A presentation I gave at the EGM of Ireland's National Association of General Practitioners. Shows progress in some areas of health; payments to GPs since 2002; and argues that general practice should embrace measures which show its value and contribution to healthcare.
From High Hopes to HITECH: Money and Meaningful Use. Centricity Healthcare User Group. This presentation covers meaningful use, IT Adoption, interoperability, network effects, transparency and better outcomes from the use of Health Information Technology.
Health is of central importance to well-being. The standard and reach of health services have improved in Ireland over recent decades as indeed have health outcomes. However, not all of this progress has been experienced equally by all sections of the population. In particular, there are significant and persistent disparities in healthcare outcomes adjusted for socio-economic status. Similar disparities in the level of access to healthcare and the scope of healthcare provision point to a systemic problem. This paper considers a policy approach that could deliver a single, universal, comprehensive and integrated health service fit for purpose and one to which all people can have access on the basis of need and not ability to pay. Our costing exercise demonstrates that health system transition and reform will entail additional demands on public resources with implications for fiscal policy.
South EIP 2019-20 NCAP Results& Recovery Planning - November 2020Sarah Amani
A regional stock take of current performance against national standards with a summary of support available to recover and restore to expected levels of patient experience, service quality and outcomes.
From High Hopes to HITECH: Money and Meaningful Use. Centricity Healthcare User Group. This presentation covers meaningful use, IT Adoption, interoperability, network effects, transparency and better outcomes from the use of Health Information Technology.
Health is of central importance to well-being. The standard and reach of health services have improved in Ireland over recent decades as indeed have health outcomes. However, not all of this progress has been experienced equally by all sections of the population. In particular, there are significant and persistent disparities in healthcare outcomes adjusted for socio-economic status. Similar disparities in the level of access to healthcare and the scope of healthcare provision point to a systemic problem. This paper considers a policy approach that could deliver a single, universal, comprehensive and integrated health service fit for purpose and one to which all people can have access on the basis of need and not ability to pay. Our costing exercise demonstrates that health system transition and reform will entail additional demands on public resources with implications for fiscal policy.
South EIP 2019-20 NCAP Results& Recovery Planning - November 2020Sarah Amani
A regional stock take of current performance against national standards with a summary of support available to recover and restore to expected levels of patient experience, service quality and outcomes.
eHealth Summit: "Case Study: The applied research for connected health (ARCH)...3GDR
Slides from National eHealth Summit, 30 Sept 2015 at Carton House, Kildare: Maria Quinlan, Research Lead Change Work-Package, ARCH.
#eHealthSummit15
http://www.ehealthsummit.ie
http://mhealthinsight.com/2015/09/25/mhealth-insights-from-the-ehealth-summit/
eHealth Summit: "ICT Use in Irish General Practices: An Intra-Practice Adopti...3GDR
Slides from National eHealth Summit, 30 Sept 2015 at Carton House, Kildare: Jane Bourke, Lecturer in Economics, University College Cork.
#eHealthSummit15
http://www.ehealthsummit.ie
http://mhealthinsight.com/2015/09/25/mhealth-insights-from-the-ehealth-summit/
eHealth Summit: "Delivering Services that are Fit for the Future: From Strate...3GDR
Slides from National eHealth Summit, 30 Sept 2015 at Carton House, Kildare: Prof George Crooks OBE, Medical Director NHS 24 and Director, Scottish Centre for Telehealth and Telecare
#eHealthSummit15
http://www.ehealthsummit.ie
http://mhealthinsight.com/2015/09/25/mhealth-insights-from-the-ehealth-summit/
This presentation by David MOLONEY was made at the 3rd Joint DELSA/GOV Health Meeting, Paris 24-25 April 2014. Find out more at www.oecd.org/gov/budgeting/3rdmeetingdelsagovnetworkfiscalsustainabilityofhealthsystems2014.htm
Helen Southwell, Diabetes Commissioning Lead, South Worcestershire CCG,
Dr. Matthew Goodman, Chief Medical Officer, Mapmyhealth
Emma Innes, Matron Diabetes/Senior Lecturer, Worcestershire Acute Hospitals NHS Trust & University of Worcester
eHealth Summit: "EU Address: The EU eHealth Strategy: Connecting Member State...3GDR
Slides from National eHealth Summit, 30 Sept 2015 at Carton House, Kildare: Dr Tapani Phia, Head of Unit, eHealth & Health Technology Assessment, European Commission.
