models for acute care & emergency care - wordpress.com€¦ · 23/07/2016  · models for acute...

1

Models for Acute Care & Emergency Care

Asst. Prof. Borwornsom Leerapan, MD PhD

MGMG 548: Health Service Systems and Health SystemsCMMU, Mahidol University

July 23, 2016

Pix source: ra.mahidol.ac.th

Format

Pix source: online.wsj.com

F/U

Mini-lecture

PresentationDiscussion

Q&A

Wrapup

To-do list

2

Pix source: online.wsj.com

Housekeeping Issues

1) Your interim course evaluation

2) General feedbacks on your mid-term papers

3) Confirmed guest lecturer on July 30th (week 12):

– Mahippathorn Chinnapa, MB BCh MRCPCH

4) Tentative Guest lecturer on Aug 9th (week 13)?

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

3

Models for Acute Care

Pix source: online.wsj.com

Source: W. Simpson del.; E. Walker lith.; Day & Son, Lithrs. to the Queen.Pix source: http://en.wikipedia.org/wiki/History_of_hospitals#mediaviewer/File:Hospital_at_Scutari_2a.jpg

“Hospital at Scutari” - A ward of the hospital at Scutari where Florence Nightingale worked and helped to restructure the modern hospital

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)

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” careØInefficient 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.”

6

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

Challenges of Acute Care

Global Changes

http://www.nowandnext.com/PDF/trends_and_technology_timeline_2010.pdf

• Urbanization• Globalization• Localism

• Personalization• Digitalization• Individualism

• Debt• Volatility• Anxiety• EnvironmentalChange• Sustainability

7

Megatrends in Global Healthcare

12MegatrendsfromMultiperspectives:• Executivesatmajor

pharmaceutical companiesandcareproviders

• Scientistsandinventors• Academicsatmedicaland

businessschools• Expertsingovernment

agenciesandNGOs• Practicingphysicians

Source:KarenDillon&SteveProkesch.GlobalChallengesinHealthCare:IsRationinginOurFuture?HBRBlogNetwork.Availablefrom:http://blogs.hbr.org/cs/2010/04/global_challenges_in_health_ca.html

HarvardBusinessReview

Source:http://hbr.org/web/extras/insight-center/health-care/globaltrends/2-slide

Megatrends in Global Healthcare #1

8

Source:http://hbr.org/web/extras/insight-center/health-care/globaltrends/3-slide

Megatrends in Global Healthcare #2

Source:http://hbr.org/web/extras/insight-center/health-care/globaltrends/4-slide

Megatrends in Global Healthcare #3

9

Source:http://hbr.org/web/extras/insight-center/health-care/globaltrends/5-slide

Megatrends in Global Healthcare #4

Source:http://hbr.org/web/extras/insight-center/health-care/globaltrends/6-slide

Megatrends in Global Healthcare #5

10

Source:http://hbr.org/web/extras/insight-center/health-care/globaltrends/7-slide

Megatrends in Global Healthcare #6

Source:http://hbr.org/web/extras/insight-center/health-care/globaltrends/8-slide

Megatrends in Global Healthcare #7

11

Source:http://hbr.org/web/extras/insight-center/health-care/globaltrends/9-slide

Megatrends in Global Healthcare #8

Source:http://hbr.org/web/extras/insight-center/health-care/globaltrends/10-slide

Megatrends in Global Healthcare #9

12

Source:http://hbr.org/web/extras/insight-center/health-care/globaltrends/11-slide

Megatrends in Global Healthcare #10

Source:http://hbr.org/web/extras/insight-center/health-care/globaltrends/12-slide

Megatrends in Global Healthcare #11

13

Source:http://hbr.org/web/extras/insight-center/health-care/globaltrends/13-slide

Megatrends in Global Healthcare #12

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)

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

15

Subacute Care

Pix source: online.wsj.com

Generic “Care Cycle”

Source: Verbeek & Lord (2007). The care cycle: an overview.

