Experience In Integrated Care At Hospital Clínic Barcelona - Albert Alonso

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Experience In Integrated Care At Hospital Clínic Barcelona - Albert Alonso

  1. 1. 16th Annual conference and Scientific SymposiumExperience in integrated care at Hospital Clínic Barcelona Albert Alonso Innovation Directorate
  2. 2. Defining integrated care“[Integrated care] is a concept bringing togetherinputs, delivery, management and organisation of servicesrelated to diagnosis, treatment, care, rehabilitation and healthpromotion.” (Grone & Garcia-Barbero: 2001)“[Integrated care] is a coherent set of methods and models onthe funding, administrative, organisational, service delivery andclinical levels designed to create connectivity, alignment andcollaboration within and between the cure and care sectors.” (Kodner & Spreeuwenberg: 2002)HISI Annual Conference, Dublin, November 16th 2011
  3. 3. Why we need integrated care?Because of our failings in current health and social care systems: – Addressing the changing demand for care – Poor efficiency fragmented approaches (disease versus patient) – Improving the quality and continuity of care – Recognising that health and social care outcomes are interdependent – Exclusion of vulnerable groups (Wait, European Social Network Conference, Edinburgh 2005)HISI Annual Conference, Dublin, November 16th 2011
  4. 4. Innovative care for chronic conditions Positive Policy Environment Links Community P Health Care r Organisation Prepared e p a r e d Community Health Care Supporters Team Mo ed Patients & tiv rm at fo Families ed In Better Outcomes for Chronic Conditions Innovative care for chronic conditions: building blocks for actions: global report. Epping-Jordan J, editor. 2002. Geneva, Switzerland : Non-communicable Diseases and Mental Health, World Health Organization.HISI Annual Conference, Dublin, November 16th 2011
  5. 5. Service model Normalisation Redefinition of roles Allocation of resources Integrated care (80%) Traditional care (20%) Adapted from Berg M et al. Health Information Management. Integrating information technology in health care work. Routledge 2004.HISI Annual Conference, Dublin, November 16th 2011
  6. 6. Service model Normalisation Redefinition of roles Allocation of resources ICT Integrated care (80%) Traditional care (20%) Adapted from Berg M et al. Health Information Management. Integrating information technology in health care work. Routledge 2004.HISI Annual Conference, Dublin, November 16th 2011
  7. 7. Redefining roles across the systemHISI Annual Conference, Dublin, November 16th 2011
  8. 8. Platform and functionalitiesHISI Annual Conference, Dublin, November 16th 2011
  9. 9. Making it workHISI Annual Conference, Dublin, November 16th 2011
  10. 10. Home hospitalisation programme Exacerbated COPD patients (222)Home Hospitalisation (121) Control group (101) ER Intervention Discharge Discharge Home Intervention < 24h Accessibility Visit Outpatient clinic 8 wk after discharge HISI Annual Conference, Dublin, November 16th 2011
  11. 11. Home hospitalisation programme 28% Control group Readmission 20% Intervention groupEmergency room 22% visits 10% ** - 2.4 SGRQ Total - 6.9 ** Savings 2033€ 1255€**HISI Annual Conference, Dublin, November 16th 2011
  12. 12. Home hospitalisation programmeHISI Annual Conference, Dublin, November 16th 2011
  13. 13. Home hospitalisation programmeHISI Annual Conference, Dublin, November 16th 2011
  14. 14. Home hospitalisation programmeHISI Annual Conference, Dublin, November 16th 2011
  15. 15. Prevention of exacerbations programmeHISI Annual Conference, Dublin, November 16th 2011
  16. 16. Prevention of readmissions programmeHISI Annual Conference, Dublin, November 16th 2011
  17. 17. A new standard?HISI Annual Conference, Dublin, November 16th 2011
  18. 18. A new standard? Yes! “...An integrated care pathway with flexible shared-care arrangements between primary care and hospital, facilitated by information technologies, has an enormous potential to decrease hospital admissions in chronic obstructive pulmonary disease patients.”HISI Annual Conference, Dublin, November 16th 2011
