The document summarizes an integrated care organization being launched in North West London to improve collaboration between GPs, specialists, and other providers. The key points are:
1) The integrated care pilot aims to reduce emergency admissions by 30% and nursing home admissions by 10% for diabetics and elderly patients, as well as overall costs by 24%, through improved collaboration across organizations.
2) The pilot will have a joint governance model where representatives from each provider organization are on a decision-making board to oversee the pilot.
3) Financial arrangements include aligning incentives, sharing funding across organizations, and pooling a small amount of funds to cover additional care and management costs from increased collaboration.
The best of clinical pathway redesign - practical examples of delivering bene...NHS Improvement
The examples here showcase just some of the innovations that have enabled thousands of patients to enjoy better health and well-being thanks to practicalservice improvements implemented on various clinical pathways
The best of clinical pathway redesign - practical examples of delivering bene...NHS Improvement
The examples here showcase just some of the innovations that have enabled thousands of patients to enjoy better health and well-being thanks to practicalservice improvements implemented on various clinical pathways
Transforming care for cancer patients - spreading the winning principels and ...NHS Improvement
Transforming Care for Cancer Patients - Spreading the Winning Principles and Good Practice This publication, the third in a series*, supports the Cancer Reform Strategy’s (2007) Transforming Inpatient Care Programme. Its aim is to illustrate ‘how’ NHS Trusts are spreading tested improvements (Published July 2009).
Stroke rehabilitation in the community: commissioning for improvementNHS Improvement
Stroke rehabilitation in the community: commissioning for improvement
provides a comprehensive guide to the development of effective community rehabilitation services. Together with detailed examples of good practice and information about early supported discharge (ESD) service models implemented in England, it explores factors which influence local commissioning, and identifies tools to assist with commissioning and funding rehabilitation. This new publication is particularly relevant to the emerging commissioning landscape, the development of a new outcomes framework, and the positioning of stroke within long term conditions. (Published July 2012)
New Business Models and Primary Care ContractingNHS England
General Practice Transformation Champions conference, 22 November 2017
Workshop 3.5 New Business Models and Primary Care Contracting - Led by Ed Waller & Paul Maubach
NEHTA and Department of Health & Ageing hosted a Software Developer Conference in conjunction with CHIK's Health-e-Nation 2012 conference in March 2012.
Mick Reid of McKinsey & Co took part in the “What’s in it for me?” panel describing the process and outcomes of Cairns health region study.
By Annette Gardner, PhD, MPH
Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco
The Patient Protection and Affordable Care Act (ACA) is an opportunity to coordinate care among health care providers and transform local nets into seamless systems of care. The study conducted by Dr. Annette Gardner, PhD, MPH, at the Philip R. Lee Institute for Health Policy Studies, UCSF, shows safety net integration activities in five counties—Contra Costa, Humboldt, San Diego, San Joaquin, and San Mateo—suggests much progress has been made to this end in these counties.
This Report describes the factors that affect a local safety net's ability to develop integrated delivery systems and lessons learned from the implementation of 30 safety net integration "best practices".
Building the evidence: developing the winning principles for children and you...NHS Improvement
Building the evidence: developing the winning principles for children and young people is the latest publication from the Children and Young People Survivorship team and was launched at the fourth national test community workshop. (Published September 2010).
This consultation document sets out proposals to establish a new framework for developing the healthcare workforce and seeks views on the systems and processes that will be needed to support it. The final date for responses is 31st March 2011, but earlier expressions of view would be helpful.
Going up a gear: Practical steps to improve stroke careNHS Improvement
Going up a gear: Practical steps to improve stroke care
The Stroke Improvement Programme's publication draws together the key themes and learning from the 2009/10 projects and includes ‘top tips’ that have emerged from the projects to help others as they make improvements in stroke care
Transforming care for cancer patients - spreading the winning principels and ...NHS Improvement
Transforming Care for Cancer Patients - Spreading the Winning Principles and Good Practice This publication, the third in a series*, supports the Cancer Reform Strategy’s (2007) Transforming Inpatient Care Programme. Its aim is to illustrate ‘how’ NHS Trusts are spreading tested improvements (Published July 2009).
