Professional Educational Programme 2011 The implications of mobile technology in facilitating Integrated CareAlbert AlonsoInformation Systems Directorate
Defining integrated care “[Integrated care] is a concept bringing together inputs, delivery, management and organisation of services related to diagnosis, treatment, care, rehabilitation and health promotion.” (Grone & Garcia-Barbero: 2001) “[Integrated care] is a coherent set of methods and models on the funding, administrative, organisational, service delivery and clinical levels designed to create connectivity, alignment and collaboration within and between the cure and care sectors.” (Kodner & Spreeuwenberg: 2002)
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)
Innovative care 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.
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.
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.
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 Home hospitalisationprogramme
Home hospitalisation programme 28% Control group Readmission 20% Intervention group 22% Emergency room visits 10% ** - 2.4 SGRQ Total - 6.9 ** 2033€ Savings 1255€**
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.”
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”
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 viewpoint
Changing the viewpoint Disease Management System Health Management System Citizen Management System
New environments for action Prevention Chronic diseases Dependency
Integratedcare 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 ......
Integratedcare at HCB Work plan definition Normalisation of practices Reallocation of roles ICT application Case evaluation Follow-up & event handling Case identification Discharge
Integratedcare at HCB Case evaluation Workplan definition Discharge Case identification Follow-up Event handling
Identification Assessment Working Plan Follow-up Discharge Linkcare® Application
Enhances quality and provides support for interpretation of forced spirometry testing performed by non-specialized actors (Primary Care, Home, Pharmacies, Insurance companies, …) CSCW tools for remotesupport: e-SpiroQ
Integratedcare at HCB Summary 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 conditions