#eHealthSummit15
http://www.ehealthsummit.ie
http://mhealthinsight.com/2015/09/25/mhealth-insights-from-the-ehealth-summit/
This presentation was made by Kristina Garuoliene, Lithuania, at the 3rd Health Systems Joint Network meeting for Central, Eastern and South-eastern European Countries held in Vilnius, Lithuania, on 25-26 April 2019
eHealth Summit: "Case Study: The applied research for connected health (ARCH)...3GDR
Slides from National eHealth Summit, 30 Sept 2015 at Carton House, Kildare: Maria Quinlan, Research Lead Change Work-Package, ARCH.
#eHealthSummit15
http://www.ehealthsummit.ie
http://mhealthinsight.com/2015/09/25/mhealth-insights-from-the-ehealth-summit/
eHealth Summit: "ICT Use in Irish General Practices: An Intra-Practice Adopti...3GDR
Slides from National eHealth Summit, 30 Sept 2015 at Carton House, Kildare: Jane Bourke, Lecturer in Economics, University College Cork.
#eHealthSummit15
http://www.ehealthsummit.ie
http://mhealthinsight.com/2015/09/25/mhealth-insights-from-the-ehealth-summit/
eHealth Summit: "Delivering Services that are Fit for the Future: From Strate...3GDR
Slides from National eHealth Summit, 30 Sept 2015 at Carton House, Kildare: Prof George Crooks OBE, Medical Director NHS 24 and Director, Scottish Centre for Telehealth and Telecare
#eHealthSummit15
http://www.ehealthsummit.ie
http://mhealthinsight.com/2015/09/25/mhealth-insights-from-the-ehealth-summit/
This presentation by David MOLONEY was made at the 3rd Joint DELSA/GOV Health Meeting, Paris 24-25 April 2014. Find out more at www.oecd.org/gov/budgeting/3rdmeetingdelsagovnetworkfiscalsustainabilityofhealthsystems2014.htm
Helen Southwell, Diabetes Commissioning Lead, South Worcestershire CCG,
Dr. Matthew Goodman, Chief Medical Officer, Mapmyhealth
Emma Innes, Matron Diabetes/Senior Lecturer, Worcestershire Acute Hospitals NHS Trust & University of Worcester
eHealth Summit: "EU Address: The EU eHealth Strategy: Connecting Member State...3GDR
Slides from National eHealth Summit, 30 Sept 2015 at Carton House, Kildare: Dr Tapani Phia, Head of Unit, eHealth & Health Technology Assessment, European Commission.
#eHealthSummit15
http://www.ehealthsummit.ie
http://mhealthinsight.com/2015/09/25/mhealth-insights-from-the-ehealth-summit/
This presentation was made by Kristina Garuoliene, Lithuania, at the 3rd Health Systems Joint Network meeting for Central, Eastern and South-eastern European Countries held in Vilnius, Lithuania, on 25-26 April 2019
Commissioning for outcomes,
Wednesday 21 January 2015 - 13.00 to 13.45
Hosted by Bob Ricketts CBE, Director of Commissioning Support Services and Market Development for NHS England.
The CMS Innovation Center hosted a special webinar featuring Dr. Patrick Conway, CMS Deputy Administrator for Innovation and Quality and CMS Chief Medical Officer, on Monday, November 10, 2014 from 10:30am – 11:30 am ET. Dr. Conway will provided an update about the work of the CMS Innovation Center and the models being tested to improve better care for patients, better health for our communities, and lower costs through improvement for our health care system. Opportunities for questions were provided.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
1 armstrong presentation on price and tariff setting v2Oliver O'Connor
Presentation at a forum I organised on Money Follows the Patient hospital payment systems 4 September 2012
John Armstrong is actuary with Aviva in Ireland
Application of EU Single Market rules to providers of healthcare in Ireland anticipating move to Universal Health Insurance - legal and practical arguments
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- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
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Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Triangles of Neck and Clinical Correlation by Dr. RIG.pptx
National Association of GPs Presentation 20 July 2013
1. Health
Reform, Efficiency
and Quality
- how far yet to go?
Oliver O’Connor
ooc@sky.com
www.oliveroconnor.co
National Association of General Practitioners Conference
Portlaoise, 20 July 2013
www.oliveroconnor.co
1
2. Health Reform
• It goes on and on, a never-ending river…
• Is any country not engaged in health reform?
