A New Primary Care Activity Classification

1. Can we overcome the current divorcebetween professionals and managersand find a common language able to do health and management?. NEW CASE-MIX CLASSIFICATION FOR PROFESSIONALS, AND MANAGERS. TWO IN ONE. Ángel Ruiz Téllez. CYMAP Fernando A. Alonso López. CS Dobra Cantabria

2. angelruiztellez@cymap.es +00 34 637.53.23.59Contact:Ángel Ruiz Téllezangelruiztellez@cymap.eswww.cymap.es& Ángel Ruiz Téllez in Linkedin

3. angelruiztellez@cymap.es +00 34 637.53.23.59ISIS Manager© Project ( Measure of Professional Excellence = Effectiveness + Efficiency ) spreads out along : • 6 Regional Spanish Health Services, • 200 Primary Care Health Centres, • 2000 Family Practice or Paediatrician • 2 Million people

4. angelruiztellez@cymap.es +00 34 637.53.23.59ISIS Manager© Project On eight questions 1.-Do you know the existence of 7 Groups of Problems in Primary Care, that show the 7 qualities of a good Family Practice?: 2.-Do you know that the previous 7 groups are divided in other 24 Solving Basic Models SBM, that represent the 24 models of therapeutic homogeneous professional behaviour? 3.-How could we interpret the retrospective information when into a ICPC Code can exists very different clinical syndromes? 4.-How measure the Preventive Activity? 5.-Do you know that the relation between Activity and Costs is negative and not positive?. 6.- Do you know that the “Portfolio Services”, reach only the 10% of epidemiological reality?. 7.-Do you know that there are 14.000 Episodes Hoped, in a standard patient panel?. 8.-Would you know that we would find 4 areas of professional behaviour, in, more or less, a law of quarters?

5. angelruiztellez@cymap.es +00 34 637.53.23.59ISIS Manager© Project ( Measure of Professional Excellence = Effectiveness + Efficiency ) Previous conditions Useful to any health record software if are observed next conditions: •Systems with informatics health records, •Working with, and around, the Episode of Attention. •Items of Activity (pharmacy, referrals, laboratory values, diagnostic or therapeutic procedures, etc) Episode of Attention related.

6. angelruiztellez@cymap.es +00 34 637.53.23.59 1.-Do you know the existence of 7 Groups of Problems in Primary Care, that show the 7 qualities of a good Family Practice?:G.R.E./NCC© Group Related Episodes by Need of Care Criteria © G.R.E. DESCRIPTION The chart shows the evaluation of the whole annual A PROBLEMS OF COLLECTIVE ORIENTATION professional activity, distributed in such 7 groups, and, B CONSUMTIVE OR DISABLING DISEASES every one showing the 3 types of Episodes. The blue B1 SANITARY PROBLEM OF SOCIAL ORIGIN ones (the Solved) , in relation to the red ones (the Seen) C HEALTH PROBLEMS THAT TEND TO AN SPONTANEOUS RESOLUTION , and those ones with regard to the green ones (the D SPECIFIC PROBLEMS OF INDIVIDUAL HEALTH, DEPENDANT ON TECHNICAL ABILITIES. Hoped) E HEALTH PROBLEMS OF LOW FEASIBILITY, IN PRIMARY CARE P HEALTH NEEDS WITH EFFECTIVE PREVENTION 100% 90% Whole annual professional activity 80% evaluated: 70% 60% Hoped Ep 1. The “Seen Episodes” with regard to 50% Seen Ep the “Hoped Episodes” 40% Solved Ep 30% 20% 2. The “Solved Episodes” in relation to 10% the “Seen Episodes” 0% A B B1 C D E P

7. angelruiztellez@cymap.es +00 34 637.53.23.59 1.-Do you know the existence of 7 Groups of Problems in Primary Care, that show the 7 qualities of a good Family Practice?:G.R.E./NCC© Group Related Episodes by Need of Care Criteria © G.R.E. DESCRIPTION To solve the C Problems’ Group requires: A PROBLEMS OF COLLECTIVE ORIENTATION • Our older members... B CONSUMTIVE OR DISABLING DISEASES B1 SANITARY PROBLEM OF SOCIAL ORIGIN C HEALTH PROBLEMS THAT TEND TO AN SPONTANEOUS RESOLUTION D SPECIFIC PROBLEMS OF INDIVIDUAL HEALTH, DEPENDANT ON TECHNICAL ABILITIES. E HEALTH PROBLEMS OF LOW FEASIBILITY, IN PRIMARY CARE P HEALTH NEEDS WITH EFFECTIVE PREVENTION 100% 90% 80% 70% • owners of a large range of experience 60% inuncertainty management Hoped Ep 50% Seen Ep 40% •Who can restrain, put a curb the Solved Ep excessive patients’ requests in the: 30% 20% •“Non-Diseases” 10% •Low Severity Problems 0% C A B B1 C D E P

