, Divisions of GP, community
health, aged care facilities and nursing homes
Apply to QH to endorse recognised guidelines
n
Endorsed guidelines to be made available on QHEPS
n
n
Provide a suitable clinical information system (CIS) for
recall and follow up care of people with chronic diseases
including HF
n
n
n
n
n
Provide funding, education and ongoing support for the CIS
100% of eligible facilities
Area Health
received education on each of Services
the relevant HF guidelines
Districts
‘Quick Reference’ clinical
Cardiac
guide developed and
Collaborative
distributed to 100% QH
facilities
Statewide
Process agreed within QH for Cardiac Clinical
Network
endorsement of guidelines
Extent to which guidelines
have been adopted
Chief Health
Officers Office
A CIS will be identified
Area Health
Services
Number of facilities that have
implemented the CIS as
baseline
Increased number of facilities
implementing CIS
Liaise with Divisions of GP with regard to the register and
recall system utilised in General Practice – National
Collaborative in cardiac disease
2.2.3 To educate the community, in particular high risk
groups, to recognise signs of HF and seek appropriate
treatment.
n
n
Key
Stakeholders
Liaise with Universities, NHF, NHMRC and other bodies to
ensure emerging evidence is incorporated in planning and
clinical practice
2.2.2 Identify a suitable patient register and recall system
for use in primary care to enable early diagnosis and follow
up care.
n
n
Develop and distribute ‘Quick Reference’ clinical guide from
recognised guidelines for clinical use, including New York
Heart Association classifications
n
n
Key Milestones and
Performance Measures
n
Community awareness
programs implemented
Districts
Cardiac
Collaborative
Information Technology
QAS
NHF
Continue to liaise with the NHF, QAS and other relevant
organisations to fund awareness campaigns in relation to HF
29
Cardiac Services Strategy for Coronary Heart Disease,
Heart Failure and Rheumatic Heart Disease for Queensland 2005–2015
3.1.2 Heart Failure (continued)
Objectives
Initiatives and Key Activities
2.3 To ensure that
people with HF are
appropriately
investigated, treated
and educated to reduce
their risk of recurrent
events, disability and
death.
2.3.1 Improve access to echocardiography services across
the State.
n
n
n
n
n
n
n
n
n
n
n
n
n
n
30
Key Milestones and
Performance Measures
n
Provide education on indications for echocardiography
targeting staff in hospitals, primary health care and Divisions
of GP
Expand and/or implement outreach services for
echocardiography using a hub and spoke model (based on
episodes of care for HF and patterns of activity within
Districts)
Utilise digital imaging techniques and online data transfer
for echocardiography reporting through a ‘hub and spoke’
model
n
Investigate existing telehealth facilities suitable for use in
echocardiography services available to Districts
n
Establish regional infrastructure and data links where
necessary
n
Increase availability of echocardiography training to cardiac
scientists by establishing training positions at tertiary
facilities, establishing links to universities and offering
clinical placements for students
n
Establish a staff development position at tertiary facilities
to support cardiac scientists undertaking specialist training
n
Promote echocardiography as a specialist stream to other
Allied Health workers
Provide financial support for staff to undertake post graduate
training in echocardiography
Increase availability of echocardiography equipment,
across the State, by increasing number of portable
echocardiography machines for outreach services,
increasing number of echocardiography machines in high
volume areas, and utilising private facilities where
appropriate
Increase number of sonographer positions in Districts based
on analysis of episodes of care and patterns of activity
Increase number of cardiologists to report echocardiograms
in hub hospitals
Establish coordination and quality control of
echocardiography services across the State
Liaise with the Queensland Health (QH) Statewide Radiology
Service in development of echocardiography services
n
n
n
Number of facilities with
echocardiography services
increased
– Number of
echocardiography
machines per facility
increased
– Number of FTE cardiac
sonographers per facility
increased
Quality control measures for
echocardiography services
established
Number of FTE sonographer
training positions increased
Number of FTE sonographer
staff development positions
increased
Number of cardiac
sonographers funded to
undertake postgraduate
training increased
Number of facilities using
telehealth within their
echocardiography service
increased
Waiting time for inpatient and
outpatient echocardiography
within target time frame
Number of echocardiographs
performed per service
increased
Number of FTE Cardiologists
employed by QH
Key
Stakeholders
Area Health
Services
Districts
Cardiac
Collaborative
Statewide
Cardiac Clinical
Network
Statewide
Telehealth
Service
Work Force Units
QH Statewide
Radiology
Services
Cardiac Services Strategy for Coronary Heart Disease,
Heart Failure and Rheumatic Heart Disease for Queensland 2005–2015
3.1.2 Heart Failure (continued)
Objectives
Initiatives and Key Activities
2.3 To ensure that
people with HF are
appropriately
investigated, treated
and educated to reduce
their risk of recurrent
events, disability and
death.
(continued)
2.3.2 Promote that patients admitted to hospital with HF are
reviewed by a cardiologist or physician, where available, and
have access to specialist review for complex co-morbidities.
Establish protocol for referral to cardiologist/physician using
‘hub and spoke’ model
Key Milestones and
Performance Measures
n
n
n
n
n
n
n
n
n
n
n
Provide outreach education on indications and referral
processes to staff in hospitals, Divisions of GP and primary
health care
Formalise documentation of indications and referral routes
to ensure open and transparent communication
Develop standard referral information requirements and
make it available to GPs, primary health professionals and
other referring bodies
Develop minimum standard guidelines, from the recognised
clinical guidelines, to assist in future development of HF
pathways and have available on QHEPS
Establish / enhance cardiologist positions based on activity
and need
Establish HF Nurse Practitioner positions in areas based
on activity and need
n
n
n
n
n
n
n
Increase the number of physicians/cardiologists in regional
areas based on episodes of care
Investigate the use of telehealth for specialist consultations
n
n
2.3.3 Increase the number of HF Nurse Specialists in acute
settings to ensure people admitted to hospital with HF are
assessed and educated in hospital and that coordinated
management is continued on discharge from hospital, in liaison
with GP and community health services.
