Stroke Care in Thailand “The role of Siriraj” · Lean Stroke Fast Track 34 min (91%) Siriraj...

Stroke Care in Thailand “The role of Siriraj”

รศ.นพ.เชดชย นพมณจำรสเลศ รองผอานวยการโรงพยาบาล คณะแพทยศาสตรศรราชพยาบาล มหาวทยาลยมหดล

P Watanapaเอกสารแนบ 3

ศนยโรคหลอดเลอดสมองศรราช

Multidisciplinary Care team: iCOE

“Better patient outcome

and quality of life”

Event to door Door to Needle time

57 min (70%)

Lean Stroke Fast Track


34 min (91%)


Lean Project



34 min (91%)

Siriraj Mobile Stroke Unit



34 min (91%)

Event to door


Event to needle


1669024198888

StrokeMimics

StrokeUnit

ER

4hrs

หนาทหลกของหนวยรกษาอมพาตเคลอนท phase 2

▪วนจฉยโรคหลอดเลอดสมองเฉยบพลนดวยการเอกซเรยคอมพวเตอรสมอง (CT brain/ multiphase CTA/ CT perfusion), Rapid Software

▪กลองค ▪DUAL Stroke Fast Track for AIS and ICH

▪ Identify LVO (mechanical thrombectomy patient selection)

▪ใหยาละลายลมเลอดทางหลอดเลอดดำ (iv-rtPA)

▪Teleconsultation

Payment rewards population value:

quality and efficiency

Quality impacts reimbursement

Partnerships with shared risk

Increased patient severity

IT utilization essential for population health management

Scale increases in importance

Realigned incentives, encouraged coordination

Value-BasedSecond Curve

Volume-BasedFirst Curve

Fee-for-service reimbursement

High quality not rewarded

No shared finanical risk

Acute inpatient hospital focus

IT investment incentives not seen by hospital

Stand-alone care systems can thrive

Regulatory actions impede hospital-physician

collaboration

Volume-Based Value-Based

Value-based reimbursement

Seamless care acrossall settings

Proactive and systematicpatient education

Workplace competencies and education on population health

Integrated, comprehensiveHIT that supports risk

stratification of patients with real-time accessibility

Mature community partnerships to collaborate on

community-based solutions

Second Curve ofPopulation Health

First Curve ofPopulation Health

Volume-based reimbursement

Fragmented care across settings

Targeted patient education(disease specific)

Workplace competencies andeducation lack population

health focus

Limited HIT data sorces,real-time access or data

mining for populationhealth analysis

Limited communitypartnerships


VOLUME TO VALUE

POPULATION HEALTH

TheGap

TheGap

www.hpoe.org

10 must-do strategies were identified for the hospital field to implement; however, the first 4 were identified as major priorities.

1. Aligning hospitals, physicians, and other providers across the continuum of care

2. Utilizing evidenced-based practices to improve quality and patient safety

3. Improving efficiency through productivity and financial management

4. Developing integrated information systems

5. Joining and growing integrated provider networks and care systems

6. Educating and engaging employees and physicians to create leaders

7. Strengthening finances to facilitate reinvestment and innovation

8. Partnering with payers

9. Advancing an organization through scenario-based strategic, financial, and operational planning

10. Seeking population health improvement through pursuit of the “triple aim”

MUST-DO STRATEGIES

SECOND CURVE OFPOPULATION HEALTH

These tactics are:

• Value-based reimbursement

• Seamless care across all settings

• Proactive and systematic patient education

• Workplace competencies and education on population health

• Integrated, comprehensive HIT that supports risk stratification of patients with real-time accessibility

• Mature community partnerships to collaborate on community-based solutions

2

3

4

1


















collaboration
















health focus





VOLUME TO VALUE

POPULATION HEALTH

TheGap

TheGap

www.hpoe.org












MUST-DO STRATEGIES


These tactics are:







2

3

4

1


















collaboration
















health focus





VOLUME TO VALUE

POPULATION HEALTH

TheGap

TheGap

www.hpoe.org












MUST-DO STRATEGIES


These tactics are:







2

3

4

1

2012: Contract for Healthy Future, Role of Medical Technologies in Steering Health Care Systems Onto a Sustainable Path

2017: Value Based Technology-

based

Payment based on regulatory

requirements MDR/ IVDR

HTA-based

Payment based on the

relative clinical

effectiveness and

incremental cost-

effectiveness ratio

Value-based

Payment linked to value to patient,

institution, health

system and broader societal benefits

Outcome-based

Payment linked to the real-world

patient outcome

MedTech Europe CEO Round Table

2012: Contract for Healthy Future, Role of Medical Technologies in Steering Health Care Systems Onto a Sustainable Path