  19. 19. A new standard? But! “... In the integrated care approach, several models are available and we now require comparative studies.” “We must also be aware that from a healthcare provider perspective, further studies of this model must include cost- effectiveness as well as effectiveness in older disabled patients with chronic obstructive pulmonary disease”HISI Annual Conference, Dublin, November 16th 2011
  20. 20. What had we learnt (2006)?• There were better alternatives to the current approach of chronic patient management.• These alternatives were safe, cheaper and generated better clinical outcomes and professional and patient satisfaction.• Information technologies facilitated some of the aspects related to their implementation.• Most of the difficulties concerned the organisation of care delivery and professionals.• There was a need to change our viewpointHISI Annual Conference, Dublin, November 16th 2011
  21. 21. Changing the viewpoint Disease Management System Health Management System Citizen Management SystemHISI Annual Conference, Dublin, November 16th 2011
  22. 22. Time scale for integrated care at HCB2000-03 • Embryonic ICT platform • Clinical validation of limited model2004-06 • Conceptual SOA platform • Market analysis / deployment strategy2007 • Integrated Care Unit is created2008-12 • Effective deployment: Facing co-morbidity, articulation health / social care. Sustainable business models. • Reliability of ICT platform2010 • Creation of the spin-off2010-13 • Large scale-deployment / regional levelHISI Annual Conference, Dublin, November 16th 2011
  23. 23. New environments for action Prevention Chronic diseases DependencyHISI Annual Conference, Dublin, November 16th 2011
  24. 24. Integrated care at HCB• Approach by programmes: – Set of normalised actions as well as evaluation tools that target precise service objectives. – The programme is based on a process model but it is not the (entire) process. Programme “A” Programme “B” Programme “C” Patient Programme “D” Programme ......HISI Annual Conference, Dublin, November 16th 2011
  25. 25. Integrated care at HCB Work plan definition Case Normalisation of practices evaluation Reallocation of roles ICT application Follow-up & event handling Case identification DischargeHISI Annual Conference, Dublin, November 16th 2011
  26. 26. Integrated care at HCB Case evaluation Workplan definition Case Discharge identification Follow-up Event handlingHISI Annual Conference, Dublin, November 16th 2011
  27. 27. Linkcare® Application Identification Assessment Working Plan Follow-up DischargeHISI Annual Conference, Dublin, November 16th 2011
  28. 28. Linkcare® Application Planner Pre-defined Template PersonalizedHISI Annual Conference, Dublin, November 16th 2011
  29. 29. Linkcare® Application Service Library Available Templates PersonalizedHISI Annual Conference, Dublin, November 16th 2011
  30. 30. Linkcare® Application Monitoring EducationHISI Annual Conference, Dublin, November 16th 2011
  31. 31. Linkcare® Application Profile Management Collaborative Tools Personalization Contact details Call Centre Co-morbidities Availability Doc. Repository Service Optimization Language Patient’s interactions Agenda Management Voi- IP PhoneHISI Annual Conference, Dublin, November 16th 2011
  32. 32. Linkcare® ApplicationHISI Annual Conference, Dublin, November 16th 2011
  33. 33. CSCW tools for remote support: e-SpiroQ Enhances quality and provides support for interpretation of forced spirometry testing performed by non-specialized actors (Primary Care, Home, Pharmacies, Insurance companies, …)HISI Annual Conference, Dublin, November 16th 2011
  34. 34. Integrated care at HCBSummary• HCB’s integrated care programme is a powerful approach to meet the demand of a variety of health and social care needs• The model and associated technology (Linkcare®) is proving to meet expectations from both patients and professional• Advanced versions should cover: – Implementing knowledge intelligent to assist patients and professionals in the optimisation of the mix of services – Extension of services to cover other conditions and/or different stages of the conditionsHISI Annual Conference, Dublin, November 16th 2011
  35. 35. Thanks for your attentionHISI Annual Conference, Dublin, November 16th 2011

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