PIPPI project: community of practice in procurement based on value

13 Dec
Ramon Maspons

Innovation has been present in the AQuAS blog with projects such as Antisuperbugs and Ritmocore but there are many more on the go right now. Today we put the focus on the purchase of innovation and on how this innovative methodology can have an impact on clinical practice.

We interview Ramon Maspons, engineer specialised in the management of innovation and technology, coordinator of innovation at AQuAS.

What tools does the health system at present have within its reach to add value to healthcare?

The public procurement of innovation is one of the facilitating instruments when adopting innovation and developing policies for technology and innovation. Due to the characteristics of the health sector this becomes a strategic element. There are other sectors where this does not happen because the public purchaser does not have market power.

In what way does innovation provide added value?

At a first level, we could say that if there is no application no value is generated. At a second level, I would say that the changes in the process are what add value. And at a third level, we could talk directly about the user.

A very brief article was published not long ago on this subject in the journal Annals de Medicina. Recently, in another context, the King’s Fund published a report on models of innovation.

Could you highlight an innovative project within the field of innovation?

Yes, the PIPPI project, coordinated by the Karolinska University Hospital in which AQuAS is involved, together with six other institutions in the hospital and university environment in Sweden, Holland, Italy, Austria, Spain, Finland and the United Kingdom. It is a platform made up of hospitals from the European Hospital Alliance, which is the network of the most relevant European hospitals, and then AQuAS. The focus of this work group is the new models of procurement based on value using digital technologies as an element to transform health services.

Work group of the PIPPI project

 

Have you considered changing the name of the project?

No, but in fact yes, because the name has curious meanings and connotations in different languages. This was one of the subjects that arose in the Kickoff meeting of the project.

Jokes aside, what is the involvement of AQuAS in the PIPPI project?

The expertise of AQuAS in assessment, innovation and the procurement of innovation is key. This project proposes an environment where the different stakeholders involved in change can come to an agreement and work together, both when revealing the needs of a health system, of hospitals, as well as when involving companies, technological centres, universities, patients and caregivers.

It is a very ambitious aim. What would you say is special about this project?

Its strategic focus of putting the different stakeholders involved in improving healthcare in the same project but having the support of the leadership of hospitals and an assessment agency. Identifying needs and solutions using this vast network of diverse expertise is one of the strengths of this project.

How will the PIPPI project work?

The project needs to develop a community of practice where challenges can be posed and solutions considered within an international framework.

Could you be a little more specific about which environments digital technologies will have an impact on in the health services?

By all means. We can include very different subjects such as co-creation with clinicians, telemedicine, data analytics, artificial intelligence, and so on. Some aspects are nearer on the horizon and others more distant. There exists a powerful reflection on digital technologies: it is said that everything that is digitalised is dematerialised and demonetised (it may be a subject too complex to go into here) and there are also those who say that, in the end, what is digitalised is democratised, but now that really would be going into other subjects.

Earlier you mentioned involving patients – who and what are we talking about exactly?

The patient is a key element in procurement based on value because the patient generates value and this is something difficult for other sectors to understand. When we talk of digital transformation, the involvement of patients is often as necessary as it is a sensitive issue and a certain methodology is therefore required, or specific game rules. We are talking about complex systems which require complex ways of working where, among other things, very diverse sensitivities, organisational models, governances, health systems or types of providers are involved. In short, what we are talking about is getting patients to become a part of identifying needs and taking decisions; we are talking about expert patient concepts, the participation of citizens and about health literacy.

And how are you going to achieve all this?

As members of this consortium, we have the experience, knowledge, methodologies and leadership to forge ahead with a project of this nature. I recommend looking at the presentation of Romualdo Ramos and Tanja Stamm of the Medical University of Vienna to know more about this project.

What is the aim of the PIPPI project in a few words?

Impossible in just a few words, but can I do it in nine? Facilitating the joint design of the best healthcare possible.

What are the SISCAT atlas of variations all about?