n
n
n
A protocol for referral routes
for people with HF developed
Area Health
Services
100% of eligible facilities
received referral protocol
Districts
Standard HF referral
information developed
100% of eligible facilities
received referral information
A minimum standard guide
for HF clinical pathways
developed
100% of eligible facilities
received guide
Cardiac
Collaborative
Pathways
Statewide
Cardiac Clinical
Network
Health
Information
Branch
Number of FTE cardiologist/
physicians employed in
regional areas in QH
Number of HF Nurse
Practitioner positions in
Queensland increased
Number of admitted episodes
of care for HF per facility
monitored
Number of admitted episodes
of care for HF by State, Area,
District and Indigenous status
monitored
Decreased per capita
mortality rates for the State
and by Indigenous status
Number FTE HF Nurse
Specialist positions per
District and Area increased
Area Health
Service
100% of facilities provided
with education on transport
procedures
Cardiac
Collaborative
Districts
Introduce or increase HF Nurse Specialist positions in high
volume areas based on analysis of episodes of care and
patterns of activity
2.3.4 Develop and implement mechanisms to transfer
patients with severe acute HF to a tertiary facility for
management when required.
n
n
Key
Stakeholders
Liaise with QH Transport Coordination Team regarding
patient transport options, for example, a non-emergency
air service
Liaise with Clinical Coordination Centre regarding patient
care and transport as required
n
Transport
Coordination
Team
CCC
Liaise with QAS and RFDS regarding patient transport
31
Cardiac Services Strategy for Coronary Heart Disease,
Heart Failure and Rheumatic Heart Disease for Queensland 2005–2015
3.1.2 Heart Failure (continued)
Objectives
Initiatives and Key Activities
2.4 To ensure
2.4.1 Ensure that all patients with HF, their families and
appropriate systems are carers, receive multidisciplinary education regarding their
in place for optimal long treatment and ongoing care, and a clear discharge plan.
term management of
n Promote the distribution and use of NHF literature – Let’s talk
people with HF that
about Heart Failure, and the phone support service, Heartline
reduces unplanned or
n
Develop/source patient education videos on HF medications
avoidable hospital
and non-pharmacological interventions
admissions.
n Utilise telehealth links with Pharmacists to provide discharge
counselling on medications as needed
n
n
n
n
Support the introduction of HF clinics based on analysis of
episodes of care and patterns of activity utilising hub and
spoke model
n
n
32
n
n
n
n
Identify community health and GP clinics suitable for HF
clinics
n
Introduce facility based heart failure teams (physician,
nurse, pharmacist, social worker, physiotherapist,
occupational therapist, dietician, support staff) based on
episodes of care
100% of facilities with access
to relevant and updated HF
patient education materials
Number of facilities using
telehealth for HF patient
education
Number of avoidable hospital
admissions for HF monitored
and reduced
Key
Stakeholders
Area Health
Services
Districts
Statewide
Telehealth
Service
NHF
Health
Information
Branch
Electronic medical and
nursing discharge summaries
developed
Information
Technology
Increased number of facilities
with HF clinics including
hospital, community and GP
Area Health
Services
Statewide
A standardised HF Action Plan Cardiac Clinical
developed and disseminated Network
to 100% of facilities
Cardiac
Collaborative
Number of HF Nurse
Practitioner positions in
Queensland increased
Districts
Number of FTE
Area Health
multidisciplinary HF teams per Services
District and Area increased
Districts
Investigate a variety of service delivery models, for example,
hospital and community based, telephone support, home
visits
2.4.5 Develop and implement systems for IHW and/or
Community Controlled Health Services (CCHS) to be involved
in coordination of follow up care and secondary prevention
strategies for Indigenous people.
n
n
Develop and implement standard heart failure action plan
form for use across the State
2.4.4 Develop multidisciplinary teams with outreach capacity
to support management of people with HF.
n
n
Develop and implement comprehensive electronic medical
and nursing discharge summaries in all hospitals across the
State
2.4.3 Implement HF clinics for investigation and follow-up
care.
n
n
Utilise telehealth links with HF Nurse Specialist to provide
discharge counselling on non-pharmacological interventions
as needed
2.4.2 Ensure that the community based doctor/health care
provider receives a discharge summary that outlines a
suggested titration strategy for medications and prescribed
regime both in hospital and the community.
n
Key Milestones and
Performance Measures
n
Indigenous representation on
all Cardiac Clinical Networks
CCHS
Indigenous
Health Unit
Establish communication networks between facilities, CCHS
and IHW within Districts
Area Health
Services
Utilise Indigenous Patient Liaison Officers (PLO), where
available, to assist in coordination of care
Districts
Incorporate referral to CCHS, IHW, and PLO into clinical
pathways
Statewide
Cardiac Clinical
Network
Cardiac Services Strategy for Coronary Heart Disease,
Heart Failure and Rheumatic Heart Disease for Queensland 2005–2015
3.1.2 Heart Failure (continued)
Objectives
Initiatives and Key Activities
2.4.6 Ensure titration schedules are widely available in
2.4 To ensure
appropriate systems are emergency departments, hospital wards, general practice,
in place for optimal long and community centres, to assist dose titration.
term management of
n Provide education on the titration guidelines targeting staff
people with HF that
in hospitals, primary health care and Divisions of GP
reduces unplanned or
n Utilise HF Nurse Specialist and Specialist HF Pharmacists
avoidable hospital
to promote the use of and advice on titration schedules
admissions.
