Integrated care – AQuAS Blog

How to foster an integrated health and social care centred on the individual in a local environment

14 Mar

SUSTAIN is a Horizon2020 European Project related to integrated care for older people that live at home with complex health and social needs. Thirteen initiatives from seven European projects participate in it.

It is a project whose aim is to improve a range of things including the care centred on the individual, the coordination of teams of professionals, the preventive nature of care, safety and efficiency.

In Catalonia, two initiatives (Social and Health Integration of Sabadell Nord and the Programme for complex chronic and advanced patients and the geriatric population of Osona) have participated in the design and development of projects for improvement which have been assessed by AQuAS (you can read the report and article here).

On 23^rd January, 2019, professionals involved in the groups that are the driving force of the two local initiatives (Sabadell and Osona) of integrated health and social care – family doctors, workers and social workers, nurses, geriatric and management personnel- met at AQuAS in their first joint meeting.

(SUSTAIN team Sabadell, Osona and AQuAS in Barcelona

The professionals were able to share thoughts on one question: What remains of the SUSTAIN project in the territory?

This was the starting point to identify specific actions that can make the projects sustainable and to also comment on aspects for improvement beyond the projects.

The aim was to identify opportunities within reach of the local initiatives themselves that could serve to generate a more favourable environment for integrated health and social care centred on the individual, both preventive and reactive in nature.

From the brainstorming that was done, a multitude of local actions can be derived with which to drive integrated health and social care centred on the individual. Let’s look at it in detail:

Prioritise at a population level Delimiting a population group for which it is deemed most important to apply the new PIAI method (Individualised Plan for Integrated Care), so that efforts can be concentrated on this group until the context allows for scaling up to the entire population of 65 and older. One possibility would be the older people who live at home with complex health and social needs who at present receive home-based healthcare, or for those cases known by primary healthcare but are not beneficiaries of home-based social care. This would be done in order to eliminate the barrier limiting access to social services or because there is a lack of awareness of these social service
Provide continuity in coordination between sectors, while taking into consideration the suitability of the new PIAI method for each individual case Continuing with periodic meetings of the team of professionals in charge of the multidimensional assessment of needs so as to plan an individualised and integrated health and social care (at least of the triad of primary care, family medicine-nursing-social work). These meetings, held on a monthly basis, would enable the teams to consider who, among those users visited recently (in primary care centres, at home, at local social services, at intermediary care in the case of Osona), would particularly benefit from the integrated and participative approach of SUSTAIN, with the possible introduction of changes or objectives to improve their care and their quality of life.
Inviting professionals that have not participated in SUSTAIN to use the new PIAI method, giving these professionals the necessary tools (time, training) so they can familiarise themselves with the approach of integrated health and social care centred on the individual. With this in mind, there is talk of the importance of “maintaining the spirit of SUSTAIN” and in gradually getting the most reluctant professionals more involved in introducing changes to their way of working.
Carrying out an analysis of the different capacities and responsibilities of each professional in primary care teams (family medicine-nursing-social work-social health work), and sharing out roles and responsibilities ad hoc, which can enhance the skills of each individual. This could mean that professionals who officially occupy the same position (for example, family medicine) would become specialised in one or another type of care (emergency, development of the PIAI, specific pathologies), and it would mean accepting that not all professionals with the same position need do the same: “one-size-only professionals are not needed”.
Enhancing the figure of the spokesperson in a healthcare team, both when dealing with a user as well as an internal coordinator of a team, emphasising that the user has a team with professionals that interact with each other in order to provide solutions to their different needs as quickly as possible. The emphasis is on the opportunity that workers and social workers have in acting as liaison officers between primary care, local social services and community resources while at the same time coordinating actions which are contained in the PIAI.
Analysing how the figure of the social and health worker can best fit in In the case of Sabadell, this figure has only been incorporated very recently. An analysis will need to be carried out with the entire group of professionals that intervene in care but especially with the social workers (under contract with local social services, socio-health workers or social workers specialised in intermediary care). This will be done in order to understand their capacities and perspectives of what function each professional should have bearing in mind their particularities and the specific environments in which they work (for example, specific tools and procedures they can apply, what information systems they have at their disposal or what other professionals they are in direct contact with).
Set up safe and respectful local systems with the LOPD (Spanish personal data protection law) in order to exchange the minimal information necessary to carry out a joint multidimensional assessment and to share the PAIAs among the most important professionals in each case. The example of Integrated System of Health in Osona (SISO) is mentioned, which enables primary care professionals to see which users are admitted in the hospital centres that make up the system, or the mechanism foreseen by the County Council of Osona to enable social health workers employed in health centres to consult the degree of dependency of a user.

We end this post by commenting that this week we participated in the final conference of the project in Brussels.