19 Jan
atles-variacions-siscat
Laura Muñoz (Atlas of variations SISCAT), Laia Domingo (RaCat), Olga Martínez (RaCat)

At present, if you live in the region of Terres de l’Ebre and need to be operated on to have a knee replacement, it is quite probable that the type of technique used is one which preserves the posterior cruciate ligament. On the other hand, if you go and live in Girona, the chances of having the same kind of knee replacement will be a lot less, but in contrast, the type of technique chosen will be that of stabilising the posterior.

 

If you live in Girona and have respiratory difficulties susceptible for home-based CPAP treatment (continuous positive airway pressure), you will more likely be prescribed this therapy than if you live in Lleida or the Terres de l’Ebre. If you live in Lleida, in contrast, there is more probability of you being prescribed oxygen therapy at home than if you live in the Terres de l’Ebre region and suffer from some kind of respiratory disease that could benefit from this treatment. And if you live in the coastal neighbourhoods of Barcelona you will more likely be prescribed mechanical ventilation at home than if you live in a neighbourhood situated further inland for those respiratory ventilation disorders that might need this technique.

Why does this happen? There is no evidence to suggest which type of intervention is most suitable and it is simply the fact that the health professionals of one region are more inclined than those of another to choose one technique over another. This variability reveals the existence of schools linked to certain hospital centres that condition the choice of the type of intervention or technique used.

This is the type of information that the Atlas of variations in clinical practice of the Catalan Healthcare System (SISCAT) make available to health professionals and the entire population, and which has been led and developed by AQuAS since 2011.

The aim of these atlases is to identify, describe and reduce the variability that can lead to increased well-being, quality and an improvement in the use of available resources. Up to the present, 7 atlases have been developed in which the variations in hip and knee arthroplasty operations have been analysed, as well as the variability in home-based respiratory therapies (oxygen therapy, mechanical ventilation and continuous positive airway pressure), the variation in intravenous thrombolysis in patients with ischemic stroke and the variability and in renal replacement therapy in patients with chronic kidney failure (haemodialysis, peritoneal dialysis and kidney transplant).

One of the sources of data for this study, in fact, the most widely used, is the basic minimum group of data obtained at the time of a hospital discharge (CMBD-AH, the Catalan acronym) where the results are presented as activity rates, reasons for standardised uses and variability statistics. The methodology that lies behind this initiative can be seen here. The basic strategy of all the analyses is to compare the rates of use (numerator: for example, hospital admittances) of the inhabitants in a region (denominator: for example, basic area of health), regardless of the centre where patients have been treated or admitted. In addition, both the rates and the reasons for use are reflected in maps to better visualise the data which is another interesting point nowadays.

Apart from all this, it is important to stress that all the atlases include actions and recommendations for planners (Health Department), insurer (CatSalut), providers and professionals, and which have been developed by a unique team of experts with whom the results of the atlases are discussed.

This year, we have decided to take another step forward and convert the publications we have had till now in a static format (PDF), into dynamic publications that facilitate greater interaction with the data and, therefore, a more global view of the clinical practice analysed.

This is an example of the visualisation of the interactive hip and knee arthroplasty atlas which feeds off the data in the Catalan Arthroplasty Registry (RaCat):

atles-digital-siscat-berga

Next year, you will be able to know whether there are variations in the Catalan territory regarding hospitalisations for back surgery, in the repair of abdominal aortic aneurysms and in gastrointestinal cancer surgery (esophagus, pancreatic, liver, stomach and rectal cancer).

We cannot end this post without thanking all the speakers that made the presentations seminar of the Atlas of variations in clinical practice of SISCAT possible last 21 November, and especially to Enrique Bernal-Delgado, the key professional in the analysis initiative and in mapping the variations of clinical practice in the Spanish National Health System.

As far as AQuAS is concerned, it is one of our work lines which was begun some time ago now which has recently generated publications such as this article on respiratory diseases and this article on kidney disease.

And I ask myself, …. now that we have the tools to identify and describe the variability in clinical practices which are carried out in Catalonia, why don’t we try and explain them? The atlases of variations in clinical practice of SISCAT are a key tool to ask ourselves questions.

Post written by Laura Muñoz, statistician.