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Josep Roca. Gestión hospitalaria en tiempos de crisis

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Estrategias para la adopción de nuevas prestaciones de servicios para pacientes crónicos La experiencia del Hospital Clínico de Barcelona Josep Roca Hospital Clinic.IDIBAPS.University of Barcelona
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Page 1: Josep Roca. Gestión hospitalaria en tiempos de crisis

Estrategias para la adopción de nuevas prestaciones de servicios para pacientes

crónicos

La experiencia del Hospital Clínico de Barcelona

Josep RocaHospital Clinic.IDIBAPS.University of Barcelona

Page 2: Josep Roca. Gestión hospitalaria en tiempos de crisis

Health system redesign

Page 3: Josep Roca. Gestión hospitalaria en tiempos de crisis

INTEROPERABILITY AMONG PROVIDERS

• Level A - Barcelona – Esquerra

• Level B - Spain and Europe

Patient summary record and electronic prescription

EAPs ICS

EAPsCAPSE

EAPs ICS

EAPsCAPSE

EAPs ICS

EAPsCAPSE

• 540.000 habitantes

• 18 ABS y 2 CAPs II (5 empresas

distintas)

BARCELONA ESQUERRA

EAP Gesclínic

EAP Les Hortes

EAPsVallplasa

Hospital Clínic

Hospital SagratCor

Clínica Plató

CAP II Manso (ICS)

CAP II Numància(ICS)

EAP Gesclínic

EAP Les Hortes

EAPsVallplasa

Hospital Clínic

Hospital SagratCor

Clínica Plató

CAP II Manso (ICS)

CAP II Numància(ICS)

EAP Gesclínic

EAP Les Hortes

EAPsVallplasa

Hospital Clínic

Hospital SagratCor

Clínica Plató

CAP II Manso (ICS)

CAP II Numància(ICS)3D

3G

3A

2A

2C

4A

2D

2E

4B5C4C

3E

5D

3C

3B

2B

5A5B

5E

3D

3G

3A

2A

2C

4A

2D

2E

4B5C4C

3E

5D

3C

3B

2B

5A5B

5E

distintas)

• 4 Hospitales

• 1 Centro Sociosanitario principal y

otros de menor dimensión

• 3 Proveedores de Salud Mental

• Servicio de Emergencias Médicas de

Cataluña

Page 4: Josep Roca. Gestión hospitalaria en tiempos de crisis

Permanent Comission

TechnicalManagement

TeamRedesignImplementation

& follow-up

Barcelona Esquerra

Deployment at Barcelona Esquerra 2009:

Territorial Health Care Comission Barcelona Esquerra

Institutionsrepresentative

Process 1

Process 2

Process 3

Process 4

Em

erge

ncie

s

Soc

ial C

are

Hea

lth T

rans

port

Hom

e C

are

Ped

iatr

ic c

are

Pha

rmac

y

Men

tal h

ealth

IT

Operational Committees

Spe

cial

ized

Car

e

Page 5: Josep Roca. Gestión hospitalaria en tiempos de crisis

Pro

cess

Un

its

HOSPITALCommunity

Care

FamilyPhysicianTransplant

Deployment at Barcelona Esquerra 2009:

Hospitals vs territorial healthcare

Pro

cess

Un

its

Nurse

Social Worker

HomeCare

Dementia

COPD

CHF

TerritorialHealthcare

Page 6: Josep Roca. Gestión hospitalaria en tiempos de crisis

Deployment at Barcelona Esquerra

The Vision

Page 7: Josep Roca. Gestión hospitalaria en tiempos de crisis

INTEGRATED HEALTH SECTOR BARCELONA-ESQUERRA (AISBE)

CHRONIC CARE UNIT

STRUCTURES RELEVANT TO CONTINUITY OF CAREIN CHRONIC RESPIRATORY PATIENTS

CHRONIC CARE UNIT

LINKCARE HEALTH SERVICES S.L.

