EHR-Enabled Chronic Care Management: A Davies Story

14 abr. 2015 - Learning Objective 1: Reproduce the design and implementation of standardized care plans for patients with chronic conditions. Learning Objective 2: Design condition-based guides that educate patients on achieving the best quality of life with their chronic condition. Learning Objective 3: Construct a solid ...
3MB Größe 11 Downloads 32 vistas
EHR-Enabled Chronic Care Management: A Davies Story April 14, 2015 Vicent Moncho Mas CIO MARINA SALUD

DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of HIMSS.

Conflict of Interest Vicent Moncho Mas, CIO Has no real or apparent conflicts of interest to report.

© HIMSS 2015

Learning Objectives Learning Objective 1: Reproduce the design and implementation of standardized care plans for patients with chronic conditions. Learning Objective 2: Design condition-based guides that educate patients on achieving the best quality of life with their chronic condition. Learning Objective 3: Construct a solid governance and change management structure to support EHR-enabled improvement.

Index

1. Introducing Dénia Health Department 2. Demographic approach 3. CHF integrated program 4. Results 5. Conclusions

Index

1. Introducing Dénia Health Department 2. Demographic approach 3. CHF integrated program 4. Results 5. Conclusions

Geographical scope



Population: More than 150,000 residents (financed mainly per capita)



Tourism: From March to October



Municipality: 34 towns [ Dénia: approximately 40,000 – Vall d’Alcalà: around 200 ]



Total area : 297 square miles (759 km²) • Population density: 635 people per square mile (245 hab/km²)

Operational scope RED ASISTENCIAL MARINA SALUD

1 Hospital 4 Integrated Health Centers (Specialized care) 34 Primary Care Centers (11 Basic areas)

Index

1. Introducing Dénia Health Department 2. Demographic approach 3. CHF integrated program 4. Results 5. Conclusions

Stratification Scenario

Stratification Scenario

Chronic analysis SCP Clasificación por Morbilidad y Riesgo Clínico 6 5 7 4 3 8 2 9 1

Enfermedad significativa crónica en múltiples sistemas orgánicos Enfermedad dominante o crónica moderada única Enfermedad dominante crónica en tres o más sistemas orgánicos Enfermedad crónica menor en múltiples sistemas orgánicos Enfermedad crónica menor única Neoplasias dominantes, metastásicas y complicadas Historia de enfermedad aguda significativa Necesidades sanitarias elevadas Estado de salud sano TOTAL Pacientes DHD

# Pacientes % Pacientes

Pacientes % No % Acum. Equivalentes Sanos Pareto

17.783

11,43%

872.434

55%

55%

24.366

15,66%

326.748

21%

76%

1.500

0,96%

174.600

11%

87%

6.487

4,17%

65.129

4%

91%

15.652

10,06%

51.808

3%

95%

874

0,56%

45.168

3%

97%

9.015 532 79.372 155.581

5,79% 0,34% 51,02%

21.636 18.950

1% 1%

99% 100%

1.576.473

Chronic patients status 5, 6 (27.09% of DSD) represents 76% of complexity (patients equivalents)

Chronic analysis SCP Clasificación por Morbilidad y Riesgo Clínico 6 5 7 4 3 8 2 9 1

Enfermedad significativa crónica en múltiples sistemas orgánicos Enfermedad dominante o crónica moderada única Enfermedad dominante crónica en tres o más sistemas orgánicos Enfermedad crónica menor en múltiples sistemas orgánicos Enfermedad crónica menor única Neoplasias dominantes, metastásicas y complicadas Historia de enfermedad aguda significativa Necesidades sanitarias elevadas Estado de salud sano TOTAL Pacientes DHD

# Pacientes % Pacientes

Pacientes % No % Acum. Equivalentes Sanos Pareto

17.783

11,43%

872.434

55%

55%

24.366

15,66%

326.748

21%

76%

1.500

0,96%

174.600

PATIENTS87% ATTENDED IN 11% SPECIALIZED CARE 2013

6.487

4,17%

15.652

65.129 4% SCP LEVEL

91%TOTAL COST

10,06%

51.808

53%

95% 22,0%

874

0,56%

45.168

63%

97% 15,7%

9.015 532 79.372 155.581

5,79% 0,34% 51,02%

21.636 TOTAL 1%PATIENTS 99% 18.950 1% 100% AVG COST (5, 6)

95.334 1.132,84 €

1.576.473

Levels 5, 6, represents 37.7% of total cost in Specialized Care, level 5 represents 22%

Chronic analysis SCP Clasificación por Morbilidad y Riesgo Clínico 6 5 7 4 3

# Pacientes % Pacientes

% No % Acum. Pacientes Equivalentes Sanos Pareto

Enfermedad significativa crónica en múltiples 17.783 11,43% 872.434 55% sistemas orgánicos Enfermedad dominante o crónica moderada COST OF PATIENTS ATTENDED IN SPECIALIZED CARE WITH ICC326.748 DIAGNOSIS21% 24.366 15,66% única Enfermedad dominante crónica en tres o más SCP LEVEL TOTAL COST # PATIENTS 0,96%% AVG COST11% 1.500 174.600 sistemas orgánicos Enfermedad crónica menor en múltiples 1 7.136,63 € 4 2,0% 1.784,16 € 6.487 4,17% 65.129 4% sistemas orgánicos 2 9.134,14 €15.652 3 10,06% 1,5% 51.808 3.044,713% € Enfermedad crónica menor única

