Developing Benchmarking Systems in Finland

Transcription

1 Knowledge for welfare and health Hariet Finne-Soveri M.D. Ph.D. STAKES (CHESS) and City of Helsinki, interrai 1 Developing Benchmarking Systems in Finland Harriet Finne-Soveri, M.D. Ph.D. Senior Researcher at STAKES (harriet.finne-soveri@stakes.fi) Chief Medical Officer, Social Department, City of Helsinki (harriet.finne-soveri@hel.fi)

2 Knowledge for welfare and health Hariet Finne-Soveri M.D. Ph.D. STAKES (CHESS) and City of Helsinki, interrai 2 Finland Population: 5,2 million Member of EU since 1995 Republic: president + parliament Currency: Euro One of the leading countries as to internet and mobile phones

3 Knowledge for welfare and health Hariet Finne-Soveri M.D. Ph.D. STAKES (CHESS) and City of Helsinki, interrai 3 City of Porvoo -- Helsinki, STAKES STAKES, the National Research and Development Centre for Welfare and Health, is committed to promoting the well-being and health of people, and to securing equal access for all to high-quality and effective welfare and healthcare services. STAKES produces information and know-how in the field of welfare and health and forwards them to decision-makers and other actors in the field. As a centre of expertise overseen by the Ministry of Social Affairs and Health, STAKES bases its functions on research, development and information resources

4 Knowledge for welfare and health Hariet Finne-Soveri M.D. Ph.D. STAKES (CHESS) and City of Helsinki, interrai 4 Contents Background Benchmarking project for the elderly care services, in Finland Results Lessons learned Summary and conclusions

5 Knowledge for welfare and health Hariet Finne-Soveri M.D. Ph.D. STAKES (CHESS) and City of Helsinki, interrai 5 Background The ageing population Increasing expenditure Shortage of labour Concern about quality of care Gallen-Kallela: Akka ja kissa

6 Knowledge for welfare and health Hariet Finne-Soveri M.D. Ph.D. STAKES (CHESS) and City of Helsinki, interrai 6 Concern about quality of care health-care services increasingly complained about. somehow I've got the feeling that the patients are not listened to, any more...

7 Knowledge for welfare and health Hariet Finne-Soveri M.D. Ph.D. STAKES (CHESS) and City of Helsinki, interrai 7 How to make our money to cover the need? In the future? We have substantially simplified your tax form: 1. How much did you earn last year? 2. How much do you have left? 3. Send us all the money you have left

8 Knowledge for welfare and health Hariet Finne-Soveri M.D. Ph.D. STAKES (CHESS) and City of Helsinki, interrai 8 Benchmarking project for the elderly care services, in Finland Gallen-Kallela: Akka ja kissa What was done Who we are

9 Knowledge for welfare and health Hariet Finne-Soveri M.D. Ph.D. STAKES (CHESS) and City of Helsinki, interrai 9 RAI benchmarking project for the elderly care services Benchmarking Education / Training Software STAKES Chydenius Institute RAIsoft.ltd Goal: to implement RAI-systems into elderly care services in order to improve quality and efficiency of care

10 Knowledge for welfare and health Hariet Finne-Soveri M.D. Ph.D. STAKES (CHESS) and City of Helsinki, interrai 10 RAI benchmarking project for the elderly care services Benchmarking Education / Training Software STAKES Chydenius Institute RAIsoft.ltd LTF LTF in in > -> Home-Care Home-Care in in > -> Acute Acute Care Care in in -> ->

11 Knowledge for welfare and health Hariet Finne-Soveri M.D. Ph.D. STAKES (CHESS) and City of Helsinki, interrai 11 RAI/Benchmarking Information System in Finland Residents Management Nurses RAI assessments RAIsoft-LTC software (Windows) - Initial assessment - 6 month follow-up - Significant change in status Patient level reports: MDS items, RAPs, Scales (ADL, Pain, Depression, RUG-III etc.) Data transfer to Stakes (National Research and Development Centre for Welfare and Health) -twicea year Facility/ward level reports based on National Research and Development Benchmarking-data RAI/MDS based indicators Centre for Welfare and Health