Stroke rehabilitation in the community: commissioning for improvementNHS Improvement
Stroke rehabilitation in the community: commissioning for improvement
provides a comprehensive guide to the development of effective community rehabilitation services. Together with detailed examples of good practice and information about early supported discharge (ESD) service models implemented in England, it explores factors which influence local commissioning, and identifies tools to assist with commissioning and funding rehabilitation. This new publication is particularly relevant to the emerging commissioning landscape, the development of a new outcomes framework, and the positioning of stroke within long term conditions. (Published July 2012)
New Business Models and Primary Care ContractingNHS England
General Practice Transformation Champions conference, 22 November 2017
Workshop 3.5 New Business Models and Primary Care Contracting - Led by Ed Waller & Paul Maubach
NEHTA and Department of Health & Ageing hosted a Software Developer Conference in conjunction with CHIK's Health-e-Nation 2012 conference in March 2012.
Mick Reid of McKinsey & Co took part in the “What’s in it for me?” panel describing the process and outcomes of Cairns health region study.
By Annette Gardner, PhD, MPH
Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco
The Patient Protection and Affordable Care Act (ACA) is an opportunity to coordinate care among health care providers and transform local nets into seamless systems of care. The study conducted by Dr. Annette Gardner, PhD, MPH, at the Philip R. Lee Institute for Health Policy Studies, UCSF, shows safety net integration activities in five counties—Contra Costa, Humboldt, San Diego, San Joaquin, and San Mateo—suggests much progress has been made to this end in these counties.
This Report describes the factors that affect a local safety net's ability to develop integrated delivery systems and lessons learned from the implementation of 30 safety net integration "best practices".
Building the evidence: developing the winning principles for children and you...NHS Improvement
Building the evidence: developing the winning principles for children and young people is the latest publication from the Children and Young People Survivorship team and was launched at the fourth national test community workshop. (Published September 2010).
This consultation document sets out proposals to establish a new framework for developing the healthcare workforce and seeks views on the systems and processes that will be needed to support it. The final date for responses is 31st March 2011, but earlier expressions of view would be helpful.
Going up a gear: Practical steps to improve stroke careNHS Improvement
Going up a gear: Practical steps to improve stroke care
The Stroke Improvement Programme's publication draws together the key themes and learning from the 2009/10 projects and includes ‘top tips’ that have emerged from the projects to help others as they make improvements in stroke care
Similar to Mark Spencer & Rebecca Rawesh: Launching an integrated care organisation in North West London (20)
Evaluation of the Integrated Care and Support Pioneers ProgrammeNuffield Trust
Nick Mays of the Policy Innovation Research Unit presents some conclusions from the early evaluation of the Integrated Care and Support Pioneers Programme.
Effectiveness of the current dominant approach to integrated care in the NHSNuffield Trust
Jonathan Stokes of the Greater Manchester Primary Care Patient Safety Translational Research Centre presents a systematic review of case management in integrated care.
Providing actionable healthcare analytics at scale: Understanding improvement...Nuffield Trust
Thomas Woodcock, Improvement Science Fellow at Imperial College London, talks about the various measurement approaches and processes when working at large scale to assess care quality improvements.
Ramani Moonesinghe, Associate National Clinical Director for Elective Care at NHS England, discusses the use of data for monitoring care quality at various levels within the system.
Paul Aylin, Co-Director of the Dr Foster Unit at Imperial College London, gives concrete examples of using a specific statistical model for monitoring care quality, cumulative sum (CUSUM).
Martin Utley, Director of the Clinical Operational Research Unit at University College London, reflects upon his involvement in the launch of specific tools to monitor care quality for paediatric cardiac surgery.
Evaluating new models of care: Improvement Analytics UnitNuffield Trust
Martin Caunt, Improvement Analytics Unit Project Director and NHS England and Adam Steventon, Director of Data Analytics at The Health Foundation share insights into how they have approached evaluating new models of care.
