Sveus konferens 25 november 2014
Sveus konferens 25 november 2014 Melvin Samsom, Andreas Ringman Uggla, Karolinska Universitetssjukhuset 1 Value Based Health Care Melvin Samson Chief Execu4ve Officer Andreas Ringman Uggla Chief Health Care Delivery Officer Patients always first Variation in practise (Mulley AG. BMJ 2009) 4 Variation in quality (survival rates) 5-‐year survival stage I and II NSCLC -‐ hospital of diagnosis Zizo indicators (hospitals) 5 Increasing costs 6 Fragmentation of patient care 7 A new world The patient of the future: From passive object to active subject From patient to person From non-entity to decisive entity The physician of the future: Doesn’t call the shots, he provides a service From host to guest (Don Berwick) From God to guide (Bas Bloem) 8 Patient centered - Excellent quality - Personalized Health Care Value based Health Care 9 Value Based Health Care Outcomes that matter to patients • Do we know what these outcomes are? = Cost per patient Value • How do we assess their wishes in a comprehensive way? • Are we able to deliver their need? • Are we able to reinvent the system that we have build over the last 4 decades? VBHC at Karolinska Outcomes that matter to patients Value based improvement process emanating from value for the patient group Costs & Resources Patient flow & standardised care programmes Infrastructure and enablers Value based health care is based on five main elements Karolinska Nätverkssjukvården Gemensamma centrala funktioner Externa aktörer ÖV Lab SLV Hälsoprof. IVA AnOp AKM Strategisk ledningsgrupp för vårdproduktion PFA PFA B&F Specialitet 3 Specialitet 2 Patientgrupp 2 Specialitet 1 Patientgruppsspecifik kompetens Patientgrupp 1 PFA PFA PFA Forum för taktiskt styrning PFA-forum Patientgrupp 3 PFA PFA PFA Forum för operativ styrning Patientgrupp 4 FoU/U&I integrerat längs med hela patientflödet Erfarenhetsutbyte Focus on patient groups with responsible PFA Define patient group Multiprofessional, engaged personnel and Measurement of Patients quality & cost Identify possible quality registers Decide on PFA Utilise all work done so far around the patient group Map out the process for the patient group Define Parameters: • Patient-relevant outcomes • Costs • Resources • Processes Build the digital dashboard 12 K-VBV - Patientgrupper_Projektgruppsmöte #4_10Nov2014_vFinal.pptx Clinical personnel the driving force behind VBHC-work, based on K´s values • All relevant disciplines and operations are involved The patients perspective is central Relevant external partners, i.e. med-tech companies Prioritization & cont. improvement Decisions based on results achieved Utilise tools for improvements: • Research • Education • Innovations • Developments • Flow improvements • Network healthcare Implementation and follow-up Stöd Utbildning Utnämning Eskalering Beslut Clear and consistent governance A holistic view of resources, patient flow and quality Transparency in all decision-making level of the organization Decisions taken at the lowest possible level The patient group is the key unit in value-based health care Individual patients... ...with similar conditions... ...jointly constitute a specific patient group Patient group 1 E.g. Myocardial infarction ICD: I19I21 13 Karolinska - workshop on organization_26Nov2014_vSend.pptx Patient group 2 Patient group 3 Patient group 4 Result from mapping: 260 unique patient groups across Karolinska # patient groups 260 75 260 Unique pediatric Total 240 220 200 72 180 160 140 120 100 113 80 60 40 20 0 Unique adult 14 Shared 1. Baserat på antal patientgrupper i augusti 2014 – totalsiffran har ändrats i pågående arbete Källa: Pågående inventering av Patientgruppskartläggning på Karolinska 2014 Karolinska - workshop on organization_26Nov2014_vSend.pptx Patient groups are typically one of three types – diagnosis, symptoms or multiple factors Patient Patient group type 15 Karolinska - workshop on organization_26Nov2014_vSend.pptx Example and description Diagnosis • Prostate cancer – diagnosis or suspicions of diagnos can be confirmed at an early stage and is followed by distinct diagnostic and treatment activities Symptom • Abdominal pain – may be the result of a number of underlying conditions but similar diagnostic activities required regardless Multiple factors • Elderly with multimorbidity – require a holistic view and special care for their specific needs to be met 79% of inpatient days quantified – 20 patient groups account for 35% of total volume 79% of all treatment days quantified The 20 major patient groups account for ~ 35% of all treatment days % Treatment days 100 25,000 17 90 10,000 4 80 9,000 70 8,000 60 7,000 100 50 40 6,000 5,000 79 4,000 30 3,000 20 2,000 10 1,000 0 0 Kvant. Ej Ej väldef. kvant Tot 16 Karolinska - workshop on organization_26Nov2014_vSend.pptx Patient groups Childbirth, premature infants, heart disease and cancers are the largest groups Patient group Treatment days ~# Beds 21 900 Normalgraviditet 11 200 Stroke 10 800 Lymfoid sjukdom 10 400 Svåra luftvägsinfektioner 9 700 Hjärtsvikt 9 300 Hjärtischemi Måttligt underburna barn 7 300 CNS-tumörer 7 100 Primär lungcancer 7 100 6 500 Njursvikt Myeloid sjukdom 6 100 Hjärtklaffsjukdom 5 900 Höftfrakturer 5 500 Sepsis 5 500 Frakturer i bröstkorg, ryggrad2 5 500 5 300 CNS-aneurysm Konfusion 4 700 Extremt underburna barn 4 600 Gallvägssjukdom 4 500 4 200 Kognitiv svikt 0 17 Karolinska - workshop on organization_26Nov2014_vSend.pptx 5 000 10 000 15 000 20 000 25 000 79 41 39 38 35 34 26 26 26 24 22 21 20 20 20 19 17 17 16 15 To enable the transformation a new role has been designed at Karolinska – “Patientflödesansvarig” Register based research project shows that method A > method B PFA Innovationcooperation on telecare enables 20% higher outpatient care INTERNAL KAROLINSKA EXTERNAL KAROLINSKA Outcome Patient flow Cost Faster emergency care through improved flow on X-ray Research results can be applied directly through training in the patient flow group = Rehab-chain with external parties require monitoring outcomes across care providers Value A decision support tool has been developed in-house that integrates outcomes metrics with resources and costs Today 10 pilot groups ongoing at Karolinska Pilot group Patient group defined Main person responsible identified (PFA) Acute Myocardial infarction Tomas Jernberg Rectal cancer Torbjörn Holm Newly diagnosed Rheumatoid Arthritis Cecilia Carlens Pre-term infants BouBou Hallberg Ischemic stroke Christina Sjöstrand Prostate cancer Ingrid Ehrén Congestive heart failure Eva Mattsson Breast cancer Irma Fredriksson Breast pain TBD: Umut Heliborn Objectives agreed upon Multidisciplinary & -professional group identified Current status for patient flow mapped Outcomes and process metrics selected Resources and costs for patient flow mapped First Symptom based patient group = Done = In development = Challenge encountered Continuous improvement initiated Goal: 80% of our defined patient group volumes guided by VBHC-principles by 2018 80% Goal 2018 New Karolinska 35% Half-time 2016 10% TODAY 2014 21 Karolinska - workshop on organization_26Nov2014_vSend.pptx 2015 2016 2017 2018
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