12 Knowledge for welfare and health Hariet Finne-Soveri M.D. Ph.D. STAKES (CHESS) and City of Helsinki, interrai 12 Benchmarking project:stakes In addition to RAI-data to collect information about: staffing expenditure well-being of the staff experienced quality of care

13 Knowledge for welfare and health Hariet Finne-Soveri M.D. Ph.D. STAKES (CHESS) and City of Helsinki, interrai 13 Benchmarking project:stakes to: collect electronic data semiannually =>database teach how to use web results for comparisons feed the data in the website (anonymous, aggregate) each unit gets individual feed-back form organize 2-day meetings semiannually NOT to: create interventionstudies - yet

14 Knowledge for welfare and health Hariet Finne-Soveri M.D. Ph.D. STAKES (CHESS) and City of Helsinki, interrai 14 Benchmarking project:stakes Palvelutalo Esimerkkilaitos I.1a.Mikä tah. onnettomuus K. riski, XI ast. paineh I.2. Kaatuilu M. riski, XI ast. paineh II.1.Käytösoire, joka vaik. muihin XI ast. painehaavat M. riski, II.1. Käyt.oire, joka vaik. muihin X.2. Vähäinen aktivit. osallist X.1. Liikkum. est. väl. päivitt. käyttö K. riski, II.1. Käyt.oire, joka vaik. muihin II.2. Masennusdiagn. tai -oireet IX.3. Unilääk. väh. 3 krt/vk II.3. Masennus ilman hoitoa IX.2. Rauhoit. ja unilääkk. käyttö III.1. Väh. 9 lääkettä K. riski, IX.1. Antipsyk. käyttö ilman psyk. oir V.1. Virts./ulost. pidätyskyvytt. M. riski, IX.1. Antipsyk. käyttö ilman psyk. oir M. riski, V.1. Pidätyskyvytt IX.1. Antipsyk. käyttö ilman psyk. oireita K. riski, V.1. Pidätyskyvytt VIII.4. Ei liikelaaj. ylläpitoa liikuntakyvyttömillä VIII.1. Vuoteeseen hoidettavat V.2. Pid.kyv. -ei koul.suunn V.3. Katetri VII.3. Kuivuma M. riski, V.3. Katetri VII.2. Letkuravitsemus K. riski, V.3. Katetri VII.1. Painon lasku V.4. Ulost. pakkaut VI.1. Virtsatieinf

15 Knowledge for welfare and health Hariet Finne-Soveri M.D. Ph.D. STAKES (CHESS) and City of Helsinki, interrai 15

16 Knowledge for welfare and health Hariet Finne-Soveri M.D. Ph.D. STAKES (CHESS) and City of Helsinki, interrai 16

17 Knowledge for welfare and health Hariet Finne-Soveri M.D. Ph.D. STAKES (CHESS) and City of Helsinki, interrai 17

18 Knowledge for welfare and health Hariet Finne-Soveri M.D. Ph.D. STAKES (CHESS) and City of Helsinki, interrai 18 RAI benchmarking project for the elderly care services STAKES Chydenius Institute RAIsoft.ltd Anja Noro Harriet Finne-Soveri Tarja Itkonen Kaija Lindman Juha Laine Timo Hujanen Marianna Ryymin Satu Kerppilä Magnus Björkgren Johan Boholm Pia Vähäkangas Robert Årstöm

19 Knowledge for welfare and health Hariet Finne-Soveri M.D. Ph.D. STAKES (CHESS) and City of Helsinki, interrai 19 Some benchmarking results from the longterm care facilities Participants Casemix Quality Gallen-Kallela: Akka ja kissa

20 Knowledge for welfare and health Hariet Finne-Soveri M.D. Ph.D. STAKES (CHESS) and City of Helsinki, interrai 20 Participants (beds) Noro, A., Finne-Soveri, H., Björkgren, M., Vähäkangas, P. (toim.). Ikääntyneiden laitoshoidon laatu ja tuottavuus -RAI-järjestelmä vertailukehittämisessä. RAI-raportti Assisted Living Nursing-Home Chronic Care Hospitals Overall

