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Public Policy and Health Policy นน. นนนนน นนนนนนน [email protected] [email protected] Facebook , Twitter : Morchuchai 1

Rama Nurse Public Policy

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public policy development for caring chronic diseases

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Page 1: Rama Nurse Public Policy

1

Public Policy and Health Policy

นพ. ชู�ชู�ย ศรชู�น� [email protected]

[email protected] Facebook , Twitter : Morchuchai

Page 2: Rama Nurse Public Policy

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What is ‘policy’?

a course of action or inaction (Heclo 1972)

a course of action adopted and pursued by a government, party, rulers, statesman (Oxford English Dictionary)

a set of interrelated decisions … concerning the selection of goals and the means of achieving them within a specified situation … (Jenkins 1978)

decisions taken by those with authority and responsibility for a given policy area (Buse et al 2005)

any course of action followed primarily because it is expedient or advantages in a material sense

Page 3: Rama Nurse Public Policy

นโยบ�ยส�ธ�รณะ ( Public Policy ) กั�บส�ขภ�วะของประชู�กัร

นโยบ�ยด้��นส�ธ�รณส�ข (Public Policy) นโยบายเพื่�อการดำ�าเน�นสาธารณส�ข ที่�เป็�นเร�องที่�เก�ยวข�องที่างดำ�านส�ขภาพื่โดำยตรง

นโยบ�ยส�ธ�รณะเพ��อส�ขภ�พ (Healthy Public Policy) นโยบายสาธารณะที่�แสดำงความห่$วงใยอย$างชั'ดำเจนในเร�องส�ขภาพื่ พื่ร�อมที่�จะร'บผิ�ดำชัอบต$อผิลกระที่บที่างส�ขภาพื่ ที่�อาจเก�ดำข+,นจากนโยบายน',น ขณะเดำ�ยวก'นก-เป็�นนโยบายที่�ม�$งสร�างเสร�มส�งแวดำล�อมที่',งที่างส'งคม และกายภาพื่ที่�เอ�,อต$อการม�ชั�ว�ตที่�ม�ส�ขภาพื่ดำ� และม�$งให่�ป็ระชัาชันม�ที่างเล�อก และสามารถเข�าถ+งที่างเล�อกที่�ก$อให่�เก�ดำส�ขภาพื่ดำ�ไดำ�

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ระด้�บของนโยบ�ย• นโยบ�ยของร�ฐบ�ล-แถลงกั�รณ$ของน�ยกัฯ• กัฎหม�ย พรบ พรกั กัฎกัระทรวง ประกั�ศ • แผนพ�ฒน�เศรษฐกั�จและส�งคมแห/งชู�ติ�• แผนแม/บทแห/งชู�ติ� • บ�ญชู2ย�หล�กัแห/งชู�ติ�• ชู�ด้ส�ทธ�ประโยชูน$ของระบบประกั�นส�ขภ�พ

• กัฎหม�ย กัฎระเบ2ยบในระด้�บจ�งหว�ด้ • แนวท�งระด้�บเขติติรวจร�ชูกั�ร • มติ�ของคณะกัรรมกั�รจ�งหว�ด้ อ�เภอ

• แนวท�งกั�รค�ด้เล�อกัเวชูภ�ณฑ์$ของโรงพย�บ�ล• Clinical Practice Guidelines, Standard Operating Procedures (SOP) เชู/น Laboratory manuals

•กั�รจ�ด้ง�นประชู�มว�ชู�กั�ร

นโยบ�ยระด้�บชู�ติ�

นโยบ�ยระด้�บพ�5นท2�

นโยบ�ยระด้�บองค$กัร

Page 5: Rama Nurse Public Policy

5

Policy diagram

Input Process

By product

Input Human resources Financial resources Instruments Technical knowledge

Output

Outcome Effect Impact

Short term Long term

Page 6: Rama Nurse Public Policy

6

The Policy Triangle

Walt G and Gilson L, Reforming the health sector in developing countries: the central role of policy analysis, Health Policy and Planning 1994; 9: 353-70

