Impact of the Provision of Social Carewithin a Palliative Care Programmeon Healthcare Costs: The SAIATU Project
The coordination of social and health resources in palliativecare is not an element of excellence, but rather a necessity....
Background & Scope of the Project                                     The SAIATU Project:                                 ...
General Comments                       Pilot studies in palliative care have been successful                       in term...
What is required?
Description & Analysis of the   SAIATU Programme
Description & Analysis of the SAIATU Programme                Methodology                                      •  National...
Description & Analysis of the SAIATU Programme    Overview of the Results         Description of the                Analys...
Description & Analysis of the SAIATU ProgrammeDescription of the SAIATU Programme                               A. Backgro...
Description & Analysis of the SAIATU ProgrammeDescription of the SAIATU Programme                             C. Objective...
Description & Analysis of the SAIATU ProgrammeDescription of the SAIATU Programme                                         ...
Description & Analysis of the SAIATU Programme                                                   F. Human Resources & Role...
Description & Analysis of the SAIATU Programme  Description of the SAIATUSAIATU  Descripción del programa Programme       ...
Description & Analysis of the SAIATU programmeprogramm                                                    Period        A....
Description & Analysis of the SAIATU programme      Programme Activities                                     Social       ...
Description & Analysis of the SAIATU programme      Programme Activities                                              C. A...
Description & Analysis of the SAIATU programme    Programme Activities            Assessment of         C. Admisison to th...
Description & Analysis of the SAIATU programme          Programme Activities                                              ...
Description & Analysis of the SAIATU programme          Programme activities                                       E. Data...
Description & Analysis of the SAIATU programme          Programme Activities                             F. Use of Resourc...
Description & Analysis of the SAIATU programme          Programme activities                   G. Preferences & place of d...
The Programme s Impact onUse of Healthcare Resources                               In these difficult economic times, the ...
The Programme s Impact on Healthcare Resourcesuse Retrospective observational cohort study on the intensity of care (resou...
Comparative Analysis of the Intensity of Healthcare  Differences in Intensity of Healthcare between the 3 groups: Primary ...
Comparative Analysis of the Intensity of Healthcare.  Differences in Intensity of Healthcare between the 3 groups: Special...
Comparative Analysis of the Intensity of Healthcare                                  No. of outpatient appointments       ...
Comparative Analysis of Costs related to the Intensity of Healthcare                      SAIATU                   PC+SC  ...
Conclusions                          - The present project organises the new portfolio of services                        ...
“The   inclusion of social services in the        provision of palliative care is the                natural way to expand...
Enterprising Solutions for Health (EH) S.L.        Edificio Galia Puerto, 1ª Planta Crtra. de la Esclusa, 11. 41011 Sevill...
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Saiatu brief

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Saiatu Project presentation. First amazing results.

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  1. 1. Impact of the Provision of Social Carewithin a Palliative Care Programmeon Healthcare Costs: The SAIATU Project
  2. 2. The coordination of social and health resources in palliativecare is not an element of excellence, but rather a necessity." Herrera E ( Washington, 2006 World Cancer Congress)
  3. 3. Background & Scope of the Project The SAIATU Project: In-home social support services complementary to palliative c linical ser vices , to improve the comprehensiveness of care provided to individuals with advanced terminal illnesses & their families -  Description of the specialised services offered to end-of-life patients & their families under the SAIATU Programme -  Costs of the various services that have been provided under the SAIATU Programme -  Satisfaction of family members with the care received under the SAIATU Programme - Impact that the SAIATU Programme could have on the use of healthcare resources (including cost savings) in the care of end-of-life patients  www.es-health.com
  4. 4. General Comments Pilot studies in palliative care have been successful in terms of quality, effectiveness, efficiency & cost- savings. The prevalence of chronic illness & lack of home carers should start to stimulate the development, within palliative care, of sufficient support from social community support networks to ensure that healthcare provided is actually useful. It is necessary to set up projects that respond to this reality & make an effort to assess their effectiveness & efficiency.  www.es-health.com
  5. 5. What is required?