21 Knowledge for welfare and health Hariet Finne-Soveri M.D. Ph.D. STAKES (CHESS) and City of Helsinki, interrai 21 Municipalities Espoo Hanko Helsinki Iitti Jämsä Jämsänkoski Karjaa Kauhava Kokkola Kurikka Laitila Lapua Lappeenranta Lieto Nivala Nokia Nurmijärvi Oulu Porvoo Rauma Seinäjoki Sipoo Tampere Vantaa Ylivieska RAI-municipalities in Finland - Long-term care RAI 2.0 Health Centre Hospitals Residential Homes Service housing 27 municipalities 300 units 7,000 beds 21 % of long-term care beds Home care RAI-HC Home health care and home help 9 municipalities 4,700 home care clients Helsinki Kauhava Kokkola Lappeenranta Mikkeli Nokia Oulu Porvoo Vantaa

22 Knowledge for welfare and health Hariet Finne-Soveri M.D. Ph.D. STAKES (CHESS) and City of Helsinki, interrai 22 Cognition Through Types of Care, in Finland Source: RAI-benchmarking database STAKES 2004 Long-term care n=6500 Home-Care n= % 90 % 80 % 70 % 60 % 50 % 40 % CPS Erittäin vaikea häiriö Very severe decline CPS Vaikea häiriö Severe decline CPS Melko vaikea häiriö CPS Keskivaikea häiriö Moderate/severe CPS Lievä häiriö Moderate decline 30 % 20 % 10 % 0 % Home-Care Kotihoito Palvelutalo Service Vanhainkoti Homes for Chronic Terveyskeskus care housing the Aged hospitals CPS Rajatapaus Mild decline Borderline CPS Ei häiriöitä Intact cognition

23 Knowledge for welfare and health Hariet Finne-Soveri M.D. Ph.D. STAKES (CHESS) and City of Helsinki, interrai 23 Cognition Through Types of Care, in Finland Source: RAI-benchmarking database STAKES 2004 Long-term care n=6500 Home-Care n= % 90 % 80 % 70 % 60 % 50 % 40 % CPS Erittäin vaikea häiriö Very severe decline CPS Vaikea häiriö Severe decline CPS Melko vaikea häiriö CPS Keskivaikea häiriö Moderate/severe CPS Lievä häiriö Moderate decline 30 % 20 % 10 % 0 % Home-Care Kotihoito Palvelutalo Service Vanhainkoti Homes for Chronic Terveyskeskus care housing the Aged hospitals CPS Rajatapaus Mild decline Borderline CPS Ei häiriöitä Intact cognition

24 Knowledge for welfare and health Hariet Finne-Soveri M.D. Ph.D. STAKES (CHESS) and City of Helsinki, interrai 24 Case-mix index (means) according to type of institution, semi-annually Source: RAI-benchmarking database STAKES ,40 1,20 1,00 Long-term care n=6500 Home-Care n=1200 0,80 0,60 0,40 Palvelutalo Vanhainkoti Terveyskeskus 0,20 0,00 Kevät Syksy Kevät Syksy Kevät Syksy Kevät Syksy Kevät Syksy Kuvio 1. Kustannuspainojen keskiarvot laitostyypeittäin eri mittausajankohtina.

25 Knowledge for welfare and health Hariet Finne-Soveri M.D. Ph.D. STAKES (CHESS) and City of Helsinki, interrai 25 Staffing ratio per resident (means) according to type of institution, annually ,8 0,7 0,6 0,5 uja.htm: Noro, A., Finne-Soveri, H., Björkgren, M., Vähäkangas, P. (toim.). Ikääntyneiden laitoshoidon laatu ja tuottavuus -RAI-järjestelmä vertailukehittämisessä. RAI-raportti. 0,4 Assisted living Nursing home Chronic care hospital Overall mean 0,3 0,2 0,

26 Knowledge for welfare and health Hariet Finne-Soveri M.D. Ph.D. STAKES (CHESS) and City of Helsinki, interrai 26 Chemical restraints in Columns represent the overall means Line represents the single nursing home to make the change Antipsychotic medications Sedatives and hypnotics Hypnotic use 3+ times per week 2000 spring 2000 fall 2001 spring 2001 fall 2002 spring 2002 fall 2003 spring