8. angelruiztellez@cymap.es +00 34 637.53.23.59 1.-Do you know the existence of 7 Groups of Problems in Primary Care, that show the 7 qualities of a good Family Practice?:G.R.E./NCC© Group Related Episodes by Need of Care Criteria © G.R.E. DESCRIPTION A PROBLEMS OF COLLECTIVE ORIENTATION To solve the D Problems’ Group requires: B CONSUMTIVE OR DISABLING DISEASES • Our modern Doctors... B1 SANITARY PROBLEM OF SOCIAL ORIGIN C HEALTH PROBLEMS THAT TEND TO AN SPONTANEOUS RESOLUTION D SPECIFIC PROBLEMS OF INDIVIDUAL HEALTH, DEPENDANT ON TECHNICAL ABILITIES. E HEALTH PROBLEMS OF LOW FEASIBILITY, IN PRIMARY CARE P HEALTH NEEDS WITH EFFECTIVE PREVENTION 100% 90% 80% 70% 60% Hoped Ep 50% Seen Ep 40% 30% Solved Ep •With a lot of expertise, skills on Diag-Therapeutic procedures: 20% •Injuries, wounds, 10% pyelonephritis..... 0% D A B B1 C D E P

9. angelruiztellez@cymap.es +00 34 637.53.23.59 1.-Do you know the existence of 7 Groups of Problems in Primary Care, that show the 7 qualities of a good Family Practice?:G.R.E./NCC© Group Related Episodes by Need of Care Criteria © G.R.E. DESCRIPTION To solve the B&B1 Problems’ Group requires: A PROBLEMS OF COLLECTIVE ORIENTATION B CONSUMTIVE OR DISABLING DISEASES •Abilities to do a Family Therapeutic Orientation B1 SANITARY PROBLEM OF SOCIAL ORIGIN C HEALTH PROBLEMS THAT TEND TO AN SPONTANEOUS RESOLUTION D SPECIFIC PROBLEMS OF INDIVIDUAL HEALTH, DEPENDANT ON TECHNICAL ABILITIES. E HEALTH PROBLEMS OF LOW FEASIBILITY, IN PRIMARY CARE P HEALTH NEEDS WITH EFFECTIVE PREVENTION 100% 90% 80% 70% 60% Hoped Ep 50% Seen Ep 40% Solved Ep 30% 20% •The known Community Medicine. 10% 0% B B1 A B B1 C D E P

10. angelruiztellez@cymap.es +00 34 637.53.23.59 1.-Do you know the existence of 7 Groups of Problems in Primary Care, that show the 7 qualities of a good Family Practice?:G.R.E./NCC© Group Related Episodes by Need of Care Criteria © G.R.E. DESCRIPTION A PROBLEMS OF COLLECTIVE ORIENTATION To solve the P Problems’ Group requires: B CONSUMTIVE OR DISABLING DISEASES Vocation towards the B1 SANITARY PROBLEM OF SOCIAL ORIGIN C HEALTH PROBLEMS THAT TEND TO AN SPONTANEOUS RESOLUTION Effectiveness Prevention D SPECIFIC PROBLEMS OF INDIVIDUAL HEALTH, DEPENDANT ON TECHNICAL ABILITIES. E HEALTH PROBLEMS OF LOW FEASIBILITY, IN PRIMARY CARE P HEALTH NEEDS WITH EFFECTIVE PREVENTION 100% 90% 80% 70% 60% Hoped Ep 50% Seen Ep 40% Solved Ep 30% 20% •Avoiding the superfluous prevention. 10% 0% P A B B1 C D E P

11. angelruiztellez@cymap.es +00 34 637.53.23.59 1.-Do you know the existence of 7 Groups of Problems in Primary Care, that show the 7 qualities of a good Family Practice?:G.R.E./NCC© Group Related Episodes by Need of Care Criteria © G.R.E. DESCRIPTION A PROBLEMS OF COLLECTIVE ORIENTATION To solve the E Problems’ Group requires: B CONSUMTIVE OR DISABLING DISEASES •our best “open minded” doctor... B1 SANITARY PROBLEM OF SOCIAL ORIGIN C HEALTH PROBLEMS THAT TEND TO AN SPONTANEOUS RESOLUTION D SPECIFIC PROBLEMS OF INDIVIDUAL HEALTH, DEPENDANT ON TECHNICAL ABILITIES. E HEALTH PROBLEMS OF LOW FEASIBILITY, IN PRIMARY CARE P HEALTH NEEDS WITH EFFECTIVE PREVENTION 100% 90% 80% 70% 60% Hoped Ep 50% •Able to manage, monitoring and Seen Ep 40% coordinate Health Problems of Solved Ep 30% low feasibility in PC, with: 20% •Hospital, 10% •Second level 0% •Social resources... E A B B1 C D E P

