Innovative approaches in community-based care to improve clinical outcomes.

Transcription

1 Innovative approaches in community-based care to improve clinical outcomes. Maria Chiara Corti Direzione Attuazione Programmazione Sanitaria Dpt. Health Care Resource Planning Regione Veneto

2 The Regional Health Service in Veneto Provincia Rovigo Verona Padova Venezia Treviso Vicenza Belluno LHU 22 LHU 4 LHU 5 LHU 20 LHU 21 LHU 1 LHU 2 LHU 7 LHU 3 LHU 8 LHU 9 LHU 15 LHU 6 LHU 12 LHU 13 LHU 16 LHU 17 LHU 14 LHU 18 LHU 19 LHU 10 The Regional Health Service (Servizio Sanitario Regionale, SSR) provides universal health coverage to all resident citizens through the Local Health Units (21 Trusts in the Region). LHUs are financed based on a capitation system so far adjusted only for age, gender and geographic area (mountain, islands ). segreteria regionale per la sanità, regione veneto About health care professionals over hospital beds *

3 n Adjusted Clinical Groups (ACG) in Veneto Region VERON A PADOV A In April 2012, the Veneto Region, in collaboration with the Johns Hopkins University in Baltimore, started a pilot use of the Adjusted Clinical Groups (ACG) system in order to better measure the case-mix in the population 1 million inhabitants, 20% of the Regional population segreteria regionale per la sanità, regione veneto

4 The Veneto Region population ETÀ N % MEDIANA MODA MEDIA RAPPORTO DI GENERE (M/F) Assistiti ,13 1,09 Maschi ,44 Femmine , Males Females

5 Demographic indicators Trends ,Veneto Region 25% Figura 1.11 Percentuale popolazione di età superiore ai 65 anni sul totale rilevato nei censimenti dal 1961 al 2011 e linea tendenziale di crescita (Fonte: Istat) Proportion of population aged 65 years and more Old dependency ratio (pop 65 /pop15-64)x100 Year 1961:13,8% year 2011: 31,6% 20% 15% 10% Ageing index (pop 65 /pop 0-14)x100 year 1961: 37,2% year 2011: 144,5% 5% 0% % Over 65 9,1% 10,8% 12,9% 15,4% 18,3% 20,6% Source: censuses ISTAT ( Italian Institute of Statistic ) 5

6 % Prevalence distribution by presence of Chronic Conditions age > 65 in Veneto patologie UOMINI media =1.8 DONNE media =2.4 PROVA : Progetto Veneto Anziani M.C. Corti et al, JAGS,

7 The pyramid of health needs in the comunity PALLIATIVE CARE COORDINATED DISCHARGE CASE MANAGEMENT END OF LIFE MULTIMORBIDITY INSTABLE ACUTE MAJOR HOSPICE, COMMUNITY HOSPITAL COMMUNITY ACUTE HOSPITALS, INTENSIVE CARE SPECIALIST CARE REFERRAL AND COORDINATED CARE MULTIPLE CHRONIC CONDITIONS, STABLE COMMUNITY HOSPITAL REHABILITATION SPECIALIST CARE DISEASE MANAGEMENT SINGLE CONDITION, LONG TERM PRIMARY CARE REHABILITATION DIAGNOSIS HEALTH PROMOTION Health Management Tool DEVELOPMENT OF SYMPTOMS WELL PRIMARY CARE COMMUNITY PREVENTION Health Care Setting

8 The pyramid PALLIAZIONE 5= Very high 1% of health needs weight 10,2 COORDINAMENTO CURE CASE MANAGEMENT COORDINAMENTO CURE DISEASE/CASE MANAGEMENT PDTA, DISEASE MANAGEMENT 4 = High 3,5 % 3 = Moderate 17,4 % 2 = Low 17 % weight 5,1 weight 2,4 5 Resource Utilization Bands=RUBS weight 0,9 DIAGNOSTICA DIFFERENZIALE 1 = Healthy users 44,2 % weight 0,3 PROMOZIONE SALUTE SCREENING HEALTH MANGEMENT TOOL 0= Non users 16.8% weight 0 Local weight

