Health Services and Facilities Planning

This report outlines a strategic health service plan (HSP) that can help to reduce the burden of cardiovascular diseases (CVD) and minimize the rates of morbidity and mortality caused due to CVD and thus help to improve the wellbeing and health of the Australian people.

Running head: HEALTH SERVICES AND FACILITIES PLANNING
Health Services and Facilities Planning
Name of the Student
Name of the University
Author Note

1HEALTH SERVICES AND FACILITIES PLANNING
Executive Summary:
CVD is considered as one of the most significant contributors of morbidity and
mortality both globally and in Australia. In Australia, CVD is the highest causes of death due
to disease and the risks are found to be higher among the Indigenous population compared to
the non indigenous population. A health service plan has been developed which can help to
improve the health and wellbeing of the Indigenous people in South Western Sydney by
reducing the risks of CVD among the people. Various determinants of health has been
addressed, however the main determinant that was focused on was awareness of both the risk
factors as well as recovery strategies which can help to reduce the burden of disease. The
SHP mainly acknowledges that by improving the awareness of the people and increasing
access to health service can further help to reduce the burden of the disease.

2HEALTH SERVICES AND FACILITIES PLANNING
Contents
Executive Summary:..................................................................................................................1
Introduction:...............................................................................................................................4
Environmental scan including:...................................................................................................4
-Policy and Planning Framework...........................................................................................4
-Determinants of health..........................................................................................................5
-Burden of disease for selected population............................................................................5
-Morbidity and Mortality data................................................................................................5
Needs Assessment......................................................................................................................5
Improving awareness of the impact of CVD on overall Health and wellbeing:....................5
Improving awareness of strategies that can be used to reduce the risks of CVD..................6
Improving Access to care among individuals at high risk:....................................................6
Service Profile within Local Health District (LHD)..................................................................6
Relevant Facilities:.................................................................................................................6
Services:.................................................................................................................................7
Role Delineation Levels:........................................................................................................7
Models of Care:......................................................................................................................7
Current Inpatient and Outpatient activity levels (separation and bed days by facility and
clinical areas):............................................................................................................................7
Catchment and reverse catchment profiles..............................................................................10
Situational Analysis, Strategic Issues and Priorities................................................................11

3HEALTH SERVICES AND FACILITIES PLANNING
Future Service Profiles.............................................................................................................12
Key Goals.................................................................................................................................12
Recommendations:...................................................................................................................13
Conclusion................................................................................................................................14
References:...............................................................................................................................15

4HEALTH SERVICES AND FACILITIES PLANNING
Introduction:
Cardiovascular diseases (CVD) are considered to be one of the most significant
contributors towards morbidity and mortality across the globe, especially in developed and
developing nations. According to the World Health Organization, CVD is the number 1 cause
of death with an estimated mortality of 17.9 million people (as of 2016), representing 31% of
all deaths due to diseases and 85% of these deaths have been due to stroke or heart attacks.
The CVD includes a wide range of conditions caused by disorders of the heart and its blood
vessels (who.int, 2018). According to the Australian Bureau of Statistics, Ischemic heart
disease is the main cause of mortality in Australia which caused 19,777 deaths (as of 2015) or
12.4% of the total number of deaths that year (159,052) (abs.gov.au, 2017). This information
shows the significance of CVD to public health (Roth et al., 2017). Reports show that in the
NSW area, the number of hospitalization due to CVD have reduced in the last 20 years,
however still continues to be the most common cause of death, contributing to 35% of the
mortality rate in the region and is responsible of 3/4th of all death for individuals above 75
years and there were 4,763 hospitalizations between 2010 and 2011 due to cardiac diseases
and 1962 for strokes (swslhd.health.nsw.gov.au, 2013).
The aim of this report is to present a strategic health service plan (HSP) that can help
to reduce the burden of the disease and minimize the rates of morbidity and mortality caused
due to CVD and thus help to improve the wellbeing and health of the Australian people. The
report will outline the impact of CVD on public health and different recommendations that
can be suggested in order to improve the condition.
Environmental scan including:
-Policy and Planning Framework

