Experience In Integrated Care At Hospital Clínic Barcelona - Albert Alonso

16th Annual conference and Scientific Symposium

Experience in integrated care at Hospital
Clínic Barcelona

Albert Alonso
Innovation Directorate

Defining integrated care

“[Integrated care] is a concept bringing together
inputs, delivery, management and organisation of services
related to diagnosis, treatment, care, rehabilitation and health
promotion.”
(Grone & Garcia-Barbero: 2001)

“[Integrated care] is a coherent set of methods and models on
the funding, administrative, organisational, service delivery and
clinical levels designed to create connectivity, alignment and
collaboration within and between the cure and care sectors.”
(Kodner & Spreeuwenberg: 2002)

HISI Annual Conference, Dublin, November 16th 2011

Why we need integrated care?

Because of our failings in current health and social care systems:
– Addressing the changing demand for care
– Poor efficiency fragmented approaches (disease versus
patient)
– Improving the quality and continuity of care
– Recognising that health and social care outcomes are
interdependent
– Exclusion of vulnerable groups

(Wait, European Social Network Conference, Edinburgh 2005)


Innovative care for chronic conditions
Positive Policy Environment

Links

Community P Health Care
r
Organisation

Prepared
e
p
a
r
e
d
Community Health Care
Supporters Team

Mo
ed Patients & tiv
rm at
fo Families ed
In

Better Outcomes for Chronic Conditions
Innovative care for chronic conditions: building blocks for actions: global report. Epping-Jordan J, editor. 2002. Geneva, Switzerland :
Non-communicable Diseases and Mental Health, World Health Organization.


Service model

Normalisation

Redefinition of roles

Allocation of resources

Integrated care (80%)

Traditional care (20%)

Adapted from Berg M et al. Health Information Management. Integrating information technology in health care
work. Routledge 2004.


Service model

Normalisation

Redefinition of roles

Allocation of resources
ICT

Integrated care (80%)

Traditional care (20%)

Adapted from Berg M et al. Health Information Management. Integrating information technology in health care
work. Routledge 2004.


Redefining roles across the system


Platform and functionalities


Making it work


Home hospitalisation programme
Exacerbated
COPD patients (222)

Home Hospitalisation (121) Control group (101)

ER Intervention

Discharge Discharge
Home Intervention < 24h
Accessibility

Visit Outpatient clinic 8 wk after discharge

28% Control group
Readmission
20% Intervention group

Emergency room 22%
visits 10% **

- 2.4
SGRQ Total
- 6.9 **

Savings 2033€
1255€**


Prevention of exacerbations programme


Prevention of readmissions programme


A new standard?


A new standard?

Yes!
“...An integrated care pathway with
flexible shared-care arrangements
between primary care and
hospital, facilitated by information
technologies, has an enormous potential
to decrease hospital admissions in chronic
obstructive pulmonary disease patients.”


A new standard?

But!
“... In the integrated care approach,
several models are available and we now
require comparative studies.”
“We must also be aware that from a
healthcare provider perspective, further
studies of this model must include cost-
effectiveness as well as effectiveness in
older disabled patients with chronic
obstructive pulmonary disease”


What had we learnt (2006)?

• There were better alternatives to the current approach of
chronic patient management.
• These alternatives were safe, cheaper and generated
better clinical outcomes and professional and patient
satisfaction.
• Information technologies facilitated some of the aspects
related to their implementation.
• Most of the difficulties concerned the organisation of
care delivery and professionals.
• There was a need to change our viewpoint


Changing the viewpoint

Disease Management System

Health Management System

Citizen Management System


Time scale for integrated care at HCB
2000-03 • Embryonic ICT platform
• Clinical validation of limited model

2004-06 • Conceptual SOA platform
• Market analysis / deployment strategy

2007 • Integrated Care Unit is created

2008-12 • Effective deployment: Facing co-morbidity,
articulation health / social care. Sustainable
business models.
• Reliability of ICT platform
2010 • Creation of the spin-off

2010-13 • Large scale-deployment / regional level


New environments for action

Prevention

Chronic diseases

Dependency


Integrated care at HCB
• Approach by programmes:
– Set of normalised actions as well as evaluation tools that target
precise service objectives.
– The programme is based on a process model but it is not the
(entire) process.

Programme “A”

Programme “B”

Programme “C”
Patient Programme “D”

Programme ......



Work plan
definition

Case Normalisation of practices
evaluation Reallocation of roles
ICT application
Follow-up
& event handling
Case
identification

Discharge



Case
evaluation

Workplan
definition
Case Discharge
identification
Follow-up
Event handling


Linkcare® Application

Identification
Assessment Working Plan

Follow-up
Discharge



Planner
Pre-defined Template
Personalized



Service Library
Available Templates
Personalized



Monitoring
Education



Profile Management Collaborative Tools Personalization
Contact details Call Centre Co-morbidities
Availability Doc. Repository Service Optimization
Language Patient’s interactions
Agenda Management Voi- IP Phone


CSCW tools for remote support: e-SpiroQ

Enhances quality and provides support for interpretation of
forced spirometry testing performed by non-specialized
actors (Primary Care, Home, Pharmacies, Insurance
companies, …)



Summary
• HCB’s integrated care programme is a powerful approach to
meet the demand of a variety of health and social care needs
• The model and associated technology (Linkcare®) is proving to
meet expectations from both patients and professional
• Advanced versions should cover:
– Implementing knowledge intelligent to assist patients and
professionals in the optimisation of the mix of services
– Extension of services to cover other conditions and/or different stages
of the conditions


Thanks for your attention


Experience In Integrated Care At Hospital Clínic Barcelona - Albert Alonso

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