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Value & Science Driven Healthcare
Jan A. Hazelzet, MD PhD
CMIO &
Vice-Director Strategy & Policy IT
Erasmus MC, Rotterdam,...
ERASMUS MC Sophia Children’s Hospital
 Pediatric Intensivist
 ≈ 1400 admissions/y
 28 + 6 beds
 Age: 0-18 y
 Staff:
...
Healthcare: Rapidly Increasing Complexity
 Diagnostic and treatment options are expanding and changing
 Chronic diseases...
These are our aims!
More information:
http://koers18.online-magazine.nl
Ambition 1: Continually adding Value
Our guiding p...
Care Path
Focus on the outcomes that matter most to patients
What is happening in Erasmus MC?
 For 8 diagnose teams outcome measures and initial patient conditions
with instruments a...
20141105_Call#3_v1029v2.pptx 15Copyright © 2013 by the International Consortium for Health Outcomes Measurement. All right...
Team around Disease or Condition
5: Check4: Praktijk,
tijd & taken
3: Prioriteit
& instrument
2: Patiënt
& uitkomst
1: Proces
& pad
INLEZEN &
VERSIE1 ZORGP...
https://gemstracker.org/
Cooperation
Participation:
• Prostate ca
• Cleft Lip Palate
• Stroke
• Macula
Degeneration
• ……
The first ICHOM publication, the localized
prostate cancer set, is in press!
Time driven activity based costing
Our implementation
Value Based Carepaths as Management Tool
We measure & manage:
• Quality of Care (Outcome)
• Efficiency ...
What to do in 2015 and onwards
 Proceed with defining process and outcome measures.
 Increase patient involvement
 To d...
Erasmus MC
Institute for Public
Health & Prevention
Erasmus MC
Quality of Care
Organization
Erasmus MC
Center for
Value-Ba...
2014 2015 2016
Brain tumors*,
Prostate Ca*, Stroke*,
Breast cancer*, Cleft
Lip*, Bladder cancer*,
Obesity*, Turner
Syndrom...
j.a.hazelzet@erasmusmc.nl
@JanHazelzet
Voorbeeld professionalblok
HI.48-1.SEH.VPK
Things to do
☐ Stroke sein uitzetten na vooraanmelding
10 minuten voor aankomst...
Uitkomstmaten en Meetinstrumenten
Uitkomstmaat Meetinstrument
Mortaliteit <7dgn < 3mnd
Basale Zelfredzaamheid Barthel / MR...
Initiële Patiënt Condities en Categorisaties
Initiële Patiënt Conditie Categorisatie
Ernst van het infarct 2e meting NIHSS...
Time Driven Activity Based Costing
per blok en per scenario
T= tijd in minuutprijs (bruto jaarsalarissen)
M= diagnostiek
O...
