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About HARP
Background
HARP was developed in the late 1990’s to address the increased demand on acute health care services. HARP was initially implemented as more than 80 pilot projects that were tasked with identifying those clients at risk of, or already experiencing, frequent emergency presentations or hospital admissions, in order to provide them with alternative interventions.
Evaluation:
The HARP projects were formally evaluated in 2004-05. The results of the evaluation were published in the HARP Public Report in 2006. The report demonstrated that in a 12 month period, HARP clients experienced:
- 35 per cent fewer emergency department attendances
- 52 per cent fewer emergency admissions
- 41 per cent fewer days in hospital.
The reduced need for hospital services was equivalent to approximately:
one emergency department attendance
two emergency admissions
six days spent in hospital each year for every HARP client.
Mainstreaming:
On the basis of the program’s successful outcomes identified in the 2006 HARP Public Report, the 87 individual HARP projects were mainstreamed through amalgamation into 15 HARP services across Victoria. From 2005-2007 HARP was expanded to provide services within sub-regional areas, resulting in the provision of 22 state-wide HARP services.
HARP Expansion 2010:
Funding through the Commonwealth of Australian Governments (COAG) Long Stay Older Patients (LSOP) initiative enabled 13 additional HARP programs to be piloted in rural Victoria between 2007-2010. These projects specifically provided care to older people and as such were named HARP Better Care of Older People (HARP BCOP).
Initial evaluation findings indicate that HARP BCOP clients experienced:
- 64% reduction in hospital separations post intervention, compared to pre-HARP BCOP utilisation
- 55 % reduction in the number of ED presentations, compared to pre-HARP BCOP utilisation
- 39% reduction in the number of clients presenting to the emergency department (ED) post discharge from HARP BCOP.
This initial data suggests that HARP BCOP has had a positive impact on hospital utilisation in rural Victoria by significantly reducing the hospital and ED utilisation of the HARP BCOP cohort.
As of July 2010 the 13 rural HARP BCOP pilots have been mainstreamed into the Victorian HARP, resulting in 35 state-wide HARP services.
Model of care
The HARP service delivery model is based on the Kaiser Permanente Chronic Care framework and the Wagner Chronic Care model.
Care coordination, self-management support and specialist medical care are core components of HARP, with the primary focus of reducing the demand of clients with chronic disease and complex needs on the acute hospital system.
Table 1: Kaiser Permanente Pyramid
Who is a HARP client?
HARP continues to target levels one and two of the Kaiser Permanente pyramid (Table 1) that is high risk patients who are either already presenting frequently to hospital or at imminent risk of doing so, and require a holistic, integrated, person-centred approach.
A HARP client is a person with chronic disease and or complex needs, who is frequently presenting to hospital or at risk of doing do. This includes:
- People with chronic heart disease;
- People with chronic respiratory disease;
- People with diabetes:
- Older people with complex needs;
- People with complex psychosocial needs; and
- People with other chronic diseases and complex comorbidites.
HARP eligibility includes the criteria of the client having at least one emergency department presentation or hospital admission in the last 12 months.
For a copy of the HARP eligibility criteria please see:
Guidelines
HARP is governed by the Health Independence Program (HIP) guidelines. The Health independence programs guidelines (guidelines) have been developed to provide direction for and facilitate the alignment of, Post-Acute Care (PAC) services, Sub-acute Ambulatory Care Services (SACS), and Hospital Admission Risk Program (HARP) services.
Health Independence Programs guidelines