Lisa Annaly, Head of Provider Analytics at the Care Quality Commission, discusses lessons learned from the CQC as they have worked to monitor care quality over time.
Kate Silvester, a healthcare systems engineer, discusses the challenges of working with data and statistical techniques for real-time monitoring of care quality.
Monitoring quality of care: making the most of dataNuffield Trust
Chris Sherlaw-Johnson, Senior Research Analyst at the Nuffield Trust, introduced the Monitoring quality of care conference and gives an overview of some of the approaches that we've been using at the Trust to identify where care quality has been improving, especially for frail and older people.
Providing actionable healthcare analytics at scale: Insights from the Nationa...Nuffield Trust
Christopher Boulton, Falls and Fragility Fracture Audit Programme Manager at the Royal College of Physicians and Rob Wakeman, Clinical Lead for Orthopaedic Surgery at the National Hip Fracture Database talk about what they have learned by analysing the national hip fracture database.
Providing actionable healthcare analytics at scale: A perspective from stroke...Nuffield Trust
Benjamin Bray, Research Director and the Sentinel Stroke National Audit Programme, presents at the Monitoring quality of care conference about stroke care analytics.
New Models of General Practice: Practical and policy lessonsNuffield Trust
Nuffield Trust policy researchers Rebecca Rosen and Stephanie Kumpunen present findings from our upcoming report on large scale general practice models.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Mark Spencer & Rebecca Rawesh: Launching an integrated care organisation in North West London
1. Launching an integrated
care organisation for North
West London
Integrated Care in London GP – Specialist collaboration
London:
and ‘Teams Without Walls’
Wednesday 9th February 2011
Dr Mark Spencer & Dr Rebecca Rawesh
2. There are five things we want to this afternoon
1 Overview of IC pilot and what we’re trying to
achieve
2 Structure, governance and organisation
design for the IC pilot
3 Fi
Financial arrangements and implications of
i l t d i li ti f
the IC pilot
4 Clinical engagement strategy
g g gy
Integrating clinical relationships and creating
5
multi-disciplinary systems
1
3. OVERVIEW OF IC PILOT
The NWL integrated care pilot brings providers together to work across
organisational boundaries to improve care cost-effectively
Why integrated care?
Brent: 37,000
▪ Current outcomes in
C t t i Ealing: 25,000 patients
care for the elderly and patients
people with diabetes in
NWL leave room for Westminster:
improvement 122,000
,
patients
▪ Locally there is much
enthusiasm for
integrated working and
improving collaboration Hounslow: Hammersmith and Kensington and
across clinicians 33,000 patients Fulham: 101,000 Chelsea: 62,000
patients patients
1) Become a ‘beacon’ for delivering integrated care to the local population
beacon
What are involving primary, secondary, community, social and mental health sectors
we trying
2) Decrease emergency admissions by 30% and nursing home admissions by
to
achieve 10% for diabetics and frail elderly
in NWL? 3) To overall reduce cost of these groups by 24% over 5 years
4) Significantly improve patient experience
2
4. 3 The NWL integrated care pilot will remove barriers to enable the system
to implement whole system change across care pathways
Overview Clinical changes Clinical enablers
▪ The 8 PCTs and
providers in NWL face Aligned incentives Joint governance
a £1bn funding gap
by 2015
▪ GPs from across 5
PCTs, Imperial College
Healthcare, social
services and central
London Community Outcomes incentives will be aligned Representatives from each provider
health have worked across providers, and providers will organisation will be part of a joint
together to design a pilot Diabetes & the Elderly share a pool of funding governing, decision-making body that
MDTs manage the health monitors and acts on issues
▪ This has been of a population, and
supported by Kaiser specific programmes Information sharing
I f ti h i
Organisational development
Permanente, Nuffield target patients based on and culture
Trust, King’s Fund and need and risk
McKinsey stratification
and Co.