2017: Value Based Technology-

based

Payment based on regulatory

requirements MDR/ IVDR

HTA-based

Payment based on the

relative clinical

effectiveness and

incremental cost-

effectiveness ratio

Value-based

Payment linked to value to patient,

institution, health

system and broader societal benefits

Outcome-based

Payment linked to the real-world

patient outcome

MedTech Europe CEO Round Table

จากขอมลฐานะทางการเงนของโรงพยาบาลรฐทงหมด 896 แหงโรงพยาบาลศนย โรงพยาบาลทวไป และโรงพยาบาลชมชน ณ 31 ตลาคม 2560

5 Copyright © Michael Porter 2016

Solving the Health Care Problem

• The fundamental goal and purpose of health care is to improve value for patients

• Delivering high value health care is the definition of success

• Value is the only goal that can unite the interests of system participants

• Improving value is the only real solution

• The question is how to design health care delivery systems and organizations that substantially improve patient value

Value = Health outcomes that matter to patients

Costs of delivering these outcomes

13Copyright © Michael Porter 2016

The Outcome Measures Hierarchy

Survival

Degree of health/recovery

Time to recovery and return to normal activities

Sustainability of health/recovery and nature of recurrences

Disutility of the care or treatment process (e.g., diagnostic errors and ineffective care, treatment-related discomfort,

complications, or adverse effects, treatment errors and their consequences in terms of additional treatment)

Long-term consequences of therapy (e.g., care-induced illnesses)

