The VISC+ project is an opportunity to improve the quality of health care

26 Feb

Argimon JMJosep Maria Argimon, AQuAS Director

VISC+ is a project under the Big Data, the new observational research methodology that makes use of the high availability of data arising from the mass digitization of the modern society activities, added to the analytical potential of current technology. The European Union is generally allocating and in particular in health area, both for the added value it can bring to the public services development and for the revitalization in the field of entrepreneurship. For example, between 2016 and 2020 the EU will invest 500 million Euros to Big Data (in health, energy and manufacturing related projects), while private companies will contribute 2,000 million Euros.

Similarly, the European Institute of Innovation and Technology’s KIC Health Initiative (communities of knowledge and innovation) has one of its nodes in Barcelona, and AQuAS is one of its associate members. KIC Health has a budget of 2,100 million for the coming years and counts with the participation of public and private sector, this being a requirement of the initiative. This space between public initiative and innovative company is where the aforementioned methodology should find its most prolific field, being one of the strategic lines, along with others such as cancer or aging issues. Continue reading

Preference sensitive health care: the causes of variations

19 Feb

Jordi VarelaJordi Varela. Editor of the blog “Advances in Clinical Management

There is a case-mix part (25% according to Wennberg) such as inguinal hernia, cataracts, metrorrhagia or knee osteoarthritis, for which modern medicine has an effective surgical response, although in the application of the technique there is often a margin for the doctor’s interpretation, another margin for the subjectivity of the patient, such as pain perception or adaptation to the lack of visual acuity, as well as a very important factor: the decision of the patient himself. There are men who prefer to wear a brace to hernia surgery and women who prefer to live with their uterus, provided that the degree of the discomfort and metrorrhagy allows them to.

After this introduction, let’s see the Variations in Health Care, the good, the bad and the inexplicable report by John Appleby and his collaborators, published by King’s Fund in 2011, which states that variations in hospitalization rates are pervasive and persistent, and even affect common interventions known to be effective such as hip replacement for advanced osteoarthritis cases.

Distribution rates of hip replacement in England 2009/10

Note that although adjusted for age and sex, the rate of hospitalization for hip replacement (with lighter blue line) in the graphic, are observed in 18 PCT (Primary Care Trust) that show a value of 60 interventions per 100,000 inhabitants per year, while at the other extreme, there are 20 showing a rate of 140. That is, citizens of the latter communities have a 2.3 times higher probability of being operated on for prosthetic hip replacement than the citizens of the former. The same report shows that these regional differences are extended to other elective procedures such as knee, cholecystectomies or coronary angioplasty.

Whichever way you look, this type of variation in the use of health care resources for procedures seemingly well identified and standardized, is universal, and this is seen when comparisons between systems (countries) are being made, but don’t disappear when, as in the English case, intra-communities and intersystem analysis are being made. If I may, I’ll next show a Spanish example from the Variaciones de la Práctica Médica (VPM) initiative that has the support of all autonomous regions. I have in hand the final report of the VPM research project: Variations in the use of knee arthroplasty in the National Health System, from which I have chosen this graph:


I think in the above graph it should be noted that, excluding outliers health areas (in light blue), there are Spanish territories where inhabitants have a probability of knee prosthesis intervention 6.4 times higher than inhabitants from the areas with the lowest rates. And this occurs in a health system that is considered one of the most fair and accessible in the world.

Where is the problem? What explains these extraordinary variations?

To answer these questions, there’s nothing better that to resort to a 1977 investigation led by a young Wennberg. The following table, published in Tracking Medicine by the same author (Oxford University Press 2010), there is a summary of the results of this work. It’s the comparison of two small communities: Middlebury in Vermont vs. Randolph in New Hampshire. As seen in the table, the two communities have the same socioeconomic characteristics, the same prevalence of chronic diseases, and the same doctor accessibility. However, the Middlebury citizens are hospitalized 67% more than those of Randolph, and undergo surgery 63% more.