▪ The pilot will have major
j
clinical and financial Other
Oth opportunities
t iti
benefits A group creates overall
coordination across
providers to improve A mechanism for sharing that Leaders and clinical teams spanning
care and meet aggregates patient-level data so that it provider organisations will undertake
commissioning intentions can be analysed and accessed in a joint training and development, and
(e.g.,
(e g reduce LOS) timely, seamless way
y y will begin to develop their own team
g p
cultures
SOURCE: NWL Integrated care working team (Aug 2010) 3
5. Mission statement created by TIMB
1) Deliver high quality care for patients that makes an improvement in patient
outcomes and satisfaction
2) Increase the level of trust, coordination and collaboration across clinicians with
GPs, consultants and other providers working together towards better patient care
3) Become a ‘beacon’ for delivering integrated care to the local population
4) Create a vehicle for delivering productivity and efficiency improvements within
and across the various providers
5) Improve the satisfaction of clinicians and healthcare workers across the sector
through their ability to deliver proactive care
6) Make the IMB, as a representative group of providers, accountable for ensuring the
successful and timely launch of the IC pilot
7) Ensure all providers are on-board and signed-up to pilot by g
) p g p p y giving ample
g p
opportunity to engage in the project and shape the IC
8) Ensure that all stakeholders are engaged including third sector, users of services
and carers of those users
SOURCE: Interviews, Transitional IMB 4
6. STRUCTURE AND GOVERNANCE OF IC PILOT
Governance model
IC pilot LA Patients &
PCTs ACV1
commis Public
▪ The IC pilot will establish
new relationships between
providers in NWL Mental
▪ These will be based on CLCH Imperial LA providers Third Sector
Health
contractual relationships
rather than a new
organisation
▪ The IC pilot will establish
p GP practice
mechanism for co-
ordination and funding flows GP practice GP IC
amongst providers leadership
▪ The Management Board
(IMB) will agree resource GP practice
IC
plans, funds sharing, Pilot
membership, etc GP practice
▪ Decision making will be by IMB
consensus
Providers
LEGEND
▪ The IC pilot will include GPs, Imperial, CLCH, Local Authorities and Joint vehicles
Mental Health trusts Commissioners
▪ GP practices elect leaders to represent primary care in the IC pilot. Providers
▪ Providers will pool a small amount of funds into the IC pilot to cover Funding flow
F di fl
Pooling of funds
costs of more activity and mgmt
1 Sector Acute Commissioning Vehicle
SOURCE: NWL Integrated care working team (Aug 2010) 5
7. STRUCTURE AND GOVERNANCE OF IC PILOT
Integrated Management Board
IMB Board
(Chair: Prof. Elisabeth Paice)
Imperial (5 votes) GP Practices (11 votes) Central London Local Authorities (1 Third Sector (2 Mental Health (1
Community
C it vote)
t ) votes)
t ) vote)
t )
Healthcare (2 votes)
Claire Holloway /
Claire Perry, Brent: Dr Mandy Craig (James Reilly) Geoff Alltimes, Benn Peter Cubbon,
Managing Director Chief Executive Chief Executive Keaveney, Chief Executive
Officer Officer, London Lead, Age UK Officer
Borough
Tony Graff, Chief Hammersmith &
Ealing: Dr Jennifer Durandt Jane Clegg,
Finance Officer Fulham Roz
Director of
Rosenblatt,
Operations
Diabetes UK
Josip Car, Clinical
Programme Director, Marian Harrington,
Hounslow: Dr Liz Morris
PH Director of Adult
Services,
Westminster City
Julian Redhead, Council
Director of Medicine Hammersmith & Fulham: Dr
Tim Spicer, Dr Simon
Edwards and Dr Peter
Jonathan Valabhji, Fermie
Clinical Lead -
Diabetes
Kensington & Chelsea: Dr
David Taube, Tahir, Dr Simon Ramsden
Medical Director
Edward Dickinson,
, Westminster: Dr Ruth
Clinical Lead - O'Hare, Peter Crutchfield,
Elderly 1 TBC
6
8. Financial modelling suggests that £10m can be saved from emergency
admissions; with a proportion split across the various providers
Funding
F di approach for integrated care pilot year (2011/12)
hf i d il Funding fl
F di flows (2011/12)
£m (based on high-level analysis)2 Amount (£m) £m (based on high-level analysis)2 Incentive Payment