  6. 6. Description & Analysis of the SAIATU Programme
  7. 7. Description & Analysis of the SAIATU Programme Methodology •  National & international experience to date on social care & accompaniment in palliative care •  Scientific literature, websites of related institutions & organisations Document •  Idenfication of successful programmes, tasks, roles, human resources, pilot analysis studies, etc. •  Questionnaire •  Face-to-face interveiws with professionals Qualitative •  Types of services & the way they are provided, roles/tasks of the professionals, training, description of the programme, etc. analysis •  Review of records •  Retrospective analysis •  Demographic characteristics, social value, admission to the programme, Quantitative activities, bereavement, place of death, etc. analysis  www.es-health.com
  8. 8. Description & Analysis of the SAIATU Programme Overview of the Results Description of the Analysis of the SAIATU Programme Programme Activities A. Background B. Programme Vision & Mission A. Population C. Objectives B. Sociodemographic Characteristics D. Beneficiaries C. Admission to the Programme E. Portfolio of Services D. Data on Activities F. Human Resources & Roles E. Data on Costs H. Organisation of the Activities F. Use of Resources I. Documentation & Data G. Preferences & Place of Death Management System H. Family Satisfaction J. Cost Structure ¿Qué necesidades hay?
  9. 9. Description & Analysis of the SAIATU ProgrammeDescription of the SAIATU Programme A. Background B. Programme Vision & Mission Programme for specialised in-home social care connected with palliative care, tailored to the needs of individuals with advanced illnesses & their families. “ To provide specialised “To broaden our palliative support & accompaniment care framework from a to patients with terminal social perspective in order illnesses & their families Mission to provide high-quality care through a continuous social Vision that responds to the social care service to enable needs of patients & their patients to stay at home families” during the end-of life phase” ¿Qué necesidades hay?
  10. 10. Description & Analysis of the SAIATU ProgrammeDescription of the SAIATU Programme C. Objectives1. To provide support, face-to-face &/or by telephone, for thecare & emotional accompaniment of patients & families at anytime of day, even at night (in exceptional circumstances), everyday of the year2. To collaborate with other palliative care resources in theBasque Country to ensure comprehensive care throughspecialised social support3. To facilitate in-home care & meet the wishes of patients whoprefer to die at home & their families, alleviating pain & offeringaccompaniment & support in the care of physical symptoms, aswell as emotional & social needs4. To support family members throughout the course of theillness & after the death in the bereavement period
  11. 11. Description & Analysis of the SAIATU ProgrammeDescription of the SAIATU Programme D. Beneficiaries E. Portfolio of services Definition of the target population Patients with cancer Patients with progressive chronic illnesses Portfolio of services Care protocols Patients Accompaniment Monitoring of symptoms Information Respite care Bereavement support Communication Care support BADLs ¿Qué necesidades hay? Family members 24x7x365 Specialised care
  12. 12. Description & Analysis of the SAIATU Programme F. Human Resources & RolesDescription of the SAIATU Programme H. Organisation of the Activities   I. Documentation & Data Management SystemHuman Resources & Roles Organisation of the Activities Provision of services Coord -  Face-to-face -  By telephone Referral of patients Shared Nurses Doctors (RNs & Operation of the programme Roles aux.) Documentation & Data Management System Social Workers Description of the documentation system ¿Qué necesidades hay?