5HEALTH SERVICES AND FACILITIES PLANNING
The Framework for the Strategic Health Plan for Cardiovascular diseases aims to
improve understanding the health risks for cardiovascular diseases as well as its risk factors,
and help the people to understand strategies to minimize the risks of the disease through
behavioral modifications. The aim of the framework is to reduce the burden of the disease
through better awareness (Eggbeer et al., 2015).
-Determinants of health
Several determinants of health can be attributed to cardiovascular diseases, which
help to increase the risks of the disease and reduce the overall health and wellbeing of people.
These determinants include social determinants such as socioeconomic position (SEP), race,
ethnicity, access to care, language and culture and residential environment (Braveman &
Gottlieb, 2014).
-Burden of disease for selected population
The risks of cardiovascular disease have been found to be higher among Aboriginal
and Torres Strait islanders compared to the non indigenous Australians. According to the
Australian Institute of Health and Welfare, 38% of Indigenous Adults in Australia have risks
for CVD and diabetes compared to non indigenous Australians (26%) (aihw.gov.au, 2015).
-Morbidity and Mortality data
According to the Australian Heart Foundations, individuals from Aboriginal and
Torres Strait Island communities had a 70% higher risk of mortality due to CVD. Also, the
incidence of CVD has also increased from 10.5% (as of 2001) to 12.0% (as of 2013) showing
an increase in the diagnosis for the condition among the Indigenous population
(heartfoundation.org.au, 2018).
Needs Assessment

6HEALTH SERVICES AND FACILITIES PLANNING
Analysis of relevant literature has revealed several important health needs that need to
be addressed by the Health Service Plan (HSP) which have been discussed next:
Improving awareness of the impact of CVD on overall Health and wellbeing:
By improving the awareness about the impacts of CVD among the public, an effective
health seeking behavior can be developed which can help in an earlier diagnosis of the
condition and support healthy lifestyle among individuals at high risk. Understanding how
CVD can impact the long term health of the individuals can further help to know why such
knowledge is important to improve the wellbeing of people (World Health Organization,
2017; Loucks et al., 2015).
Improving awareness of strategies that can be used to reduce the risks of CVD
Apart from improving the awareness about the impact of CVD on health and
wellbeing, the main aim is to improve knowledge about strategies that can be used by the
people to reduce the risks through behavioral modifications such as increasing exercise, and
diet, reduction or cessation of unhealthy behaviors such as smoking, drinking alcohol and
consuming unhealthy diet (Shay et al., 2015).
Improving Access to care among individuals at high risk:
The HSP also aims to improve access to care for individuals at high risks for CVD,
such as Indigenous Australians as well as individuals diagnosed with hypertension, obesity
and type 2 diabetes (Record et al., 2015).
Service Profile within Local Health District (LHD)
Relevant Facilities:

7HEALTH SERVICES AND FACILITIES PLANNING
The relevant facilities that can be involved in the HSP include primary healthcare
clinics, diagnostic clinics, hospitals and referral clinics. These facilities are primarily
involved in the initial diagnosis of cardiovascular diseases among patients. The facilities and
services related to patient education is also involved which can help in the process of health
education among the patients (Mossialos et al., 2016).
Services:
The various services that can be involved to reduce the risks of CVD among the target
population include: Emergency Health Services, Health Education Services, Lifestyle
Consultation Services, Primary Care Giver and Social Care Services.
Role Delineation Levels:
The standard services which are involved in role delineation for the HSP includes
endocrinology, gastroenterology, general and cute medicine, geriatric medicine,
haematology, immunology, palliative care, rehabilitation medicine, general surgery as well as
Aboriginal Health Services.
Models of Care:
The HSP focuses on a Community based model and self management support systems
for health improvement using a patient centric, timely and efficient, evidence based and
coordinated plan for reducing the risks of CVD in the target population. The plan aims to
increase the awareness about CVD, its risk factors and strategies that can be used to reduce
the risks of the disease (Record et al., 2015).
Current Inpatient and Outpatient activity levels (separation and bed days by facility
and clinical areas):

