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The Development of National Programmes of Care in Ireland

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Delivered by Dr Colin Doherty, Epilepsy Clinical Lead, Health Service Executive at the IPHA Annual Meeting 2010 during the Session entitled "Ensuring the best health outcomes for Irish patients while …

Delivered by Dr Colin Doherty, Epilepsy Clinical Lead, Health Service Executive at the IPHA Annual Meeting 2010 during the Session entitled "Ensuring the best health outcomes for Irish patients while securing value for money".

Published in: Health & Medicine

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    • 1. The development of national programmes of care Colin Doherty MD National Clinical Lead in the Epilepsy programme DQCC HSE
    • 2. Journey Hospital A Hospital C Hospital B Private H GPA GPB A&E A&E Hospital D Nursing Home A Nursing Home B GPC
    • 3. What are the consequences of such fragmented care?
    • 4. Example 1. Patient Safety • Studies done since the 1970's have shown the high incidences of medical errors and deaths resulting from them. • The Harvard Medical Practice Study (1991) estimated iatrogenic injury contributed to 180,000 deaths in US annually, more recent figures suggest 98,000. • A recent study suggested that 17% of hospitalized patients are the victim of an error • Yet, today only 3% of physicians believe that medical errors are a principal health concern. There is more concern with car accidents!
    • 5. Comparisons
    • 6. Alarming Medical Safety Stats • The total number of medical errors and deaths equals three jumbo jets crashing every 2 days (note in 1998 no domestic airline fatalities) • The error rate of ICU's (Intensive Care Units) 1.7% would be like the post office losing over 16,000 pieces of mail every hour of every day. • Or like our banks wrongly cashing 32,000 checks every hour of every day, every year! • 7,000 patients die each year because of sloppy handwriting. • 7.5 million unnecessary medical and surgical procedures are performed annually. • More than half of the U.S. population has received unnecessary medical treatment.
    • 7. Now for the Good News • There is a way to reform the health system to create a high quality, low cost system that fair and equitable for all citizens. • A proper system of Chronic Disease Management is central to this process. • 2. Principles: 1. Align all funding and payment incentives to encourage integrated care of chronic disease: Centralize when necessary; decentralized when possible. 2. Promote value conscious consumption of HC. Provide quality, cost effective, transparent care backed by evidence and outcomes.
    • 8. Objective of Quality and Clinical Care Directorate & the National Programmes Dr. Barry White
    • 9. What is the mission of the Directorate of Quality & Clinical Care? • Better care and better use of resources • If patients get the right treatment we can save lives and money
    • 10. 2. Why take a programmatic approach to change? •The advantages of developing chronic disease management programs are: – Structured approach – Change is led by experienced clinicians. – Generates clinical buy-in and ownership from the start – Engages Colleges and professional bodies. – Enables greater organisational responsiveness i.e. frontline staff can access the top of the organisation in one step via the national lead. – Sustained focus
    • 11. 4. What are the clinical programs & initiatives? • 2. Chronic disease management programs – Stroke – Acute coronary syndrome – Heart failure – Asthma/COPD – Diabetes – Epilepsy – Mental health • 3. Outpatient management programs – Dermatology – Neurology – Rheumatology – Orthopaedics • 4. Emergency function related programs – Acute Medicine – Elective surgery – Diagnostic Imaging – Care of the elderly • 5. Key Quality Safety and Risk initiatives – Governance – Underperforming clinician process – Patient safety bundles – Incident reporting – Audit • 6. Other Clinical program areas – Obstetrics – Paediatrics – ICU – HCAI – Palliative care – Neurorehab • 7. Enabling programmes – Development of a resource allocation model – Pharma strategy – Implementation of Clinical Directorates – Defining a standard approach to delivering change 1.PrimaryCarePro
    • 12. 4. Overall principles • Set goals that achieve gains in cost, quality, access and compliance • Set goals that are simple and meaningful – e.g. prevent 300 stroke deaths • Target what is achievable • Nationalise existing local good practice - do not reinvent the wheel • Ensure local ownership (authority, accountability and responsibility) • Ensure patient involvement
    • 13. Hospital B Private H GPA
    • 14. Example of care pathway for chronic disease: epilepsy Prevention Managed Primary Care (PC) Secondary hospital Care SC Tertiary Hospital care regional (RC) centre National Specialist centre Antenatal care Alcohol abuse Stroke prevention -HTN -Cholesterol -Afib -smoking Brain trauma -Speeding -Alcohol General Epilepsy Care -Diagnosis -Classification -Treatment and first AID -Prognosis -Life style triggers -SUDEP AEDs -Choice -Side effects -Interactions -Long Term Illness card Women’s Issues -Contraception -Pregnancy -Breastfeeding Social issues -Driving -Employment -safety Psychology -Cognitive effects -Mood effects General Epilepsy Care -First Seizure -Acute management of refractory seizures -Status Epilepticus Diagnostics -Brain imaging -EEG (if possible) -Classification -Initiate Treatment Referral -Primary Care -Regional Epilepsy Centre Rapid Access Clinic -Mobile phone -E-mail -Video Link -Phone -Community Epilepsy nurse clinic General Epilepsy Care -First Seizure -Acute management of refractory seizures -Status Epilepticus Diagnostics -Brain imaging -EEG -Classification -Initiate Treatment -Treatment review for Refractory epilepsy -Prognosis Access from PC and SC -Rapid Access Clinic -Subspecialty Epilepsy Clinic -A&E -Video-Consultation -E-mail/phone/fax -Self management Prog Counselling -Epilepsy Nurse specialist -Nurse Led clinic -Brainwave CRO Pre-Surgical Diagnostics -Brain imaging (3T) -EEG -Video-EEG -Classification -Neuropsychology -Neuropsychiatry Access from PC, SC and RC -Rapid Access Clinic -Subspecialty Epilepsy Clinic -A&E -Video-Consultation -E-mail/phone/fax Counselling -Epilepsy Nurse specialist -Nurse Led clinic -Brainwave CRO
    • 15. National Epilepsy Service of Ireland (NESI) Dublin 1 Paediatric 1 National Centre 1 Adult Cork 1 Paediatric 1 Adult Sligo 1 Adult Galway 1 Adult Limerick 1 Adult 1-5 years 5-10 years EPR Networks and Videolinks
    • 16. Centres The National Epilepsy Service of Ireland. Welcome to the NESI web portal. Our mission is to provide our patients with epilepsy, their families, doctors and carer’s with the most comprehensive access to specialist epilepsy opinion, advice, and service in Europe. We guarantee access to one of our centres within two weeks of first seizure and once registered we provide state of the art disease surveillance and management according best national and international practice. www.nesi.ie/standardsofcare Specialist centres near you Staff Teaching Research Nursing Community support GP access Patient Resources NESI search home Web Images Groups News more>> Nov 25th 2015 Epilepsy Services in Ireland