Actors

Context

Content Process

Page 7: Rama Nurse Public Policy

แนวท�งกั�รสร��งนโยบ�ยส�ธ�รณะเพ��อส�ขภ�พ : 8 Elements

ฉุ�กเฉุ�น

โรคเร�5อร�ง

ส�ขภ�พจ�ติ

พ�ฒน�กั�รเด้6กั

ผิ1�ส1งอาย�

ฟื้85 นฟื้�ผ��พ�กั�รว�ย

ร�/น

ภ�ค2ส�ขภ�พ

ม�ลน�ธ�ส�ธ�รณส�ขแห/งชู�ติ� 2553

Page 8: Rama Nurse Public Policy

Relationships between the functions and objectives of health systems

Performance framework (WHO, 2000)

Page 9: Rama Nurse Public Policy

Global Attention to Health Systems

Page 10: Rama Nurse Public Policy

‘6 Building Blocks’

Source: World Health Organization. Everybody’s Business: Strengthening health systems to improve health outcomes—WHO’s Framework for Action. Geneva: WHO, 2007, page 3.

Page 11: Rama Nurse Public Policy

Care Management for Chronic Diseases

Health Policy and Healthy Public Policy Development

Diseases or Service Response Health System Response

Page 12: Rama Nurse Public Policy

Care Management : Chronic illness

Insurance Model Utilization review, quality assurance

function Compliance and access orientation No integration

Care Delivery Model Develop standard tools: CPG, care map Linear integration

Security (Continuum Care) Model Community health care, optimum care

site Continuous quality improvement Promote wellness and community health

status Multidimensional integration

12

Page 13: Rama Nurse Public Policy

พ�ฒน�กั�รท�งเศรษฐกั�จ ส�งคม เทคโนโลย2 กั�บกั�รพ�ฒน�นโยบ�ยคว�มเข�มแข6งระบบ

“ ” ส�ธ�รณส�ข โรคเร�5อร�ง

Page 14: Rama Nurse Public Policy

2005

โครงสร��งประชู�กัรท2�เปล2�ยนแปลงประเทศไทยท2�เปล2�ยนแปลง

Page 15: Rama Nurse Public Policy

Generation 2010 2020 2030

Baby Boomer( 50 ป: ข;5นไป)

6,462 - -

Gen X(31 - 49 ป:) 15,742 15,742 -

Gen Y(18 - 30 ป:) 3,750 3,750 3,750

Gen M - 6,462 22,204

Page 16: Rama Nurse Public Policy
Page 17: Rama Nurse Public Policy

Prevalence Hypertension: 23% male, 21% female All samples are hypertensive, >140/90 mmHg,

Effective coverage of hypertension, adult >15 yr. 2003

Source: National Health Exam Survey

6

12

11

19

5

5

77

64

0% 20% 40% 60% 80% 100%

Male (N=7,544)

Female (N=7,580)

treated + well control Treated, not well controlledDiagnosed, no treatment Not diagnosed

Page 18: Rama Nurse Public Policy

Prevalence DM: 6% male, 7% female All samples have FBS, >126 mg/dl

Effective coverage of DM, adult >15yr. 2003 Source: National Health Exam Survey

9

15

24

34

2

2

66

49

0% 20% 40% 60% 80% 100%

Male (N=2,045)

Female (N=2,601)

treated + well control Treated, not well controlledDiagnosed, no treatment Not diagnosed

Page 19: Rama Nurse Public Policy

19

คนชู�5นกัล�งในไทยป: 2533-2549

0

2

4

6

8

10

12

14

16

2529 2531 2533 2535 2537 2539 2541 2542 2543 2544 2545 2547 2549 2550

69-346 บาที่/ว'นเส�นความยากจน-346 บาที่/ว'น

จ�นวนคร�วเร�อนชู�5นกัล�ง แยกัติ�ม 2 น�ย�ม จ�านวนคนชั',นกลางอย1$ระห่ว$างน�ยามที่',งสอง ค�อ 12-