  13. 13. Description & Analysis of the SAIATU Programme Description of the SAIATUSAIATU Descripción del programa Programme J. Cost structure Total costs of the SAIATU ProgrammeITEMS To 31/12/2011 % of total costs To 31/10/2011Personnel costs 114,826.69 68.5% 97,536.82Insurance 955.35 0.6% 781.65Health & safety measures 165.20 0.1% 135.16Medical examinations 312.00 0.2% 255.27  Consultancy/Advice 599.43 0.4% 490.44Telephone charges 1.472.72 0.9% 1,012.37Total 118,331.39   70.5% 100,211.72 UNFORESEEN ADDITIONAL COSTS To 31/12/2011 % of total costs To 31/10/2011Training/Education 3,000.00 1.8% 2,250.00Co-working costs 990.00 0.6% 810.00 ¿Qué necesidades hay?Communication costs 2,485.00 1.5% 2,033.18Salary increases (new pay deal) 42,924.08 25.6% 35,119.70
  14. 14. Description & Analysis of the SAIATU programmeprogramm Period A. Population Programme Activities Feb-Oct 2011 B. Sociodemographic characteristics n = 40 Marital statusMean age: 75 years old[SD11.89] Cancer diagnoses: 90% (n=35). Non-cancer diagnoses: 10% (n= 4) Urotelial Urothelial 2,9% . Rectum Recto 2,9%Pleural Mesothelioma Amyotrophic lateral sclerosis Mesotelioma pleural 2,9% . Oesophagus Esófago Squamous cell 2,9% Bone marrow aplasiaEpidermiode del labio . 2,9% Carcinoma of the lip Estómago Stomach 5,7% . Ischaemic cardiomyopathy . . Renal Renal 8,6% Mama Breast . 8,6% Chronic renal failure . . Cerebral Brain 8,6% Pulmón Lung 17,1% . Colon Colon 14,3% . Prostate Prostata . 22,9%
  15. 15. Description & Analysis of the SAIATU programme Programme Activities Social A. Population Assessment B. Sociodemographic characteristics Role of the primary caregiver Social support On admission to the SAIATU No. of Families Programme (n=30)* No social resources 9 With social resources 21 Private support & external carers 12 Social resources Economic resources 5 Technical resources 4 Requests for technical resources, No. of Families met by the programme in all cases (n=12)* 100% role as primary caregiver •  57% partner Technical resources 10 •  38% children Coordination with other services 2 ¿Qué necesidades hay? of cases in which there was recorded expenditure •  5% others (e.g., grandchildren, nephews/nieces) *Analysis
  16. 16. Description & Analysis of the SAIATU programme Programme Activities C. Admission to the Programme60 Awareness of the illness5040 16 3 3 8 1 Nv NV30 No No20 34 37 36 Yes Si 32100 Diagnóstico Prognosis Diagnosis Diagnosis Pronóstico Diagnostico Prognosis Pronostico Level of Independence Level of Independence Number of patients (n=38)* Rate Independent 0 0% Mild dependence 5 13.1% Moderate dependence 10 26.3% ¿Qué necesidades hay? Severe dependence 9 23.7% Complete dependence 14 36.9%
  17. 17. Description & Analysis of the SAIATU programme Programme Activities Assessment of C. Admisison to the Programme symptoms Average of 5 symptoms /patient Weakness 42.8% Insomnia 8.6% Tiredness 42.8% Nausea 8.6% Pain 37.1% Vomiting 8.6% Physical symptoms Dysphagia 31.4% Dyspnoea 5.7% Constipation 31.4% Coughing 5.7% Anorexia 28.6% Hiccups 5.7% Weight loss 11.4% Diarrhoea 5.7% Confusion 2.8% Existential suffering 31.4% Sadness 17.1% Psychological & emotional aspects Depression Anxiety 8.6% 5.7% Apathy 2.8% Dry mouth 25.7% Ulcers 20.0% Assistence needed for walking 17.1% End-of-life signs Jaundice 5.7% Agony 2.8% Pruritus 2.8% ¿Qué necesidades hay? Oedema Aphonia 2.8% 2.8%