Tier1

Tier2

Tier3

Health Status Achieved

or Retained

Process of Recovery

Sustainability of Health

Source: NEJM Dec 2010

• Achieved clinical status

• Achieved functional status

• Care-related pain/discomfort

• Complications

• Reintervention/readmission

• Long-term clinical status

• Long-term functional status

14Copyright © Michael Porter 2016

9.2%

17.4%

95%

43.3%

75.5%

94%

Incontinence after one year

Severe erectile dysfunction after one year

5 year disease specific survival

Average hospital Best hospital

The Importance of Measuring Multiple Outcomes Prostate Cancer Care in Germany

Source: ICHOM

2.2.2 Patient-Reported Health Status

2.2.2 Patient-Reported Health Status

2.2.3 Patient Experience Survey1.แพทยใหความส าคญกบการตรวจรางกายเพอการวนจฉยโรค

2.แพทยใหขอมล /แนะน าวธการและทางเลอกในการรกษา

3.ค าถามและขอสงสยไดรบค าตอบทชดเจนจากแพทย

4.แพทยรบฟง / พดคยใหทานคลายความกงวลในอาการเจบปวย

5.มโอกาสไดพดคยกบพยาบาลหรอเจาหนาท เรองอาการเจบปวย

6.พยาบาลหรอเจาหนาท สามารถตอบค าถามและขอสงสยไดชดเจน

7. ถกละเลยและไมใสใจในการดแล

8.ไดมสวนรวมในการตดสนใจในเรองการรกษา

9.ไดรบการดแลอยางเทาเทยม และไมถกเลอกปฏบต

10.ไดรบค าแนะน าขนตอนในการรบบรการของโรงพยาบาล

11.อาการเจบปวยทงกายและใจไดรบการดแลเปนอยางด

12.แพทยผใหการรกษา เปดโอกาสใหผปวย/ญาตไดซกถาม

13.ผปวยและญาต ไดรบขอมลการรกษาทเปนประโยชนจนสามารถดแลตนเองได

14.ไดรบขอมลการใชยา ผลขางเคยงและอาการทตองเฝาระวงอยางชดเจน

15.ไดรบค าแนะน าอยางชดเจนถงอาการผดปกตทตองกลบมาพบแพทย และการมาตรวจตามนด

16.ทานจะแนะน าผอนมาใชบรการโรงพยาบาลแหงน

2.2.3 Patient Experience Survey1.แพทยใหความส าคญกบการตรวจรางกายเพอการวนจฉยโรค

2.แพทยใหขอมล /แนะน าวธการและทางเลอกในการรกษา

3.ค าถามและขอสงสยไดรบค าตอบทชดเจนจากแพทย

4.แพทยรบฟง / พดคยใหทานคลายความกงวลในอาการเจบปวย

5.มโอกาสไดพดคยกบพยาบาลหรอเจาหนาท เรองอาการเจบปวย

6.พยาบาลหรอเจาหนาท สามารถตอบค าถามและขอสงสยไดชดเจน

7. ถกละเลยและไมใสใจในการดแล

8.ไดมสวนรวมในการตดสนใจในเรองการรกษา

9.ไดรบการดแลอยางเทาเทยม และไมถกเลอกปฏบต

10.ไดรบค าแนะน าขนตอนในการรบบรการของโรงพยาบาล

11.อาการเจบปวยทงกายและใจไดรบการดแลเปนอยางด

12.แพทยผใหการรกษา เปดโอกาสใหผปวย/ญาตไดซกถาม

13.ผปวยและญาต ไดรบขอมลการรกษาทเปนประโยชนจนสามารถดแลตนเองได

14.ไดรบขอมลการใชยา ผลขางเคยงและอาการทตองเฝาระวงอยางชดเจน

15.ไดรบค าแนะน าอยางชดเจนถงอาการผดปกตทตองกลบมาพบแพทย และการมาตรวจตามนด

16.ทานจะแนะน าผอนมาใชบรการโรงพยาบาลแหงน

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

CFN1 CFN2 CFN3 CFN4 CFN5 CFN6 CFN7Always 90.23% 88.37% 82.22% 80.21% 69.35% 79.33% 16.81%

Most of the Time 7.20% 9.04% 10.82% 11.83% 19.74% 15.76% 1.18%

Half of the Time 1.54% 2.07% 5.15% 4.63% 8.05% 4.39% 2.36%

Seldom 0.51% 0.52% 0.77% 1.54% 1.30% 0.52% 8.85%

Never 0.51% 0.00% 1.03% 1.80% 1.56% 0.00% 70.80%

Perc

enta

ge

Indicators Code

1.Did the nurses treat you with courtesy and respect? CFN1

2.Did the nurses listen carefully to you? CFN2

3.Did the nurses explain things in a way you could understand? CFN3

4.Were there sufficient nurses on duty to care for you in hospital? CFN4

5.Did the nursing staff respond immediately to your call bell? CFN5

6.Did you have confidence and trust in the nurses treating you? CFN6

7.Did the nurses talk in front of you as if you weren’t there? CFN7

YOUR CARE FROM NURSES

Health'care'cost'

Direct''

Medical'''

Doctor'fee''Drugs''

Inves6ga6ons'Procedures'

Hospitaliza6on'Rehabilita6on'

Non=medical''

Transporta6on'Foods'

Family'care''Child'care''Home'aids'

Indirect'

Medical''

Costs'of'health'care'consump6on'during'year'of'life'gained'as'a'result'of'a'health'care'interven6on'

Non=medical''

Income'lost'from'sick=leaved'

Intangible''

The'monetary'value'of'pain,'suffering,'

distress'etc.'associated'

with'treatment'

Type of Cost

Copyright © 2014 Oracle and/or its affiliates. All rights reserved. |

Big Data Helps to Solve Challenges

Across the whole HC ecosystem which were not addressable before

Increased R&D Productivity

Personalized Medicine

Improved Quality & Safety

Personalized Care

Participatory & Preventive Care

Discovery Research

Diagnostics Pharma /Biotech Medical Devices

Clinical Research

Care Delivery

Care Management

Population/ Global Health

38

Copyright © 2014 Oracle and/or its affiliates. All rights reserved. |

… But There Are Still Hurdles to Overcome

Legal framework for data sharing 1

Lack of trust and reluctance to share data 2

Technological challenges: reliability and structure of data 3

Structural challenges: Lack of multidisciplinary experts 4

Lack of robust business models 5

39

Hurdles

Design Thinking

Care Redesign

IT, Innovation, Robot, etc

Job RedesignR2R

Value Driven Care Model

KMCulture

wasteHTACost

Value Need

Safer Better Faster Happier Cheaper

Lean Philosophy

16 Copyright © Michael Porter 2016

Transforming Health Care

• We know the path forward

• Value for patients is the True North

• Value-based thinking will revolutionize care delivery, payment, and strategy for health systems

• Standardized outcome measurement is the single most powerful driver

• ICHOM is honored to partner with the OECD to support health ministers in accelerating this agenda

Making It Happen!

Stroke Care in Thailand “The role of Siriraj” · Lean Stroke Fast Track 34 min (91%) Siriraj...

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