(continued)
2.4.7 Encourage regular review of patient’s medications to
detect deleterious agents.
n
n
n
n
100% of facilities with the HF
medication titration
guidelines available
Key
Stakeholders
Statewide
Cardiac Clinical
Network
Cardiac
Collaborative
n
Number of FTE pharmacists
per District and Area
increased
Area Health
Services
Districts
Work with community pharmacists for medication review
(Medicare referral)
n
Utilise community health and primary health care centres
as collection points for medication where appropriate
Number of health care centres Area Health
used for medication collection Services
points
Districts
Develop strategies with nearest pharmacy (private/QH)
for effective dispensing of medications to this population
2.4.9 Promote immunisation against influenza and
pneumococcal disease in all people with HF.
n
n
Increase pharmacist numbers in line with patterns of activity
for HF
2.4.8 Improve access to medication for disadvantaged
groups.
n
Key Milestones and
Performance Measures
Expand current QH eligibility criteria to include people with
HF under 65 years of age as per recommendations of “The
Australian Immunisation Handbook”, 8th Edition, 2003,
National Health and Medical Research Council (NHMRC)
Promote the administration of the new criteria to GPs,
hospitals, and primary care health professionals
Queensland Strategy for Chronic Disease 2005–2015
2.4.10 Implement state wide model for self management
programs in conjunction with Australian Government,
non-government organisations and private sector.
n
n
Immunisation eligibility
criteria changed to include
people with HF less than
65 years of age
Number of HF patients
immunised through hospital
based HF clinics
Statewide
Cardiac Clinical
Network
Cardiac
Collaborative
Communicable
Diseases
Division of GP
To be determined by Chronic
Disease Strategy
Implementation Team and
Indigenous Health Unit
Chronic Disease
Strategy
2.4.11 Introduce Multidisciplinary Chronic Disease Primary
Health Care teams in the community that support and work
with existing primary health care delivery systems.
2.4.12 Implement or enhance multidisciplinary CHIP (CHIP+)
program across Health Service Districts.
2.4.13 Increase availability of IHW to facilitate education
and treatment of HF among the Indigenous population.
2.4.14 Improve access to mainstream services for Indigenous
people by addressing local barriers, employment of Indigenous
people and ensuring good practice care is delivered.
Indigenous Health Unit
2.4.15 Consolidate partnerships with CCHS to progress
Indigenous health management in relation to HF.
Indigenous
Health Unit
33
Cardiac Services Strategy for Coronary Heart Disease,
Heart Failure and Rheumatic Heart Disease for Queensland 2005–2015
3.1.2 Heart Failure (continued)
Objectives
Initiatives and Key Activities
Key Milestones and
Performance Measures
Key
Stakeholders
Standard 3: Device therapy for patients with HF
3.1 To ensure systems 3.1.1 Ensure recognised guidelines for HF patients eligible
are in place to recognise, for implantable cardiac defibrillators (ICD) are available and
in use across the State.
stratify, and manage
patients with HF who
n Promote the availability and utilisation of recognised
would benefit from an
guidelines across the State
implantable device
n
Apply to QH to endorse recognised guidelines
(Implantable Cardiac
Defibrillator or
n Endorsed guidelines to be made available on QHEPS
Biventricular Permanent
n Develop guidelines to inform decisions regarding risk
Pacemaker).
and benefits in line with indication criteria
3.1.2 Ensure agreed routes of referral for patients requiring
implantable devices are available and in use across the State.
n
n
n
n
n
Establish protocol for referral to physician and then onto
tertiary centre, using hub and spoke model
Educate staff in hospitals, Divisions of GP and primary
health care professionals about routes of referral
Develop standard referral information requirements and
make available for physicians, GPs, primary health
professionals
3.1.3 Establish target activity levels for implantable devices.
n
n
n
n
n
Recognise and plan for potential growth in device therapy
n
n
n
n
34
Statewide
100% of eligible facilities
received education on each of Cardiac Clinical
the relevant guidelines
Network
Process agreed within QH for
endorsement of guidelines
Cardiac
Collaborative
A protocol for referral routes
for people requiring device
therapy developed and 100%
of eligible facilities received
protocol
Statewide
Cardiac Clinical
Network
100% of eligible facilities
received education regarding
device therapy referral
protocol
Area Health
Services
Districts
Standard device therapy
referral information developed
and distributed to 100% of
eligible facilities
State target for ICD
implantation established
Area Health
Services
Number of ICD procedures
performed by State, Area and
facility increased
Districts
Statewide
Cardiac Clinical
Number of ICD procedures per Network
100,000 population by State
Health
and Area increased
Information
Improved rates of ICD
Branch
implantations compared with
those undertaken in other
Australian States
Number of Indigenous people
having ICD implantation
increased
Cardiac Services Strategy for Coronary Heart Disease,
Heart Failure and Rheumatic Heart Disease for Queensland 2005–2015
3.1.2 Heart Failure (continued)
Objectives
Initiatives and Key Activities
3.1 To ensure systems 3.1.4 Expand electrophysiology (EP) services for the State.
are in place to recognise, n Resource existing electrophysiology labs to full capacity
stratify, and manage
and establish additional facilities
patients with HF who
n Increase workforce: electrophysiologists and cardiac
would benefit from an
scientists trained in electrophysiology
implantable device
(Implantable Cardiac
n Increase ability for tertiary facilities to provide
Defibrillator or
electrophysiology training to cardiac scientists by
Biventricular Permanent
establishing training positions
Pacemaker).
n Establish a staff development position at tertiary facilities
(continued)
to support cardiac scientists undertaking specialist training
n
n
n
n
n
n
Key
Stakeholders
Number of facilities providing
device therapy services
increased
Statewide
Cardiac Clinical
Network
Number of FTE
electrophysiologists per
District and Area increased
Area Health
Services
Waiting time for ICD clinics
within target time frame
Area Health
Services
Districts
Waiting time for implantable
ICD implantation within target Health
Information
time frame
Branch
Investigate benefits of an EP outreach service to support
regional facilities with recruitment difficulties
3.1.5 Provide clinicians with the ability to support long term
management plans for patients post implantation of devices,
which includes ICD generator replacement strategies.
n
Key Milestones and
Performance Measures
n
Districts
Adequately resource ICD clinics for projected increase
in patient numbers
Health
Information
Branch
Monitor development of technology for remote checking
of ICD’s, for example, internet based programs
Investigate outreach clinics in regional areas for follow up
of patients
Standard 4: Rehabilitation for people with HF (secondary prevention and disease management)
4.1 To provide
evidence-based
rehabilitation and
secondary prevention
programs for people
diagnosed with HF.