15 ล�านคร'วเร�อน

ประเทศไทยท2�เปล2�ยนแปลง

Page 20: Rama Nurse Public Policy

20

ร�อยละคร�วเร�อนท�กักัล�/มท2ม2อ�ปกัรณ$อ�นวยคว�มสะด้วกั

เทศบ�ล

นอกัเทศบ�ล

รถยนต2ส$วนบ�คคล

รถบรรที่�กเล-ก / รถป็3กอ'พื่ / รถต1�

เตาอบไมโครเวฟ

เคร�องป็ร'บอากาศ

เคร�องซั'กผิ�า

รถจ'กรยานยนต2

ว�ที่ย�

เคร�องเล$นว�ดำ�โอ / ว�ซั�ดำ� / ดำ�ว�ดำ�

ต1�เย-น

โที่รศ'พื่ที่2เคล�อนที่�

ห่ม�อห่�งต�มอาห่าร

โที่รที่'ศน2

0 10 20 30 40 50 60 70 80 90 100

17.59

21.19

22.89

26.74

57.71

60.77

68.02

78.51

85.73

88.14

91.04

96.44

รถยนต2ส$วนบ�คคล

เคร�องป็ร'บอากาศ

เตาอบไมโครเวฟ

รถบรรที่�กเล-ก / รถป็3กอ'พื่ / รถต1�

เคร�องซั'กผิ�า

ว�ที่ย�

เคร�องเล$นว�ดำ�โอ / ว�ซั�ดำ� / ดำ�ว�ดำ�

โที่รศ'พื่ที่2เคล�อนที่�

รถจ'กรยานยนต2

ห่ม�อห่�งต�มอาห่าร

ต1�เย-น

โที่รที่'ศน2

0 10 20 30 40 50 60 70 80 90 100

4.81

5.19

7.12

19.70

41.56

56.64

66.63

74.54

77.68

81.77

83.01

94.71

ความต�องการส�งอ�านวยความสะดำวกที่�าให่�ตลาดำส�นค�าอ�ป็โภคบร�โภคให่ญ่$และ

ขยายต'ว เชั$น เคร�องใชั�ไฟฟ8า ยานพื่าห่นะ อาห่ารแป็รร1ป็ เก�ดำการผิล�ตและการจ�าง

งานในป็ระเที่ศ

คร'วเร�อนม�ค$าใชั�จ$ายที่�เก�ยวข�องก'บ การเร�ยนร1 �เพื่�มมากข+,น เชั$น ดำ�าน

การส�อสาร และการเดำ�นที่างใน โอกาสพื่�เศษ รวมที่',งการลงที่�นดำ�าน

คอมพื่�วเตอร2และเชั�อมต$ออ�นเที่อร2เน-ต

ประเทศไทยท2�เปล2�ยนแปลง

Page 21: Rama Nurse Public Policy

เศรษฐกั�จไทยข;5นกั�บเศรษฐกั�จโลกั253

3253

9254

0254

1254

3254

7

กั�รบร�โภครวม 65.9

62.8

62.6 63.3

63.2

63.6

• ภ�คเอกัชูน 57.1

54.4

54.4 53.8

54.0

54.9

• ภ�คร�ฐบ�ล 8.8 8.4 8.2 9.6 9.2 8.6

กั�รลงท�นรวม 39.1

42.5

34.2 21.3

19.9

22.5

• ภ�คเอกัชูน 33.2

32.1

22.7 12.1

12.5

16.4

• ภ�คร�ฐ 5.9 10.4

11.6 9.2 7.4 6.1

ส/งออกัส�นค��และบร�กั�ร

36.5

42.0

45.7 55.3

64.7

65.7

น�เข��ส�นค��และบร�กั�ร

41.54

49.2

44.3 38.8

49.8

54.0

ท2�ม� : สศชู.