12. angelruiztellez@cymap.es +00 34 637.53.23.59 1.-Do you know the existence of 7 Groups of Problems in Primary Care, that show the 7 qualities of a good Family Practice?:G.R.E./NCC© Group Related Episodes by Need of Care Criteria © G.R.E. DESCRIPTION To solve the A Problems’ Group requires: A PROBLEMS OF COLLECTIVE ORIENTATION •High competent professional B CONSUMTIVE OR DISABLING DISEASES B1 SANITARY PROBLEM OF SOCIAL ORIGIN C HEALTH PROBLEMS THAT TEND TO AN SPONTANEOUS RESOLUTION D SPECIFIC PROBLEMS OF INDIVIDUAL HEALTH, DEPENDANT ON TECHNICAL ABILITIES. E HEALTH PROBLEMS OF LOW FEASIBILITY, IN PRIMARY CARE P HEALTH NEEDS WITH EFFECTIVE PREVENTION 100% 90% 80% 70% 60% Hoped Ep •able to treat problems of collective 50% Seen Ep orientation, for their epidemiological, 40% economical o social significance, with the Solved Ep 30% best effectiveness and efficiency like: 20% •transmissible diseases, Ischemic 10% heart diseases, mental illness, etc 0% A A B B1 C D E P

13. angelruiztellez@cymap.es +00 34 637.53.23.59 1.-Do you know the existence of 7 Groups of Problems in Primary Care, that show the 7 qualities of a good Family Practice?:G.R.E./NCC© Group Related Episodes by Need of Care Criteria © G.R.E. DESCRIPTION A PROBLEMS OF COLLECTIVE ORIENTATION B CONSUMTIVE OR DISABLING DISEASES All of seven groups define a B1 SANITARY PROBLEM OF SOCIAL ORIGIN C HEALTH PROBLEMS THAT TEND TO AN SPONTANEOUS RESOLUTION good generalist D SPECIFIC PROBLEMS OF INDIVIDUAL HEALTH, DEPENDANT ON TECHNICAL ABILITIES. E HEALTH PROBLEMS OF LOW FEASIBILITY, IN PRIMARY CARE P HEALTH NEEDS WITH EFFECTIVE PREVENTION 100% 90% 80% 70% 60% Hoped Ep 50% Seen Ep And the professionals can check out 40% 30% Solved Ep their profiles 20% 10% 0% A B B1 C D E P

14. angelruiztellez@cymap.es +00 34 637.53.23.59 1.-Do you know the existence of 7 Groups of Problems in Primary Care, that show the 7 qualities of a good Family Practice?:G.R.E./NCC© Group Related Episodes by Need of Care Criteria © G.R.E. DESCRIPTION A PROBLEMS OF COLLECTIVE ORIENTATION B CONSUMTIVE OR DISABLING DISEASES All of seven groups define a B1 SANITARY PROBLEM OF SOCIAL ORIGIN C HEALTH PROBLEMS THAT TEND TO AN SPONTANEOUS RESOLUTION good generalist D SPECIFIC PROBLEMS OF INDIVIDUAL HEALTH, DEPENDANT ON TECHNICAL ABILITIES. E HEALTH PROBLEMS OF LOW FEASIBILITY, IN PRIMARY CARE P HEALTH NEEDS WITH EFFECTIVE PREVENTION 100% 90% 80% 70% 60% Hoped Ep 50% Seen Ep And the professionals can check out 40% 30% Solved Ep their profiles 20% 10% 0% A B B1 C D E P