Commissioners in NWL currently spend a 187 Additional Resource
1
disproportionate amount on diabetes and the elderly. £10*m comes out of acute Infrastructure Cost
For a pilot of 380,000 the spend on these groups is care due to IC pilot QIPP Payment
£187
~£187
IC pilot providers agree the care pathways and targets 10*
2 for diabetes and the elderly and propose these to Commissioner
3.30 1.60
commissioners
Commissioners reflect outcomes in provider SLAs and -6.7 2.10
3 Commissioner
other contracts, expecting a decrease of activity they
p g y y
Balance
provide in 2011/12 for the diabetes and elderly pilot1
population
Does the IC pilot IC Joint Venture
Commissioners keep the balance as part of its QIPP 3.3 deliver allocates
4
contribution improvements? funding
The £6.7m that will be contributed by commissioners
5
via contracts (CQUIN and LES) is divided as follows:
▪ Additional out of hospital resource for more proactive -2.1 No Yes
care (guaranteed payment)
▪ Infrastructure costs to run the pilot (guaranteed -1.6
payment) 3.00 3.00
▪ Incentive payment for outcomes (dependent on 30
-3.0
achieving goals)
Payment for
If outcomes are not delivered by the IC pilot, the £3 acute over-
5 performance
million of incentive funding will not be paid
Any additional savings made by the IC p
y g y pilot will be kept
p Split of incentive payments and additional resource to be
6
by the providers recommended by finance group via detailed modeling
1 Figures are calculated as a best estimate of the commissioning intentions specific to diabetes and elderly based on a pilot population of 380,000
2 Analysis being further developed in current phase of work moving from top-down analysis to bottom-up modelling
* Assumes actiivity removed at full PbR tariff from provider – in reality 30% marginal rate applies for activity reduction in 2011/12 7
9. OVERVIEW OF IC PILOT
Lots of work to be done in the next few months – 7 working groups set up
Workstream
W k t Working group
W ki Responsibilities
R ibiliti
▪ Design the new governance structure for sign-off by IMB including
Governance roles, responsibilities, processes and various enablers required for
Governance collaborating
and Finance ▪ Discuss and problem-solve the various contractual and financial
Finance implications of the IC pilot and how various providers will come
together to deliver the change required
Clinical Working ▪ Define clinical interventions for both Diabetes and Elderly Care (in
Groups
G separate groups) and set protocols and set core clinical agenda
Clinical
▪ Define the ‘solution space’ for local MDT design (e.g., size, duration,
MDT Mechanics frequency of interaction etc.) and develop a general toolkit to support
local implementation
▪ Create and design an evaluation platform with metrics for the
Evaluation patient experience, financial impact, clinical outcomes and change
Evaluation and management to be used during the pilot
and
Research ▪ Identify various research opportunities within integrated care and
Research
discuss possible work and undertake research agreed upon within
the group
▪ Form ‘technical design group’ to decide how to implement the
Information required IT solutions and ‘functional design group’ to decide what the
Information
IT will need to look like
Co-chairs (one GP and one Imperial Consultant) have been
appointed for each working group
8
10. We have already detailed and begun an intensive engagement strategy…
Key dates
y
January February March April Dates
IMB 1 2 3 4 5 ▪ Page 26
Kick-Off
▪ 8th Feb
MDT Support ▪ 1st Mar
Forum (all 1 2 3 4 5 ▪ 23rd Mar
Clinicians) ▪ 13th Apr
▪ 27th Apr
GP Road-shows 1111 1 1 12
▪ Various
GP Practice-by-
2
▪ Various
Practice Visits
One-on-one
Interviews 1 1 11 1112 ▪ Various
Imperial Fortnightly Imperial internal IC pilot meetings (when invited)
Engagement <Best approach to be defined with Imperial >
▪ TBC
Other Provider
Engagement
<Various mechanisms depending on provider> ▪ TBC
9
11. 3 We have agreed the care pathways for frail elderly and diabetic patients
The clinical working group for the elderly identified priority areas The clinical working group for diabetes agreed roles and quality