• No one model, no one best system
• Assess what we do and what is planned in Ireland
www.oliveroconnor.co
2
3. Health Reform – main themes
• What we do – activity and services by health staff
• What we get – the patient experience
• What we pay – public and private funding
• How we pay – tax, private insurance, out of pocket
• How we manage – health provider organisations
• How we govern – public and private law oversight
• How we perform – efficiency, outcomes
www.oliveroconnor.co
3
4. Health Reform – priorities?
• What we do
• Move to more primary care: measures?
• Waiting times and ED improvement by SDU
• HSE Clinical programmes: a high clinical priority, leadership
• What we get
• Free GP care – await new announcement – ‘free’ primary care
• Equal access to all hospital care – awaits eventual UHI
• What we pay
• Fiscal constraint. 20% cuts since 2008. No growth ahead.
• How we pay
• Universal Health Insurance: ‘building blocks’ first. Long way off.
• Money Follows the Patient hospital payments: in shadow 2014; full 2015?
• How we manage
• No major changes
• How we govern
• 6 Hospital groups, HSE re-organisation, ultimately insurer role
• How we perform
• HealthStat development?
• New measurements actually driving change? HSE KPIs?
www.oliveroconnor.co
4
5. Health Reform – evaluation
• Ultimately, all to lead to Universal Health Insurance
• ‘Building blocks’ to be in place by 2015/16: a metaphor
• Ultimate achievement: 2021 earliest (two terms of Government)
• Highly complex interrelated changes at every level
• Payment systems
• Role of hospitals
• Role of primary care providers
• Role of insurers
• Role of State organisations and regulators
• Service integration and competition
• Public entitlements and contributions
• C-O-S-T
• White Paper this year – but more like a series of documents?
www.oliveroconnor.co
5
6. Health Reform – what about…
• What we do
• How we perform
i.e.
• Clinical effectiveness
• Cost efficiency
delivering
• Best health status and outcomes at a reasonable cost
www.oliveroconnor.co
6
7. The Money: Health Spending
• HSE €13.4bn net
• Most on primary and community service
• Insurance €1.6bn
• Most on secondary, hospital-based services
• Private, out of pocket est €2.5bn
• Most on primary services, drugs, elective
• Total €17.5bn (est.)
• Most on primary or non-hospital services
• Do we get all we can for this?
• What gets measured? Gets attention?
www.oliveroconnor.co
7
8. HSE spending composition
0 1,000 2,000 3,000 4,000 5,000 6,000
Hospitals
Community Services
PCRS
Children & Families
Corporate
Pensions
National Services (inc Amb)
Population Health
Repayment scheme
Financial Allocations of HSE Gross Spend €14.16bn 2013
0
4,117
2,562
1,535
998
733
541
477
400 392
114 77 72
HSE Financing by Care Group 2013
Acute
PCRS
Disability
Fair Deal - Nursing Home
Mental Health
Children & families
Multi-care group
Primary Care
Older people
• PCRS includes GP fees and
practice supports
• Primary care includes some out
of hours services
www.oliveroconnor.co
8
9. Performance: life years
• Big increases at age 65+: most likely health service effect?
• Even in the four years of last decade
www.oliveroconnor.co
9
10. High relative to EU
• Not just because of Central and E European states
• Higher than Germany, UK; lower than France, NL
Source: Dept of
Health, Health Key
Trends, 2012
www.oliveroconnor.co
10
11. Measured improvements
• Deaths from diseases of circulatory system and heart down
Source: Dept of
Health, Health Key
Trends, 2012
www.oliveroconnor.co
11
12. Cancer catch-up still needed
• 5 year survival improving but behind wealthiest EU countries
Source: Dept of
Health, Health Key
Trends, 2012
www.oliveroconnor.co
12
13. Child immunisation rates up
• Sustained progress over a decade
• Slight downward movement on meningococcal immunisations
in 2010-11
Source: Dept of
Health, Health Key
Trends, 2012
www.oliveroconnor.co
13
14. More efficient? Yes, but…
• Spending back to 2007 levels but activity up
• Overall 10% cut in public non-capital spending since 2009
• Up to 20% cut in hospital budgets since 2008 (mostly staff costs)
• But inpatient discharges up 3%
• Day cases up 1.3%, continuing trend
• Average length of stay down 4% (still not best though)
• Staff cut by 10,000
• ‘Efficiency’ gains yes.
• Hospitals and healthcare staff are doing more with fewer personnel
and at lower cost
• But our hospital costs per procedure are still high internationally
• Input-output or payment-activity measure not enough or not
appropriate
• Health outcomes?
