**WP5&WP10 - Project Integrate...Service stas,cs Promo,ng learning | Developing guidance | Sharing...
Transcript of **WP5&WP10 - Project Integrate...Service stas,cs Promo,ng learning | Developing guidance | Sharing...
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Promo,nglearning|Developingguidance|Sharingideas
ThisprojecthasreceivedfundingfromtheEuropeanUnion’sSeventhFrameworkProgrammeforresearch,technologicaldevelopmentand
demonstra,onundergrantagreementno.305821www.projec,ntegrate.eu
Coordina,ngcareforpeoplewithmentalhealthchallengesandtheircarers(WP5)
John Øvretveit, Director of Research, Professor of Health Innovation and Evaluation, Karolinska Institutet, Stockholm, Sweden
Promo,nglearning|Developingguidance|Sharingideas
Context:HealthcareandSocialservicesinSweden
Healthcare Socialservices
• Taxfundedsocialservices• Municipali,esalsoboth
purchasersandprovidersofsocialservices.
• Tax-funded• Coun,esbothpurchasersandprovidersofhealthcare.
Stockholm
• Governmentreformsforprivateproviders(e.g.primarycare)
Coun,es(21) Municipali,es(290)
Specialiststhrough:• Referralsfromfamilydoctor• Emergencydepartment
Promo,nglearning|Developingguidance|Sharingideas
METHODS(1min),
Casestudy Documents:legalforma,onofTioHundraAB,plans,minutes,consultancyreports Interviews Servicesta,s,cs
Promo,nglearning|Developingguidance|Sharingideas
FINDINGS(2mins),
NorrtaljeIntegratedhealthandsocialcareorganisa;onAligningcultures– Differentviewsaboutcompetenceandwayofworking.– Interven,onsforbe`ercommunica,on.– jointbudget– Internalrealloca,onoffundingpossibleInformalagreementsReduction of in-hospital care Clinical outcomes, patient satisfaction = comparable to national averages Increased staff satisfaction Increased costs because of successful recruitment of professionals Challengeincoordina,onwithexternalservices
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DISCUSSIONincllimita,onsect(2mins).
Norrtalje External threat and previous history of collaboration Structural and financial integration enables intended changes to be carried out
– New joint units bringing together health and social services – co-location of services
Cultural integration – Shared forum – Education – Shared planning and care management
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FINDINGS-2(2mins),Sodertaljecoordinatedcarenetworkmodel
Standardisation – Needs assessment – CAN – Care planning and follow-up
Real staff behaviour change towards collaboration Client-inclusive practice à quality of care Outcomes: Higher independence and coping scores (CAN) Costs and quality
– Quality Higher than national average – Rapid access to outpatient care – Low inpatient care utilisation
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CONCLUSIONS
Norrtälje: top-down – merger removing barriers Södertälje: bottom-up – network overcoming barriers
”Purchaser integration” – contracts push ”Provider integration” – professional pride pull
Patient/client integration – choice personalised health systems
Surprises?
Promo,nglearning|Developingguidance|Sharingideas
ThisprojecthasreceivedfundingfromtheEuropeanUnion’sSeventhFrameworkProgrammeforresearch,technologicaldevelopmentand
demonstra,onundergrantagreementno.305821www.projec,ntegrate.eu
Promo,nglearning|Developingguidance|Sharingideas
ThisprojecthasreceivedfundingfromtheEuropeanUnion’sSeventhFrameworkProgrammeforresearch,technologicaldevelopmentand
demonstra,onundergrantagreementno.305821www.projec,ntegrate.eu
Suppor,ngcarecoordina,onwithdigitalhealthtechnologies(WP10)
John Øvretveit, Director of Research, Professor of Health Innovation and Evaluation, Karolinska Institutet, Stockholm, Sweden
Promo,nglearning|Developingguidance|Sharingideas
CONTEXT
Ourpreviousresearch Mostsafety&qualityproblemsarecommunica,on-related DHTgreatpoten,alforimprovingcommunica,on &fordamagingcommunica,on:
– replacefacetofaceverbal-lost,unauthorisedaccess,toomuchunstructuredinforma,onmakeitdifficulttofindwhatyouneedquickly
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METHODS(1min),
CasestudiesofDHTsuppor,ngICschemes2015 2SwedenmentalhealthICcases 1SpainBarcelona“hospitalathome”caremanagementscheme(outreach) ReportsfromFP7teamsTilburg(diabetes)andBerlin(geriatrics)onHITsystemsintheirICexamples Interviews;documentanalysis;surveytoTilburgandBerlin RapidreviewofDHTsupportforIC
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FINDINGS(2mins),
EMRnotEHR(shared)andlimitedaccess/linking; Pa,entPortalsbeginningbutnotused Pa,entsbewildered-whysofarbehindotherservices- egwhycan’twesendemails?- Whyaskingmeallthisagain-worriesme. StaffresignedtoITprovider-centeredsystemsunder-designedforusers Noremotemonitoringortelemedicine–faxandphone Theseareadvancedexamples,
– publicservices/systems–Swedeninvestmentininfrastructure– Butpublicserviceskillsandaltudesandsecuritypreoccupa,on
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DISCUSSIONincllimita,onsect(2mins). Currentfunc,oninglimited; Planstodevelopovernext5yearsLocal,Na,onalandEU MorePa,entandclinicianfocusbo`omupbalance ITdepartmentsunder-resourced(security);under-skilled;under-designed;lackofagreedstandardsforEHRandcomms;lackofinvestmentusinguserdesign Technicalchallengesbutprivacy/securitybecomingthegreaterchallenge
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CONCLUSIONS–10recommenda,ons
1 Ensurepa,entsareatthecenter,withachoiceofrole2 Financing–pursuefasterreform3 Reachagreementabouttechnicalstandards4. Privacy–updatelawsandprocedurestogettherightbalance5 Developpoli,calprocessestopreventinnova,onbeing
blocked(autonomy,workredesign) Surprises?
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FINDINGS(2mins),
SwedishHITprac,ces:cardlog-ins;EMRaccessauto-auditedmonthly;na,onal/localflexibilityforPHRdevelopment(plaoorm);strategy;qualityregisters
BarcelonaandCatalonaHIT:HIEnetworkforEMRs;localintegra,onofHITintohospitalsystemandPHClinking
Promo,nglearning|Developingguidance|Sharingideas
ThisprojecthasreceivedfundingfromtheEuropeanUnion’sSeventhFrameworkProgrammeforresearch,technologicaldevelopmentand
demonstra,onundergrantagreementno.305821www.projec,ntegrate.eu