4.1.1 Promote the availability and understanding of
recognised guidelines for the identification, assessment
and management of people who are likely to benefit from
rehabilitation.
n
n
Work in collaboration with NHF and ACRA to ensure best
practice
n
100% of facilities with access
to guidelines
Statewide
Cardiac Clinical
Network
Cardiac
Collaborative
Disseminate recognised guidelines and provide education
targeting staff in hospitals, Divisions of GP and primary
health care
35
Cardiac Services Strategy for Coronary Heart Disease,
Heart Failure and Rheumatic Heart Disease for Queensland 2005–2015
3.1.2 Heart Failure (continued)
Objectives
Initiatives and Key Activities
4.2 To ensure that all
4.2.1 Promote and support programs that provide people
eligible people with HF
with HF access to rehabilitation.
are actively referred and n Enhance and increase CR programs to accommodate HF
have access to a
patients based on episodes of care and patterns of activity
rehabilitation program
n
Utilise telehealth links with CR Coordinators/HF Nurse
tailored to HF.
Specialists to provide advice and assistance with patient
rehabilitation
4.2.2 Support referral practices that promote all suitable
people with HF being referred to an outpatient rehabilitation
program.
n
n
n
n
n
n
Establish guidelines for referral of people to rehabilitation
programs
Provide education on guidelines for referral of people to
rehabilitation programs targeting staff in hospitals, Divisions
of GP and primary health care
n
n
n
36
n
n
n
n
n
Regularly update and disseminate a list of CR programs
and contacts in Queensland via QHEPS and NHF websites
Key
Stakeholders
Area Health
Number of HF rehabilitation
programs / places per District Services
increased
Districts
Extent to which guidelines
have been adopted
Number of HF referrals to
outpatient rehabilitation
programs increased
Number of program places
per District and Area Health
service
Number of pathways
developed with referral to
outpatient rehabilitation
increased
Area Health
Services
Districts
Pathways
Cardiac
Collaborative
Include referral to rehabilitation on discharge report to GP,
regional hospital, primary health care professional
Include referral to rehabilitation on pathway
Partner with private providers to provide rehabilitation
where public programs are not available
4.2.3 Ensure rehabilitation programs are evidence-based
and supported by appropriately trained staff.
n
Key Milestones and
Performance Measures
n
Promote and provide funding for training programs for health
professionals involved in rehabilitation
Support professional development of hospital staff (medical,
nursing and allied health) and primary health staff (GP,
practice nurses) through local education programs,
conferences and scientific meetings
Provide support and funding for IHW to complete the IHW
specific NHF training package in the management of
cardiovascular disease, including rehabilitation
Work in conjunction with NHF and ACRA to provide materials
and resources
n
Number of health
professionals, including IHW,
funded to participate in
education and training
relevant to CR increased
Area Health
Services
Number of CR programs with
access to resource materials
Statewide
Cardiac Clinical
Network
Districts
NHF
Cardiac Services Strategy for Coronary Heart Disease,
Heart Failure and Rheumatic Heart Disease for Queensland 2005–2015
3.1.2 Heart Failure (continued)
Objectives
Initiatives and Key Activities
Key Milestones and
Performance Measures
Key
Stakeholders
Standard 5: Palliative care for people with end-stage heart failure
5.1 To maximise the
quality of life and
comfort of patients with
intractable HF by
providing a palliative
care approach to
treatment and care in
the person’s setting of
choice.
5.1.1 Develop and implement guidelines for referral, access
and appropriate management of palliative HF patients.
n
n
n
n
n
Develop guidelines and referral pathways in collaboration
with palliative care service providers based on the Palliative
Care Service Framework for Queensland
n
n
n
n
n
n
Palliative care referral routes Area Health
and guidelines developed and Services
disseminated to 100% of
Districts
facilities
CPCRE
The HF initiatives in the
Palliative Care Service
Framework will be progressed
by the CPCRE
Develop links with the Centre for Palliative Care Research and
Education (CPCRE) to foster research and education that
leads to development of evidence-based HF palliative
services
Develop links with specialist palliative care consultancy
services
Utilise Palliative Care Australia’s Standards for Providing
Quality Palliative Care for all Australians as a framework for
enhancing the quality of palliative services for people with HF
n
The HF initiatives in the
CPCRE
Palliative Care Service
Framework will be progressed
by the CPCRE
Increase the capacity of existing palliative care specialist
services to provide the level and quality of services that meet
the needs of patients with end stage heart failure
Support and encourage community based support groups
for patients and families
Implement programs that develop the capacity of primary
care providers to provide palliative care to people with HF,
such as the Program of Experience in the Palliative Care
Approach (PEPA) for general Medical Practitioners.
Support the ongoing delivery of the Palliative Care
Information Service by Karuna Home Hospice Service
5.1.3 Develop or enhance Hospital in the Home and Hospital
in the Nursing Home programs for HF.
n
n
Promote implementation of the recommendations regarding
palliative support as is set out in the guidelines
Contemporary Management of the Patient with Chronic Heart
Failure in Australia, NHF and CSANZ, 2002
5.1.2 Support public awareness initiatives aimed at the
broader community and health care professionals, to build
understanding of the palliative approach and to lessen
anxieties associated with end of life situations.
n
n
Investigate development or enhancement of Hospital in
the Home and Hospital in the Nursing Home programs for
people with end stage HF
n
The HF initiatives in the
CPCRE
Palliative Care Service
Framework will be progressed
by the CPCRE
Promote the utilisation of the resource kit for up-skilling
nursing home staff in the management of end stage HF with
the aim of reducing unnecessary presentations to Emergency
Departments
Promote the utilisation of the Guidelines for the Palliative
Approach in Residential Aged Care developed through the
National Palliative Care Program
Utilise the CPCRE to provide training about guidelines to
staff in residential care facilities
37
Cardiac Services Strategy for Coronary Heart Disease,
Heart Failure and Rheumatic Heart Disease for Queensland 2005–2015
3.1.2 Heart Failure (continued)
Objectives
Initiatives and Key Activities
5.1 To maximise
the quality of life and
comfort of patients
with intractable HF by
providing a palliative
care approach to
treatment and care
in the person’s setting
of choice.