CLINICAL INSTITUTES

Page 8: Josep Roca. Gestión hospitalaria en tiempos de crisis

- enhanced citizens life style - well standardized care paths

Integrated Care Strategies for Chronic Patients

Modulation of disease progress

Efficient patient management

Page 9: Josep Roca. Gestión hospitalaria en tiempos de crisis

pro

vid

ers

net

wo

rk

Service model

• Target patients • Management by programs• Well standardized interventions• Patient-centered care

Patient Supportcenter

pro

vid

ers

net

wo

rk

• Triage• Self-management• Remote monitoring

Personal Health Folder

Page 10: Josep Roca. Gestión hospitalaria en tiempos de crisis

INTERVENTIONS

� HOME HOSPITALIZATION

� PREVENTION OF HOSPITALIZATIONS

� HOME MONITORING

� HOME REHABILITATION

� HIGH QUALITY SPIROMETRY IN PRIMARY CARE

� HOME MONITORING

Page 11: Josep Roca. Gestión hospitalaria en tiempos de crisis

Cardiovascular

Respiratory

Diabetes - Obesity

Activity organized by care programs including clusters of diseases

Diabetes - Obesity

Fragile patients

Page 12: Josep Roca. Gestión hospitalaria en tiempos de crisis

Deployment and Adoption 2010-20122010-2012

Page 13: Josep Roca. Gestión hospitalaria en tiempos de crisis

Current Deployment atBarcelona Esquerra (Nexes)

Wellness & RehabilitationWellness & Rehabilitation

Frailty - Transitional care - Palliative care

Home hospitalisation

Support

Frailty - Transitional care - Palliative care

Home hospitalisation

Support

Page 14: Josep Roca. Gestión hospitalaria en tiempos de crisis

Need for operational definitions of frailtyand identification of associated services

System-related factors

Organizational model

Professional & health care resources

Patient-related factors

Socio-demographic

Chronic conditions

Treatment & self management

Integrated care strategieswith ICT support

Scenario

Treatment & self management

Health & Social resources

Dependency

Satisfaction & self-efficacyinformation

Quality of life

Page 15: Josep Roca. Gestión hospitalaria en tiempos de crisis

VERY LOW COMPLEXITY

LOW COMPLEXITY HIGH COMPLEXITY in addition, they show some of the following factors

Patients with none of these factors

1. More than two co-morbid conditions and Charlson index > 2

2. High score of anxiety/depression (HAD > 6)3. Home bound being alone at home for more than

50% of the day4. Home bound with a caregiver of similar age

1. High hospitalization rate in the previous year (> 2 admissions including emergency room visits)

2. Tertiary level therapy at home (non-invasive mechanical ventilation, etc…)

Assignment level of complexity (frailty)

4. Home bound with a caregiver of similar age5. Treatment adherence assessed by Morinsky-

Greens (> 4 different pills/day)6. Oxygen therapy7. Need of social support8. Need of low complexity home care services

(wound cures)

etc…) 3. End-stage complex disease

Page 16: Josep Roca. Gestión hospitalaria en tiempos de crisis

Hospital specialized units

Not eligible (EXCLUSION CRITERIA)

NoYes

Patient assessment .Assignment level of complexity (frailty group)

Informed consent

Eligibility assessment of all patients (+ 40 years old) admitted because of

exacerbation of COPD + other respiratory diseases

Number of participants who do

Emergency room Day care / Home hospitalization

Eligible (INCLUSION CRITERIA)

Accepted to participateLiving in the areaInability to use the ICT

equipment (patient and caregiver)Advanced cancer

Randomization

INTERVENTION CURRENT CARE AT THE

PARTICIPATING HOSPITAL

CURRENT CARE

not accept to participate and

their reasons are recordedVery low Low High

Baseline measurements

Training/Installation

Very low

Low

High

Follow-up measurements

Page 17: Josep Roca. Gestión hospitalaria en tiempos de crisis

Tailored intervention by level of complexity (frailty)

1. Education of self-management including co-morbidities (pharmacological/non-pharmacological therapies) and elaboration of personalized action plan

2. Access to the call centre3. Access to personal health folder

VE

RY

LO

W

CO

MP

LE

XIT

LO

W C

OM

PL

EX

ITY

HIG

H C

OM

PL

EX

ITY

4. Visit at home within 72 h including primary care team and social support team

5. Video-conference during 1 week6. Remote sensors monitoring (defined on individual basis by the 6. Remote sensors monitoring (defined on individual basis by the

specialists)7. Remote questionnaire monitoring8. Home-based rehabilitation (physiotherapists and/or occupational

therapists) 9. Connection with convalescence centre (if needed)

10. Video-conference up to 1 month (defined on individual basis by the specialists)11. Additional remote sensors (defined on individual basis by the specialists)12. Remote support of the specialists including home or day hospital visit when needed

Page 18: Josep Roca. Gestión hospitalaria en tiempos de crisis

ROADMAPROADMAP

The 4 P’s of Medicine:

Predictive

Personalized

Preventive

Participatory

Personal Health

SystemMedicine

2020

We should develop the potential to be at the forefront of healthcare delivery innovation

by embracing the evolution of medicine and technology

Use of technology

Evolved Integrated Care Services

Personal Health Services

2011


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