Rehabilitation

Promotion & Prevention

Diagnosis

Treatment

Management

16

• 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.

Subacute Care? Intermediate Care? Transitional Care?

Source:www.dhcs.ca.gov/provgovpart/Pages/SubacuteCare.aspx

• 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”

Subacute Care? Intermediate Care? Transitional Care?

Source: Melis, researcher & Olde Rikkert BMJ (2004)

17

Emergency Care

Pix source: online.wsj.com

Emergency Medical Services (EMS)

Source:www.ems.gov/whatisems.htm

• 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.

18

Emergency Medical Services (EMS)

Source:www.ems.gov/whatisems.htm

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

Emergency Medical Services (EMS)

Pix source:adaptedfromwww.ems.gov/whatisems.htm

Prehospital care

Emergencycare

Specialtycare&Rehabilitation

Prevention&PublicEducation

19

1) Complimentary between prehospital and hospital activities2) Promoting emergency medical services/department in hospital

settings3) Appropriately managing of emergency patients on site4) Appropriately managing of of emergency patients during

transport 5) Regulating emergency calls and medical emergency patients6) Utilizing the partners of networks

12 Main Characteristics of EMS

Pix source:online.wsj.com

7) Conducting monitoring and evaluation8) Implementing quality control, normative role, policy making,

programming and accreditation process9) Enforcing by law, regulation and policies10) Interfacing between the community and the private

professionals11) Establishing the role of the emergency medical services

management committees12) Conducting disaster planning and community relations

12 Main Characteristics of EMS

Pix source:online.wsj.com

20

Issues in Thai EMS Systems

Source: Treerutkuarkul A. Emergency care will be free for all from April 1. Bangkok Post. 2012 March 14.

Source: Treerutkuarkul A. Private hospitals fear ‘chaos’: Call for clear definition of ‘emergency patients’. Bangkok Post. 2012 March 29.

Some Relevant

Questions for Thai EMS?

21

EMCO : Emergency Claim On line

– EMCO(EmergencyClaimonLine)iselectronicclaimprogramfunctionsasawindowforproviderstoreimburseemergencyservicefee.Thefeearewithdrawnfromcooperatingfundsforemergencyservicesadministratebyclearinghouse.

– EMCOwassetupby lawandcommencedon1April2013withobjectives:• ToimproveEmergencyCareAccessibility becausepatientaccesstoemergencyservicewithout coveragescreeningandwithout advancepayment.

• TominimizeMortalityandmorbidity rate• Toprotected HumanRight• Tominimize financialexpenditure duebytheclearing house

Source: Suriyawongpaisal P (2013.)

ลงทะเบียนเบ้ืองต้น

บันทึกข้อมูล

การให้บริการ

ประมวลผล

จ่ายเงินชดเชย

น่าส่งเอง

โรงพยาบาล

นอกระบบกองทุน

Clearing House

ฉุกเฉิน-วิกฤต-เร่งด่วน

จ่ายเง ินชดเชย

ค่าบริการ

สิทธิ อปท ./ครูเอกชน/รัฐวิสาหกิจ

?

ส่งใบแจ้งหน้ี

ให ้กองท ุน

ท ี่เก่ียวข้องกองท ุน

จ่ายเง ินคืน

Clearing House 1669

https://www.google.co.th/?gws_rd=cr,ssl&ei=JIvLU77xGcyOuAT5rYL4Cg#q=EMCO+clearing+house+ppt

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.)

23

Some Relevant

Questions for Thai EMS?

Source: Suriyawongpaisal P, Sakulphanit T, Naka P. (2013.)

Food-for-Thought

Pix source: online.wsj.com

24

“I never think of the future - it comes soon enough.”

--Albert Eistein (1879 - 1955)

Pix source:teachermoloneyking.com

Q& ADiscussions

Pix source: online.wsj.com