Representatives of the Osona SUSTAIN team, Sabadell and AQuAS in Brussels

Post written by Jillian Reynolds, Lina Masana, Nuri Cayuelas and Mireia Espallargues.

Integrated care in Europe: Change management? The ACT@Scale experience

28 Feb

The ACT@Scale project responds to the need for a deeper look into the results and conclusions that came out of the previous project, Advancing Care Coordination and Telehealth Deployment (2013-2015) and it follows the strategic lines proposed by the European Association on Active and Healthy Ageing (EIP on AHA).

This new project, ACT@Scale, began in March 2016 within the framework of the Horizon 2020 programme which was financed by the European Union. The aim is on transforming health processes and the provision of services related to integrated care and telemonitoring.

How have we done all this?

Different regions in Europe, the industry and innovative academic institutions have worked in collaboration over these past few years. The Agency for Health Quality and Assessment of Catalonia (AQuAS) has been one of the partners in this consortium leading the work-package Change Management, Stakeholder Management and Staff Engagement.

With 15 partners, in association, from 8 countries of the European Union and with the coordination of Phillips Healthcare we have worked collaboratively in order to consolidate and scale up the best practices identified in integrated care and telemonitoring so that they can be transferred to other European regions.

The Basque Country, The Netherlands, Scotland, Germany and Catalonia have contributed with a total of 15 programmes of integrated care, both innovative and of reference, regarding best practices in health. In particular, Catalonia has participated with five reference programmes of good practices in integrated care: Programme of Chronic Care, of the Badalona Serveis Assistencials; Nursing Homes, of MUTUAM; Frail Care for Older People, of the Parc Sanitari Pere Virgili; Complex Case Management, of the Hospital Clínic de Barcelona and the Promotion of Physical Activity, also of the Hospital Clínic de Barcelona.

ACT@Scale has developed a framework of assessment based on experience, practice and evidence using the Donabedian theoretical framework. To assess the implementation of the programmes, a collaborative methodology (Plan-Do-Study-Act) has been used. Thus, in order to assess processes of implementation and scalability, research has been done within four work packages:

Service Selection, led by Kronikgune
Business Models, led by the University of Groningen
Citizen Empowerment, led by NIRE
Change and Stakeholder Management, led by AQuAS

What have we learnt in relation to Change Management, Stakeholder and Staff Engagement?

In relation to Stakeholder Management, the leaders of the programmes that completed the questionnaires agreed that participative and co-creation strategies need to be introduced to improve the quality of integrated care and to reduce the resistance of stakeholders to change, where all identified stakeholders feel part of the process.
In terms of Change Management, regarding leadership, new communication strategies need to be incorporated which should be based on a collaborative methodology so as to detect and prioritise needs, implement them and monitor and assess them within the processes of change initiated.
In terms of Staff Engagement, we can confirm that the implementation of programmes of integrated care is a dynamic process in which potential risks need to be identified and therefore, assessment and redesign need to be ongoing..

Integrated care contributes to the creation of new health scenarios, some in a state of change and others as yet unknown. These new scenarios should make us think about defining new professional profiles, new areas of expertise and identify new actors and “actresses”.

Post written by Núria Rodríguez-Valiente.

Adjusted morbidity groups: a new population morbidity classifier

2 Feb

At present, chronic pathologies have become a challenge for health systems in developed countries. The majority of sick people that use health services have multiple morbidity and this increases with age. The presence of multiple morbidity is associated with a greater use of resources for care (both health and social) and a lower quality of life.

In this context, it is necessary to measure multiple morbidity to be able to determine its impact. There are two large sets of measurements of multiple morbidity: on the one hand, a simple count of the diseases (usually chronic) of each person and, on the other, indexes which indicate the burden of an individual’s diseases based on the ranking of pathologies giving each one a differential weighting drawn from clinical criteria provided by groups of experts and/or statistical analysis based on mortality or the utilisation of health services.

The Adjusted Morbidity Groups (AMG) are encompassed in this last group, the only one of these tools developed in Europe on the basis of a public health system, universal in nature and eminently free.

The characteristics and functioning of the AMG can be found in this article. In a nutshell, we can say that the AMG have been validated statistically, by analysing their explanatory and predictive capacity. In this validation, the AMG have shown better results than other tools in the majority of indicators studied, including those relative to social and health care.

They have also been validated clinically by primary care doctors, both in Catalonia and in the Community of Madrid. The main results of these validations are that the AMG show a good classification of the patient in terms of risk, that this good classification increases with the complexity of the patient, the preference of clinicians for this tool with respect to other tools to classify morbidity and finally, that it is a useful tool for assigning a level of intervention in accordance with the needs of patients.