to improve care in the pilot elderly population through integration standards, and so the pilot will remove barriers to this
Segments # of patients in pilot1 Segments # of patients in pilot1
In care 2,462 High needs 1,976
Support needed 3,337
3 337 Intermediate needs 3,969
3 969
Independent but at risk 2,850 Low needs 9,454
Independent and well 10,599 Newly diagnosed 1,106
Early identification of elderly Impact evidence Programme elements Impact evidence
1
frail people/risk stratification ▪ 30% reduction in bed Short term
days Risk Case ▪ Higher % with BP
stratification management under 140/80 and
2
Prevention programmes ▪ 20-80% reduction in
(falls, medicine management) emergency admissions cholesterol under 4.5
Telemonitoring ▪ Improved HbA1c
over time Diabetic
& telephone
Pro-active care planning and ▪ Reduction in registry
support control (<7.5)
3
delivery by community team readmissions ▪ 100% uncontrolled and
%
▪ 40-70% reduction in Improved
Patient complex patients on
education care plans
Appropriate falls screening
programmes
4 Longer term
emergency responses ▪ Improved satisfaction ▪ 20-25% reductions in
▪ People getting the Multi-disciplinary Patient-held admissions
Pro-active case management “right care” across team meetings records ▪ 40% Reduction in bed
5
of complex patients social and health days
Clinical ▪ 80% Reduction in
Care planning
6 Improved information flows education amputations
Both pathways are based on individually case managing patients through
p y y g gp g
pathway-based MDTs and applying a risk-stratified set of interventions based on individual needs
1 Pilot population estimated to be 380,000
SOURCE: NWL Integrated care working team (Aug 2010) 10
12. MULTI-DISCIPLINARY SYSTEMS
Our vision for a multi-disciplinary system – 7 core elements of the NWL
model
Element Description
1 List of covered population and associated data
Patient from all setting of care
registry
2 Segmentation of individual patients by risk
Risk
stratification
3 Clinical Development of clinical protocols and care
protocols and packages (including activity and resource
care packages requirements) for each risk group
4 Creation of individual care plans in one-to-one
Care plans meetings between clinicians and patients
5 Delivery of care plans by multiple professional
Care delivery groups
6 Discussion of management of most complex cases
Case
conference
7 Review by MDS of patient experience, clinical
y p p ,
Performance
P f
outcomes, financial performance and team
review effectiveness
SOURCE: Team analysis 11
13. OVERVIEW OF IC PILOT
Following this phase of work; mechanisms will be in place to monitor and
support the IC pilot within the first year
Post-Pilot
Pilot
Pre-Pilot
▪ Start of Dec 2010 to end of ▪ End of April 2011 to end of ▪ End of April 2012 onwards
Timeline April 2011 April 2012
▪ Develop work-streams and ▪ Provide on-going support to ▪ Agree ongoing resourcing
Focus of work enablers to IC pilot through MDTs across sector that and funding based on
various working groups have been formed decision to continue pilot or
▪ Ensure milestones are ▪ Continue roll-out of more not
reached, through practices and MDTs across ▪ Monitor progress through
transitional IMB, and the sector (and/or sign-up evaluation platform and
decisions made on-time for more) performance management
launch ▪ Monitor progress through processes
▪ Support and coordinate evaluation platform and ▪ TBD (based on success of
ramp-up across NWL to performance management pilot): Introduce new
form MDTs processes pathways and expand
scope or partners of pilot
Enabler to ▪ Clinical Engagement ▪ Clinical Engagement ▪ Clinical Engagement
success ▪ Rapid input and work from ▪ Identification of early ▪ Output from research group
working groups success metrics on new opportunities
12
14. Questions for discussion
1 How can we learn from you?
2 How should ‘organisational development be
organisational development’
handled during the IC pilot?
What financial arrangements need to work
3
for
f success? ?
4 How can we get clinicians to work together
more collaboratively?
y
13