8HEALTH SERVICES AND FACILITIES PLANNING
The number of hospitalizations for Cardiovascular Diseases in South Western Sydney
Local health District has seen significant fluctuations over the years with an slight reduction
in hospitalizations over the last couple of years, according to the report by NSW Government
as shown in the graph below:
CVD Hospitalizations in South Western Sydney LHD (source: healthstats.nsw.gov.au, 2018)
Similarly, there also has been a decline in the number of hospitalizations for CVD
among elderly individuals, as shown in the graph below:

9HEALTH SERVICES AND FACILITIES PLANNING
CVD hospitalizations for people based on age groups (source: healthstats.nsw.gov.au, 2018)
The above graph shows that there has been some decrease in the number of
hospitalizations and diagnosis of CVD among Australians in NSW in the recent few years.
However, the hospitalizations for CVD still continue to be a biggest contributor of hospital
admissions, causing approximately 576,000 hospitalizations as of 2016/2017 and there has
been an increase in the rate of CVD by 2.2%, according to the Australian Heart Foundation
(heartfoundation.org.au, 2018b). This clearly shows that CVD still continues to be significant
factors that affect the health and wellbeing of people especially in South Western Sydney
region.
Data on hospital separations for specific cardiovascular diseases have also shows
significant changes since 2000. According to Australian Heart Foundation, these trends
shows an overall improvement in care for CVD and a reduction in hospital stays, especially
for Angina Pectoris among both men and boys as well as women and girls. Such trends can
be well understood from the graphs below:

10HEALTH SERVICES AND FACILITIES PLANNING
Trends in hospital separations for specific cardiovascular causes for men and boys
(1999-2000 to 2012-2013). (source: heartfoundation.org.au, 2018c)

11HEALTH SERVICES AND FACILITIES PLANNING
Trends in hospital separations for specific cardiovascular causes for women and girls
(1999-2000 to 2012-2013). (source: heartfoundation.org.au, 2018c).
Catchment and reverse catchment profiles
The primary catchment profiles that can be used to collect data regarding the patient
can include data from general surgery wards, orthopedics, obstetrics and gastroenterology.
Within the LHD levels, the catchment can involve all healthcare services that can be accessed
by the people for the assessment and diagnosis of CVD and its related co morbidities and risk
factors. Healthcare organizations located within the South Western Sydney would provide an
ideal catchment for important information on this regard. Additionally, community
outreaches and community care centers that works towards the Indigenous communities can
also provide excellent clinical data related to CVD among the indigenous people
(heartfoundation.org.au, 2018c).
The reverse catchment profile can include data related to CVD diagnosis among the
non indigenous people, which can be used to compare and contrast the health data and
understand if any health gap exists in the context of CVD between indigenous and non
indigenous Australians.
Situational Analysis, Strategic Issues and Priorities
Analysis of the current situation clearly showed that the number of hospitalizations
caused due to CVD is still significant in the South Western Sydney LHD area. Even though
there has been some reduction in the incidence of CVD over the last few years, it still
continues to be one of the most significant contributors of morbidity and mortality among
Australians, especially among the Aboriginal and Torres Strait Islander people, who has
higher risks of CVD compared to the non indigenous Australians (abs.gov.au, 2017).