Neoplasias dominantes, metastásicas y 0,56% 3 - € 874 0,0% 45.168 - 3% € complicadas 2 Historia de enfermedad aguda significativa 9.015 5,79% 21.636 1% 4 1.371,25 € 1 0,5% 1.371,25 € 9 Necesidades sanitarias elevadas 532 0,34% 18.950 1% 1 Estado de salud sano 5 133.864,52 €79.372 25 51,02% 12,3% 5.354,58 € TOTAL Pacientes DHD 155.581 1.576.473 6 444.247,01 € 83 40,7% 5.352,37 € 8

TOTAL

7

326.370,48 €

32

15,7%

10.199,08 €

8

45.613,83 €

4

2,0%

11.403,46 €

9

129.781,16 €

6

2,9%

21.630,19 €

375.483,47 €

46

22,5%

8.162,68 €

1.473.002,48 €

204

7.220,60 €

55% 76%

CHF both

prevalence in

Care,

Primary

Emergency

87% 91% 95%

Department

and

Hospitalization

97% 99% 100%

Patients

with

Diagnosis of CHF represents

2% of

SC Cost in 2013

Chronic analysis % No % Acum. Pacientes SCP Clasificación por Morbilidad y Riesgo Clínico # Pacientes % Pacientes Equivalentes Sanos Pareto PATIENTS ATTENDED IN SPECIALIZEDsignificativa CARE 2013 crónica en múltiples Enfermedad 6 17.783 11,43% 872.434 55% 55% sistemas orgánicos TOTAL COST SCP LEVEL Enfermedad dominante o crónica moderada 5 5 24.366 15,66% 326.748 21% 76% 22,0% única Enfermedad dominante en tres o más 15,7% crónica 7 6 0,96%WITH ICC 174.600 87% COST OF PATIENTS ATTENDED1.500 IN SPECIALIZED CARE DIAGNOSIS11% sistemas orgánicos 95.334 TOTAL PATIENTScrónica menor Enfermedad enSCP múltiples LEVEL TOTAL COST 6.487 # PATIENTS AVG COST 4% 4 4,17% % 65.129 91% 1.132,84 € AVGsistemas COST (5,orgánicos 6) 1 7.136,63 € 4 2,0% 51.8081.784,163% € 3 Enfermedad crónica menor única 15.652 10,06% 95% Neoplasias dominantes, metastásicas y 2 9.134,14 € 30,56% 1,5% 45.1683.044,713% € 8 874 97% complicadas 3 - € - 5,79% 0,0% 21.636 - 1% € 2 Historia de enfermedad aguda significativa 9.015 99% 9 Necesidades sanitarias elevadas 532 0,34% 18.950 1% 100% 4 1.371,25 € 1 0,5% 1.371,25 € 1 Estado de salud sano 79.372 51,02% 5 133.864,52 € 25 12,3% TOTAL Pacientes DHD 155.581 1.576.4735.354,58 €

TOTAL

6

444.247,01 €

83

40,7%

5.352,37 €

7

326.370,48 €

32

15,7%

10.199,08 €

8

45.613,83 €

4

2,0%

11.403,46 €

9

129.781,16 €

6

2,9%

21.630,19 €

375.483,47 €

46

22,5%

8.162,68 €

1.473.002,48 €

204

7.220,60 €

Managing 204 CHF chronic patients we can control 2% of total cost

Index

1. Introducing Dénia Health Department 2. Demographic approach 3. CHF integrated program 4. Results 5. Conclusions

CHF program – CM Organization CC Ó

SS

S

C O OG S

O



COMMUNICATION SOLUTION GO LIVE

2º Nivel

USERS High Management Committee; Clinical Record Committee

C T O

CHANGE REQUEST

CHANGE REQUEST

Level 1 PCP/ PCU

Middle Management C A L L

CHANGE REQUEST INCIDETN QUERY

End Users

COMMUNICATION SOLUTION GO LIVE

C E N T E R

SUPPORT AREA (HELP DESK)

INCIDENT QUERY

THIRD PARTY ESCALATION

Level 3

Technology Providers

APPLICATION DEVELOPMENT AREA

CHF program – Process Map

Medical prescription

Program inclusion

Program inclusion

Program inclusion

Patient follow up

Clinical protocols & pathways

Adapted Care plans

Adapted Care plans

Adapted Care plans

Adapted Care plans

Adapted Care plans

Adapted Care plans

Adapted Care plans

Adapted Care plans

Index

1. Introducing Dénia Health Department 2. Demographic approach 3. CHF integrated program 4. Results 5. Conclusions

CHF program incidence in SC activity Data collected from 146 Patients included in CHF program 2013-2014 ACTIVIDAD URGENCIAS urgencias % urgencias ingresadas ICC % urgencias ingresadas MS Tiempo de permanencia ICC Tiempo de permanencia MS