15. angelruiztellez@cymap.es +00 34 637.53.23.59 2.-Do you know that the previous 7 groups are divided in other 24 Solving Basic Models SBM, that represent the 24 models of therapeutic homogeneous professional behaviour?: SBM DESCRIPTIONSBM© Solving Basic Models© A01 TRANSMISSIBLE DISEASES A02 RISK HABITS A03 RISK FACTORS100% A04 HEALTH PROBLEMS OF HIGH MORBIDITY OR MORTALITY 90% A05 HEALTH PROBLEMS OF HIGH SOCIOECONOMIC INFLUENCE 80% B01 CONSUMTIVE DISEASES 70% B02 DISABLING ILLNESSES B11 SANITARY PROBLEMS OF SOCIAL ORIGIN 60% C01 SPECIFIC SYNDROMES THAT TEND TO AN NATURAL RESOLUTION 50% C02 CHRONIC SYMPTOM/COMPLAINT OF LOW RISK OR LOW UNCERTAINTY 40% C03 ACUTE AND BANAL HEALTH PROBLEMS 30% SYMPTOM/COMPLAINT OF POTENTIAL RISK AND UNCERTAINTY IN A C04 SHORT TERM 20% SYMPTOM/COMPLAINT OF HIGHER POTENTIAL RISK AND 10% C05 UNCERTAINTY IN A LONG TERM 0% D01 SPECIFIC PROBLEMS WITH MODERATE SEVERITY/COMPLEXITY SPECIFIC PROBLEMS WITH MODERATE SEVERITY AND MINOR A01 A02 A03 A04 A05 P01 P02 P03 B01 B02 B11 C01 C02 C03 C04 C05 E01 E02 E03 E04 D01 D02 D03 D04 D02 COMPLEXITY SPECIFIC PROBLEMS WITH MINOR SEVERITY AND MODERATE Solved Ep Seen Ep Hoped Ep D03 COMPLEXITY D04 SPECIFIC PROBLEMS WITH MINOR SEVERITY AND COMPLEXITY And, so, in an only chart, the professionals, quickly, can E01 SPECIALIZED PROBLEMS OF LOW THERAPEUTIC FEASIBILITY-LTF IN PRIMARY CARE-PC observe his o her profile, in the 24 SBM, understanding their E02 SPECIALIZED PROBLEMS LTF-PC WITH SHARED CONTROL strength and weakness around each one of them. E03 SPECIALIZED PROBLEMS LTF-PC DIAGNOSED IN PC SPECIALIZED PROBLEMS LTF-PC THAT CAN BE DIAGNOSED IN PC & E04 WITH SHARED CONTROL Above those SBM we have the whole classification, in P01 SANITARY EDUCATION ABOUT HEALTH DOUBTS P02 PROMOTION OF HEALTHY LIFE STYLES detail, with around 1.000 Modulated Episodes, each one P03 SCREENING AND SECONDARY PREVENTION OF PREVALENT DISEASES allocated[to one specific SBM.

16. angelruiztellez@cymap.es +00 34 637.53.23.59 3.-How could we interpret the retrospective information when into a ICPC Code can exists very different clinical syndromes?. Modulated Episodes©ModEp DESCRIPTION SBM Creating different subgroups ofR74.01 UPPER RESPIRATORY INFECTION ACUTE (<1 YEAR) D01 Episodes, allocated to one o more UPPER RESPIRATORY INFECTION ACUTE WITHOUT RESPIRATORYR74.02 PROBLEMS (1-13 YEAR) C01 ICPC , according to therapeuticalR74.03 UPPER RESPIRATORY INFECTION ACUTE WITH RESPIRATORY C04 orientation. PROBLEMS (1-13 YEAR)……. Let’s see one example around the ICPC Code R74- UPPER R74 RESPIRATORY INFECTION ACUTE It isn’t the same a Cold in a breast-fed baby, or in a child with Asthma or without. There are three different problems, Modulation with the same code, with three Selection Criteria, and with three Resolution Criteria, that need to be allocated in their Engine respective SBM. Because we analyse informatics records retrospectively, is impossible discriminate and interpret the information without doing groups of problems depend on the Selection Criteria , what will allow us to state the Resolution Criteria to SC1 SC2 SC3 analyze the Effectiveness. So, you will be able to understand that was needed to allocate each one to different Groups of SBM , and so, Managers and Professionals will have a common language. RC1 RC2 RC3