From 2012, the AMG were developed in the framework of an agreement of collaboration between CatSalut and Catalan Health Institute. Subsequently, they have been implemented at a national level in 13 autonomous communities thanks to an agreement reached between CatSalut and the Ministry of Health, Social and Equality Services. As a result of the implementations done during 2015, 38 million people of the Spanish population have been classified. The final goal of this agreement is to jointly develop a tool to stratify the population and which could be applicable to the entire National Health System by means of adapting the AMG.

Similarly, the AMG are being used in several European projects concerning the stratification and integration of health and social care.

In summary, we can assert that the AMG are a new classifier of morbidity which shows comparable results -at the very least- to those provided by other classifiers on the market. On the other hand, having been developed using the information from our health system (universal and eminently free), it can not only be adapted to new requirements or strategies of our organisations, but also to other health systems as well as to specific areas or populations. Evidence of this last point is that at the moment, together with the Master Plan of Mental Health and Addictions of the Health Department, a specific classifier is being developed for patients with mental health and addiction problems.

Post written by David Monterde (Oficina d’Estadística. Sistemes d’Informació. Institut Català de la Salut), Emili Vela (Àrea d’Atenció Sanitària. Servei Català de la Salut) and Montse Clèries (Àrea d’Atenció Sanitària. Servei Català de la Salut).

Wishing you all a Joyous Festive Season from the AQuAS blog

29 Dec

nadal-2016-marta-millaret — Marta Millaret

From the blog AQUAS we hope you are having a good festive season and would like to thank you for reading and following us.

We publish weekly in Catalan, Spanish and English on subjects related to the projects that are being carried out at AQuAS and we also publish contributions from guest authors. The editorial line of the blog includes a focus on assessment from different points of view and areas of the health system.

Along these lines, we have dealt with healthcare and quality results presented by the different agents who make up the healthcare system, the whole range of observatories of the Catalan Health System (including that which deals with the effects of the economic crisis on the health of the population and innovation), qualitative research, integrated care, the assessment of mHealth, inequalities in health, patient involvement, doctor-patient communication, shared decisions, patient and citizen preferences, variations in medical practice, the prevention of low-value clinical practices, the impact of research, information and communications technology, data analysis in research, tools for the visualisation of data, innovation and health management, the gender perspective in science, statistical issues, clinical safety with electronic prescriptions, chronicity (not forgetting chronicity in children), the effects of air pollution in health and current topics.

The most read articles in 2016 have been:

Never before have we been so healthy and at the same time, never before have we been so sick, de Lluís Bohígas
Integrated care: what is the main underlying idea?, de Vicky Serra
Low-value clinical practices: the physicians give their opinion!, de Johanna Caro
When the system hampers innovation in healthcare, de Gemma Bruna
Indicators for the health services assessment, de Mireia Espallargues
Communicate what?? Communication skills for health care professionals, de Carme Carrion

However, we have published many more texts, 51 posts to be precise, without counting this one, with the aim of sharing knowledge and generating a space for reflection, open and useful for everyone.

Thank you very much, a joyous festive season and see you in the new year!

Post written by Marta Millaret (@MartaMillaret), blog AQuAS editor.

Is it possible to combine active and healthy ageing with innovation?

22 Dec

The European Innovation Partnership on Active & Healthy Ageing (EIPonAHA) is an initiative of the European Commission to deal strategically with the social challenges associated to active and healthy ageing, to make good practices in innovation more visible and to facilitate exchanges between regions, all of which promote interregional cooperation and the value of excellence.

What is its aim? To improve the health and quality of life of Europeans, especially of people older than 65, and to give support to the sustainability and efficiency of health and social care systems in the long term as well as to enhance the competitiveness of EU industry through expansion in new markets.

The reflection on how health systems interact with an ageing population and care in chronicity has been been one of the main lines followed in the AQuAS blog during 2016; they are subjects that affect our society and, precisely because of this, are part of the Health agenda.

In this context, having links to European projects is fundamental, where networking, collaborative projects and assessment are absolutely essential.

This is the underlying idea of the Reference Sites awards which assess regional European health ecosystems based on four axes:

Political, organisational, technological and financial willingness for an innovative approach to active and healthy ageing
The capacity to share knowledge and resources for innovation
Contributiing to European cooperation and transferability of own practices
Providing evidence of positive impact

The status of “Reference Site” is awarded to systems, alliances and ecosystems in health which comprise different players at a regional European level (government authorities, hospitals and care organisations, the health industry, SMEs and start-ups, research and innovation organisations and civil society) which have invested in developing and implementing innovative-based approaches to active and healthy ageing. These practices must be carried out with a comprehensive approach and vision and proof of the impact of their results must be provided.

Four stars is the highest distinction awarded by EIP on AHA and this is the score obtained by Catalonia as a leading health ecosystem and a reference for institutions and European organisations in the area of innovation in active and healthy ageing. These factors encourage the internationalisation and visibility of the Catalan health system and at the same time increase the possibilities for creating initiatives and forming consortiums for collaborative work with other European regions.

