IMPLEMENTATION OF THE STROKE SET IN CRUCES UNIVERSITY HOSPITAL (OSAKIDETZA)

Fernández Maiztegi, Covadonga; Luna Rodriguez, Alain; Rodriguez-Antigüedad Zarranz, Alfredo; Chávarri Rubio, Itziar; Fraga Arnaiz, Mª José; Otero Rodriguez, Begoña; Acaiturri Ayesta, Mª Teresa; Rodriguez Tejedor, Santiago; Guzmán Alonso, Margarita; Arana Arri, Eunate; Benito Ruiz de la Peña, Raquel; Gallego Camiña, Inés

Context Fig.1: Our organization has a great commitment with VBHC

• VBHC requires a redesign of health processes taking the patient as the axis of the system

• This analysis allows to review the protocols, to detect areas for improvement and to reduce clinical variability, leading to the expertization of our teams

• LEAN and cost analysis of the process detects inefficiencies in the clinical pathway that can be eliminated

• The inclusion of the patient's voice through the Customer Journey Map (PREM) in addition with the costs will allow us generate scorecards for clinical decision making.

Impact of change on outcomes

BEDS

843

CONSULTATIONS

887.000

EMERGENCIES

191.000 OPERATING THEATERS

33

SURGERIES

31.000

DECEMBER 2016 • Specific team building • Process mapping • Clinical data forms design • Inclusion of PROMs • Patient experience (PREMs) • Educational and informative

material: “My Quality of Live” Stroke Booklet

FROM JUNE 2017 • Data audit • Dairy meeting point • Structured forms in the

clinical history • Osakidetza Health Council

(telephone) • Patient Health folder • GIP (integral program

manager) • Inclusion of a task scheduler

Cruces University Hospital/IHO Ezkerraldea-Enkarterri-Cruces belongs to Osakidetza (Health Basque Service). Our organization is strongly committed to the VBHC (Fig 1). We work with an approach that involves the full equation of value (Clinical outcomes, PROMs, PREMs and Costs). We have an information system that allows us to know the cost per patient throughout all the assistance cycle (Primary and Hospital) (Fig.2). We want to share our experience of implantation of the ICHOM standard set in stroke.

Fig. 2: Cost by medical condition, (Stroke)

144 patients included in the ICHOM program 2018, OSI EEC

Measurement of health outcomes requires reviewing patient’s care process and implies a transformation of the relationship between the health system and the patient. The greater longevity and prevalence of chronic diseases in our patients as well as the use of increasingly effective but more expensive treatments requires the use of new variables in the evaluation of outcomes. It is mandatory to know the impact of what we do and to check with our patients if the expected results have been achieved.

Background

What did we do?

APRIL 2017 • Inclusion of patients (Fig 3) • Weekly team meetings

Implementation of new tools

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• Implementing VBHC entails a transformation of the organization, and it requires a strong leadership

• It is mandatory to create multidisciplinary teams from a process perspective, including user experience, costs and medical research. The process map from the patient's perspective is the first step in the implementation of ICHOM.

• Before starting the process, it is essential to have appropriate tools for data collection, analysis and visualization of the results.

Lessons points

Fig.3: Between April 24th 2017 and December 31th 2018 a total of 325 patients have been included, 254 with an established stroke (a), 71 with a transient ischemic attack (TIA) (b). You can appreciate the different evolution of patients stratified by treatment type(c).

3.a 3.b 3.c