17. angelruiztellez@cymap.es +00 34 637.53.23.59 3.-The Modulated Episodes ( ± 1000, each one allocated to one specific SBM ) Above those SBM we have the whole classification, in detail, with around 1.000 Modulated Episodes, each one allocated to one specific SBM. Modulated Episodes© SBM DESCRIPTIONModEp DESCRIPTION SBM A01 TRANSMISSIBLE DISEASESR74.01 UPPER RESPIRATORY INFECTION ACUTE (<1 YEAR) D01 A02 RISK HABITS UPPER RESPIRATORY INFECTION ACUTE WITHOUT RESPIRATORY A03 RISK FACTORSR74.02 C01 PROBLEMS (1-13 YEAR) A04 HEALTH PROBLEMS OF HIGH MORBIDITY OR MORTALITY UPPER RESPIRATORY INFECTION ACUTE WITH RESPIRATORY A05 HEALTH PROBLEMS OF HIGH SOCIOECONOMIC INFLUENCER74.03 C04 B01 CONSUMTIVE DISEASES PROBLEMS (1-13 YEAR) B02 DISABLING ILLNESSES……. B11 SANITARY PROBLEMS OF SOCIAL ORIGIN C01 SPECIFIC SYNDROMES THAT TEND TO AN NATURAL RESOLUTION C02 CHRONIC SYMPTOM/COMPLAINT OF LOW RISK OR LOW UNCERTAINTY R74 C03 ACUTE AND BANAL HEALTH PROBLEMS SYMPTOM/COMPLAINT OF POTENTIAL RISK AND UNCERTAINTY IN A C04 SHORT TERM SYMPTOM/COMPLAINT OF HIGHER POTENTIAL RISK AND C05 Modulation UNCERTAINTY IN A LONG TERM D01 SPECIFIC PROBLEMS WITH MODERATE SEVERITY/COMPLEXITY Engine D02 SPECIFIC PROBLEMS WITH MODERATE SEVERITY AND MINOR COMPLEXITY SPECIFIC PROBLEMS WITH MINOR SEVERITY AND MODERATE D03 COMPLEXITY D04 SPECIFIC PROBLEMS WITH MINOR SEVERITY AND COMPLEXITY SPECIALIZED PROBLEMS OF LOW THERAPEUTIC FEASIBILITY-LTF IN E01 SC1 SC2 SC3 E02 PRIMARY CARE-PC SPECIALIZED PROBLEMS LTF-PC WITH SHARED CONTROL E03 SPECIALIZED PROBLEMS LTF-PC DIAGNOSED IN PC SPECIALIZED PROBLEMS LTF-PC THAT CAN BE DIAGNOSED IN PC & E04 WITH SHARED CONTROL P01 SANITARY EDUCATION ABOUT HEALTH DOUBTS P02 PROMOTION OF HEALTHY LIFE STYLES RC1 RC2 RC3 P03 SCREENING AND SECONDARY PREVENTION OF PREVALENT DISEASES SC: Selection Criteria RC: Resolution Criteria

18. angelruiztellez@cymap.es +00 34 637.53.23.59 3.-The Modulated Episodes ( ± 1000, each one allocated to one specific SBM ) Modulated Episodes© SBM DESCRIPTIONModEp DESCRIPTION SBM A01 TRANSMISSIBLE DISEASESR74.01 UPPER RESPIRATORY INFECTION ACUTE (<1 YEAR) D01 A02 RISK HABITS UPPER RESPIRATORY INFECTION ACUTE WITHOUT RESPIRATORY A03 RISK FACTORSR74.02 C01 PROBLEMS (1-13 YEAR) A04 HEALTH PROBLEMS OF HIGH MORBIDITY OR MORTALITY UPPER RESPIRATORY INFECTION ACUTE WITH RESPIRATORY A05 HEALTH PROBLEMS OF HIGH SOCIOECONOMIC INFLUENCER74.03 C04 B01 CONSUMTIVE DISEASES PROBLEMS (1-13 YEAR) B02 DISABLING ILLNESSES……. B11 SANITARY PROBLEMS OF SOCIAL ORIGIN C01 SPECIFIC SYNDROMES THAT TEND TO AN NATURAL RESOLUTION C02 CHRONIC SYMPTOM/COMPLAINT OF LOW RISK OR LOW UNCERTAINTY R74 C03 ACUTE AND BANAL HEALTH PROBLEMS SYMPTOM/COMPLAINT OF POTENTIAL RISK AND UNCERTAINTY IN A C04 SHORT TERM SYMPTOM/COMPLAINT OF HIGHER POTENTIAL RISK AND C05 Modulation UNCERTAINTY IN A LONG TERM D01 SPECIFIC PROBLEMS WITH MODERATE SEVERITY/COMPLEXITY Engine D02 SPECIFIC PROBLEMS WITH MODERATE SEVERITY AND MINOR COMPLEXITY SPECIFIC PROBLEMS WITH MINOR SEVERITY AND MODERATE D03 COMPLEXITY D04 SPECIFIC PROBLEMS WITH MINOR SEVERITY AND COMPLEXITY SPECIALIZED PROBLEMS OF LOW THERAPEUTIC FEASIBILITY-LTF IN E01 SC1 SC2 SC3 E02 PRIMARY CARE-PC SPECIALIZED PROBLEMS LTF-PC WITH SHARED CONTROL E03 SPECIALIZED PROBLEMS LTF-PC DIAGNOSED IN PC SPECIALIZED PROBLEMS LTF-PC THAT CAN BE DIAGNOSED IN PC & E04 WITH SHARED CONTROL P01 SANITARY EDUCATION ABOUT HEALTH DOUBTS P02 PROMOTION OF HEALTHY LIFE STYLES RC1 RC2 RC3 P03 SCREENING AND SECONDARY PREVENTION OF PREVALENT DISEASES R74.01