• Too much activity?
• Still over-use of ED?
• Avoidable hospitalisation? etc. etc
www.oliveroconnor.co
14
15. OECDdevelopingprice/volumecomparisons
OECD, Joint session of the meetings of
Health Accounts Experts and Health Data
Correspondents, 11 October 2012
“Explaining differences in hospital expenditure across OECD
countries: the role of price and volume measures “
www.oliveroconnor.co
15
16. UK NHS unit costs lower
Notes: Recent efficiency gains in Ireland should have narrowed the gap
Casemix a post-hoc averaging of cost; not very precise
Patient level / procedure level costing needed
Exchange rate €1=£0.80
0
5,000
10,000
15,000
20,000
25,000
HIP REPLACEMENT + CCC HIP REPLACEMENT - CCC KNEE REPLACEMT +CSCC KNEE REPLACEMT -CSCC
€ Irish Casemix rates vs UK NHS Tariffs - selected orthopaedics
Ireland 2009
Ireland -10%
UK Average
www.oliveroconnor.co
16
17. A look at GPs…
• Up 31% since 2002
• Numbers up 7.7% since 2008, though health spending down
10% and HSE staff cut 10,000
0
500
1000
1500
2000
2500
3000
2002 2003 2004 2005 2006 2007 2008 2009 2011 2012
No. GPs with GMS contract
Source: Dept of
Health, Health Key
Trends, 2012
www.oliveroconnor.co
17
18. More GMS patients
• Up 58% since 2002
• Numbers up 37% since 2008
• April 2013 – up 4.3% on April 2012
• Plus 129,000 GP Visit Card patients
0
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
1.8
2
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Eligible GMS Medical Card Patient (m)
www.oliveroconnor.co
18
19. Total GMS payments to GPs
$0
$100
$200
$300
$400
$500
$600
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
GP Allowances €m
GP Fees €m
• Payments up €201m, 71%, since 2002
• Up 1.7% since 2008 (down 3.4% since 2009)
• New FEMPI cut to make savings of €38m (7.9% - 7.5%? stated)
Source: HSE, PCRS
GMS income before variable and fixed costs of each practice
www.oliveroconnor.co
19
€445m
20. Payments per GP
• Payment per GP up 31% since 2002
• Down 5.6% since 2008
• With new FEMPI cut, will be down 13.1% on 2008
GMS income before variable and fixed costs of each practice
Source: HSE, PCRS
$0
$20
$40
$60
$80
$100
$120
$140
$160
$180
$200
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
GMS Payments per GP (€000s)
www.oliveroconnor.co
20
21. Payments per GMS patient
• Payment per eligible patient up 10% since 2002, down 26% since 2008
• With new FEMPI cut, will be down 33% since 2008
• A 33% efficiency gain? Pity we don’t also have output/outcomes data
• Free GP care for whole population would cost c.€600m more at this rate
• ESRI calculated non-medical card holder GP costs at c.€389-€479m, 2009
$0
$50
$100
$150
$200
$250
$300
$350
$400
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
GMS Payments per Medical Card Patient (€s)
Source: HSE, PCRS
GMS income before variable and fixed costs of each practice
www.oliveroconnor.co
21
22. GMS Pharmacy payments
• Up 86% since 2002, down 5.2% since 2008
• With FEMPI cut €32m, will be down 12.7% since 2008
• But depends on volumes of prescriptions and pricing
• 1,690 GMS pharmacists 2011, up from 1,620 in 2008
$0
$50
$100
$150
$200
$250
$300
$350
$400
$450
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
GMS Pharmacy Fees and Mark-Up €m 2002-12
Sources: HSE, PCRS
www.oliveroconnor.co
22
23. What do we get? What is
measured?
