the smart specialised paediatric hospital of the future€¦ · ern hospital managers mtg (paris)...
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Ruben Diaz, MD, PhD Secretary General
European Childrens Hospital’s Organisation (ECHO)
The Smart Specialised Paediatric Hospital of the
Future
16th May 2019 ERN Hospital Managers Mtg (Paris)
Conflict of interest
I have no actual or potential conflict of interest in relation to this presentation
Pediatric population is decreasing due to decreasing birth rates representing a smaller fraction of the population
Source: OECD 2018
Impact of population aging and increased incidence of chronic illness on healthcare spending puts the focus on allocating resources for the older population
Pediatric Hospital Model
Standalone Hospital University Hospital Pediatric Center
University Hospital Pediatric Center Standalone Hospital
Models of pediatric clinical care favor an environment amenable to children and their families in a setting where there is concentration of medical and nursing expertise
The evolution of a Children´s hospital
Concentration of pediatric tertiary care increases the overall complexity in
children’s hospitals
Impact of Rare Diseases
Rare Disease (RD) Patients vs. the remaining case load
0%
20%
40%
60%
80%
100%
Número de Pacients Utilització de Recuros
Resta
MM
Patients 8%
Resources 30%
Remaining Caseload RD
SJD Case Study
80% of rare diseases have a genetic component and often the diagnosis is made in childhood, placing the weight of diagnosis and clinical care in tertiary pediatric centers
Tertiary Care Profile (Present and Future)
Multidisciplinary clinical teams with high degree of
specialization Evidence-based medicine
focused on outcomes
• Training of pediatric medical and nursing specialists • New competencies in clinical care • Simulation methodology
Human Resources
• Lack of comparable peers within each EU country to benchmark operations and results adapted to pediatric care models. Need for pediatric hospital networking to compare operations and share best practices
• Development of well-established clinical and patient-reported pediatric centered outcomes.
Clinical Operations
• Introduction of patient experience metrics in the design and evaluation of clinical services
Patient/Family centered care
Infrastructures to accommodate for high
complexity and incorporate and evaluate different treatment
modalities
Tertiary Care Profile (Present and Future)
• Increase in high acuity spaces for complex care • PICU beds • Operating rooms
• Digitalization and development of AI capability to track and analyze patient data
Infrastructures
• Incorporate capacity for • Cell-mediated therapy • Gene therapy • High resolution imaging • ……….
• Value-assessment (Value-based care)
High Technology Treatments
• Development of clinical research units to run academic and pharma-sponsored clinical trials • EU-funded c4c platform
Clinical Research
Tertiary Care Profile (Present and Future)
Expanding referral area & outreach capacity
• Development of patient portals • Telemedicine
Patient Access
• Physician-Physician teleconsultations • High-level acuity telemonitorization
• ICU monitoring
Specialized Consultations
6.998 14.627
23.711 29.631
39.500
2,9%
5,8%
9,1% 10,7%
13,8%
0,0%
2,0%
4,0%
6,0%
8,0%
10,0%
12,0%
14,0%
16,0%
0
5.000
10.000
15.000
20.000
25.000
30.000
35.000
40.000
45.000
2014 2015 2016 2017 Prev2018
Highlights • Faced with a decreasing birth rate across Europe, tertiary care children’s hospitals
are consolidating their mission by concentrating complexity and expertise and becoming reference centers. A bigger challenge is financing the high cost of care for their patient mix within the different payment models across the EU.
• Diagnosis and treatment of rare diseases is a high cost enterprise
• Clinical care requires specialized clinical training highly in demand and often not easily available.
• Quality improvement and benchmarking requires collaborative work among peer hospitals of similar profile to identify best outcomes and help hospitals improve value. There is increased focus on improving patient experience as a measure of increase value for patients.
• By becoming tertiary care hubs, the implementation of high level technology can be cost-effective. A culture of innovation is promoted to improve clinical care.