3. jan hazelzet vbhc prize 20150409
3. jan hazelzet vbhc prize 20150409
3. jan hazelzet vbhc prize 20150409
3. jan hazelzet vbhc prize 20150409
3. jan hazelzet vbhc prize 20150409
3. jan hazelzet vbhc prize 20150409
3. jan hazelzet vbhc prize 20150409
3. jan hazelzet vbhc prize 20150409
3. jan hazelzet vbhc prize 20150409
3. jan hazelzet vbhc prize 20150409
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3. jan hazelzet vbhc prize 20150409

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VBHC Prize 2015 Dr. Jan Hazelzet

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3. jan hazelzet vbhc prize 20150409

  1. 1. Value & Science Driven Healthcare Jan A. Hazelzet, MD PhD CMIO & Vice-Director Strategy & Policy IT Erasmus MC, Rotterdam, The Netherlands j.a.hazelzet@erasmusmc.nl
  2. 2. ERASMUS MC Sophia Children’s Hospital  Pediatric Intensivist  ≈ 1400 admissions/y  28 + 6 beds  Age: 0-18 y  Staff:  12 intensivists / 4 fellows  ≈ 120 fte. nurses  CMIO  Strategic planning of IT  Clinician’s perspective  IT-Governance  Clinical Documentation / EMR  Personalized Medicine  Value Based Health Care Liaison Medical <=> Informatics
  3. 3. Healthcare: Rapidly Increasing Complexity  Diagnostic and treatment options are expanding and changing  Chronic diseases and comorbid conditions are increasing  Care delivery has become increasingly fragmented  Health care safety, quality, and outcomes fall short of their potential  Growth rate of health care expenditures is unsustainable  Overtreatment / under treatment  Pace of change is too slow  No Patient Centered Care Best Care at Lower Cost: The Path to Continuously Learning Health Care in America. IOM 2012
  4. 4. These are our aims! More information: http://koers18.online-magazine.nl Ambition 1: Continually adding Value Our guiding principle for research, education, and health care is creating added value for patients Understanding the health, diseases, and wishes of patients Personalized medicine (individualized treatment) Prevention Translating knowledge into useful, innovative products and health care concepts
  5. 5. Care Path
  6. 6. Focus on the outcomes that matter most to patients
  7. 7. What is happening in Erasmus MC?  For 8 diagnose teams outcome measures and initial patient conditions with instruments are defined  Participation in (inter)national workgroups (ICHOM);  A blueprint is developed to define outcome measures; 2018: 80%  IT platform (GemsTracker) is organized to measure outcomes.  Costs are measured on the basis of time spent (TDABC);  Teams are accompanied and assisted for all sections of care  Work in progress!!
  8. 8. 20141105_Call#3_v1029v2.pptx 15Copyright © 2013 by the International Consortium for Health Outcomes Measurement. All rights reserved. Value based healthcare
  9. 9. Team around Disease or Condition
  10. 10. 5: Check4: Praktijk, tijd & taken 3: Prioriteit & instrument 2: Patiënt & uitkomst 1: Proces & pad INLEZEN & VERSIE1 ZORGPAD 0: Intake Blueprint Value-Based Care Cycle THEORIE, AANDOENING, PAD EN TEAM DE SESSIES PLENAIR OUTCOME MANAGER & LEIDING ZORGPAD OUTCOME MANAGER INDIVIDUEEL OUTCOME TEAM ZORGPAD X INDIVIDUEEL SAVE THE DATE EN INLEZEN THEORIE VOORBEREIDING VERSIE 2 ZORGPAD THEORIE, AANDOENING EN PROCESPAD CHECK OP GUIDELINES EN PREMS VOORBEREIDING VERSIE 3 ZORGPAD UITKOMSTMATEN EN PATIENT INITIAL CONDITIONS SCORING MATEN EN CONDITIONS VOORBEREIDING, INSTRUMENTEN & SCORINGEN UITKOMSTMATEN CONDITIONS EN INSTRUMENTEN LITERATUURCHECK EN PEERLIJSTEN VOORBEREIDING FINAAL PAD, PROCES, METINGEN & TAKEN START 4WKN PAPERBASED PILOT EINDPRESENTATIE, INPUT FINANCE EN EVALUATIE VOORBEREIDING TERUGKOMSESSIE NA 4 WKN PAPERBASED PILOT FINAAL PAD EN IMPLEMENTATIE IT
  11. 11. https://gemstracker.org/
  12. 12. Cooperation Participation: • Prostate ca • Cleft Lip Palate • Stroke • Macula Degeneration • ……
  13. 13. The first ICHOM publication, the localized prostate cancer set, is in press!