9 Population and costs by RUBs 100% 90% 20% 80% 70% 60% % 5. Very High 4. High 3. Moderate 50% 40% 30% 20% 10% 0% % population % costs 2. low 1. Healthy users, no diagnosis 0. Non users

10 Disease EDC EDC (EDC) per per RUB RUB by RUBs Contusions and abrasions Multiple sclerosis Rheumatoid arthritis Chronic renal failure

11 Costo Totale medio 1, ,566 3,882 % assistiti 5,182 6,527 9,455 Co-prevalence of chronic conditions and costs in Veneto 10, , , , , Più di 5 Costo Totale medio N. Chronic conditions 0 11

12 Costs : % cumulative distribution MORE THAN 60% OF RIESOURCES ARE USED BY 8% OF THE TOTAL POPULATION TARGET FOR CASE MANAGEMENT)

13 PIANO SOCIO-SANITARIO REGIONALE NEW PLAN FOR HEALTH AND SOCIAL CARE IN VENETO REGION ( )

14 NEW PLAN FOR HEALTH AND SOCIAL CARE IN VENETO REGION ( ) 26,000 beds RESIDENTIAL SERVICES HOME PRIMARY CARE Answering to the changing PALLIATIVE CARE needs of an aging population SPECIALIST CARE with increasing multimorbidity HOME CARE 3,5 beds per for acute care 0,5 for rehabilitation care INTERMEDIATE CARE 1,2 beds per 1000 H O S P I T A L DISTRICT LEVEL PRIMARY CARE 14

15 Integration between hospitals and primary care: intermediate care Country hospital (stabilization and adaptation to recent disability) Rehabilitation Unit (functional recovery) Hospice (palliative care) A place closer to home Focused on function rather than diagnoses and procedures Prognostic trajectories for patients with multi-morbidity 15

16 Care Management List Patient Id Age Sex Total Cost Rescaled Total Cost Resource Index Probability High Total Cost Probability IP Hospitalization ,50 16,0 0,9 0, ,71 16,6 0,9 0, ,53 12,8 0,8 0, ,10 11,8 0,8 0, ,98 11,5 0,8 0, ,59 10,4 0,7 0, ,62 10,5 0,7 0, ,44 10,6 0,7 0, ,98 10,6 0,7 0,3

17 ACG generates patient summaries (1)

18 ACG generates patient summaries (2)

19 Pilot use of Guided Care Model Piloting the training of nurses as case managers in 2013 Targeting the 100 most complex patients in a practice Will work in the same place as GPs Online course for nurses and GPs. Will be adapted to the Italian environment Possible extension to 6 LHUs in the 2014.

20 Hospital vs primary care : a dichotomy of the past Emergency Room Outpatient Imaging Primary Care Medicina Cardiologia Neurologia Orthopedics. Health District Prevention Surgical ward Surgery OR ICU Pediatria Geriatric ward Fonte: Edwards & McKee Obgyn Lab and Path 20

21 Building bridges between hospital and primary care: today s scenario Cure Primarie Imaging Maternal And Child Prevention DH & DS Outaptient clinics Trauma Imaging OR. Triage Lab. Path. Medical Obstetrics Intensive Care Pediatrics Imaging Lab. & Path Nursing homes Intermediate and & Rehab Semintensive Acute OR DH & DS Fonte: Edwards & McKee Primary Care ICU Specialty Hospital 21

22 Health care in the future: planning for the change Case Manager Imaging Lab & Path Primary Care Diagnostica Outpatient specialty clinics Intermiediate Rehab and residential care Fonte: Edwards & McKee Transitional teams Disease management OR. Imaging ICU ER Observ. Semintensive Intensive S.O. Specialty Imaging High Spec. Lab. & Path 22