Models for Acute Care & Emergency Care

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Systems CMMU, Mahidol University July 23, 2016 Pix source: ra.mahidol.ac.

1 Models for Acute Care & Emergency Care Asst. Prof. Borwornsom Leerapan, MD PhD MGMG 548: Health Service Systems and Health Systems CMMU, Mahidol University July 23, 2016 Pix source: ra.mahidol.ac.th Format F/U Presentation Discussion Q&A To-do list Minilecture Wrap up Pix source: online.wsj.com 1

2 Housekeeping Issues 1) Your interim course evaluation 2) General feedbacks on your mid-term papers 3) Confirmed guest lecturer on July 30 th (week 12): Mahippathorn Chinnapa, MB BCh MRCPCH 4) Tentative Guest lecturer on Aug 9 th (week 13)? Pix source: online.wsj.com 1. What exactly are acute care & other related services such as emergency and subacute care? 2. What are the current challenges of acute care? 3. How could healthcare managers help improving the delivery of acute care? What could be successful business models? 4. Discussions/Q&A Outline for Today Pix source: online.wsj.com 2

3 Models for Acute Care Pix source: online.wsj.com Hospital at Scutari - A ward of the hospital at Scutari where Florence Nightingale worked and helped to restructure the modern hospital Source: W. Simpson del.; E. Walker lith.; Day & Son, Lithrs. to the Queen. Pix source: 3

Acute Care includes all promotive, preventive, curative, rehabilitative or palliative actions, whether oriented towards individuals or populations, whose primary purpose is to improve

4 Acute Care includes all promotive, preventive, curative, rehabilitative or palliative actions, whether oriented towards individuals or populations, whose primary purpose is to improve health and whose effectiveness largely depends on time-sensitive and, frequently, rapid intervention. Source: Hirshon et al. (2013) Domains in Acute Care? Source: Hirshon et al. (2013) 4

5 What are the challenges of our current acute care/hospital care models? Pix source: online.wsj.com Challenges of Acute Care ØLimited access to timely care ØInefficient approaches to managing acute illnesses Cares are provided in a fragmented, poorly coordinated care provided by multidisciplinary providers Financial burdens of healthcare expenditure, especially from the ineffective and inefficient interventions Too many patchwork efforts that may improve outcomes for specific conditions ( vertical programs ) but not the overall functioning of the health system You can t solve today s problems with yesterday s solutions. 5

6 Challenges of Acute Care Changes at Micro-level: Advancing medical knowledge Disrupting healthcare technology and innovation Changes at Meso-level: Improving healthcare delivery design Changes at Macro-level: Changing demography Emerging economies and geopolitical systems Global change, megatrends that affect health and healthcare Global Changes Urbanization Globalization Localism Personalization Digitalization Individualism Debt Volatility Anxiety Environmental Change Sustainability 6

Megatrends in Global Healthcare Harvard Business Review 12 Megatrends from

providers Scientists and inventors Academics at medical and business

HBR Blog Network. Available from: http://blogs.hbr.

7 Megatrends in Global Healthcare Harvard Business Review 12 Megatrends from Multiperspectives: Executives at major pharmaceutical companies and care providers Scientists and inventors Academics at medical and business schools Experts in government agencies and NGOs Practicing physicians Source: Karen Dillon & Steve Prokesch. Global Challenges in Health Care: Is Rationing in Our Future? HBR Blog Network. Available from: Megatrends in Global Healthcare #1 Source: 7

Megatrends in Global Healthcare #2 Source: http://hbr.

8 Megatrends in Global Healthcare #2 Source: Megatrends in Global Healthcare #3 Source: 8

Megatrends in Global Healthcare #4 Source: http://hbr.

9 Megatrends in Global Healthcare #4 Source: Megatrends in Global Healthcare #5 Source: 9

Megatrends in Global Healthcare #6 Source: http://hbr.

10 Megatrends in Global Healthcare #6 Source: Megatrends in Global Healthcare #7 Source: 10

Megatrends in Global Healthcare #8 Source: http://hbr.

11 Megatrends in Global Healthcare #8 Source: Megatrends in Global Healthcare #9 Source: 11

Megatrends in Global Healthcare #10 Source: http://hbr.

12 Megatrends in Global Healthcare #10 Source: Megatrends in Global Healthcare #11 Source: 12

Megatrends in Global Healthcare #12 Source: http://hbr.org/web/extras/insight-center/health-care/globaltrends/13-slide Improving Acute Care?

13 Megatrends in Global Healthcare #12 Source: Improving Acute Care? ØTo develop an acute care service delivery model that will function in parallel with preventive and primary services. ØTo improve coordination between deliverers of acute care services, such as emergency physicians, surgeons and obstetricians, to deliver critical acute care services efficiently and effectively. Source: Adapted from Hirshon et al. (2013) 13

14 Improving Acute Care? ØTo quantify the burden of acute care diseases and injuries, including health economics and cost-effectiveness components, to justify integrating acute care within health systems. ØTo hold national and international discussions to encourage better integration of acute care within local and national health systems. Source: Hirshon et al. (2013) Relevant Questions For Thailand Acute Care Systems? Ø Megatrends vs. fads and fashions? Are they global trends? Are they inevitable? Are they sustainable? Ø Changes vs. Resistance to Changes Professional cultures Organizational cultures Societal cultures 14

15 Subacute Care Pix source: online.wsj.com Generic Care Cycle Promotion & Prevention Rehabilitation Diagnosis Management Treatment Source: Ver beek & Lord (2007). The care cycle: an overview. 15