Being self-critical of the different health systems is as important as the knowledge and recognition of one’s own strengths and values. Sharing this is a way of acknowledging the involvement and work done by many professionals. We do not work in isolation; as a whole, this work has involved and involves AQuAS, the Fundació TicSalut, the HUBc (Health University of the Barcelona Campus), the ICS (Catalan Health Institut), the IDIAP Jordi Gol (Institute for Research in Primary Care), the Pere Mata Institute, the IRB Lleida (Biomedical Research Institution of Lleida), the VHIR (Vall d’Hebron Institut de Recerca), the Consorci Sanitari del Garraf and the Institut Guttmann.

Last 7 December in Brussels, on behalf of the Department of Health, I received the award for the Catalonia Reference Site group given by the European Commission. It is relevant because this fact defines Catalonia as one of the most dynamic and leading European regions in number and quality of initiatives, investment and results in generating and implementing innovative solutions to resolving problems in care and health to elderly people, chronic patients and other groups of risk patients.

The fact that Catalonia has obtained this distinction from the European Commission has a very clear meaning: Catalonia is recognised as one of the leading European regions regarding active and healthy ageing and innovation.

On we go.

Post written by Toni Dedéu (@Toni_Dedeu), Managing Director of AQuAS.

Elderly person with stroke: integrated care from the acute phase to the return home

9 Dec

Stroke has a high incidence, a growing prevalence and is the pathology with the second highest impact in the world in terms of disability among adults. Despite important advances in acute stroke management, which have led to a progressive decrease in acute stroke deaths, in terms of residual disability, stroke continues to have an extremely high impact on survivors, their families, their caregivers and on society in general.

Evidence shows that the approach to patients throughout the process of care in stroke, from the acute phase to the rehabilitation phase, needs to be multidisciplinary since patients have multiple health care and social needs which require a strong coordination between the different levels of healthcare. However, the tendency is still to organise conferences and congresses focused on only one speciality or level of healthcare.

On the other hand, and in self-criticism, even though stroke is one of the main reasons for using intermediate or long-term healthcare services, this sector almost never takes part in the decision making process of stroke care organisation. Neither does it do much research in stroke and in general, tends to put little thought into improving knowledge in treatments or in innovating the organisation of services compared to, for example, other conditions such as thighbone fractures.

This is why the Parc Sanitari Pere Virgili organised a monothematic symposium on 27 October, two days before the World Stroke Day. It focused on the treatment and management of stroke in elderly people from a different perspective: we traced the trajectory from the “needle” of the thrombolysis in the acute phase, passing through rehabilitative care and “reablement” in the post-acute phase, to the transition back to home life, describing the care given to patients especially, but not forgetting the attention caregivers need.

The presentations reflected and reinforced the need for a multidisciplinary approach in all phases of stroke. As an added value, in all cases the speakers not only combined recommendations derived from literature with their own practical healthcare experience but also provided data from their own research or innovation projects, in many cases with data published recently.

Among the speakers there was a varied representation from very different disciplines which included neurologists, geriatricians, physiotherapists, occupational therapists, speech therapists, social workers, a health economist and the representative of the stroke patients association who chaired a roundtable.

Some of the items that were highlighted most strongly during the symposium were:

The large amount of increasingly more accurate data available on all phases of stroke management. In Catalonia, this data is being provided by the Results Centre, which encourages transparency and allows for benchmarking thereby facilitating a reduction in variability and the sharing of best practices.
Despite improvements in the treatment of acute stroke patients using mechanical thrombectomy together with systemic thrombolysis, 40% of patients are left with a considerable disability as a consequence of stroke. This “glass half-full” should therefore encourage more to be done in terms of acute stroke management, and also in post-acute care which is still vital.
In acute care, age should not be a discriminating factor. This is in line with the concept that chronological age does not correspond necessarily to biological age and that two elderly people of the same age can have a totally different “functional potential” (a concept which in practice in the field of geriatrics is understood as meaning more or less “frail”).
Advances have not only been made in acute care but also in the field of primary and secondary preventive care. Accordingly, the development, the approval of and the use of NOACs (new oral anticoagulants) have been a determining factor since they offer an alternative for those patients where traditional anticoagulants are not a therapeutic option.
The rehabilitation prognosis is multifactorial. A recent proposal stemming from a multi-centre Catalan study led by our hospital and published recently, is based on a simple algorithm which incorporates the social factor (presence of the caregiver) together with the severity of the stroke (using the NIHSS score), functional status (according to the Barthel index) and cognitive function (a result of the Rancho Los Amigos scale). This allows patients to be classified in three levels of rehabilitation complexity, but who might evolve differently, with different needs for intervention, both in the rehabilitation process and regarding their return home.
Integrated interventions in geriatric rehabilitation can be home-based for certain patients as an alternative to a hospital admission. This model, deeply rooted in England and which has proven to be beneficial, is producing good results in our context in different pathologies including stroke. Innovative formulas such as “Comprehensive Home-based Hospitalisation” have, in our context, come about from the alliance between home-based geriatric care teams (doctor, nurse and social worker) and those of home-based rehabilitation (rehabilitation doctor, physiotherapist, occupational therapist and speech therapist).
In terms of physiotherapy, treatments should be more standardised and their efficacy demonstrated. During the symposium, interesting evidence was presented on the control of the trunk and its importance throughout the rehabilitation process in stroke.
Dysphagia is a very prevalent risk condition in patients who have suffered a stroke. Different proposals of scales for assessment at the bedside were shown which can be applied by nurses, reserving the speech therapist’s intervention for the most complex cases which require a more specialised assessment.
In rehabilitation, the support from the ICT (“telerehabilitation” which patients can receive following the instructions and programme configuration of the physiotherapist) allows treatments to be extended in time and intensity along with face-to-face treatment.
Working with caregivers is important. Apart from guiding them within the system, the availability of support groups for exchanging personal experiences, for a social worker, for example, could have an impact on the adaptation of the caregiver to the new situation. To this effect, an innovative experience was developed in our centre with a high degree of acceptance by patients and their families.
Continuity in the recovery process is key and the integration of health and social services guarantees an added value. The pilot “Return Programme” in the city of Barcelona, the result of the alliance between the Catalan Health Service and the City Council of Barcelona was presented. It allows for the direct activation of social services, from acute care and long-term care hospitals so that patients can receive the necessary aid when they return home and thus avoid unnecessary and dangerous delays.

In summary, much progress has been made in the treatment of stroke, especially in the acute phase, but innovation is also being carried out in the successive phases and the symposium showcased different experiences which have been implemented in our context. Drawing conclusions from the symposium, the take home messages are that a comprehensive view of the entire process is key, as well as an integrated and coordinated approach between the different levels of healthcare and social services. On the other hand, more research needs to be carried out especially in the post-acute and chronic phases resulting from the disease and this poses a challenge because of the difficulty in designing and implementing complex interventions where designs such as standard clinical trials are not the solution.

Post written by Marco Inzitari (@marcoinzi) and Laura Mónica Pérez, Parc Sanitari Pere Virgili, Barcelona.

Broadening perspectives in health service assessment

8 Sep

What lies behind a significant volume of hospital readmissions? What makes a service present a good healthcare praxis? What obstacles are there when changing to a healthcare model such as in major out-patient surgery which encourages patients to go home on the same day as their operation? Do managers and nursing staff have the same opinion about what efficiency is in an operating theatre? What is the perception of professionals of the possible benefits of people-centred attention?

Do we all see a dragon?

Drac

Reality is complex and therefore approaches are needed which facilitate the interpretation and understanding of that reality. With qualitative research, places can be reached otherwise unattainable when using other methodological aproximations. When answering questions like those we asked ourselves previously, a truly qualitative approach is required. We need to make the approach using an adequate and credible technique to validate the process of all those involved and to ensure precision in results as is done in quantitative research but not forgetting that we need to be critical and independent in the analysis made.

We will briefly outline the evolution of the qualitative approaches in the context of the assessment of health services. A reflection on the usefulness of qualitative techniques in the assessment of health services or medical technologies is not a new one and you can find a series on this subject in the British Medical Journal of 1995 and in the Health Technology Assessment report of 1998.

bmj-1995-eng

Health assessment agencies have given great importance to questions about the scientific evidence available when talking about the efficiency and safety of treatments and biomedical interventions of a clinical nature. Randomized controlled trials and systematic reviews are considered to be the reference standards for causal atributions of the benefits of an intervention for the improvement in the health status of patients.

Society has evolved and the needs of the system adapt to this. We formulate new questions related to the preferences and expectations of users facing treatment and how different professionals contribute to providing better results in patient health care. One must bear in mind that when assessing the benefits and results of attention given, many factors come into play.

In this context, the paradigm of evidence based medicine and the supposed superiority of quantitative approaches and of some study designs above others, have created obstacles in the application of qualitative research. In this sense, the letter to the editors of the British Medical Journal signed by more than 70 researchers of reference for giving their support to qualitative research is clear proof of this remaining obstacle.

bmj-2016-eng

Questioning the efficacy of a medical drug cannot be answered using a qualitative approach but we can broaden the scope of questions that we pose ourselves.

For example, we can consider asking ourselves questions, among others, about the preferences of patients, the perception of the benefits of a medical drug, the expectations or opinion of professionals that prescribe it or the possible reasons for a low adherence of the medical drug.

