INTEGRAL HEALTHCARE AREA OF

BARCELONA ESQUERRA

Albert Alonso

Innovation Directorate

7E

5D

5D 5D

4C

3C

3A

8H

9F

9E

10I

10D

10B

10A

1A1C

1D

3B3D

9G

1B

2H

1E

2A

2D

2B3G

2C

2E

4A

2G5A

6B

6A

2J

2I

2K 10E

10F7B

7G

3E

4B

5C

5B

5E

6D

6E

7C

7A

7D

8C

8A

7F

8F

9C

8B9D

9A

8D8E

8I8G

10G

10H

10C

10J

BARCELONANORD

BARCELONA

ESQUERRA

BARCELONA

LITORAL MAR

BARCELONA

DRETA

6C

Offering an integral

health care to the

population in a territorial

framework by effective

coordination between

institutions and health

care professionals

Mission

Some key figures

• Population: 540,725 inhabitants (32% Barcelona)

• Wide variety of healthcare providers:

– Primary Care: ICS, CAPSE, EAP Poble Sec, EAP Sarrià-Vallplasa

– Hospitals: H. Clínic, H. Sant Joan de Déu, H. Sagrat Cor, H. Plató.

– Mental Health / Addictions: H. Clinic, H. Sant Joan de Déu SSM, H. Sant Pere Claver, Associació Centre Higiene Mental Les Corts, ASPB.

– Social Care / Geriatric Care: Centres Blauclinic, Pere Virgili, Clínica Sant Antoni de Barcelona

– SEM, Public Health Agency…

Starting point: dysfunctional model

• Partial and incomplete regional planning definition of the role of each provider in the basic pathology and tertiary care.

• Primary specialists disconnected from area hospitals and low resolution capability.

• Uncoordinated flows.

• Heterogeneity of Strategies, Organizational Models, Information Systems, Cultures and professional realities and concerns.

• Lack of awareness among institutions and afraid of change and to lose.

Guarantee real involvement of all

players

Defeating fears and strengthen

confidence between different actors

Overcoming cultures in which prevails the

internal orientation of providers

Managing change and territory planning

Information systems: GIPS messagin

g platform

Methodologic: scientific evidence, consensus,

participation, evaluation ...

Organisational : CAISBE, CP, OT, CO y GC, Coordinators …

Tools

Chronic Patients, ...

Reordering Specialized Care

Emergencies

Results

2003 2005 2009 2012

Slow, progressive pace

Vascular processes

Mental health processes

Cardiology processes

Endocrinological processes

Acc

ide

nts

& E

me

rge

ncy

Operating Committees

Territorial Health Care Commission Barcelona Esquerra

Technical Secretariat

Institutions Permanent Commission

Organisational model

Soci

al-h

eal

thca

re

He

alth

care

tra

nsp

ort

Po

or

pat

ien

t co

ord

inat

ion

Ph

arm

acy

Organisational model

• Deployment Clinical Groups, over 150 meetings a year and

involving about 400 professionals.

Reordering Specialized Care (RAE):

Vascular Surgery

General Surgery

Endocrinology

Cardiology

Pneumology

Dermatology

Neurology

Gastroenterology

Emergencies

Sanitary Transport

Mental Health

Information Systems

Pharmacy

Pain

Pediatric Care

Chronic Disease Care

Oncology

Epidemiological Surveillance

Tropical Diseases

Sexually Transmitted Infections

http://www.ais-bcn.cat

Information Systems

• Hospital specialists go to primary care centers using Primary Health Record Information Systems and share with GPs.

• Creating an intranet territory with protocols and clinical pathways, training sessions and research projects.

http://www.ais-bcn.cat/http://www.ais-bcn.cat/http://www.ais-bcn.cat/

Esquema de comunicacionsamb plataforma de missatgeria GIPS

Esquema de comunicacionsamb plataforma de missatgeria GIPS

Information systems

• Creation of a platform for communication between information systems of different suppliers to share the processes. Takes place in phases. Implemented clinical documents, image, visit requests and citations.

• Interoperability using a corporate system

Main results

Reordering of specialised care Consolidation displaced specialist and consulting model: Appropriateness of derivations to specialists and improved management of patients (accessibility, diagnosis and treatment).

Starting Point (2007): 22% of inappropriate derivations from GP to specialist

ENDOCRINOLOGY CARDIOLOGY DIAGNOSTICS WHICH MOTIVATE CONTROL BY

CARDIOLOGYST

Rev Esp Cardiol 2011;64:564-71

2,271 1,705

3,7344,147

0

2,000

4,000

6,000

8,000

2008 2011

1es 2es

27.9

42.5

5.3

13.5

8.8

14.9

18.4

13.7

19.5

4.5 5.3

0.1

1310.8

0

5

10

15

20

25

30

35

40

45

%

C.I IC Valv. FA HTA ECG Altres

Model convencional Atenció integrada

-15%

Main results

Emergencies

• From a Clinic centralized model to a shared model, adjusted on the basis of severity and complexity levels.

Global Evolution of Emergencies

(AISBE providers)

209.511 217.828 210.119 206.123

0

50.000

100.000

150.000

200.000

250.000

2008 2009 2010 2011

-5,37%

Main results

Emergencies

• From a Clinic centralized model to a shared model, adjusted on the basis of severity and complexity levels.

Total 2008 Total 2009 Total 2010 Total 2011

HOSPITAL CLÍNIC 69,62% 62,30% 59,36% 55,06%

H. SAGRAT COR 6,02% 6,31% 7,36% 8,10%

HOSPITAL PLATÓ 3,80% 4,23% 4,69% 5,97%

Total Hospitals 79,44% 72,83% 71,40% 69,13%

CUAP Manso 20,56% 27,17% 28,60% 30,87% GLOBAL 100,00% 100,00% 100,00% 100,00%

Main results Emergencies

• From a Clinic centralized model to a shared model, adjusted on the basis of severity and complexity levels.

Need to move

towards new

models of financing

taking into

account levels

1% 15%

46%

27%

11% 1% 12%

33%

34%

20%

2 º QUARTER 2009 (N = 27986)

2 º QUARTER 2010 (N = 23024)

LEVEL 1 LEVEL 2 LEVEL 3 LEVEL 4 LEVEL 5

181 3229 9449 9486 5641

160 3286 10621 5992 ( - 37%) 2400 ( - 57%)

- 18%

Main results Programs • Redesign clinical processes with structured programs • Example: Early Detection of Colon and Rectum Cancer.

183.549 inhabitants

4.969 FOBT positive + colonoscopy

79.884 FOBT

244 diagnostics of CCR )

1640 diagnostics high risk adenomas

6%

705 diagnostics low- risk adenomas

44%

2.380 colonoscopy -

Main results Programs • Redesign clinical processes with structured programs • Example: Implementation Teledermatology.

850 patients 2013.

Resolution: 2,59 days.

Dermatology before RAE: 6 months.

In 39,6% processes not necessary dermatologist visit.

6% cancer: relevant in terms of costs and survival.

Main results

Information Systems • Consolidation of the platform for interoperability

between primary care and hospitals, although great potential for future growth (new providers)

Teledermato

Informació administrativa: cites, informes

Circuit comunicació Imatge.

“FTP segur”

S.I. PRIMARIA SAP CLINIC

Pacs

Plataforma

Transf.

DICOM

Teleconsultation

service based on the

transmission of digital

images following the

store-and-forward

method.