19. angelruiztellez@cymap.es +00 34 637.53.23.59 3.-The Modulated Episodes ( ± 1000, each one allocated to one specific SBM ) Modulated Episodes© SBM DESCRIPTIONModEp DESCRIPTION SBM A01 TRANSMISSIBLE DISEASESR74.01 UPPER RESPIRATORY INFECTION ACUTE (<1 YEAR) D01 A02 RISK HABITS UPPER RESPIRATORY INFECTION ACUTE WITHOUT RESPIRATORY A03 RISK FACTORSR74.02 C01 PROBLEMS (1-13 YEAR) A04 HEALTH PROBLEMS OF HIGH MORBIDITY OR MORTALITY UPPER RESPIRATORY INFECTION ACUTE WITH RESPIRATORY A05 HEALTH PROBLEMS OF HIGH SOCIOECONOMIC INFLUENCER74.03 C04 B01 CONSUMTIVE DISEASES PROBLEMS (1-13 YEAR) B02 DISABLING ILLNESSES……. B11 SANITARY PROBLEMS OF SOCIAL ORIGIN C01 SPECIFIC SYNDROMES THAT TEND TO AN NATURAL RESOLUTION C02 CHRONIC SYMPTOM/COMPLAINT OF LOW RISK OR LOW UNCERTAINTY R74 C03 ACUTE AND BANAL HEALTH PROBLEMS SYMPTOM/COMPLAINT OF POTENTIAL RISK AND UNCERTAINTY IN A C04 SHORT TERM SYMPTOM/COMPLAINT OF HIGHER POTENTIAL RISK AND C05 Modulation UNCERTAINTY IN A LONG TERM D01 SPECIFIC PROBLEMS WITH MODERATE SEVERITY/COMPLEXITY Engine D02 SPECIFIC PROBLEMS WITH MODERATE SEVERITY AND MINOR COMPLEXITY SPECIFIC PROBLEMS WITH MINOR SEVERITY AND MODERATE D03 COMPLEXITY D04 SPECIFIC PROBLEMS WITH MINOR SEVERITY AND COMPLEXITY SPECIALIZED PROBLEMS OF LOW THERAPEUTIC FEASIBILITY-LTF IN E01 SC1 SC2 SC3 E02 PRIMARY CARE-PC SPECIALIZED PROBLEMS LTF-PC WITH SHARED CONTROL E03 SPECIALIZED PROBLEMS LTF-PC DIAGNOSED IN PC SPECIALIZED PROBLEMS LTF-PC THAT CAN BE DIAGNOSED IN PC & E04 WITH SHARED CONTROL P01 SANITARY EDUCATION ABOUT HEALTH DOUBTS P02 PROMOTION OF HEALTHY LIFE STYLES RC1 RC2 RC3 P03 SCREENING AND SECONDARY PREVENTION OF PREVALENT DISEASES R74.02

20. angelruiztellez@cymap.es +00 34 637.53.23.59 3.-The Modulated Episodes ( ± 1000, each one allocated to one specific SBM ) Modulated Episodes© SBM DESCRIPTIONModEp DESCRIPTION SBM A01 TRANSMISSIBLE DISEASESR74.01 UPPER RESPIRATORY INFECTION ACUTE (<1 YEAR) D01 A02 RISK HABITS UPPER RESPIRATORY INFECTION ACUTE WITHOUT RESPIRATORY A03 RISK FACTORSR74.02 C01 PROBLEMS (1-13 YEAR) A04 HEALTH PROBLEMS OF HIGH MORBIDITY OR MORTALITY UPPER RESPIRATORY INFECTION ACUTE WITH RESPIRATORY A05 HEALTH PROBLEMS OF HIGH SOCIOECONOMIC INFLUENCER74.03 C04 PROBLEMS (1-13 YEAR) B01 CONSUMTIVE DISEASES……. B02 DISABLING ILLNESSES B11 SANITARY PROBLEMS OF SOCIAL ORIGIN C01 SPECIFIC SYNDROMES THAT TEND TO AN NATURAL RESOLUTION C02 CHRONIC SYMPTOM/COMPLAINT OF LOW RISK OR LOW UNCERTAINTY R74 C03 ACUTE AND BANAL HEALTH PROBLEMS SYMPTOM/COMPLAINT OF POTENTIAL RISK AND UNCERTAINTY IN A C04 SHORT TERM SYMPTOM/COMPLAINT OF HIGHER POTENTIAL RISK AND C05 Modulation UNCERTAINTY IN A LONG TERM D01 SPECIFIC PROBLEMS WITH MODERATE SEVERITY/COMPLEXITY Engine D02 SPECIFIC PROBLEMS WITH MODERATE SEVERITY AND MINOR COMPLEXITY SPECIFIC PROBLEMS WITH MINOR SEVERITY AND MODERATE D03 COMPLEXITY D04 SPECIFIC PROBLEMS WITH MINOR SEVERITY AND COMPLEXITY SPECIALIZED PROBLEMS OF LOW THERAPEUTIC FEASIBILITY-LTF IN E01 SC1 SC2 SC3 E02 PRIMARY CARE-PC SPECIALIZED PROBLEMS LTF-PC WITH SHARED CONTROL E03 SPECIALIZED PROBLEMS LTF-PC DIAGNOSED IN PC SPECIALIZED PROBLEMS LTF-PC THAT CAN BE DIAGNOSED IN PC & E04 WITH SHARED CONTROL P01 SANITARY EDUCATION ABOUT HEALTH DOUBTS P02 PROMOTION OF HEALTHY LIFE STYLES RC1 RC2 RC3 P03 SCREENING AND SECONDARY PREVENTION OF PREVALENT DISEASES R74.03