(continued)
5.1.4 Develop and facilitate training programs that enhance
the ability of health care professionals to provide quality
palliative and end of life care for patients with HF.
n
n
n
n
n
38
Utilise available resources to educate clinicians about
indicators that mark a patient’s transition to the palliative
phase, to promote appropriate and timely referral and/or
consultation with a specialist team
Increase funding to educate specialist cardiac and nursing
staff in the ‘palliative approach’, that will enhance their
capacity to care for people with end stage HF, and collaborate
with specialist palliative care and other community services
when a patient’s condition indicates the necessity
Support the inclusion of palliative care in undergraduate
curriculum of all health related disciplines
Utilise the resource kit on Palliative Care for Indigenous
People for training across the State
Maintain links with the CPCRE regarding the progress of the
three-year Palliative Care Outcome Collaboration Project
(2005–2008), which will develop outcome indicators for
each phase of palliative care
Key Milestones and
Performance Measures
n
n
Key
Stakeholders
The HF initiatives in the
CPCRE
Palliative Care Service
Framework will be progressed Area Health
Services
by the CPCRE
Districts
Number of specialist cardiac
health professionals funded
to participate in education
related to palliative care
Cardiac Services Strategy for Coronary Heart Disease,
Heart Failure and Rheumatic Heart Disease for Queensland 2005–2015
3.1.3 Rheumatic Heart Disease
Objectives
Initiatives and Key Activities
Key Milestones and
Performance Measures
Key
Stakeholders
Standard 1: Reduce the incidence of acute rheumatic fever, and thereby the prevalence of rheumatic heart disease,
in Indigenous people in Queensland.
1.1 To implement
collaborative
community and
government initiatives
designed to address
the social, economic,
environmental and
cultural determinants
of the poor health
experienced by
Indigenous people
in Queensland.
1.2 To promote and
encourage individuals
to be able to be more
responsible for their
own, and their
children’s, health
by increasing their
understanding of
ARF and RHD.
Strategic Policy for Aboriginal and Torres Strait Islander
Children and Young People’s Health 2005–2010.
To be determined by the
Indigenous Health Unit
Indigenous
Health Unit
To be determined by the
Chronic Disease Strategy
Implementation Team
Chronic Disease
Strategy
Implementation
Team
1.1.1 Work with partners to address the underlying social,
cultural, economic and environmental determinants of ARF
and RHD.
1.1.2 Promote and support community ownership, control
and acceptance of collaborative programs and resource
distribution regarding ARF and RHD.
Queensland Strategy for Chronic Disease 2005–2015.
1.2.1 Empower and prepare individuals to prevent the
occurrence of, and if it occurs, manage ARF and RHD in their
families and communities.
1.2.2 Health workers will take a lead role in educating young
adults and families about the cause, effect and prevention of
ARF and RHD.
Standard 2: Implement an effective, sustainable strategy for the early detection, treatment and on-going
management of ARF and RHD for all people in Queensland.
2.1 To provide
2.1.1 To ensure access to evidence-based, culturally safe
sustainable health
primary health care services.
infrastructure
n Promote the availability and understanding of the
(systems, physical,
Enhanced Model of Primary Health Care, The Strategic Policy
financial and personnel)
for Aboriginal and Torres Strait Islander Children and Young
that supports access
People’s Health and the Chronic Disease Strategy into work
to appropriate ARF
practices
and RHD services.
n Support the guidelines for Rural and Remote Staffing Levels
for medical officers, nurses, environmental health workers,
IHW, primary health care doctors and nurses, and allied
health workers
n
n
n
n
n
n
n
n
n
Promote cultural awareness training for QH staff
n
Ensure consistent, accessible, timely, accurate and clear
information for all health professionals, especially IHW,
about prevention of ARF and RHD
n
Introduce/ enhance primary healthcare outreach services
to areas where ARF and RHD is prevalent
Investigate the inclusion of health promotion concerning
ARF and RHD in the school curriculum in Indigenous
communities
100% of facilities with access
to relevant guidelines and
QH endorsed strategies
Number of primary health
care workers employed
by QH increased
Number of health
professionals undertaking
education and training
relevant to RHD and ARF
increased
Area Health
Services
Districts
Cardiac
Collaborative
Indigenous
Health Unit
Workforce Units
Education
Number of primary healthcare providers
outreach clinics in rural and
Statewide
remote areas increased
Cardiac Clinical
Network
Number of primary health
outreach clinics in Indigenous
communities for primary
health care increased
Support a centralised ARF and RHD recall and monitoring
system
Investigate incorporating existing information systems in all
health facilities, for example, General Practice and Primary
Health facilities and Community Controlled Health Services
(CCHS) to improve information sharing
39
Cardiac Services Strategy for Coronary Heart Disease,
Heart Failure and Rheumatic Heart Disease for Queensland 2005–2015
3.1.3 Rheumatic Heart Disease (continued)
Objectives
2.2 To improve initial
clinical management of
suspected and/or
probable cases of ARF
and RHD.
Initiatives and Key Activities
2.2.1 Encourage all health professionals to follow agreed
best practice guidelines for all cases of ARF and RHD.
n
n
n
n
n
n
Key Milestones and
Performance Measures
n
Develop a training module on the primary and secondary
prevention of ARF and RHD for health professionals
Promote training of health professionals working in high risk
areas. Include the importance of the detection of ARF and
RHD and the implications of missed diagnosis, and the
importance of referral of children aged 5-14 years for an
initial paediatric review
Promote the availability and understanding of the
recognised guidelines for the Secondary Prevention
and Management of Acute Rheumatic Fever and Rheumatic
Heart Disease, and the Primary Clinical Care Manual
n
n
n
Ensure clinical guidelines and practice manuals are updated
regularly, for example, regular review and/or sending alerts
to facilities about changing practice.
Develop and distribute a ‘Quick Reference’ clinical guide
from the guidelines for clinical use
n
Apply to QH to endorse recognised guidelines
n
n
2.3 To maintain
effective surveillance
of ARF and RHD in
Queensland so as
to be able to monitor
trends over time.
