SA HealthPlus: a controlled trial of a statewide application of a generic model of chronic illness care

Abstract

SA HealthPlus, one of nine national Australian coordinated care trials, aimed to inform policy to address the emerging crisis in chronic illness care. The trial tested the hypothesis that coordinated care would improve health outcomes within the costs of usual care. SA HealthPlus used geographic and randomised designs in eight projects in four sub-trials. A generic model of coordinated care was applied to 3115 intervention patients and compared to usual care in 1488 controls. Innovative aspects of the trial were the role of service coordinators and the behavioural and care planning approach used to place the patient at the centre of their care. Results showed improvements in self-assessed health status (SF-36) in six of eight projects and that patients with a history of prior hospitalisation in the year immediately preceding the trial were the most likely to yield cost savings. A mid trial review found that health benefits from coordinated care were more dependent on patient self- management than illness severity, a factor which subsequently led to the development of the Flinders self-management model in Australia.