21. angelruiztellez@cymap.es +00 34 637.53.23.59Solving the classification of Prevention : The Modulated Episodes Modulated Episodes© G.R.E./NCC©  G.R.E./NCC©  SBM  SubSBM  Mod Episode

22. angelruiztellez@cymap.es +00 34 637.53.23.594.-Do you know that the “Portfolio Services”, reach only the 10% of epidemiological reality?. Activity •Which will be our excellent professionals?100 90 80 70 As excellent as •When we control the 10% of the direction 60 invisible Doctors of the ship....? 50 Activity 40 ? 30 20 Roof “Portfolio Services” 10 0 Doctor A Doctor B Doctor C Doctor D We need to measure the Ship adrift 100% Activity & Manageable Costs

23. angelruiztellez@cymap.es +00 34 637.53.23.595.-Do you know that there are 14.000 Episodes Hoped, in a standard patient panel?. 100 SR = Seen / Hoped = 60/100 = 0.6 Hoped Episodes Supply Rate = SEEN Episodes / HOPED Episodes 60 ER = Solved / Seen = 40/60 = 0.66 Seen Episodes Effectiveness Rate = SOLVED Episodes / SEEN Episodes 40 SPR = Solved / Hoped = 40/100 = 0.4 Solved Social Profitability Rate = SOLVED Episodes / HOPED Episodes Episodes SPR = SR x ER = 0.6 x 0.66 = 0.4 €R = SPR / €ostsThe Supply isn’t a whole number. Efficiency Rate

24. angelruiztellez@cymap.es +00 34 637.53.23.595.-Do you know that there are 14.000 Episodes Hoped, in a standard patient panel?. 100 SR = Seen / Hoped = 60/100 = 0.6 Hoped Episodes Supply Rate = SEEN Episodes / HOPED Episodes 60 ER = Solved / Seen = 40/60 = 0.66 Seen Episodes Effectiveness Rate = SOLVED Episodes / SEEN Episodes 40 SPR = Solved / Hoped = 40/100 = 0.4 Solved Social Profitability Rate = SOLVED Episodes / HOPED Episodes Episodes SPR = SR x ER = 0.6 x 0.66 = 0.4 The Supply isn’t a whole number, but a Rate of Seen Needs / Hoped Needs. Our model allows us to measure the rest of the €R = SPR / €osts Rates: •Effectiveness Efficiency Rate •Social Profitability •Efficiency creating an environment of quality that provoke one positive bias

25. angelruiztellez@cymap.es +00 34 637.53.23.596.-Do you know that the relation between Activity and Costs is negative and not positive?. Activity Real Linear Regression •There is a proportion of professionals that More x Less make more activity by less costs and vice versa. •They are our excellent and transparent professionals. Less x More •Our invisible professionals. Professionals Costs

26. angelruiztellez@cymap.es +00 34 637.53.23.597.-Would you know that we would find 4 areas of professional behaviour, in, more or less, alaw of quarters? X Diagram Téllez-Alonso Each dot, an annual professional data Activity Costs +A: A B Let’s compare theB: difference of weighed Activity professional activity and costs, against these bothC: average values, sited in the middle of the chart, ... C DD: - Costs +