  18. 18. Description & Analysis of the SAIATU programme Programme Activities D. Data on Activities Activity from February-October 2011: 40 patients Total no. of visits 479 Mean time on - Visits in the previous 3 days 72 15.1% the programme → 26.2 days - Bereavement visits 69 14.4% Total no. of telephone calls 467 Mean no. of - Bereavement calls 67 14.3% patients on the programme at Mean time on the programme 26.2 days [SD=34.50] any one time 120 → 3.88 100 80 60 40 20 0 Feb Mar Abr May Jun Jul Ago Sep Oct Evolución visitas Visits 24,5 49,7 67,6 63,5 99,6 69,3 49,9 31,3 23,6   Telephone calls Evolución llamadas 9,2 28,7 55,3 41,3 104 83,4 60,9 54,7 30,3www.es-health.com Patients registered Evolución pacientes en curso 1,67 3,14 3,89 3,14 7,28 6,17 4,53 3,25 1,85
  19. 19. Description & Analysis of the SAIATU programme Programme activities E. Data on Costs Distribution of time by type of service provided Activity Total time (hours) % of total time Care/support visits 1,006.50 79% Bereavement visits 119 9% Monitoring telephone calls 126.3 10% Bereavement telephone calls 18.54 1% Total 1,270.34 100% Unit costs per activity Activity Total cost (€) No. Unit cost (€) Care/support visits 111,259.70 410 271.37 Bereavement visits 13,154.40 69 190.64 Monitoring telephone calls 13,961.44 400 34.90 Bereavement telephone calls 2,049.07 67 30.58 Total 140,424.60 946 148.44  www.es-health.com
  20. 20. Description & Analysis of the SAIATU programme Programme Activities F. Use of Resources Activity in primary care, specialised care & the HaH service for SAIATU patients Activity Mean 95% Confidence Interval Nurse home visits 6.86 [0.97 – 12.74] Nurse health centre appointments 3.29 [2.21 – 4.36] GP Home visits 5.11 [2.91 – 7.32] GP health centre appointments 5.09 [4.00 – 6.17] Specialist outpatient appointments 2.34 [1.28 – 3.41] Hospital A&E attendances 1.03 [0.64 – 1.41] Hospital admissions 0.63 [0.33 – 0.93] Inpatient bed days 8.87 [4.38 – 13.35] Days on the HaH programme 31.92 [18.91 – 44.93]  www.es-health.com
  21. 21. Description & Analysis of the SAIATU programme Programme activities G. Preferences & place of death H. Family satisfaction 79.5% died at home vs. 20.5% died in hospital Overall satisfaction rating (14 relatives) (0: low,10: very high) Satisfaction 0 0 (0%) 1 0 (0%) 2 0 (0%) 3 0 (0%) 4 0 (0%) 5 2(14%) 6 0 (0%) 7 0 (0%) 8 1 (7%)  www.es-health.com 9 1(7%) 10 10 (71%)
  22. 22. The Programme s Impact onUse of Healthcare Resources In these difficult economic times, the argument for good quality end-of-life care has moved away from ethical to economic considerations . (Eugene Murray, 2012)
  23. 23. The Programme s Impact on Healthcare Resourcesuse Retrospective observational cohort study on the intensity of care (resource use) provided to end-of-life patients & their families under the SAIATU programme vs. traditional healthcare (primary care [PC] + specialised care [SC], with or without support from hospital-at-home [HaH] teams) Definition of the groups SAIATU   Exposed group composed of cancer patients cared for under the SAIATU programme from the start of the programme, 1st Feb 2011, to the cut-off date, 31st Oct 2011 PC  +  SC   Unexposed group (not on the SAIATU programme) composed of cancer patients cared for through PC + SC on a outpatient & inpatient basis, but not the HaH service PC  +  SC  +  HaH   Unexposed group (not on the SAIATU programme) composed of cancer patients cared for through PC + SC on an outpatient, inpatient & hospital-at-home basis (HaH). Note: we are using PC to stand for primary care, NOT palliative care
  24. 24. Comparative Analysis of the Intensity of Healthcare Differences in Intensity of Healthcare between the 3 groups: Primary Care SAIATU PC+SC p1 PC+SC+HaH p2 Nurse home visits 0.86 1.42 0.999 2.26 0.997 [0.97 – 12.74] [0.38 – 2.46] [0.71 – 3.81] Nurse health centre 3.29 3,34 0.939 2.12 0.980 appointments [2.21 – 4.36] [1.66 – 5.02] [1.35 – 2.89] GP home visits 5.11 1.68 0.999 2.06 0.996 [2.91 – 7.32] [0.65 – 2.71] [1.08 – 3.04] GP health centre 5.09 4.36 0.878 3.66 0.985 appointments [4.00 – 6.17] [3.54 – 5.18] [2.62 – 4.70] Total primary care 20.34 10.80 0.999 10.10 0.999 visits + appointments [13.31 – 27.37] [8.18 – 13.42] [7.24 – 12.96] Comparison: SAIATU vs. PC+SC [1]   [2] Comparison: SAIATU vs. PC+SC+HaHwww.es-health.com
