Sveus konferens 25 november Melvin Samsom, Andreas Ringman Uggla, Karolinska Universitetssjukhuset
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1 Sveus konferens 25 november 2014 Melvin Samsom, Andreas Ringman Uggla, Karolinska Universitetssjukhuset 1
2 Value Based Health Care Melvin Samson Chief Execu4ve Officer Andreas Ringman Uggla Chief Health Care Delivery Officer
3 Patients always first
4 Variation in practise (Mulley AG. BMJ 2009) 4
5 Variation in quality 5- year survival stage I and II NSCLC - hospital of diagnosis Zizo indicators (survival rates) (hospitals) 5
6 Increasing costs 6
7 Fragmentation of patient care 7
8 A new world The patient of the future: From passive object to active subject From patient to person From non-entity to decisive entity The physician of the future: Doesn t call the shots, he provides a service From host to guest (Don Berwick) From God to guide (Bas Bloem) 8
9 Patient centered - Excellent quality - Personalized Health Care Value based Health Care 9
10 Value Based Health Care Outcomes that matter to patients Do we know what these outcomes are? Cost per patient = Value How do we assess their wishes in a comprehensive way? Are we able to deliver their need? Are we able to reinvent the system that we have build over the last 4 decades?
11 VBHC at Karolinska Outcomes that matter to patients Value based improvement process emanating from value for the patient group Costs & Resources Patient flow & standardised care programmes Infrastructure and enablers
12 Value based health care is based on five main elements Patientgrupp 1 Patientgrupp 2 Strategisk ledningsgrupp för vårdproduktion Patientgruppsspecifik kompetens Specialitet 1 Specialitet 2 Specialitet 3 AKM Karolinska Gemensamma centrala funktioner IVA B & F AnOp Lab Hälsoprof. ÖV SLV Nätverkssjukvården Externa aktörer PFA PFA PFA PFA-forum PFA PFA Forum för taktiskt styrning Patientgrupp 3 Patientgrupp 4 PFA PFA PFA Forum för operativ styrning FoU/U&I integrerat längs med hela patientflödet Focus on patient groups with responsible PFA Measurement of quality & cost Multiprofessional, engaged personnel and Patients Prioritization & cont. improvement Erfarenhetsutbyte Stöd Utbildning Utnämning Eskalering Beslut Clear and consistent governance Define patient group Decide on PFA Utilise all work done so far around the patient group Map out the process for the patient group Identify possible quality registers Define Parameters: Patient-relevant outcomes Costs Resources Processes Build the digital dashboard Clinical personnel the driving force behind VBHC-work, based on K s values All relevant disciplines and operations are involved The patients perspective is central Relevant external partners, i.e. med-tech companies Decisions based on results achieved Utilise tools for improvements: Research Education Innovations Developments Flow improvements Network healthcare Implementation and follow-up A holistic view of resources, patient flow and quality Transparency in all decision-making level of the organization Decisions taken at the lowest possible level 12 K-VBV - Patientgrupper_Projektgruppsmöte #4_10Nov2014_vFinal.pptx
13 The patient group is the key unit in value-based health care Individual patients......with similar conditions......jointly constitute a specific patient group E.g. Myocardial infarction ICD: I19- I21 Patient group 1 Patient group 2 Patient group 3 Patient group 4 13 Karolinska - workshop on organization_26nov2014_vsend.pptx
14 Result from mapping: 260 unique patient groups across Karolinska # patient groups Unique adult Shared Unique pediatric Total Baserat på antal patientgrupper i augusti 2014 totalsiffran har ändrats i pågående arbete Källa: Pågående inventering av Patientgruppskartläggning på Karolinska 2014 Karolinska - workshop on organization_26nov2014_vsend.pptx
15 Patient groups are typically one of three types diagnosis, symptoms or multiple factors Patient Patient group type Diagnosis Symptom Example and description Prostate cancer diagnosis or suspicions of diagnos can be confirmed at an early stage and is followed by distinct diagnostic and treatment activities Abdominal pain may be the result of a number of underlying conditions but similar diagnostic activities required regardless Multiple factors Elderly with multimorbidity require a holistic view and special care for their specific needs to be met 15 Karolinska - workshop on organization_26nov2014_vsend.pptx
16 79% of inpatient days quantified 20 patient groups account for 35% of total volume 79% of all treatment days quantified The 20 major patient groups account for ~ 35% of all treatment days % Treatment days , ,000 9,000 8, , , ,000 4,000 3,000 2,000 1,000 0 Kvant. Ej väldef. Ej kvant Tot 0 Patient groups 16 Karolinska - workshop on organization_26nov2014_vsend.pptx
17 Childbirth, premature infants, heart disease and cancers are the largest groups Patient group Treatment days ~# Beds Normalgraviditet Stroke Lymfoid sjukdom Svåra luftvägsinfektioner Hjärtsvikt Hjärtischemi Måttligt underburna barn CNS-tumörer Primär lungcancer Njursvikt Myeloid sjukdom Hjärtklaffsjukdom Höftfrakturer Sepsis Frakturer i bröstkorg, ryggrad 2 CNS-aneurysm Konfusion Extremt underburna barn Gallvägssjukdom Kognitiv svikt Karolinska - workshop on organization_26nov2014_vsend.pptx
18 To enable the transformation a new role has been designed at Karolinska Patientflödesansvarig PFA Register based research project shows that method A > method B INTERNAL KAROLINSKA Innovationcooperation on telecare enables 20% higher outpatient care EXTERNAL KAROLINSKA Patient flow Outcome Cost = Value Faster emergency care through improved flow on X-ray Research results can be applied directly through training in the patient flow group Rehab-chain with external parties require monitoring outcomes across care providers
19 A decision support tool has been developed in-house that integrates outcomes metrics with resources and costs
20 Today 10 pilot groups ongoing at Karolinska Pilot group Patient group defined Main person responsible identified (PFA) Objectives agreed upon Multidisciplinary & -professional group identified Current status for patient flow mapped Outcomes and process metrics selected Resources and costs for patient flow mapped Continuous improvement initiated Acute Myocardial infarction Tomas Jernberg Rectal cancer Torbjörn Holm Newly diagnosed Rheumatoid Arthritis Cecilia Carlens Pre-term infants BouBou Hallberg Ischemic stroke Christina Sjöstrand Prostate cancer Ingrid Ehrén Congestive heart failure Eva Mattsson Breast cancer Irma Fredriksson Breast pain TBD: Umut Heliborn First Symptom based patient group = Done = In development = Challenge encountered
21 Goal: 80% of our defined patient group volumes guided by VBHC-principles by % Goal 2018 New Karolinska 35% Half-time % TODAY Karolinska - workshop on organization_26nov2014_vsend.pptx
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