Personal Health Systems and COPD how to integrate into routine health delivery? From HealthCare to Health Promotion Josep Roca Hospital Clinic.IDIBAPS.University of Barcelona
HIGHLIGHTS CHALLENGE OF CHRONIC DISEASES A NEW RESEARCH PARADIGM TOWARD PERSONALIZED HEALTH
Catalonian healthcare system Agenda
Catalonia 7.5 million habitants Barcelona
The adaptation of the Catalonian Healthcare System to the new scenario generated by Chronic Disorders is a political mandate Health plan 2007-2015 Burden of Chronic Disorders Elderly populations Co-morbid conditions Cost containment Coordination with community services
Agenda Setting the change (2000-05) Catalonian healthcare system
Shared care across the system Hospital Emergency team Consultant Case Manager Primary Care Home Patient Relatives & care givers Mobile teams Primary Care Team
Services Target patients Management by programs Well standardized interventions Patient-centered care Patient Triage Self-management Remote monitoring Support center providers network
A frame for a Program - Patients get access to an authorized center - Patients are assessed for entry into a program - Patients are monitored and followed up through mobile technology and internet. Interoperability Integrated Health Networks Bio-connectivity Professionals Patients
Information technologies supporting - enhanced citizens life style - well standardized care paths resulting in integrated care strategies for chronic patients Modulation of disease progress Efficient patient management
INTERVENTIONS Pilots and Services HOME HOSPITALIZATION PREVENTION OF HOSPITALIZATIONS HOME MONITORING HOME REHABILITATION HIGH QUALITY SPIROMETRY IN PRIMARY CARE TELE-DERMATOLOGY SLEEP STUDIES
Summary of Clinical Trials Clinical efficacy Behavioural changes Satisfaction Cost containment Improved prognosis?
Activity organized by care programs including clusters of diseases Cardiovascular Respiratory Diabetes - Obesity Fragile patients
Technological challenge Organizational challenge
Agenda Setting the change (2000-05) Deployment plan Catalonian healthcare system
Intramural program (consolidated within 2007) Transversal Unit Chronic Care Medical Direction Open I.T. Platform Linkcare spin off Supporting chronic care: modular & interoperable Biomedical research program IDIBAPS BioCat Educational program (professionals and patients) Forum Clinic
FOCUS Prevention Chronic diseases Dependency children adults elders
INTEROPERABILITY AMONG PROVIDERS Level A - Barcelona Esquerra Level B - Spain and Europe Patient summary record and electronic prescription BARCELONA ESQUERRA 540.000 habitantes EAPs ICS EAPsCAPSE EAP Gesclínic EAP Les Hortes EAPsVallplasa Hospital Clínic Hospital SagratCor Clínica Plató CAP II Manso (ICS) CAP II Numància(ICS) 3C 5D 5E 4C 5C 4B 5A 5B 4A 3E 3G 2E 2C 3D 2B 2D 2A 3B 3A 18 ABS y 2 CAPs II (5 empresas distintas) 4 Hospitales 1 Centro Sociosanitario principal y otros de menor dimensión 3 Proveedores de Salud Mental Servicio de Emergencias Médicas de Cataluña
The Vision Deployment at Barcelona Esquerra
Deployment at Barcelona Esquerra 2009: Hospitals vs territorial healthcare HOSPITAL Community Care Process Units Transplant Dementia COPD CHF Territorial Healthcare Family Physician Nurse Social Worker Home Care
Institutions representative Deployment at Barcelona Esquerra 2009: Territorial Health Care Comission Barcelona Esquerra Permanent Comission Redesign Implementation & follow-up Technical Management Team Process 1 Process 2 Process 3 Process 4 Emergencies Specialized Care Social Care Health Transport Home Care Pharmacy Mental health Pediatric care IT Operational Committees
NEXES (Telemedicine program EU) RENEWING HEALTH (Telemedicine program EU) PITES (FIS, Carlos III)
Current Deployment at Barcelona Esquerra Main services deployed Wellness & Rehabilitation Frailty Transitional care Palliative care Home hospitalisation Support
Need for stratification by patient s risk profile Use of resources Disease phenotypes
New drivers A new paradigm in Biomedical Research: from bedside to bench and back to bedside
Agenda Setting the change (2000-05) Deployment plan Catalonian healthcare system Toward personalized care Summary
Roadmap System Medicine Programme Public Health Process redesign 1996 Research and pilots 2000-06 Deployment at Clinic 2007: Integrated Care Unit Linkcare platform Deployment at Barcelona Esquerra 2009: Sistema Informació Sanitari (SISBE) Problem-oriented information system Towards extensive deployment and adoption (from 2009) Ambient Assisted Living