27 Knowledge for welfare and health Hariet Finne-Soveri M.D. Ph.D. STAKES (CHESS) and City of Helsinki, interrai 27 Chemical restraints in Columns represent the overall means Line represents the single nursing home to make the change Antipsychotic medications Sedatives and hypnotics Hypnotic use 3+ times per week 2000 spring 2000 fall 2001 spring 2001 fall 2002 spring 2002 fall 2003 spring

28 Knowledge for welfare and health Hariet Finne-Soveri M.D. Ph.D. STAKES (CHESS) and City of Helsinki, interrai 28 QI VIII.1. Incidence of Decline in Functional Capacity (mean) During Toimintakyvyn 6 lasku months (i) in nursing homes, in Finland Kevät Syksy Kevät Syksy Kevät Syksy Kevät Syksy Kevät Syksy Paikkakunta Location -11 Paikkakunta Location -22 Paikkakunta Location -33 Paikkakunta Location -44 Paikkakunta Location -55 Paikkakunta Location julkaisuja.htm: Noro, A., Finne-Soveri, H., Björkgren, M., Vähäkangas, P. (toim.). Ikääntyneiden laitoshoidon laatu ja tuottavuus -RAI-järjestelmä vertailukehittämisessä. RAI-raportti.

29 Knowledge for welfare and health Hariet Finne-Soveri M.D. Ph.D. STAKES (CHESS) and City of Helsinki, interrai 29 Case-mix index in own NH:s compared to overall in the country and Helsinki mean (scale 0,42 (scale 0,42-2,52) 2,52) Nursing LTF in NH-1 NH-2 NH-3 NH-4 -homes (NH) Helsinki in Finland Case-mix index (mean) in Helsinki nursing-homes represent "typical mean"

30 Knowledge for welfare and health Hariet Finne-Soveri M.D. Ph.D. STAKES (CHESS) and City of Helsinki, interrai 30 Staffing ratio per resident Nursing -homes (NH) in Finland NH-1 NH-2 NH-3 NH-4

31 Knowledge for welfare and health Hariet Finne-Soveri M.D. Ph.D. STAKES (CHESS) and City of Helsinki, interrai 31 Pain without pain medication Nursing LTF in NH-1 NH-2 NH-3 NH-4 -homes (NH) Helsinki in Finland

32 Knowledge for welfare and health Hariet Finne-Soveri M.D. Ph.D. STAKES (CHESS) and City of Helsinki, interrai 32 QI VIII.1. Incidence of Decline in Functional Capacity (mean) During 6 months in nursing homes, in Finland Nursing LTF in NH-1 NH-2 NH-3 NH-4 -homes (NH) Helsinki in Finland

33 Knowledge for welfare and health Hariet Finne-Soveri M.D. Ph.D. STAKES (CHESS) and City of Helsinki, interrai 33 Lessons learned Gallen-Kallela: Akka ja kissa

34 Knowledge for welfare and health Hariet Finne-Soveri M.D. Ph.D. STAKES (CHESS) and City of Helsinki, interrai 34 It is not enough to measure - you need to pick correct method and know how to interpret your results in addition..

35 Knowledge for welfare and health Hariet Finne-Soveri M.D. Ph.D. STAKES (CHESS) and City of Helsinki, interrai 35 It is not enough to measure - unless do something with your results

36 Knowledge for welfare and health Hariet Finne-Soveri M.D. Ph.D. STAKES (CHESS) and City of Helsinki, interrai 36 Lessons learned You need to: train well give lots of support have strong leaders be patient - major change in working patterns takes time

37 Knowledge for welfare and health Hariet Finne-Soveri M.D. Ph.D. STAKES (CHESS) and City of Helsinki, interrai 37 Conclusions Benchmarking: learning from the best practices Major change is possible -just doit Gallen-Kallela: Akka ja kissa

38 Knowledge for welfare and health Hariet Finne-Soveri M.D. Ph.D. STAKES (CHESS) and City of Helsinki, interrai 38 on behalf of STAKES benchmarking team and myself!