Esteban de...

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  • 1. Mesa estratificacin de riesgos e personas con enfermedades crnicas La estratificacin en la estrategia de integracin de cuidados europea SEMFYC 8 de junio de 2013 Esteban de Manuel Keenoy
  • 2. PARTENARIADO EUROPEO DE ENVEJECIMIENTO ACTIVO Y SALUDABLE- EIP AHA Regiones,organizacionesasistenciales,pacientes,cuidadores,academia, investigacin,serviciossociales,industria proceso iterativo, flexible inspiracin Contribuir, aportar experiencia, mejores prcticas Recolectar experiencias, evidencias de apoyo para disear polticas sinergias Expandir soluciones innovadoras +2 AOS DE VIDA SALUDABLE en 2020 Triple ventaja para Europa
  • 3. Pais Vasco Comunidad Valenciana Comunidad Foral deNavarra Comunidad deMadrid Catalua Andaluca Galicia Centro Border,Midland andWestern Southernand Eastern N.Ireland S.W.Scotland W.Wales Lancashire Northummberl andTyne andWear Languedoc Roussillon Paris Alsace PaysdelaLoire Syddanmark Nordjylland Pohjois jaIt Suomi SouthKarelia Sydsverige Attik Kentriki Makedonia Piemonte Liguria EmiliaRomagna Trento Campania FriuliVenezia Giulia Gelderland ZuidHolland NoordBrabant Overijssel Groningen Dresden Stedn Morava >150 organizaciones
  • 4. SOCIALCARE PATIENTS/USERS/ CARERS INDUSTRY
  • 5. Action Area Risk Stratification EIPAHAB3ActionPlanPAHAB3ActionPlan By 2015 Chronic Conditions Programmes available at least 10% of target population in at least 50 regions By 2015 - 2020 Integrated Care Programmes serving older people, supported by innovative tools and services, in at least 20 regions SIP TARGETS 2013Monitoringimpactandoutcomes 2015 Tolkit ToolkitToolkit Increase the average number of healthy life yrs by 2 in the EU by 2020 Health status and quality of life Supporting the long term sustainability and efficiency of health and social systems Enhancing competitiveness of EU industry Chronic Conditions Integrated Care Implementation and Scale Up of Chronic Care + Integrated Care Programmes Stratificationof thepopulation ActionArea Change Management ActionArea Workforce Development Action Area Care Pathways ActionArea Patient/User Empowerment Action Area Organisational Models ActionArea Finance/Funding ActionArea Dissemination ActionArea ICTTools
  • 6. GANT POR WP Y PRINCIPALES HITOS DEL PROYECTO 2013 2014 2015 1 2 3 4 5 6 7 8 9 1 0 1 1 1 2 1 3 1 4 1 5 1 6 1 7 1 8 1 9 2 0 2 1 2 2 2 3 2 4 2 5 2 6 2 7 2 8 2 9 3 0 Nov 2012 Kick Off Meeting Kick Off Meeting Workplan ofRiskStratificationActionAreaWorkplan ofRiskStratificationActionArea Report on risk stratification baseline Report on risk stratification baseline WP42.Toolkit risk stratification WP41.Mapping of stratification experiencies Toolkit Risk Stratification Toolkit Risk Stratification WP4-1.4 Develop European baseline WP4-1.1 Mapping practices WP4-1.2 Analyze information WP4-1.3 Describe models WP4-2.3 Education material WP4-2.1 case studies WP4-2.2 Packs for risk stratification Deliverable s
  • 7. 9 Py P4.539 AG GE GC Estratificacindela poblacin Asociaracadaindividuoel ndicepredictivoderiesgo (IP) IP=0 Bajo riesgo Alto riesgo IP=36 Seleccinde poblaciones con caractersticas homogneas (patologa+ morbilidad) Listado de pacientes con caractersticas de morbilidad homogneas (IP) y patologa Validaci nclnica delos pacientes seleccion adospor la estratifica cin Validacin clnica de los listados de pacientes seleccionados por la estratificacin 1.000 pacientes seleccionados 800 pacientes renen las caractersticas Aplicaci ndela estratific acin individual Riesgo que tiene esta persona de padecer un evento adverso x POBLACIONAL INDIVIDUAL
  • 8. Nuevospreguntasdeinvestigacin 10 - What is their performance (discriminative power, predictive capacity and validity? - What methods have been used to develop them? - What data are needed? - Which are the advantages and disadvantages of each? - With what periodicity should patients data be updated? - What is the actual use of stratification tools? - How and when have stratification tools been introduced in integrated care provision models? - What have been the barriers and facilitators for their deployment? - What are the actual requirements on current Health Information Systems? - How convenient are for use in health services management and in clinical practice/point-of- care? Various stratification methods have been deployed and will be compared: - Which is the predictive ability of the tools? - How many patients were detected and intervened in an integrated manner? - Drivers and barriers for implementing a stratification method? - New solutions addressing the identified barriers? - Which is the impact of the incorporation of the stratification tools in the ICTs?
  • 9. 11 Activarestrategiasdeestratificacinenelterreno Evaluar los resultados de su implementacin en los diferentesserviciosdesaludeuropeos, Utilizacinyvaloraadidoparalaatencinalospacientes ancianosfrgiles. Definirmetodologasdeimplementacin, Analizarloscambiosestructuralesyorganizativosderivados delaaplicacinytambinsucosteefectividad. Necesidaddeinvestigacinaccin
  • 10. 12 Va a suponer un cambio crtico? Botella medio vaca o medio llena? GRACIAS!