  14. 14. Time driven activity based costing
  15. 15. Our implementation Value Based Carepaths as Management Tool We measure & manage: • Quality of Care (Outcome) • Efficiency Tasks & professionals (Processes) • Spending vs Reimbursement (Costs) • Benchmarking (Analyse)
  16. 16. What to do in 2015 and onwards  Proceed with defining process and outcome measures.  Increase patient involvement  To define a (corporate) standard set of outcome instruments  Train clinicians in each disease team in analysis and quality improvements  Measure, analyze, interpret and reporting results.  Cooperation with peers and payers, benchmarking
  17. 17. Erasmus MC Institute for Public Health & Prevention Erasmus MC Quality of Care Organization Erasmus MC Center for Value-Based Health Care “The Center for Value-Based Health Care brings together disciplines from across Erasmus Medical Center to develop and implement strategies for driving demonstrable improvements in the value we deliver for our patients.” Sustainable and transparent results for all stakeholders inside and outside the Erasmus MC are central.
  18. 18. 2014 2015 2016 Brain tumors*, Prostate Ca*, Stroke*, Breast cancer*, Cleft Lip*, Bladder cancer*, Obesity*, Turner Syndrome, Macula Degeneration*, Larynx cancer Heart failure, Sickle cell, Hemophilia, IBD, Colorectal Ca,, Pancreas Ca, Frail Elderly, Pregnancy + Childbirth, Hemifacial Microsomia, Dementia, Liver failure Neuro trauma, Bipolar Disease, ICU treatment, Cystic Fibrosis, Lung cancer Future Plans: * Outcome measures defined Together with ICHOM
  19. 19. j.a.hazelzet@erasmusmc.nl @JanHazelzet
  20. 20. Voorbeeld professionalblok HI.48-1.SEH.VPK Things to do ☐ Stroke sein uitzetten na vooraanmelding 10 minuten voor aankomst AMB ☐ Triage ☐ Gewicht & bloedglucose noteren ☐ Patiënt naar CT scan brengen ☐ Patiënt van CT tafel halen ☐ Venflon (groen rechts in elleboog) & Stroke Lab ☐ Monitoring: bloeddruk & neurologische uitval iedere 15 min ☐ ECG maken ☐ Op indicatie: alteplase spuit klaarmaken ☐ Op Indicatie: CAD plaatsen ☐ Op Indicatie: Point of Care & INR via lab Things to measure  Binnenkomst tijd en datum SEH _____________  Starttijd Trombolyse _____________  Starttijd Bolus _____________ Datum & HandtekeningMicrosectienummerPatiënt ID Tijdsduur in 45 min Vul hieronder uw taakspecifieke things to do en things to measure in en lever iedere woensdag de ondertekende lijsten in op Hs645 code 0104. Alle proces en uitkomst metingen worden maandelijks met u gedeeld en verzameld in een Erasmus MC Key Outcome Report eind 2014. Dank voor uw medewerking!
  21. 21. Uitkomstmaten en Meetinstrumenten Uitkomstmaat Meetinstrument Mortaliteit <7dgn < 3mnd Basale Zelfredzaamheid Barthel / MRS Verfijnde Zelfredzaamheid UserP Uitval NIHSS opn Kwaliteit van leven EuroQoL (bij hoge depressie score HADS) Vermoeidheid Fatigue Severity Scale Cognitieve functies MOCA Pneumonie PSI Ontslag Bloedingscomplicaties Intracranieel en extracranieel Ontslag Delier Bij risicoprofiel>3 DOS Vallen Val lijst Last Mantelzorger Care Giver Strain index
  22. 22. Initiële Patiënt Condities en Categorisaties Initiële Patiënt Conditie Categorisatie Ernst van het infarct 2e meting NIHSS Leeftijd In jaren Socio Economische Situatie Codes SES + taalbarrière j/n Geslacht m/v Comorbiditeiten Comorbiditeitlijst Atrium Fibrilleren j/n Previous Stroke j/n Woonsituatie Alleen/ VPhuis/Partner/Partner+Kinderen/Alleenstaand+ Kinderen
  23. 23. Time Driven Activity Based Costing per blok en per scenario T= tijd in minuutprijs (bruto jaarsalarissen) M= diagnostiek O= overhead in FTE/m2 x P= productiviteit %  Check kosten met vergoedingen, STZ tarieven, productieaantallen en manage het tarief

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