• Traditionally, basic activity/inputs
• # ‘contacts’: GP visits, out-of-hours consultations
• # people have medical cards etc
• # doctors work in teams
• What is paid to doctors
• Nothing that demonstrated the value of general practice
• Much more now measured in hospitals
• Some Primary Care Key Performance Indicators now in
place
• But do they demonstrate the value and outcomes of general
practice?
www.oliveroconnor.co
23
24. HSE Key Performance Indicators
• In National Service Plan and Monthly Performance Reports
Supplementary Documents
www.oliveroconnor.co
24
25. HSE - 7 KPIs in Primary Care
• Number of PCTs implementing the National Integrated Care Package for
Diabetes
• Number of Health & Social Care Networks in development
• Percentage of Operational Areas with community representation for Primary
Care Team and Network development
• No. of contacts with GP Out of Hours
• Primary Care Physiotherapy:
• no. of patients for whom a referral was received
• no. of patients seen for a first time assessment
• no. of face to face contacts / visits / appointments
• Primary Care Occupational therapy:
• no. of clients who received a direct service
• no. of clients for whom a referral was received
www.oliveroconnor.co
25
26. 7 Main KPIs in Primary Care
• Orthodontics:
• no. of patients on the assessment waiting list
• waiting time from referral to assessment
• Number of patients on the treatment waiting list - Grade 4
• Waiting time from assessment to commencement of treatment – Grade 4
• Number of patients on the treatment waiting list - Grade 5
• Waiting time from assessment to commencement of treatment – Grade 5
• Number of patients receiving active treatment
www.oliveroconnor.co
26
27. A data desert
• What do these KPIs tell us about, and help deliver from, General
Practice?
• Certain levels of team-organisation
• Activity levels out of hours
• …
• Clinical effectiveness of general practice?
• Cost efficiency / value for money of general practice?
• Evidence of best practice in action and for development?
• Nothing on effectiveness or value of General Practice
• Should other existing KPIs be associated directly with General Practice
• E.g. child and adult immunisation rates?
• A lot more to do
www.oliveroconnor.co
27
28. OECD: can GPs help more?
• Indicators relating to long term conditions ‘which should be fully
managed in the community’ (hospital admissions rates can show
+/- performance of primary care)
• Asthma admissions
• Diabetes – incl. avoidable limb amputations
• Influenza Vaccinations for 65+, link to COPD Admissions rates
• Ireland: some of these are in HSE Acute Services KPIs, but not in
primary care
• Mental health indicators ?
• Data capture: e.g. Danish General Practice Database
• Information on 30 areas of general practice, made available to all
practices
• Depression, COPD, heart disease, diabetes, childhood and adult
vaccination, contraception etc
• Enables identification of patients being sub-optimally treated
• Comparisons with other practices
• Patient monitoring of own data
www.oliveroconnor.co
28
29. Selected indicators - COPD
Source: OECD
Health at a Glance
2011
• Ireland worst on admission rate; could do much better on vaccinations
www.oliveroconnor.co
29
30. Selected indicators - Diabetes
• Ireland good on prevalence and on admissions; could be better
www.oliveroconnor.co
30
31. Asthma prevalence and
admissions
• As quoted in the HSE KPI metadata for Acute Hospitals
• Ireland could do better for women at the same prevalence rate
www.oliveroconnor.co
31
32. Recommendations for
Denmark’s primary care
Source: OECD REVIEWS OF HEALTH CARE QUALITY: DENMARK, April 2013
• Setting a national vision for how the primary care sector should deliver seamless
and co-ordinated care, especially in light of increasing burden of long-term
conditions and a faster through-put in specialist care
• Bringing about a more transparent, formalised and verifiableprogramme of
continual professional development for all primary care practitioners, supported by
national standards, guidelines and time-limited financial incentives.
• Rewarding quality and continuity of the care that GPs provide, such as through
sharing of useful local experiences of successful integrated care
models, encouragement of group-based practice models, and piloting of advanced
nursing roles.
• Developing quality mechanisms – such as clinical guidelines and standards –
centered around patients with multiple chronic conditions and long-term care
needs, and the co-ordinating role of the general practitioner.
• Strengthening the information infrastructure underpinning quality in primary
care, for example by establishing a quality register for chronic care based in
primary care and by making better use of the DAK-E data capture system.
www.oliveroconnor.co
32
33. Conclusions
• Seek to demonstrate not just assert effectiveness and efficiency of
General Practice
• Demand measurement, even when it shows under-performance
• Seek out and implement meaningful performance indicators for
General Practice on clinical quality and cost efficiency
• Avoid subsuming indicators into acute care or other areas of health
management
• Embrace ex-ante cost-effectiveness assessments
• Embrace new technologies and change in practice management
and clinical care
• Help move cost-reduction agenda to cost-effectiveness agenda
• Don’t just seek more inputs (more GPs, more money for GPs), but
more cost- and clinically-effective investment
• Expect HSE / insurers to be more demanding and discerning
purchasers of care – meet the challenge head on
www.oliveroconnor.co
33