2.3.1 Support and promote the use of a single, centralised
and computerised system for recall and follow-up of people
with ARF and RHD.
n
n
n
n
n
40
Provide a suitable statewide CIS for recall of ARF and
RHD patients
Support and educate all health professionals in the use
and importance of consistent data collection
Promote reporting of ARF as a notifiable disease through
education
Encourage communication between all agencies responsible
for the ongoing management of people with ARF and RHD by
enabling access to the QH CIS
Encourage these agencies to undertake further education
and other relevant training programs in relation to detection
and recall of people with ARF and RHD
n
n
n
Training program developed
for health professionals,
including IHW, targeting ARF
and RHD prevention and
management
Number of health
professionals undertaking
education and training
relevant to RHD and ARF
increased
100% of facilities with access
to relevant guidelines
100% of Northern Area
Health Service facilities
where education on ARF
and RHD guidelines has
been offered
Key
Stakeholders
Area Health
Services
Districts
Cardiac
Collaborative
Indigenous
Health Unit
Statewide
Cardiac Clinical
Network
Chief Health
Officers Office
‘Quick Reference’ clinical
guide developed, distributed
to 100% of eligible facilities
Process agreed within QH for
endorsement of guidelines
Extent to which eligible
facilities adopt guidelines
A CIS will be identified
Number of facilities that
have the CIS increased
Number of reports of ARF
via notifiable diseases
records monitored
Area Health
Services
Districts
Information
Technology
Health
Information
Branch
Cardiac Services Strategy for Coronary Heart Disease,
Heart Failure and Rheumatic Heart Disease for Queensland 2005–2015
3.1.3 Rheumatic Heart Disease (continued)
Objectives
2.4 To invest in
increased service
capacity in the
community.
Initiatives and Key Activities
2.4.1 Provide adequate resources and support for health
services to manage people with ARF and RHD effectively
in all communities.
n
n
n
n
n
n
n
n
n
n
Key Milestones and
Performance Measures
n
Enhance/introduce existing remote outreach services
to areas of need
n
Support the employment of multidisciplinary teams in the
community including practice nurses in General Practice,
dentists, IHW, allied health workers and Nurse Practitioners
where appropriate
n
Provide support staff for Medicare claims to be completed
at clinics and hospitals
Source or develop culturally appropriate resources for staff
to use for client education
Develop and implement a comprehensive electronic medical
and nursing discharge summaries in all hospitals across the
State to ensure follow-up of people with ARF and RHD
Introduce/enhance telehealth services to assist in
diagnosis, treatment and management of ARF and RHD
n
n
Promote working relationships between cardiac health
professionals, IHW and CCHS
Provide appropriate forums for community members and
others to discuss relevant issues regarding health education
and the importance of follow-up of people with ARF and RHD
Provide regular feedback to communities on forum
outcomes and issues
Area Health
Number, location and
frequency of cardiac outreach Services
clinics in rural and remote
Districts
areas increased
Workforce Units
Number, location and
frequency of cardiac outreach Indigenous
clinics in Indigenous
Health Unit
communities increased
CCHS
ARF and RHD patient
Statewide
information developed/
Cardiac Clinical
sourced
100% of facilities with access Network
to relevant and updated
patient education materials
n
n
n
Support the development of culturally appropriate places
for Aboriginal and Torres Strait Islanders to access primary
health care services
n
n
n
Key
Stakeholders
Electronic medical and
nursing discharge summaries
developed and distributed to
100% of facilities
Health
Information
Branch
Number of facilities with
access to telehealth services
increased
Number of facilities using
telehealth for specialist
consultations or outpatient
clinics increased
Number of facilities using
telehealth for patient
education for ARF and
RHD increased
Indigenous representation on
all Cardiac Clinical Networks
Number of ARF and RHD
community forums held
increased from baseline
Number of admitted episodes
of care of RHD by State, Area,
District and Indigenous
status monitored
41
Cardiac Services Strategy for Coronary Heart Disease,
Heart Failure and Rheumatic Heart Disease for Queensland 2005–2015
3.1.3 Rheumatic Heart Disease (continued)
Objectives
2.5 To promote
systems that provide all
patients suspected of
having RHD with
comprehensive clinical
assessment in a
geographically suitable
environment.
Initiatives and Key Activities
2.5.1 Improve ongoing management of people with RHD
through better access to echocardiography services.
n
n
n
n
n
n
42
Key Milestones and
Performance Measures
n
Expand echocardiography outreach services, including
portable echocardiography machines, utilising private
facilities where appropriate
Provide education on indications for echocardiography
targeting staff in hospitals, primary health care and
Divisions of General Practice
Utilise digital imaging techniques and on-line data transfer
facilities for echocardiography reporting purposes through
a ‘hub and spoke’ model
Investigate existing telehealth facilities suitable for use
in echocardiography service available to Health Service
Districts
Establish regional telehealth infrastructure and data links
between health care providers where necessary
Increase number of sonographer positions in Districts based
on analysis of episodes of care and patterns of activity
n
Number of facilities with
echocardiography services
increased (Additional
performance measures in
Heart Failure section)
Number of facilities with
portable echocardiography
machines increased
Key
Stakeholders
Area Health
Services
Districts
Statewide
Cardiac Clinical
Network
Information
Technology
Cardiac Services Strategy for Coronary Heart Disease,
Heart Failure and Rheumatic Heart Disease for Queensland 2005–2015
3.1.4 Quality and Performance
Objectives
Initiatives and Key Activities
Key Milestones and
Performance Measures
Key
Stakeholders
Standard 1: Monitoring of quality and performance for CHD, HF and RHD
1.1.1 To implement and support standardised, user-friendly,
1.1 To use and
sustainable and broadly applicable CIS.
standardise existing
and future clinical
n Develop an interface between systems to allow access and
information systems
sharing of information across the continuum. For example,
(CIS) to promote sharing
enable hospital, traditional communities and primary health
of, and access to,
care facilities to access the CIS such as the Ferret program
accurate and timely
n
Enable non-QH health professionals (eg. GPs) to access
information along the
QHEPS in order to share information regarding patient
continuum of care.