12HEALTH SERVICES AND FACILITIES PLANNING
Considering the higher prevalence of CVD among the Indigenous Australians, it is
vital that the health risks and the burden of disease in these communities be reduced at the
soonest. Hence the primary strategy is to develop the wellbeing of these communities by
supporting better care and reduction of the risk factors of CVD among Indigenous
Australians.
The health priorities of the HSP is to develop awareness of the adverse impact of
CVD on the health and wellbeing of people, as well as understanding how the risks for CVD
can be lowered through behavioral modifications such as change in diet, increasing physical
activities and reducing harmful behavior such as smoking and drinking alcohol (aihw.gov.au,
2015).
Future Service Profiles
Various services can be used to reduce the burden of CVD on the target population,
such as:
Health Education: This strategy can help to increase awareness about health
conditions such as CVD and how it impacts the health and wellbeing, as well as the different
risk factors such as obesity, diabetes and hypertension that can increase risks of CVD.
Healthy Diet Programs: This can be used to improve understanding of diet choices
that can help to maintain a healthy cardiovascular system and avoid food which can adversely
affect cardiovascular health.
Physical Activity Programs: This is another important strategy that can help the
people to understand exercise routines that can minimize the risks of CVD or its related co
morbid conditions such as Obesity, Diabetes and Hypertension.

13HEALTH SERVICES AND FACILITIES PLANNING
Addiction Services: These services can help the people to avoid and give up unhealthy
behavior such as smoking and drinking alcohol, which can increase risks of CVD and related
conditions (heartfoundation.org.au, 2018)
Key Goals
The main goals of the health service plan are to reduce the impact of CVD among
Indigenous Australians and thus improve the health and wellbeing of the people. The goal
can be further differentiated into smaller goals such as:
Goals/ Objectives Strategies Resources
1. Increasing awareness
of the impacts of
CVD among the
target population
Healthcare education, Online resources, scientific
journals, books,
newspapers, broadcast
media, health workshops,
referrals
2. Increasing the
awareness of the
strategies that can be
used to reduce the
impact of CVD
Healthcare education, General Physicians,
referrals. Workshops and
media
3. Improving access to
care among the
Indigenous
Australian
Communities
Setting up additional care
centers to support individuals
diagnosed of CVD,
improving early detection of
CVD through outreach clinics
Primary care physicians,
mobile clinics, referral
services, outpatient services
4. Reducing the overall Improving the cardiovascular General Physicians,

14HEALTH SERVICES AND FACILITIES PLANNING
number of
hospitalizations due
to CVD among the
target population
health of the people referrals. Workshops and
media
Recommendations:
Some of the key recommendations that can be provided for the Health Service Planning are:
1. Helping the people understand how CVD can affect their health and wellbeing
thereby allowing them to make informed decisions that can affect their health and
wellbeing.
2. Helping the people to understand how they can improve their own health and
wellbeing through changing their diet and lifestyle and thus reduce the risks of CVD.
3. Increasing the availability of healthcare services, especially in remote regions to
improve early diagnosis of CVD and thus have early treatment for best results.
4. Using evidence based practices for strategies to reducing the risks of CVD among the
target population.
5. Using cultural sensitivity to work with individuals from Aboriginal and Torres Strait
Islanders in order to understand their cultural expectations in a better manner (Roth et
al., 2017; Eggbeer et al., 2015; Shay et al., 2015)
Conclusion
An overview of the prevalence of CVD in Australia shows that even though there has
been some decline in the incidence of CVD in the past, it still continues to be a significant
cause of hospitalization, morbidity and mortality among Australians. The problem has been

15HEALTH SERVICES AND FACILITIES PLANNING
found to be even more significant in case of Indigenous Australians. The Health Service Plan
aims to reduce the burden of the disease for CVD in the South Western Sydney area. The
plan have outlined the necessity of improving awareness of the health risks of CVD and
strategies to reduce CVD risks as an important strategy to reduce the burden of the disease
along with strategies such as improving accessibility of care, which can help to reduce the
incidence of CVD in the target population.