27. angelruiztellez@cymap.es +00 34 637.53.23.597.-Would you know that we would find 4 areas of professional behaviour, in, more or less, arule, a law of quarters? X Diagram Téllez-Alonso Each dot, an annual professional data Activity Costs +A: A BB: ActivityC: C DD: - Costs +

28. angelruiztellez@cymap.es +00 34 637.53.23.597.-Would you know that we would find 4 areas of professional behaviour, in, more or less, arule, a law of quarters? X Diagram Téllez-Alonso Each dot, an annual professional data Activity Costs +A: AExcellent B & InvisibleB: ActivityC: C DD: - Costs +

31. angelruiztellez@cymap.es +00 34 637.53.23.597.-Would you know that we would find 4 areas of professional behaviour, in, more or less, arule, a law of quarters? X Diagram Téllez-Alonso Each dot, an annual professional data Activity Costs +A: A Logical B & WarriorsB: ActivityC: C DD: - Costs +

34. angelruiztellez@cymap.es +00 34 637.53.23.597.-Would you know that we would find 4 areas of professional behaviour, in, more or less, alaw of quarters? X Diagram Téllez-Alonso Each dot, an annual professional data Activity Costs +A: A BB: Activity PrudentC: & C Calm DD: - Costs +

37. angelruiztellez@cymap.es +00 34 637.53.23.597.-Would you know that we would find 4 areas of professional behaviour, in, more or less, arule, a law of quarters? X Diagram Téllez-Alonso Each dot, an annual professional data Activity Costs +A: A BB: ActivityC: Generous C DD: - Costs +

39. angelruiztellez@cymap.es +00 34 637.53.23.597.-Would you know that we would find 4 areas of professional behaviour, in, more or less, arule, a law of quarters? X Diagram Téllez-Alonso Each dot, an annual professional data + A B Activity C D - Costs +

40. angelruiztellez@cymap.es +00 34 637.53.23.59 7.-Would you know that we would find 4 areas of professional behaviour, in, more or less, a rule, a law of quarters? X Diagram Téllez-Alonso Each dot, an annual professional data + A B•That is possible because the upperones have a bigger clinical appliedcompetence, perhaps because theyknow a little bit more medicine. Activity C D - Costs +

41. angelruiztellez@cymap.es +00 34 637.53.23.59 7.-Would you know that we would find 4 areas of professional behaviour, in, more or less, a rule, a law of quarters? X Diagram Téllez-Alonso Each dot, an annual professional data + A B•That is possible because the upperones have a bigger clinical appliedcompetence, perhaps because theyknow a little bit more medicine. ActivityAnd the upper left ones, moreover,have a bigger organizationalcompetence. C D - Costs +

42. angelruiztellez@cymap.es +00 34 637.53.23.59 7.-Would you know that we would find 4 areas of professional behaviour, in, more or less, a rule, a law of quarters? X Diagram Téllez-Alonso Each dot, an annual professional data + A 350% B•That is possible because the upper betterones have a bigger clinical applied Cost-Effectivenesscompetence, perhaps because theyknow a little bit more medicine. with regards to Activity the restAnd the upper left ones, moreover,have a bigger organizationalcompetence. C D - Costs +

43. angelruiztellez@cymap.es +00 34 637.53.23.59Summarizing, what can ISIS Manager© Project do?: Can create an environment of Excellence ( Effectiveness + Efficiency ) across the “peer-review”, with controlled bias towards more activity by less costs. Activity The first stage is to have a “Valuable Information System”, according a Valuable, too, Worthy and A B Challenging Goal of Reference, “To Solve the bigger number of Epidemiological Needs Model trend with the best Effectiveness and Efficiency”The second stage is to avoid the mistrust, after reading theinformation data: •Standardizing Data (weighed social, population, C D epidemiological conditions of each Doctor patients’ Panel) •Guaranteeing the ‘Quality Data’ across a method of Costs certification of the Records Reliability ( ISIS Manager© use 100 steps control along the ‘data chain’, included the Certification in ICPC Professional Codification).

44. angelruiztellez@cymap.es +00 34 637.53.23.59CONCLUSIONS: •The “peer-review” is the one of most powerful methods of professional motivation, but must observe , fulfil, the next conditions: •Must evaluate 100% activity and 100% manageable costs. •Must evaluate the Effectiveness •To avoid the mistrust around the professional comparison, the data must be standardized and certificated in Records Reliability. •The Information System have to create an environment with controlled bias, controlled slant towards the “more activity by less costs”. • A classification like our GRE/NCC© allows, quickly, • to the professionals: •To Know his professional profile and •To learn around their strength and weakness •To the Managers: •To know the reality and act consequently.