progress and for follow-up purposes
n
n
n
n
n
n
n
Explore the expanded use of existing and emerging national
and state CISs
Develop useful reports by extracting relevant data from
each of the participating systems and presenting it in
a combined format
n
Area Health
Services
Evidence of collaboration with
stakeholders, particularly
Districts
end-users, in the selection
Cardiac
and implementation of CIS
Collaborative
Number of facilities that have
Statewide
the information technology
Cardiac Clinical
hardware, software and
Network
systems infrastructure
required to use preferred
Information
CIS increased
Technology
Preferred CIS identified
CIS are compatible with
Area Health Services and
other QH Systems
Ensure QH has copies of chosen databases placed into
the enterprise reporting environment (ERSA)
Access completed ERSA reports via QHEPS and make
available to relevant recipients with automated notification
43
Cardiac Services Strategy for Coronary Heart Disease,
Heart Failure and Rheumatic Heart Disease for Queensland 2005–2015
3.1.4 Quality and Performance (continued)
Objectives
Initiatives and Key Activities
2.1 To support the
2.1.1 To collect quality data to inform the measurement of
use of comprehensive
performance along the continuum of care.
indicators for evaluation n Establish Statewide and Area Health Service Cardiac Clinical
of cardiac services.
Networks
n
n
n
n
n
n
n
n
n
n
n
n
Review Cardiac Collaborative aims, function, management,
representation and facility participation
n
n
n
44
n
n
n
Review current data collection systems for quality, relevance,
and gaps in relation to CHD, HF and RHD
Explore introduction of existing data bases/CIS for CHD,
HF and RHD. For example, Athena database for HF
Review and evaluate existing indicators for currency and
relevance including the practice of minimum data set
numbers to be representative of total episodes of care
for each facility
n
n
Review “National data elements for clinical management of
acute coronary syndromes, May, 2005” NHF & CSANZ and
adapt for grouped health care settings i.e. primary health
care centres, rural & regional hospitals and tertiary hospitals
n
Establish outcome indicators in relation to CHD, HF and RHD
n
Adopt proposed indicators for evaluating ARF and RHD
control programs from the Guidelines for the Secondary
Prevention and Management of ARF and RHD in Australia
Access palliative care indicators when developed
Establish a standard template for all cardiac service areas
to provide annual report
Develop and implement a shared State register for coronary
angiogram, coronary angioplasty, coronary artery bypass
graft surgery and implantable devices with links to national
data systems
n
n
Fund data collection positions in Districts based on quality
data outcomes
Key
Stakeholders
Cardiac Clinical Networks
established
Area Health
Services
Cardiac Collaborative role
and function expanded
Districts
Existing indicators for CHD,
HF reviewed and updated
and distributed to 100%
of facilities
Outcome measures for CHD,
HF and RHD developed and
distributed to 100% of
facilities
Cardiac
Collaborative
Statewide
Cardiac Clinical
Network
Information
Technology
Proposed indicators from
guidelines for RHD adopted
Template for Cardiac Services
Annual Report developed and
implemented in all service
areas
Statewide registers developed
for coronary angiography,
coronary angioplasty,
coronary artery bypass graft
surgery and implantable
devices
Number of data collection
and management positions
by Area and District increased
Number of health
professionals/end users
trained in use of CIS and data
management increased
Provide support and training to staff involved in collecting,
entering, accessing and using data including;
– concepts and precepts behind data collection
and how to use data
– data entry and the use of the CIS
2.1.2 Ensure that the information derived from collected data
is communicated and used to improve performance.
n
Key Milestones and
Performance Measures
Cardiac Collaborative to ensure that information and
recommendations derived from data collection are
communicated back to relevant facilities and Clinical
Networks
Cardiac collaborative to assist in translating
recommendations in to practice
Establish Clinical Networks as the organisational structure
to monitor and coordinate conversion of data into practice
Provide information to Community Councils or other
Government and Non-Government agencies in a constructive
format that can be used to clarify program initiatives
n
n
Number of Districts with
timely access to outcome data
for cardiac services in
a useable format monitored
and increased
Number of Districts and
Clinical Networks receiving
regular clinical performance
reports from the Cardiac
Collaborative monitored
and increased
Area Health
Services
Districts
Cardiac
Collaborative
Statewide
Cardiac Clinical
Network
Information
Technology
Cardiac Services Strategy for Coronary Heart Disease,
Heart Failure and Rheumatic Heart Disease for Queensland 2005–2015
3.1.4 Quality and Performance (continued)
Objectives
Initiatives and Key Activities
2.1 To support the
2.1.3 Accommodate the high mobility of individuals,
use of comprehensive
especially Indigenous people by ensuring systems extend
indicators for evaluation beyond community boundaries.
of cardiac services.
n Increase the quality of Indigenous identification mechanisms
(continued)
n Identify the data needed to monitor adequately the general
health status of Indigenous children and young people
n
Key Milestones and
Performance Measures
n
Data set for monitoring the
general health status of
Indigenous children and
young people developed
Key
Stakeholders
Indigenous
Health Unit
Information
Technology
Explore means by which centres in other jurisdictions
can use Queensland Health data recall systems to ensure
consistent patient follow-up, for example, Lake Nash,
Northern Territory, and vice versa
45
Cardiac Services Strategy for Coronary Heart Disease,
Heart Failure and Rheumatic Heart Disease for Queensland 2005–2015
4. Summary
The Cardiac Services Strategy addresses identified gaps in service provision from a statewide
perspective. It details actions for the implementation of evidence based practice in the
prevention and management of three specified heart diseases, CHD, HF and RHD.
The broad principles that underpin the Cardiac Services Strategy include the drive to promote
health and reduce inequalities, raise the quality of clinical care and reduce variations in
access to and the quality of services, particularly for Indigenous people and people in rural
and remote areas.
For the Cardiac Services Strategy to be successful, and for ongoing evaluation of statewide
cardiac services, it is imperative that the Cardiac Clinical Networks be established and that
the role of the Cardiac Collaboratives is expanded and redefined.
A clear commitment for full funding for the Cardiac Services Strategy, timely action,
coordination and direction for implementation is required to provide improved cardiac
services across the State.