16 Subacute Care? Intermediate Care? Transitional Care? Subacute care (California): A level of care needed by a patient who does not require hospital acute care, but who requires more intensive skilled nursing care than is provided to the majority of patients in a skilled nursing facility. Pediatric subacute care is a level of care needed by a person less than 21 years of age who uses a medical technology that compensates for the loss of a vital bodily function. Subacute patients are medically fragile and require special services, such as inhalation therapy, tracheotomy care, intravenous tube feeding, and complex wound management care. Source: Subacute Care? Intermediate Care? Transitional Care? Intermediate care (UK): An approach to health care intended to facilitate patients' transitions from illness to recovery, or to prevent their transition from home managed chronic impairment to institution-based dependence, or to help terminally ill people be as comfortable as possible at the end of their lives That range of services designed to facilitate transition from hospital to home, and from medical dependence to functional independence, where the objectives of care are not primarily medical, the patients' discharge destination is anticipated, and a clinical outcome of recovery (or restoration of health) is desired Those services that do not require the resources of a general hospital, but are beyond the scope of the traditional primary care team. These can include substitutional care and care for people with complex needs Source: Melis, researcher & Olde Rikkert BMJ (2004) 16

17 Emergency Care Pix source: online.wsj.com Emergency Medical Services (EMS) Emergency Medical Services (EMS): a system that provides emergency medical care, which is activated by an incident that causes serious illness or injury, and also a system of coordinated response and emergency medical care, involving multiple people and agencies. Source: 17

Emergency Medical Services (EMS) ØAn EMS system should comprise all of the following components: Agencies and organizations (both private and public) Communications and transportation networks Trauma

18 Emergency Medical Services (EMS) ØAn EMS system should comprise all of the following components: Agencies and organizations (both private and public) Communications and transportation networks Trauma systems, hospitals, trauma centers, and specialty care centers Rehabilitation facilities Highly trained professionals Volunteer and career prehospital personnel Physicians, nurses, and therapists Administrators and government officials An informed public that knows what to do in a medical emergency Source: Emergency Medical Services (EMS) Prevention & Public Education Specialty care & Rehabilitation Prehospital care Emergency care Pix source: adapted from 18

19 12 Main Characteristics of EMS 1) Complimentary between prehospital and hospital activities 2) Promoting emergency medical services/department in hospital settings 3) Appropriately managing of emergency patients on site 4) Appropriately managing of of emergency patients during transport 5) Regulating emergency calls and medical emergency patients 6) Utilizing the partners of networks Pix source: online.wsj.com 12 Main Characteristics of EMS 7) Conducting monitoring and evaluation 8) Implementing quality control, normative role, policy making, programming and accreditation process 9) Enforcing by law, regulation and policies 10) Interfacing between the community and the private professionals 11) Establishing the role of the emergency medical services management committees 12) Conducting disaster planning and community relations Pix source: online.wsj.com 19

Issues in Thai EMS Systems Source: Treerutkuarkul A.

20 Issues in Thai EMS Systems Source: Treerutkuarkul A. Emergency care will be free for all from April 1. Bangkok Post March 14. Some Relevant Questions for Thai EMS? Source: Treerutkuarkul A. Private hospitals fear chaos : Call for clear definition of emergency patients. Bangkok Post March

EMCO : Emergency Claim On line EMCO (Emergency Claim on Line) is electronic claim

The fee are withdrawn from cooperating funds for emergency services administrate by

EMCO was set up by law and commenced on 1 April 2013 with objectives: To improve

coverage screening and without advance payment.

financial expenditure due by the clearing house Source: Suriyawongpaisal P (2013.

น จ ายเง นค น ส งใบแจ งหน ให กองท น ท เก ยวข อง จ ายเง นชดเชย ค าบร การ ลงทะเบ ยนเบ

21 EMCO : Emergency Claim On line EMCO (Emergency Claim on Line) is electronic claim program functions as a window for providers to reimburse emergency service fee. The fee are withdrawn from cooperating funds for emergency services administrate by clearing house. EMCO was set up by law and commenced on 1 April 2013 with objectives: To improve Emergency Care Accessibility because patient access to emergency service without coverage screening and without advance payment. To minimize Mortality and morbidity rate To protected Human Right To minimize financial expenditure due by the clearing house Source: Suriyawongpaisal P (2013.) Clearing House 1669 ฉ กเฉ น-ว กฤต-เร งด วน น าส งเอง โรงพยาบาล นอกระบบกองท น กองท น จ ายเง นค น ส งใบแจ งหน ให กองท น ท เก ยวข อง จ ายเง นชดเชย ค าบร การ ลงทะเบ ยนเบ องต น? ส ทธ อปท./คร เอกชน/ร ฐว สาหก จ Clearing House ประมวลผล จ ายเง นชดเชย IvLU7 7 xgcyouat5 ryl4 Cg#q=EMCO+clearing+house+ppt บ นท กข อม ล การให บร การ 21

22 Some Relevant Questions for Thai EMS? Source: Suriyawongpaisal P, Sakulphanit T, Naka P. (2013.) Some Relevant Questions for Thai EMS? Source: Suriyawongpaisal P, Sakulphanit T, Naka P. (2013.) 22

23 Some Relevant Questions for Thai EMS? Source: Suriyawongpaisal P, Sakulphanit T, Naka P. (2013.) Food-for-Thought Pix source: online.wsj.com 23

24 I never think of the future - it comes soon enough. --Albert Eistein ( ) Pix source: teachermoloneyking.com Q& A Discussions Pix source: online.wsj.com 24

Patient Centred Care (PCC)

Patient Centred Care (PCC) Rod Jackson Tabriz, April 2012 (adapted from a lecture by Gill Robb, Quality in Health Care, UoA 2012) Patient Centred Care Summary points One of domains of Quality Patient