Presentation, Harvard, Value Based Care
Upcoming SlideShare
Loading in...5
×
 

Presentation, Harvard, Value Based Care

on

  • 391 views

Presentation at Harvard, ISC, 2011

Presentation at Harvard, ISC, 2011

Statistics

Views

Total Views
391
Views on SlideShare
391
Embed Views
0

Actions

Likes
0
Downloads
0
Comments
0

0 Embeds 0

No embeds

Accessibility

Upload Details

Uploaded via as Microsoft PowerPoint

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment
  • Vi kan från start till döden CO-morbitiites: hjärt och kärl, osteoporosis, KOL, cancer, lymfom, malignt melanom. Hypothesis based on the literature, these conditions higher frequence among RA population. Well known co morbidities. They may not be influencing the outcomes or costs significantly.side effects of medication.

Presentation, Harvard, Value Based Care Presentation, Harvard, Value Based Care Presentation Transcript

  • Operationalizing value in Chronic Care: The case of Swedish Rheumatology
    • A research project involving Karolinska Institutet/Medical Management Center, Stockholm University School of Business, Karolinska University Hospital, Stockholm County Council and Harvard Business School.
  • The cycle of disease: Rheumatoid Arthritis REHAB- SERVICES Lifestyle & self-medication - SPECIALIST CARE LAB TESTS X-RAY HOSPITALIZATIONS
  • DAS28 (Disease Activity) Time
  • Disease cycle captured in the SRQ registry
  • Disease cycle captured in the SRQ registry REHAB- SERVICES
  • Capturing the entire disease cycle
  • Prioritizing measures based on the stage of the disease: defining two phases
  • First phase of disease: reaching low or no disease activity Early & aggressive treatment
    • Aims, phase 1
    • Response by DAS28CRP or patients global
    • Treatment to reach low or no disease activity
  • Second phase: long-term management and prevention Maintain low DAS28
    • Aims, phase 2
    • Low level of disease activity (Area under the curve, AUC),
    • Patient satisfaction with outcomes: trust in care, quality of life (EQ5D/QALY)
  • Second phase: long-term management and prevention Detect and curb flares
    • Number, intensity and duration of recurrences (flares).
  • RA outcome measures in the three tiers
    • Survival – Mortality
    • Health / recovery – Patients global, EQ-5D, Work ability, Daily function,DAS28, AUC Doctors global
    • Time to recovery – Time to remission, time to work ability regained
    • Disutility of care / Rx – Trust in care, Drug adverse events
    • Continuity, empathy, access etc?
    • Sustainability of health / flares – Health / recovery AUC
    • Long-term consequences of therapy – Patients global, EQ-5D, Work ability, Daily function,DAS28, AUC Doctors global, adverse events, co-morbidities
    • Control for case-mix variables (gender, age, biomarkers, socio-economic status etc)
  •  
  • Cost per patient - RA 2009 Karolinska data
    • Costs – not charges
    • Number of out-patient visits 45 404
    • Total cost 157 692 215 SEK
      • Medical service 9 481 442 SEK
      • Operation 1 917 123 SEK
      • ICU 13 311 SEK
      • Drugs 93 835 356 SEK
      • Visits 52 444 983 SEK
  • Costs – micro level
    • Stockholm County Council data sources: In-patient and out-patient data and cost per patient (CPP). Figures will be added.
  • Questions to discuss
    • Delimiting the medical condition and care cycle
    • Using the available data to operationalize value
      • Prioritizing outcomes and cost measures
      • Ensuring that measures are useful and acted upon
    • Flexibility: adjusting to new treatment goals
    • “ Patient´s choice” – reimboursement chronic care
      • Incentives for telephone follow ups
      • Self care
    • Research question(s)
    • Publication possibilities
  • Thank You!
    • Sofia Ernestam, [email_address]
    • Anna Essén, [email_address]
    • Martin Neovius, [email_address]