3. jan hazelzet vbhc prize 20150409
TRANSCRIPT
Value & Science Driven Healthcare
Jan A. Hazelzet, MD PhDCMIO &
Vice-Director Strategy & Policy IT
Erasmus MC, Rotterdam, The Netherlands
ERASMUS MC Sophia Children’s Hospital
Pediatric Intensivist ≈ 1400 admissions/y
28 + 6 beds
Age: 0-18 y
Staff:
12 intensivists / 4 fellows
≈ 120 fte. nurses
CMIO
Strategic planning of IT
Clinician’s perspective IT-Governance
Clinical Documentation / EMR
Personalized Medicine
Value Based Health Care
Liaison Medical <=> Informatics
Healthcare: Rapidly Increasing Complexity
Diagnostic and treatment options are expanding and changing
Chronic diseases and comorbid conditions are increasing
Care delivery has become increasingly fragmented
Health care safety, quality, and outcomes fall short of their potential
Growth rate of health care expenditures is unsustainable
Overtreatment / under treatment
Pace of change is too slow
No Patient Centered Care
Best Care at Lower Cost: The Path to Continuously Learning Health Care in America. IOM 2012
Building on a healthy Future
These are our aims! More information:http://koers18.online-magazine.nl
Ambition 1: Continually adding Value
Our guiding principle for research, education, and health care is creating added value for patients
Understanding the health, diseases, and wishes of patients
Personalized medicine (individualized treatment)
Prevention
Translating knowledge into useful, innovative products and health care concepts
PERSONALIZED
INTEGRATIVE
HEALTHCARE
Care Path
Focus on the outcomes that matter most to patients
What is happening in Erasmus MC?
For 8 diagnose teams outcome measures and initial patient conditions
with instruments are defined
Participation in (inter)national workgroups (ICHOM);
A blueprint is developed to define outcome measures; 2018: 80%
IT platform (GemsTracker) is organized to measure outcomes.
Costs are measured on the basis of time spent (TDABC);
Teams are accompanied and assisted for all sections of care
Work in progress!!
20141105_Call#3_v1029v2.pptx 15Copyright © 2013 by the International Consortium for Health Outcomes Measurement. All rights reserved.
Value based healthcare
Team around Disease or Condition
5: Check4: Praktijk, tijd & taken
3: Prioriteit & instrument
2: Patiënt & uitkomst
1: Proces & pad
INLEZEN & VERSIE1 ZORGPAD
0: Intake
Blueprint Value-Based Care Cycle
THEORIE, AANDOENING, PAD EN TEAM
DE SESSIES PLENAIR
OUTCOME MANAGER & LEIDING ZORGPAD
OUTCOME MANAGER INDIVIDUEEL
OUTCOME TEAM ZORGPAD X INDIVIDUEEL
SAVE THE DATE EN INLEZEN THEORIE
VOORBEREIDING VERSIE 2 ZORGPAD
THEORIE, AANDOENING EN PROCESPAD
CHECK OP GUIDELINES EN PREMS
VOORBEREIDING VERSIE 3 ZORGPAD
UITKOMSTMATEN EN PATIENT INITIAL CONDITIONS
SCORING MATEN EN CONDITIONS
VOORBEREIDING, INSTRUMENTEN & SCORINGEN
UITKOMSTMATEN CONDITIONS EN INSTRUMENTEN
LITERATUURCHECK EN PEERLIJSTEN
VOORBEREIDING
FINAAL PAD, PROCES, METINGEN & TAKEN
START 4WKN PAPERBASED PILOT
EINDPRESENTATIE, INPUT FINANCE EN EVALUATIE
VOORBEREIDING
TERUGKOMSESSIE NA 4 WKN PAPERBASED PILOT
FINAAL PAD EN IMPLEMENTATIE IT
CooperationParticipation:• Prostate ca• Cleft Lip Palate• Stroke• Macula
Degeneration• ……
The first ICHOM publication, the localized prostate cancer set, is in press!
Time driven activity based costing
Our implementation
Value Based Carepaths as Management Tool
We measure & manage:
• Quality of Care (Outcome)
• Efficiency Tasks & professionals (Processes)
• Spending vs Reimbursement (Costs)
• Benchmarking (Analyse)
What to do in 2015 and onwards
Proceed with defining process and outcome measures.
