Published on March 4, 2014
Future Hospital: from “central role” to “key role” Joan Escarrabill MD Chronic Care Program– Barcelona Esquerra. Hospital Clínic (Barcelona) Vic, December 12th 2013 1 Master Plan for Respiratory Diseases (PDMAR) & Home Respiratory Therapies Observatory (ObsTRD). FORES. Ministry of Health (Catalonia)
1133 – to XVI cent. Accommodation for sick priests XI – XV century Hospital de St Jaume Leprousy 1217 Hospital de pelegrins o St Bartomeu Hospital of pilgrims 2 buildings 24 beds 1348 Ramon de Terrades Black Death 2 Hospital de lala Santa Creu Hospital de Santa Creu
The City Council participates in the hospital management 2 buildings 24 beds 1408 Guild of shoemakers 1348 Ramon de Terrades Black Death 1525 Curch involvement 1647 Canon Pere Ramis Improvement works 3 canons 3 civilian representatives 1 councilor 1 nobleman 1 merchant or artist 3 Hospital de lala Santa Creu Hospital de Santa Creu
1713-1724 Partial use as a military hospital 1792 1845 Sisters of Charity of St. Vincent de Paul 1 Physician 1 Surgeon 1 apothecary 1 nurse (“cabo de vara”) 4 servants 1920 Surgival Service 1931 Local general hospital 1845 & 1885: Cholera 1863: Floods 4 Hospital de la Santa Creu
• Structural • Organizational Dinamic Flexible • Local Hospital • Tailored to the needs of the population Innovative 5 Hospital de la Santa Creu
J A Muir Gray. Lancet 2013;382:200-1 Better value through population and personalised medicine. Effectivity Presonalised Population medicine Quality Safety Value 6 Customize evidence Biomarkers Personal values Clinical situation Context Responsibilities to the population to be served Avoid inequalities Distribution of resources
Hospitals on the edge 1. We must promote dignity and patient-centred care 2. We must redesign services. 3. We must change the way we organize hospital care. 4. We must review medical education and training. 5. We must ensure the right mix of medical skills. 6. We must renegotiate the New Deal. 7. We must improve the availability of primary care. 8. We must revolutionize the way we use information. 9. We must embed quality improvement across the system. 10.We must show national leadership. 7
High quality care sustainable 24 hours a day, 7 days a week Continuity of care as the norm Stable medical teams for patient care and education Optimized relationships with other teams Appropriate balance between care by specialists and generalists Discharge arrangements which realistically allocate responsibility for further action http://www.rcplondon.ac.uk/projects/futurehospital-commission-background-and-workstreams 8
Lancet 2013;382:923-4 Increase (emergency) admission Pts > 85 yrs Multimorbidity Cognitive impairement Balance Reduction LOS 9
To identify the optimum care pathway for adults with medical illnesses Lancet 2013;382:923-4 Increase (emergency) admission Pts > 85 yrs Multimorbidity Cognitive impairement Balance Reduction LOS 10
Future hospital No “one size fits all” : Coordinated mangement of patients with multiple comorbidities Specialist medical care will not be confined to inside the hospital walls. 11 Hospitals must be designed around the needs of patients Continuity of care Illnes can occur in any time: 24/7/365. Reorganisation of ‘front door’ Vulnerable patients. Patient experience is valued as much as clinical effectiveness
Extended roles for physicians in the community 12
Three elements Fast track Acute care hub Ann Intern Med. 2012;157:448-449. “Hub & spoke” 13 Clinical coordination center
Disruptive business model Solution shop Value-added process Facilitated network Intutive Medicine for unstructured problems Hypothesis testing until diagnosis can be made 14 Empirical medicine Patient groups with common needs Standardization Long-term care: adherence
Disruptive business model Precision medicine Personalized medicine 15 Care plan: adherence Focus on results
Key words to summarize Concentration Complexity Context 16 Transparency Design
Concentration To be or not to be To close hospital beds or to close hospitals ? 18
Transparency General data 19 Specific data
Design The patient room of the future is being designed as a safe, private, comfortable place conducive to healing. 20
BMJ 2013;347:f5479 doi: 10.1136/bmj.f5479 “Conventional models of health service design in which a hospital site is the sole focus for the delivery of emergency, acute and elective services are dated,” “The expectation that most physicians will become highly specialised in a narrow field must be changed.” 22
Complexity What we’re trying to build is a learning health care system 24 To gather data about hospital users To run that data through predictive models and recommendation systems Personalized diagnoses and treatments
To conclude… 25
Thank you very much for your attention !!! ESCARRABILL@clinic.ub.es 26
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