This work is a benchmark for questions about the causes of variations in the use of health resources. According to Wennberg, if when demographic, socioeconomic and accessibility factors have been adjusted, such overwhelming differences still remain, one must draw the attention of the variations towards the medical practice and the availability of healthcare resources provided by doctors in each area.

The Centre for Innovation in Health Management in Catalonia: present and future

12 Feb

Montse MoaharraMontse Moharra. OIGS AQuAS

The Catalan health system is the result of a remarkable historical reality that favours the consolidation of a system characterized by public funding, multiple provision and integration of all resources in a network of public use, which makes it a reference and innovation source in management.

In this context, in 2012 the Observatori d’Innovació en Gestió de la Sanitat in Catalonia (OIGS) (The Centre for Innovation in Health Management in Catalonia) was created with the aim of collecting and giving value to the knowledge generated by innovative initiatives: innovative experiences, strategic partnerships and best practices. Currently, OIGS includes a total of 181 experiences, of which 56% are related to the management of healthcare and strategic processes, 14% with chronic patients, 14% with TIC and 7% drug related.

OIGS also offers an innovation learning space through a public portal and a community of innovation that facilitates the interaction between over 400 professional users who are already sharing their experiences.


How can an innovative experience be registered?

One has to register with the innovation community and fill in a form with the experience data. The form content is reviewed by the OIGS and the experience is published on the website if it meets the established criteria: having been implemented within an organization, generating a change, having had an impact on resource optimization and being expansible to other organizations or systems.

When the experience is published, the willing organizations may present at any time, also through the innovation community, the self-assessment of the experience. OIGS reviews and evaluates the presented self-assessment and those experiences that exceed this evaluation, obtain a quality certificate issued by AQuAS. Thus, so far 19 experiences have been certified.

Identifying the best practices in health management

Starting from the process of reviewing management innovative experiments, identifying commonalities and required by CatSalut, so far three potentially scalable experiences throughout the healthcare system have been identified: the suitability of prescribing in primary and community care; the online preoperative and the online dermatology. However, this is an ongoing process that ought to facilitate identifying new best practices.

OIGS in the future

In the near future, OIGS aims to encourage the participation of professionals and organizations that are important to system innovation; to create knowledge networks through participation in research and innovation projects at European level and organizing specific thematic workshops. The innovation community will facilitate identifying experiences that can be part of potential interest groups and that will be able to respond to the specific challenges related to European funding such as innovative public procurement.

InnoLife, una bona oportunitat per posicionar Catalunya en l’àmbit de la recerca i la innovació en salut

5 Feb

Cristina AdroherCristina Adroher. Oficina Tècnica AQuAS

Ben entrats al segle XXI la innovació és una de les claus de la generació de coneixement, de la millora de la competitivitat de l’economia i de l’augment del benestar de la nostra societat. La capacitat d’una societat per innovar és fonamental en una economia cada vegada més intensiva en coneixement. En aquest context, Europa s’enfronta a un repte important, ja que malgrat que disposa d’una base d’investigació d’excel·lència, d’empreses pioneres i de molt talent creatiu, sovint és difícil que aquestes bones idees es transformin en nous productes o serveis. Tal com s’apunta en un recent informe del Consell Assessor per a la Reactivació Econòmica i el Creixement (CAREC), hi ha dificultat en la transferència del coneixement.

Per capgirar aquesta situació la Unió Europea ha establert l’Estratègia Europea 2020 que prioritza la consolidació dels resultats de la recerca i la promoció i la transferència del coneixement. Un dels instruments destacats en el marc d’aquesta estratègia és l’Institut Europeu d’Innovació i Tecnologia (EIT), creat l’any 2008. Aquesta institució té com a objectiu millorar la capacitat d’Europa per innovar i, a través de les anomenades comunitats de coneixement i innovació (KIC), integra els tres vessants del coneixement: la formació, la recerca i la innovació.

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