2013 400 57% 15,9% 16:32:24 6:06:24

2014 VARIACIÓN 246 -39% 39% -31,2% 15,5% -2,7% 13:49:47 -16,4% 5:49:46 -4,5%

39% ED visits reduction 31% ED visits becoming inpatient reduction

CHF program incidence in SC activity Data collected from 146 Patients included in CHF program 2013-2014 ACTIVIDAD URGENCIAS urgencias % urgencias ingresadas ICC % urgencias ingresadas MS Tiempo de permanencia ICC Tiempo de permanencia MS

2013 400 57% 15,9% 16:32:24 6:06:24

2014 VARIACIÓN 246 -39% 39% -31,2% 15,5% -2,7% 13:49:47 -16,4% 5:49:46 -4,5%

ACTIVIDAD HOSPITALIZACIÓN ALTAS ESTANCIAS ESTANCIA MEDIA

2013 306 1.897 6,20

2014 VARIACIÓN 150 -51% 968 -49,0% 6,45 4,1%

51% CHF Hospitalization reduction 49%

Total

Hospitalization

CHF stays

reduction LOS increments in 4.1% (complexity increase)

CHF program incidence in SC activity Data collected from 146 Patients included in CHF program 2013-2014 ACTIVIDAD URGENCIAS urgencias % urgencias ingresadas ICC % urgencias ingresadas MS Tiempo de permanencia ICC Tiempo de permanencia MS

2013 400 57% 15,9% 16:32:24 6:06:24

2014 VARIACIÓN 246 -39% 39% -31,2% 15,5% -2,7% 13:49:47 -16,4% 5:49:46 -4,5%

ACTIVIDAD HOSPITALIZACIÓN ALTAS ESTANCIAS ESTANCIA MEDIA

2013 306 1.897 6,20

2014 VARIACIÓN 150 -51% 968 -49,0% 6,45 4,1%

TIPO DE ACTIVIDAD CONSULTAS EXTERNAS PRUEBAS DIAGNOSTICAS RADIOLOGIA

2013 970 1.024 1.118

2014 VARIACIÓN 865 -11% 741 -28% 631 -44%

28%

Reduction

diagnostic tests

in

CHF program incidence in SC activity Data collected from 146 Patients included in CHF program 2013-2014 ACTIVIDAD URGENCIAS urgencias % urgencias ingresadas ICC % urgencias ingresadas MS Tiempo de permanencia ICC Tiempo de permanencia MS

2013 400 57% 15,9% 16:32:24 6:06:24

2014 VARIACIÓN 246 -39% 39% -31,2% 15,5% -2,7% 13:49:47 -16,4% 5:49:46 -4,5%

ACTIVIDAD HOSPITALIZACIÓN ALTAS ESTANCIAS ESTANCIA MEDIA

2013 306 1.897 6,20

2014 VARIACIÓN 150 -51% 968 -49,0% 6,45 4,1%

TIPO DE ACTIVIDAD CONSULTAS EXTERNAS PRUEBAS DIAGNOSTICAS RADIOLOGIA

2013 970 1.024 1.118

2014 VARIACIÓN 865 -11% 741 -28% 631 -44%

44% Radiology

Reduction

in

CHF program incidence in Cost Data collected from 146 Patients included in CHF program 2013-2014 ACTIVIDAD URGENCIAS urgencias % urgencias ingresadas ICC % urgencias ingresadas MS Tiempo de permanencia ICC Tiempo de permanencia MS

2013 400 57% 15,9% 16:32:24 6:06:24

2014 VARIACIÓN 246 -39% 39% -31,2% 15,5% -2,7% 13:49:47 -16,4% 5:49:46 -4,5%

ACTIVIDAD HOSPITALIZACIÓN ALTAS ESTANCIAS ESTANCIA MEDIA

2013 306 1.897 6,20

2014 VARIACIÓN 150 -51% 968 -49,0% 6,45 4,1%

TIPO DE ACTIVIDAD CONSULTAS EXTERNAS PRUEBAS DIAGNOSTICAS RADIOLOGIA

2013 970 1.024 1.118

2014 VARIACIÓN 865 -11% 741 -28% 631 -44%

TIPO DE ACTIVIDAD %VARIACIÓN URGENCIAS, HOSP, UHD -45% RESTO -21% TOTAL -33%

Working with 146 patients in CHF program we have reduced Cost

in 45% in

ED visits, Hospitalization and Home Hospitalization stays

Index

1. Introducing Dénia Health Department 2. Demographic approach 3. CHF integrated program 4. Results 5. Conclusions



Population Management capabilities from EHR enables Marina Salud to identify their patient needs being proactive to take care of healthy people



The integrated management model in which Marina Salud manages the whole health department, brings the ability to fully execute integrated health programs combining Primary Care and Specialized Care Resources



CHF program is a good sample of standardized care plan for patients with chronic conditions, for achieving the best quality of life with their chronic condition avoiding acute visits. EHR is the mandatory tool to succeed in an efficient way

Questions

Vicent Moncho Mas [email protected]