The project involved redesigning the existing Chronic Disease Diabetes Model of Care to align with the MSH Service Plan. The project objectives were:
To embed a connected and enhanced model of care to improve the patient journey and to build capacity through improved system efficiencies to appropriately manage diabetes across the spectrum of the disease.
To decrease clinical variation – everyone working towards the same goal.
To develop a clear understanding of the current service provision, identify changes required and opportunities to improve.
Aims & Goals:
To improve the capacity of primary care services to prevent and manage diabetes and its complications
Develop an efficient interface between general practice (GP), community-based diabetes prevention and management services and acute services
Improve efficiencies within the acute care setting, by identifying current gaps in service
Improve work flow process – scope of practice, defined work roles
Create clear referral pathways for inpatient/outpatient services and improve patient flow