16HEALTH SERVICES AND FACILITIES PLANNING
References:
Abs.gov.au. (2017). Causes of Death, Australia, 2015. Retrieved from
http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/3303.0~2015~Main
%20Features~Ischaemic%20Heart%20Disease~10001
Aihw.gov.au. (2015). Cardiovascular disease, diabetes and chronic kidney disease—
Australian facts: Aboriginal and Torres Strait Islander people, Table of contents -
Australian Institute of Health and Welfare. Retrieved from
https://www.aihw.gov.au/reports/heart-stroke-vascular-disease/indigenous-
australians/contents/table-of-contents
Braveman, P., & Gottlieb, L. (2014). The social determinants of health: it's time to consider
the causes of the causes. Public health reports, 129(1_suppl2), 19-31.
Eggbeer, B., Hauser, M., & Johnson, S. (2015). Organizing for the'second curve'combining
health plans and provider systems: the changing healthcare environment offers
strategic advantages to provider systems that own health plans, but such integration
requires significant preparation. Healthcare Financial Management, 69(1), 62-67.
Healthstats.nsw.gov.au. (2018). HealthStats NSW Cardiovascular disease hospitalisations by
disease type and Local Health District, trends. Retrieved from
http://www.healthstats.nsw.gov.au/Indicator/cvd_typehos/cvd_typehos_lhn_trend
Heartfoundation.org.au. (2018)a. Cardiovascular risk profile of Aboriginal and Torres Strait
Islander peoples. Retrieved from https://www.heartfoundation.org.au/about-us/what-
we-do/heart-disease-in-australia/cardiovascular-risk-profile-of-aboriginal-and-torres-
strait-islander-peoples

17HEALTH SERVICES AND FACILITIES PLANNING
Heartfoundation.org.au. (2018)b. Cardiovascular disease fact sheet. Retrieved from
https://www.heartfoundation.org.au/about-us/what-we-do/heart-disease-in-australia/
cardiovascular-disease-fact-sheet
Heartfoundation.org.au. (2018)c. Australian heart disease statistics 2015. Retrieved from
https://www.heartfoundation.org.au/images/uploads/publications/RES-115-
Aust_heart_disease_statstics_2015_WEB.PDF
Loucks, E. B., Schuman-Olivier, Z., Britton, W. B., Fresco, D. M., Desbordes, G., Brewer, J.
A., & Fulwiler, C. (2015). Mindfulness and cardiovascular disease risk: state of the
evidence, plausible mechanisms, and theoretical framework. Current cardiology
reports, 17(12), 112.
Mossialos, E., Wenzl, M., Osborn, R., & Sarnak, D. (2016). 2015 international profiles of
health care systems. Canadian Agency for Drugs and Technologies in Health.
Record, N. B., Onion, D. K., Prior, R. E., Dixon, D. C., Record, S. S., Fowler, F. L., ... &
Pearson, T. A. (2015). Community-wide cardiovascular disease prevention programs
and health outcomes in a rural county, 1970-2010. Jama, 313(2), 147-155.
Roth, G. A., Johnson, C., Abajobir, A., Abd-Allah, F., Abera, S. F., Abyu, G., ... & Alla, F.
(2017). Global, regional, and national burden of cardiovascular diseases for 10 causes,
1990 to 2015. Journal of the American College of Cardiology, 23715.
Shay, C. M., Gooding, H. S., Murillo, R., & Foraker, R. (2015). Understanding and
improving cardiovascular health: an update on the American Heart Association's
concept of cardiovascular health. Progress in cardiovascular diseases, 58(1), 41-49.
Swslhd.health.nsw.gov.au. (2013). South Western Sydney Local Health District Strategic &
Healthcare Services Plan Strategic Priorities in Health Care Delivery to 2021-

18HEALTH SERVICES AND FACILITIES PLANNING
Leading care, healthier communities- South Western Sydney Local Health District.
Retrieved from
https://www.swslhd.health.nsw.gov.au/pdfs/SWSLHD_Strategic_Priorities_to_2021.p
df
Who.int. (2018). Cardiovascular diseases (CVDs). Retrieved from http://www.who.int/news-
room/fact-sheets/detail/cardiovascular-diseases-(cvds)
World Health Organization. (2017). Noncommunicable diseases: progress monitor 2017.

19HEALTH SERVICES AND FACILITIES PLANNING