Valcronic: Optimising the Efficiency and Quality of Health Services in Valencia

Valcronic: Optimising the Efficiency and Quality of Health Services in Valencia Luis Eduardo Rosado Bretón Health Minister of Valencia Brussels, 28 November 2012 1

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VALENCIAN HEALTH AGENCY 40% Regional Budget 24 Health Departments with at least one reference hospital. 18 Direct management 5 PPP 1 Consortium 34 Hospitals 28 Acute 6 Long-Term Care 1318 Care centers More than 60,000 workers 3

The care for chronic patients in the Valencia region represent: 80% of primary care consultations 60% of hospital admissions 2/3 of patients use emergency services 5,1Mill. inhab (10.6% of Spain) 16.7% of population +65 years High consumption of drugs Source: Spanish National Statistics Institute (INE). 4 4

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The ValCrònic program is an initiative from the Valencia Health Agency to improve chronic patients care that relies on the use of new technologies and a shared actuation model in Primary Care, and that involves different levels of care. The Program includes both types of interventions: 1) control and monitoring of chronic illness through patient telemonitoring and 2) improving healthy lifestyles and promoting self-care through educational health content. 6

Pre-Service preparation Pre-service Deployment and execution Service Extension Continuity and Growth June 2011 Febrary 2012 Dec 2012 Jan. 2013 dec 2013 Jan. 2014 2 health departments, 1000 high and moderate risk patients Sagunto Department: Population: >150.000 habitants Specialized care: 1 hospital (250 beds) + 1 specialties center Primary care: 11 SC+ auxiliary centers Elche Department: Population: >165.000 inhabitants Specialized care : 1 hospital(484 beds) + 1 specialized center Primary care : 6 CS + auxiliary centers KPI evaluation Extension of the new model to other health departments Impact analysis and evaluation results KPI evaluation Patients and pathologies Consolidación extension del servicio 7

1 2 Improve the quality of care for chronic patients Improve efficiency and effectiveness of care Improves communication with the patient Provides access to more information for therapeutic education Improves the degree of control and self-management of chronic diseases Improves performance of health center visits Decrease of bureaucratic or low performance visits 3 Anticipate deterioration and decompensating of patients Prevents and avoids hospital admissions (cost optimization) 4 Improve communication between professionals Development of joint ways of communication, agile and resolute between involved agents 8

TOTAL: 1.000 (+10.000 low risk) patients Devices Education and self-care support Biometric devices 1000 patients High Risk Tablet Pc Moderated Risk Smartphone 10.000 patients Low Risk Web Site 9 9

Outpatient care Hospital Care Pharmacy CARS Segmentation 10

1 2 3 4 TYPE 2 DIABETES MELLITUS CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) HEART FAILURE (HF) HYPERTENSION (HT) Combination of conditions Risk Level High Moderated Low ISOLATED HF (except HT) ISOLATED COPD ISOLATED DIABETES ISOLATED HYPERTENSION FH+ COPD HF+ DIABETES DIABETES + COPD COPD+ AHT HF+ COPD + DIABETES DIABETES + HT 11 11

Main KPI Secondary KPI 1 Primary care frequentation 1 Degree of diseases control 2 Hospital Emergency Attendance 2 Adequacy of hospital admissions 3 Non-Hospital Emergency Attendance 3 Quality of Life 4 5 6 Hospital admission Average hospital stay Home visits 4 5 Technological issues Average patients call time 7 8 9 Interconsultations Enabling of shared action Satisfaction (patients and professionals) 10 Mortality 12 12

Patient s home-generated data is sent to professionals at health centers through the corporate official Electronic Health Record (Abucasis) Telemonitoring Blood pressure Weight Glucose Oximeter Heart / respiratory rate Health questionnaires Values out of range generate alerts launching Red Flag in Abucasis Yellow flag in Abucasis 13

HOME CARE NEW MODELS OF NURSING CHRONIC PATIENT PRIMARY CARE CENTER ACUTE HOSPITAL UHD CONTINUOUS CARE (PAC/ PAS) / HOSPITAL EMERGENCY / CICU TELEMONITORING HACLES NEEDS ASSESSMENT PATIENT PROPER GUIDANCE RESOURCE CUSTOM CARE PLAN GERIATRIC CARE 14

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545 patients enrolled 456 Patients receiving the service o 388 High risk programme. o 68 Moderate risk programme Dropout rates 15% High level of patient s satisfaction and their families. More than 150 primary profesionals (nurses, doctors). care 16

Santa Pola s Health Center implements Chronic Management Plan 17

Keys to innovation Selfcare, as an essential part of the assistance. Monitoring: Continuous and integrated monitoring based on the conditions of the patient, and the place and time of the prescription. Intensive application of the TICs,both for the patient and professional. Traditional model Face to face Reactive medicine Passive patient Focused on recovery Fragmented Synchronic Data generator New model Ubiquitous Proactive Medicine Active and informed Focused on prevention and care Connected and integrated Asynchronous Smarter 18

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Male, 81 y.o, ischemic heart disease, heart failure II NYHA, severe COPD. Valcronic: COPD+ Heart Failure; High risk. Automatic alerts, without patient interaction, thanks to: Dyspnea questionnaire, cardiac questionnaire, pulse oximetry 92, weight gain alert. The patient confirms the alerts and the doctor proactively goes to the patient s address. In the very next two days the patient improves the pulseoximetry and the dyspnea questionnaire, and the weight decreases,. The diuretics remains another week, as prescribed in the hospital. The patient does not goes to the hospital and does not goes to emergencies. Male 83 y.o.,hypertension, severe COPD, home oxygen, LABA LAMA salbutamol on demand, tachycardia on pulse oximetry that does not match with frequency tensiometer. Home visit: dyspnea, arrhythmic tachicardia, probable ACFA, edemas to mid tibia. The patient does not want to go neither the health center nor the hospital (The doctor takes the ECG from the hospital and the patient is in ACFA); the patient does not want to go to the bank for anticoagulation (the doctor talks with the Internist and both antocoagulate taking samples in home address. Frequancy controlated with amiodarone; furosemide added. Heart rate maintained at 85 rpm and reduced edemas. 21

Male 84 y.o., COPD and hypertension, with 92 pulse oximetry yellow alert, no forms filled out. Home visit, increase bronchodilators, short term, corticosteroids (dacortin), antibiotics. New control in 48 hs. 94%. New control in 48 hours 97%. Patient 79 y.o. male COPD and hypertension. Nurse detects bradycardia in pulse and in blood pressure ECG: BAVC (bloqueo AV completo) is requested SAMU e income and ingreso marcapasos definitivo. 22

The Valencian Community has a wide experience in the implementation of public-private partnerships models. >20% of the population attended under a concessional model 23

1. Gearshift for transforming the system Patient oriented Focused on primary care. 2. Improves the care and the quality of life Improves the comfort and the quality of life. Improves the clinical outcome 3. Contributes to the sustainability of the system. It does not requieres parallel welfare device. It does no a parallel emergency system. It does not generate a parallel EHR. Fully integrated with corporate information systems. 4. Based in the public-private partnership. 5. Early results The patients tolerate very well the technology. The assessment of the patients and their family is very good. The preliminary assessment provides a improvement in the disease and in the efficiency of the care. 24

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