Increase patient involvement
To define a (corporate) standard set of outcome instruments
Train clinicians in each disease team in analysis and quality
improvements
Measure, analyze, interpret and reporting results.
Cooperation with peers and payers, benchmarking
Erasmus MCInstitute for Public
Health & Prevention
Erasmus MCQuality of Care Organization
Erasmus MC Center for
Value-Based Health Care
“The Center for Value-Based Health Care brings together disciplines from across Erasmus Medical
Center to develop and implement strategies for driving demonstrable improvements in the value
we deliver for our patients.”
Sustainable and transparent results for all stakeholders inside and outside the Erasmus MC are
central.
2014 2015 2016
Brain tumors*, Prostate Ca*, Stroke*, Breast cancer*, Cleft Lip*, Bladder cancer*, Obesity*, Turner Syndrome, Macula Degeneration*, Larynx cancer
Heart failure, Sickle cell, Hemophilia, IBD, Colorectal Ca,, Pancreas Ca, Frail Elderly, Pregnancy + Childbirth, Hemifacial Microsomia, Dementia, Liver failure
Neuro trauma, Bipolar Disease, ICU treatment, Cystic Fibrosis, Lung cancer
Future Plans:
* Outcome measures defined Together with ICHOM
Questions???
@JanHazelzet
Voorbeeld professionalblokHI.48-1.SEH.VPK
Things to do ☐ Stroke sein uitzetten na vooraanmelding
10 minuten voor aankomst AMB
☐ Triage
☐ Gewicht & bloedglucose noteren
☐ Patiënt naar CT scan brengen
☐ Patiënt van CT tafel halen
☐ Venflon (groen rechts in elleboog) & Stroke Lab
☐ Monitoring: bloeddruk & neurologische uitval iedere 15 min
ECG maken☐
☐ Op indicatie: alteplase spuit klaarmaken
☐ Op Indicatie: CAD plaatsen
☐ Op Indicatie: Point of Care & INR via lab
Things to measure Binnenkomst tijd en datum SEH _____________
Starttijd Trombolyse _____________
Starttijd Bolus _____________
Datum & HandtekeningMicrosectienummerPatiënt ID
Tijdsduur in 45 min
Vul hieronder uw taakspecifieke things to do en things to measure in en lever iedere woensdag de ondertekende lijsten in op Hs645 code 0104. Alle proces en uitkomst metingen worden maandelijks met u gedeeld en verzameld in een Erasmus MC Key Outcome Report eind 2014. Dank voor uw medewerking!
Uitkomstmaten en Meetinstrumenten
Uitkomstmaat Meetinstrument
Mortaliteit <7dgn < 3mnd
Basale Zelfredzaamheid Barthel / MRS
Verfijnde Zelfredzaamheid UserP
Uitval NIHSS opn
Kwaliteit van leven EuroQoL (bij hoge depressie score HADS)
Vermoeidheid Fatigue Severity Scale
Cognitieve functies MOCA
Pneumonie PSI Ontslag
Bloedingscomplicaties Intracranieel en extracranieel Ontslag
Delier Bij risicoprofiel>3 DOS
Vallen Val lijst
Last Mantelzorger Care Giver Strain index
Initiële Patiënt Condities en Categorisaties
Initiële Patiënt Conditie Categorisatie
Ernst van het infarct 2e meting NIHSS
Leeftijd In jaren
Socio Economische Situatie Codes SES + taalbarrière j/n
Geslacht m/v
Comorbiditeiten Comorbiditeitlijst
Atrium Fibrilleren j/n
Previous Stroke j/n
Woonsituatie Alleen/ VPhuis/Partner/Partner+Kinderen/Alleenstaand+ Kinderen
Time Driven Activity Based Costing per blok en per scenario
T= tijd in minuutprijs (bruto jaarsalarissen)M= diagnostiekO= overhead in FTE/m2xP= productiviteit % Check kosten met vergoedingen, STZ tarieven, productieaantallen en manage het tarief