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Innovation in care for chronic conditions
Valencia reference siteDr. Bernardo Valdivieso
Proposal......
2
- Introduction
- Good practice
- Conclusions & Scaling up
Overview
3
An introduction to the Valencia region
4
An introduction to Department LA FE
• Population: 200.000
– > 65 years old: 17,3%
• Health System
– Hospital for tertiary care: 1
– Hospital for chronic patients:1
– Primary Care Centers: 13
• Human resources
– Hospital: 6.800
– Primary Care: 350
• Activity:
• 35 % basic; 65% reference
• Budget:
• 600 M€5
Home/
Residence attention
Primary Health Care Center
Emergency
Em
erg
ency
Hospital
Ambulatory
Care
HOSPITAL HEALTH CARE
Chro
nic
Care
Are
a
Medium
Long Stay
Unit
PRIMARY HEALTH CARE
Hospital at H
om
e
6
An introduction
DEPARTMENT “LA FE”
- Introduction
- Good practice
- Conclusions & Scaling up
Summary
7
Disease management:
Patients with medium level of need
• Moderately-complex chronic conditions
Supported self care
Patients with low level of need
• Low-complex chronic conditions
Pro
fess
ion
al C
are
Case management
Patients who need a intensive level of attention
•Highly-complex chronic conditions
•End of life conditions
Innovation in care for chronic conditions
8
Disease management:
Patients with medium level of need
• Moderately-complex chronic conditions
Supported self care
Patients with low level of need
• Low-complex chronic conditions
Pro
fess
ion
al C
are
Case management
Patients who need a intensive level of attention
•Highly-complex chronic conditions
•End of life conditions
Innovation in care for chronic conditions
9
1. Identify and assign risk to chronic population
2. Adapt service portfolio
3. Plan and coordinate care across all care resources, using the methodology of case management
4. Guides and disease-specific protocols
5. Introduction, promotion and use of ICT
6. Evaluate and improve the quality, cost and service
7. Align incentives, resources and managing partnerships
Principles
Innovation in care for chronic conditions
10
Diagnosis
20 years
10 M
• Hospitalization
• Emergency
• Alternative
Clasification• CCS
• CCI
Consumos
<12 meses
• Hospitalization
• Emergency
• Alternative
• Ambulatory
Morbidity Profile
Predictive Model
Innovation in care for chronic conditions
11
Model capabilities versus total stays
Total stays Unplanned
stays
100% (87.236)
100%
75%
50%
25%
0%
79%(68.638)
40%(34.554)
26%(22.570)
Capita >14
170.540100 %
Pop. > 14
Unplanned
stays
Unplanned
stays
2.0001,2%
Hospital La Fe | Per capita stays |
Predictive Model for stratification
Innovation in care for chronic conditions
22
-
C. Inc
lusi
onSelf-Control
Self-Care
Case Manageement
Phone-visits
Doubts attention
Coordination
Education and Secundary Prevention
Program
AmulatoryCarewidothHome Care IB <30
Hospital at HomeHospitalisation
Acute
HospitalitationComplex
AmbulatoryCare Complex
Mediu
m s
tay
hos
pita
lita
tion
Inc
lusi
onC
rite
riae
-pPatient
Cuaregiver
Inc
lusión
Adapting care processes. "Case Management"
Case Management Nurses
Hospital
at Home
Unit
SpecialtiesServices
Medical
Area
Primary Health
Care Team
CareProfessional
13
IntegratedClinical Process
Practiceguidelines
Smart
Decissions
+KNOWLEDGE MANAGEMENT
ADAPT PRACTICE
REDUCE VARIABILITY
MAKING BETTER DECISIONS
Innovation in care for chronic conditions
Introducción, impulso y uso de las TiC
15
NOHMAD Chronic®.
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NOHMAD Chronic®
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Nº 1.900
% Women 48,1%
Age average 75,7
% > 75 years 63,6%
Nº systems 4,1
Nº diseases 6,3
Cardiac disease 57,4%
Diabetes 31,5%
Chronic Obstructive Pulmonary Disease 27,0%
Cancer 48,0%
Active Ingredients 9,0
% Palliative Care 50,8%
Following-up average (361,4-208,7-105,6)
Mortality (33,8-61,3-79,1)
Home mortality 70,2%
Continuous assessment
18
Unplanned staysconsumption
79%
Health-relatedQuality of Life
20%
Relative Riskfor before and after intervention
Continuous assessment
From a care load standpoint
21%
79%
Planned Unplanned
21%
53%
26%
Planned Unplanned Released
3
We are able to manage the demand
↓ direct costs
↓ indirect cost
↑ scheduled intervention
Assessment. Value proposition
Case Management Intervention
Improves healthcare.
Improves symptomatic control
Increases the quality of life of patients
Predictive Model. Complex subjects
1
Total staysUnplanned
stays
100% (87.236)
100%
75%
50%
25%
0%
79%
(68.638)
40%(34.554)
26%
(22.570)
Unplanned
stays
Unplanned
stays
20
2 4
Patientsincluded
Randomization
Branch AControl Group
198 patients
Branch BCase Management
198 patients
Branch CCase Management
Technology Nomhad99 patients
No intervention
Intervention Intervention
Processanalysis Satisfaction
Respourcesconsumption
Security
InterventionCost
Mortality
InterventionCost
Health-related
Quality of Life
100% patients included, End May-2014
Security analisis OK. 1st cut up results
Assessment. Clinical Trial
21
- Introduction
- Good practice
- Conclusions & Scaling up
Summary
22
23
Principles for scalability
1. Identify and assign risk to chronic population
2. Adapt service portfolio
3. Plan and coordinate care across all care resources, using the methodology of case management
4. Document disease-specific protocols
5. Introduction, promotion and use “smart” ICT
6. Evaluate and improve the quality, cost and service
7. Align incentives, resources and managing partnerships
Key factors
24
Principles for scalability
Innovation in care for chronic conditions
Valencia reference siteDr. Bernardo Valdivieso