Another scenario could be that of a patient with osteoarthritis who has undergone a knee replacement (arthroplasty) and who is being attended by several professionals such as the primary care doctor, the traumatologist surgeon, the anaesthetist, the nurse, the physiotherapist and other professionals if the patient has other comorbidities. That patient has certain preferences and expectations which need to be understood and then give the health care to cover those needs, which can go beyond the mere surgical procedure.

With qualitative research we develop a discourse, texts, opinions and perceptions of people, communities, with images, perspectives, ideologies and complexities. We must guarantee rigour and that the photograph and interpretation of reality that we make remain valid and coherent for the research group and the populaton or group of people that we are assessing.

The application of qualitative techniques has been on the rise using interviews, semi-structured questionnaires, field notes, focus or discussion groups to gather the opinion of different groups of professionals and users.

From my point of view, there are three examples which can be of great use to know the approach and the process in carrying out an assessment of services with a qualitative approach:

Avoiding the classic metrics means being able to measure in an alternative or complementary way by combining different approaches be they qualitative or quantitative. I find the introduction to qualitative research we find in René Brown’s TED talk the power of vulnerability. This qualitative researcher recommends we measure that which is apparently unmeasurable and go more in depth into the complex phenomenon of vulnerabilty.

We broaden perspectives by understanding the reality from within, by bearing in mind the multiple existing points of view to improve that which is disfunctional or by identifying better practices to spread them. We can measure what we want to measure. It will be necessary to adapt the approach to the context and audiences and to continue progressing to show with rigour and practice the usefulness of qualitative approaches.

We continue learning. This time, it has been at the Congrés Iberoamericà de Recerca Qualitativa en Salut (in Twitter #IICS2016) held in Barcelona, 5-7 September. The Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS) and the Agència de Salut Pública de Catalunya (ASPCAT) shared the stand to explain their experiences.

2016 Congreso Iberoamericano de Investigación Cualitativa en Salud — Santi Gómez Santos (AQuAS/ASPCAT), Dolors Rodríguez Arjona (ASPCAT), Mireia Espallargues (AQuAS), Vicky Serra-Sutton (AQuAS)

Post written by Vicky Serra-Sutton (@vserrasutton), sociologist PhD in AQuAS.

PRINCEP – The program for children’s chronic disease care wins an international award

7 Jul

PRINCEP is the acronym of the program from Sant Joan de Déu Children’s Hospital in Barcelona, launched in 2012 under the name of Integrated Response Platform for children with chronic diseases and high dependence.

The project PRINCEP offers comprehensive care to hundreds of boys and girls and since its establishment has received several awards. The latest has been the award for the best social and health integration experience, which the International Foundation for Integrated Care (IFIC) awarded during the 16th International Conference of Integrated Care (ICIC16).

This initiative is a part of the innovation community of the Observatory of Innovation in Healthcare management in Catalonia (OIGS) and is one of the 37 experiences certified by the AQuAS.

Projecte PRINCEP - equip — Project PRINCEP team in Sant Joan de Déu Children’s Hospital in Barcelona – Joaquín Gascón (nurse), Olga Valsells (agent of spiritual care), Esther Lasheras (social worker), Sílvia Ricart (pediatrician), Andrea Aldemira (pediatrician), Astrid Batlle (pediatrician). She is not in the picture but she is in the team Verónica Vélez (nurse).

Chronic disease and pediatrics?

When we speak of chronic disease, we usually think of adults and the elderly, but chronic disease is also a reality in the pediatric world. The scientific advances of the last decades have increased the survival of formerly lethal diseases and that has led to the appearance of a new phenomenon: children’s chronic disease.

Increasingly health systems allocate more of their efforts to chronic disease care, mainly because of the great economic impact this generates. Although various studies estimate that only 15% of pediatric patients have special health care needs and that less than 1% suffers from chronic diseases of high complexity, the estimated health expenditures for this small percentage are between 30% and 40%.

When you think of chronic disease patients it is not only thinking about the managing of their health. All chronic diseases represent a major impact on the patient’s surroundings. The families must come to terms with significant changes in their lives: how to relate within and outside of the family, the problems of family and work conciliation, the difficulties for a social life or the economic problems, all of this causing major emotional changes and a questioning of values.

In managing everything for the pediatric complex chronic patient, it is essential to understand that the social and family situation will have an inevitable influence on their clinical situation and therefore that it must be taken into account in the daily work.

How can we respond to the specific needs of a complex, pediatric chronic patient?

In 2012 the Sant Joan de Déu Children’s Hospital in Barcelona created the PRINCEP program, a multidisciplinary unit oriented to offering comprehensive bio-psycho-social care to pediatric patients with complex chronic diseases. Made up of pediatricians, nurses, a social worker and an agent of spiritual care, the unit seeks to optimize health resources and improve the quality of life of the patients and their families, fostering their participation in the therapeutic process, their responsibility and self-care.