  25. 25. Comparative Analysis of the Intensity of Healthcare. Differences in Intensity of Healthcare between the 3 groups: Specialised Care SAIATU PC+SC p1 PC+SC+HaH p2 Specialist 2.34 4.68 0.001* 4.30 0.001* outpatient [1.28 – 3.41] [3.34 – 6.02] [3.30 – 5.30] appointments Hospital A&E 1.03 1.86 0.000* 1.40 0.42* attendances [0.64 – 1.41] [1.53 – 2.19] [1.10 – 1.70] Hospital 0.63 1.82 0.000* 1.56 0.000* admissions [0.33 – 0.93] [1.55 – 2.09] [1.22 – 1.90] Inpatient bed 8.87 19.17 0.001* 23.88 0.006* days [4.38 – 13.35] [15.13 – 23.20] [16.49 – 31.28] Days on the 31.92 21.39 0.976 HaH [18.91 – 44.93] [14.49 – 28.29] programme Comparison: SAIATU vs. PC+SC [1]   [2] Comparison: SAIATU vs. PC+SC+HaHwww.es-health.com
  26. 26. Comparative Analysis of the Intensity of Healthcare No. of outpatient appointments No. of hospital admissions 16 60% 0 14 0.59 1.82 1.56 2.34 4.68 4.30No. or % of patients 1 50% 12 2 40% 10 0 3 8 30% 1 4 6 2 5 20% 4 3 ó3 ≥ + 6 2 7 10% 0 8≥ 9 0% SAIATU SAIATU AP+AE PC+SC AP+AE+HaD PC+SC+HaH SAIATU SAIATU PC+SC AP+AE+HaD AP+AE PC+SC+HaH No. of A&E attendances 20 18 Mean 16 0 values 14 1.03 1.86 1.40 1 in blue 12 10 2 3 8 6 4 4 5 2 6 0   SAIATU AP+AE AP+AE+HaD www.es-health.com SAIATU PC+SC PC+SC+HaH
  27. 27. Comparative Analysis of Costs related to the Intensity of Healthcare SAIATU PC+SC p1 PC+SC+HaH p2 Cost per activity 6.719 15.326 <0.001 [4.082-9.356] [12.224-18.428] * Cost per activity 18.709 23.431 0.343 + days on [13.177-24.241] [18.247-28.617] programmesNote: * values for the SAIATU group were significantly lower by one-tailed Mann-Whitney U test + Mean & 95% confidence interval The mean cost per activity was significantly lower for the SAIATU than for the PC+SC group (p<0.001). The difference between the costs related to the SAIATU with HaH group & the PC+SC+HaH group was not statistically significant (p=0.343).  www.es-health.com
  28. 28. Conclusions - The present project organises the new portfolio of services provided by a social care service within palliative care. -  Despite being a pilot study (i.e., the performance is expected to improve in the future), the SAIATU Programme shows how resources developed from a social care perspective, can be cost- effective & efficient for a healthcare system: -  Reducing the use of hospital resources & associated costs -  Promoting an increase in at-home treatment with a greater participation of primary care professionals -  While being rated as satisfactory by families- With the lack of previous examples, SAIATU could become a model programme in thefield. In this study, we observed a great impact on cost efficiency but the data used wereretrospective; accordingly, the scale of the programme should be extended & a prospectivestudy undertaken to validate these preliminary results.- For this, the first steps need to be defining the services within the social sector in detail,as well as clarifying the vision, mission, strategic plan, processes, etc. of the programme.
  29. 29. “The inclusion of social services in the provision of palliative care is the natural way to expand”. (Bosanquet)
  30. 30. Enterprising Solutions for Health (EH) S.L. Edificio Galia Puerto, 1ª Planta Crtra. de la Esclusa, 11. 41011 Seville, Spain Tel. & Fax: (+34) 955 658276 www.es-health.com
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