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Cardiac Services Strategy for Coronary Heart Disease,
Heart Failure and Rheumatic Heart Disease for Queensland 2005–2015
5. Glossary
Term
Definition
Aboriginal
A person of Aboriginal descent who identifies as an Aboriginal and is
accepted as such by the community in which he or she lives.
Acute
Coming on sharply and often brief, intense and severe.
Acute Coronary
Syndrome
Describes acute myocardial infarction (heart attack) or unstable angina
when they first present as a clinical emergency with chest pain or other
features.
Angina
Pain in the chest. Usually gripping or crushing in nature in the chest
and/or left arm and jaw felt when there is insufficient blood supply to
the heart muscle. Stable angina is the term used for angina which is
relatively predictable and the intensity and frequency of which remains
similar over long periods. Unstable angina is angina which is severe and
unpredictable and which threatens to progress to an acute myocardial
infarction.
Angiogram
A procedure in which a fine catheter is inserted via a blood vessel to
inject x-ray opaque dye into the coronary arteries to obtain an x-ray
image of the anatomy of the coronary arteries.
Asymptomatic
Without symptoms or producing no symptoms.
Audit
A methodical examination or review of clinical practice.
Burden of disease Refers to the loss of health and premature mortality at the population
level. By definition burden of disease is to be found in any population
that presents variation in health outcomes.
CABG
Coronary artery bypass grafting. An open heart operation in which
blockages to the coronary arteries are bypassed by grafting on a length
of artery or vein to bring a fresh blood supply to the heart muscle.
Cardiac
rehabilitation
This is a comprehensive exercise, education, and behavioural
modification program designed to improve the physical and emotional
condition of people with heart disease.
Cholesterol
Fatty substance produced by the liver and carried by the blood to supply
the rest of the body. Its natural function is to supply material for cell
walls and for steroid hormones, but if levels in the blood become too
high this can lead to atherosclerosis and heart disease.
Chronic disease
A disease, such as heart disease and kidney disease, that tends to
be long-lasting and persistent in its symptoms or development.
Clinical practice
guidelines
Systematically developed reviews of evidence to assist health
professionals and people with specific conditions to make decisions
in respect of their care.
Coordinated care
Care is coordinated when people experience the care they receive in
the primary, community and secondary care sectors as being provided
by the one organised service. Coordinated care relies on effective
communication, liaison and integration between services provided
in the different sectors.
47
Cardiac Services Strategy for Coronary Heart Disease,
Heart Failure and Rheumatic Heart Disease for Queensland 2005–2015
Term
Definition
Coronary Heart
Disease
Narrowing or blockage of the coronary arteries by atheroma, leading to
angina or heart attack, heart failure, and/or sudden death. Also known
as ischaemic heart disease.
Defibrillator
An instrument for delivering an electric shock in an attempt to terminate
ventricular fibrillation.
Diabetes
The name given to a group of medical conditions that are characterised
by relative or absolute deficiencies in the secretion and/or action of the
hormone insulin and other metabolic problems.
Dyslipidaemia
A lipid abnormality characterised by raised levels of both triglycerides
and low-density lipoprotein (LDL) cholesterol, and a low level of highdensity lipoprotein (HDL) cholesterol.
Echocardiogram
An image and measurement of the heart structure and function
obtained by using ultrasound.
Heart attack
(Myocardial
Infarction)
Life threatening emergency that occurs when a vessel supplying blood
to the heart muscle is suddenly blocked completely by a blood clot. The
medical term commonly used for a heart attack is myocardial infarction.
See also cardiovascular disease.
Heart failure
When the heart cannot pump strongly enough to keep the blood
circulating around the body at an adequate rate.
Hypercholesterolaemia
Raised levels of cholesterol in the blood.
Hypertension
A condition that occurs when blood pressure is sustained above the
normal range.
Indigenous
A person of Aboriginal and/or Torres Strait Islander descent who
identifies as an Aboriginal and/or Torres Strait Islander and is accepted
as such by the community with which he or she is associated.
Patient-centred
care
Patient-centred care is an approach to care in which people share
management of their illness with their health professionals. The three
elements defining patient-centred care are communication;
partnerships; and a focus beyond the specific condition to health
promotion, healthy lifestyles and quality of life.
Percutaneous
transluminal
coronary
angioplasty
(PTCA,
angioplasty)
Angioplasty of the coronary arteries i.e. the introduction of a balloon
on a catheter through the skin (percutaneous), into a blood vessel
(transluminal) and into the coronary arteries to widen them.
Primary
prevention
Promoting health in people who have not yet begun to develop disease
to help them avoid that disease. An example is counselling young
people on dietary practices to help them reduce their risk of
subsequently developing heart disease or diabetes.
Revascularisation A procedure to improve blood supply. In case of CHD these include
CABG and PTCA.
48
Cardiac Services Strategy for Coronary Heart Disease,
Heart Failure and Rheumatic Heart Disease for Queensland 2005–2015
Term
Definition
Acute Rheumatic
Fever
An acute, serious disease that affects mainly children and young adults
and can damage the heart valves, the heart muscle and its lining, the
joints and the brain. It is brought on by a reaction to a throat infection
by a particular bacterium. Now very rare in the non-Indigenous
population, it is still at unacceptably high levels among Indigenous
Australians living in remote areas.
Rheumatic heart
Disease
Chronic disease from damaged heart valves caused by earlier attack(s)
of rheumatic fever.
Risk factor
An attribute or exposure that is associated with an increased probability
of a specified outcome, such as the occurrence of a disease. Risk
factors are not necessarily causes of disease.
Secondary
prevention
Early detection and treatment of people who have begun to develop the
disease (possibly with silent symptoms). An example is screening to
detect high blood pressure so that people with preclinical symptoms
can be treated with appropriate medications or lifestyle change.
Stent
An artificial structure inserted into a coronary artery following PTCA to
support the vessel wall and reduce the risk of re-occlusion.
Torres Strait
Islander
A person of Torres Strait Islander descent who identifies as a Torres
Strait Islander and is accepted as such by the community in which he or
she lives.
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Cardiac Services Strategy for Coronary Heart Disease,
Heart Failure and Rheumatic Heart Disease for Queensland 2005–2015
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