Since its Constitution giving service to 20 patients, it currently serves more than 100 boys and girls with chronic diseases of high complexity that require frequent use of hospital resources, tracking for multiple specialties, and a need for technological support for their daily care or a high social vulnerability.

What does this innovative experience offer?

Our patients have a medical team and nursing reference, which knows and manages the case on a global basis, carries out scheduled or urgent check-ups according to the patient’s needs and which also serves as a reference during hospital stays. In addition, they have telematics care via telephone, accessible 24 hours a day in case of clinical emergencies, or by email.

Thus, a quick and effective response to questions or clinical decompensations can be given, unnecessary visits are avoided and the family’s trust, autonomy and self-care are favored. Since the beginning of the unit, we have found a decrease in the number and duration of our patients´ hospital admissions, as well as the number of visits to the emergency room. Since the beginning of the unit, we have reported a decrease in the number and duration of the our patients admissions, as well as in the number of emergency room visits. In the last four years, the number of admissions per patient and per year has been reduced from more than 5 to 1, the average time of admission from 13 to 4 days, and the average number of visits to the emergency room per patient and per year from 8 to 1.

What does the integrated care in the context of this particular project consist of?

The project PRINCEP works on external coordination, trying to encourage collaborative models of health and social care, so that families can receive the support of the health or social services closest to them that then will be integrated into the patient’s treatment plan.

Social and spiritual support is also essential. Evaluating the social and family situation from the outset allows us to identify factors of vulnerability and to accompany and to prevent situations of social risk. More than 50% of the patients and families included in the program have needed a moderate or intensive intervention by our social worker. In addition, accompanying patients and their families in the different phases of the disease facilitates adherence to the treatment as well as the adaptation to the changes, and helps to strengthen the family structure and social support network.

The social and emotional situation influences the health conditions and the empowerment and confidence of the families improves the clinical management of the pediatric, complex chronic patients who benefit from a comprehensive and global care. The integrated approach to children’s chronic disease favors the optimization of resources and improves the quality of life of patients and families.

Post written by Andrea Aldemira Liz, pediatrician of the Complex Chronic Disease Unit of the Sant Joan de Déu Hospital (@HSJDbarcelona_es).

Integrated care: what is the main underlying idea?

9 Jun

This past 23rd, 24th and 25th May, 2016, Barcelona hosted ICIC16 – The 16th International Conference on Integrated Care where 1,000 attendees from over 50 countries around the globe enjoyed an active and busy agenda.

The experience involved 92 speakers and over 23 hours, which was also possible to follow via streaming. All in all, a challenge which the organizers were successful in delivering. You can read or re-read the Twitter comments from here: #ICIC16.

ICIC - AQUAS — Gabi Barbaglia, Vicky Serra-Sutton, Laia Domingo, Mireia Espallargues, Marina Ordóñez, Montse Moharra

The International Conference on Integrated Care (ICIC) has become a must for professionals who provide care for people and managers working in the fields of health and social services, among others.

Different languages to express the same message: integrated care represents the path we need to follow in order to meet the challenges of our aging populations.

How can we do it? Integrated care proposes the integration of services as a response to the fragmentation of care practice, especially in the biomedical system. The coordination of professionals and institutions aims to improve the experience of patients’ who receive care, as well as their families and to improve their quality of life related to health. This becomes especially key when identifying patients with complex needs.

The main topics covered during the ICIC conference referred to people-centred care within the perspective of those treated and in the coordination, integration and, collaboration of services, professionals and systems (health, social, education, justice, corporate, etc.). In this regard, there were a variety of experiences presented from around the world of collaborative approaches that promote a multidisciplinary and integrated style.

ICIC-cloud-persons

The conference speakers emphasized the value of primary care and community health as being core to providing care to the community as well as the leadership of professionals from the areas of nursing, social work, the field of mental health and other disciplines and profiles.

Following this main topic, several presentations focused on different organizational models of collaborative care which report findings that endorse the adoption of strategies from the bottom up, in other words, strategies that would enable the initiatives proposed by health professionals to reach planners and administrators who, in turn, can provide the support and recognition.

It is important to highlight that there is an ever-increasing recognition of the importance of social determinants of health and looking to the community for the role it might play in shaping these determinants.

One highlight of the conference was the talk Changing culture and measuring what matters given by Alonzo L. Plough in which the speaker summarized the report: Building a National Culture of Health: background, action, framework, measures and next steps.

Don Reding from National Voices, gave an inspirational presentation with Putting what matters most to patients and communities at the heart of health and social care design.

Another outstanding presentation was that given by Professor Deirdre Heenan from the University of Ulster: Integrated care in Northern Ireland: meeting the challenge of mental health.

***You can read more about the ICIC 2016 conference by clicking on the following link:

http://lhalliances.org.uk/international-conference-on-integrated-care/

http://blog.hospitalclinic.org/2016/05/catalunya-acull-la-16-conferencia-internacional-sobre-atencio-integrada/

http://gestioclinicavarela.blogspot.com.es/2016/05/a-proposit-de-la-16th-international.html

That’s not all. Next year’s conference will be held in Dublin (land of innovators!) with the following themes:

Let’s come back to Barcelona for a while. For some time now, the Agency for Health Quality and Assessment of Catalonia (AQuAS as per the Catalan synonym) has been working on an assessment of integrated care, by way of example with the Evaluation of collaborative social and health care models.

It is also noteworthy the recent publication of the specialised report in the Social Work Magazine (Revista de Treball Social), titled: Integrated social and health care: points to reflect upon, which we believe to be a good cross-section of opinions and a good starting point.

Another iniciative in AQuAS is the SUSTAIN project -funded by Horizon2020, an opportunity for professionals to work jointly with their peers in other countries in an effort to define a roadmap and establish synergies in the field of Integrated care in Europe, a project of great interest for Catalonia.

Finally, it is vital not to lose sight of another key issue which is equality in the access to and outcomes from services, and this implies regular analysis of variations in care which have not been justified.

A further helpful instrument for incorporating the opinions of those who receive care and the professionals involved is that of shared decisions. This involves a line of work which incorporates available evidence in a specific area or department of care, the preferences of patients when faced with the different health intervention options, and the essential information for improving the knowledge of all those involved (professionals, patients and their families and environment).

Post written by Vicky Serra-Sutton, Gabi Barbaglia (@gabibarblagia), Laia Domingo, Marta Millaret (@MartaMillaret) and Mireia Espallargues.

Programming the 2016 agenda… some (good) recommendations

11 Feb

2016 is loaded with interesting and innovative events regarding management, patient experience, health 2.0, overdiagnosing, integrated care and research impact. These are our recommendations:

Innovation in management: which are the keys to success
Barcelona, February 17th, 2016

What can be done so professionals exchange their experiences and learn from one another? What can be done to spread the knowledge on innovation generated by the health system? This session of the Catalan Society of Health Care Management (SCGS) will be held in the Catalan Observatory of Innovation in Health Care Management (OIGS), and it will discuss innovation in management topics.

Practising Community on Patients’ Experiences

Esplugues de Llobregat (Barcelona), February 18^th, 2016

What is person-centred care in practice? Hospital Sant Joan de Déu will hold a session with workgroups that will deal some topics of interest, such as what person-centred care involves, the presentation of practical cases of participative design techinques for patients’ experiences, and one session on this technology as a lever to help improve patients’ experiences.

Health 2.0 Europe 2016
Barcelona, May 11th and 12th, 2016

Health 2.0 Europe 2016

European and international innovation focused on the patient-practitioner relationship, consumers’ health, data analysis, and more. More than 120 participants and 600 attendants from all over the world will gather to experience live innovative solutions for the European health care systems. Those with an innovative experience included in the OIGS register can benefit from a 15% discount in the registration fee.

ICIC16 – 16th International Conference on Integrated Care
Barcelona, May 23th – 25th, 2016

ICIC16

A gathering of researchers, clinicians and managers from all over the world. This international conference offers a chance to share experiences and the most recent evidence on the integration of public healthcare, health and social services. Among other issues, it will deal with the challenges of the population’s ageing, the integration at hospital care level of mental care services and rehabilitation services, and the new tools mhealth and digital health. Clinical leadership and models of joint work between patients, caregivers and the community will also be discussed.

EHMA Annual Conference 2016: New Models of Care. Reinventing healthcare: why, what, how

Porto (Portugal), 14-16 June 2016

The EHMA Annual Conference: “New Models of Care. Reinventing healthcare: why, what, how” will bring together policy makers, health managers, health professionals and educators to discuss new models, approaches and solutions for facing challenges that healthcare Systems will experience in the next decade and beyond.

Preventing Overdiagnosis 2016
Barcelona, September 20th – 22th, 2016

Preventing Overdiagnosis

Barcelona will follow Washington, as AQuAS, together with Oxford University, will organise the next issue of this international conference, a space to share knowledge to help debate and reflect on overdiagnosing and its nature, its potential risks, its impact on people’s health and the cost of opportunity it may offer to healthcare systems. You can register at this link.

The International School on Research Impact Assessment
Melbourne (Australia), September 19th – 23th, 2016

ISRIA2016

Annual meeting point to improve abilities in the assessment of research impact. The the International School on Research Impact Assessment (ISRIA), co-founded by AQuAS in 2013, will reach its 5th edition being faithful to its original goals of fostering the science of research impact in all scientific fields and of supporting the sustainability of research system in all the world. Up to date, ISRIA has reached the figure of 300 participants from 17 countries in the three previous editions altogether.