ประเทศไทยท2�เปล2�ยนแปลง

Page 22: Rama Nurse Public Policy

คนไทยบร�โภคน5�ติ�ลเพ��มข;5น

ข�อม1ล ส�าน'กงานคณะกรรมการอ�อยและน�,าตาล ค'ดำจากรายงานการสาธารณส�ขไที่ย พื่.ศ. 2544-2547

Page 23: Rama Nurse Public Policy

Top ten: DALYsTop ten: DALYs

% of Total 52.61 42.83

Rank DiseaseDALY('000)

% %DALY('000)

Disease

1 HIV/AIDS 645 11.3 7.4 313 Stroke2 Traffic accidents 584 10.2 6.9 291 HIV/AIDS3 Stroke 332 5.8 6.4 271 Diabetes4 Alcohol dependence/harmful use 332 5.8 4.6 191 Depression5 Liver and bile duct cancer 280 4.9 3.4 142 Ischaemic heart disease6 COPD 187 3.3 3.0 125 Traffic accidents7 Ischaemic heart disease 184 3.2 3.0 124 Liver and bile duct cancer8 Diabetes 175 3.1 2.8 118 Osteoarthritis9 Cirrhosis 144 2.5 2.7 115 COPD

10 Depression 137 2.4 2.6 111 Cataracts

Male Female

DALY

Page 24: Rama Nurse Public Policy

Burden attributable to risk factors, 1999-2004

9.4%

8.1%

5.7%

5.5%

4.5%

3.7%

2.2%

1.7%

1.3%

0.9%

0.9%

0.5%

0.3%

0.3%

0.2%

13.8%

5.8%

5.1%

5.0%

4.2%

3.9%

2.3%

1.4%

1.2%

3.6%

1.4%

0.7%

0.7%

0.4%

0.3%

0.0% 2.0% 4.0% 6.0% 8.0% 10.0% 12.0% 14.0% 16.0%

Unsafe sex

Alcohol

Tobacco

Blood pressure

Not wearing helmet

Obesity

Cholesterol

Fruit & vegies

Physical inactivity

Illicit drugs

Air pollution

Water & sanitation

Malnutrition - int standard

Not wearing seatbelt

Malnutrition - Thai standard

% of total burden

2004

1999

ล�าดำ'บป็:จจ'ยเส�ยงที่�ก$อให่�เก�ดำภาระโรคจากมากไป็ห่าน�อย ไดำ�แก$ การม�เพื่ศส'มพื่'นธ2ที่�ไม$ป็ลอดำภ'ย แอลกอฮอล2 บ�ห่ร� ความดำ'นเล�อดำส1ง การไม$สวมห่มวกและคาดำเข-มข'ดำน�รภ'ย ภาวะน�,าห่น'กเก�นและโรคอ�วน ระดำ'บโคเลสเตอรอลในเล�อดำส1ง การบร�โภคผิ'กและผิลไม�น�อย การขาดำการออกก�าล'งกาย การใชั�สารเสพื่ต�ดำ มลพื่�ษที่างอากาศ การขาดำน�,าสะอาดำ การส�ขาภ�บาลและส�ขอนาม'ยที่�ไม$เห่มาะสม และภาวะที่�พื่โภชันาการ

Page 25: Rama Nurse Public Policy

โลกัท2�เปล2�ยนแปลง

Page 26: Rama Nurse Public Policy

Information medicine “Knowledge is power” Medical process:

information process Delocalised, distributed

and direct Decision support,

information management, identity technology,imaging, visualisation, sensors,telemedicine

The home as treatment location

The Internet Patient

Page 27: Rama Nurse Public Policy

Decision Support Systems

Diagnosis, data analysis, reminders, memory empowerment, ”second opinion”

Interactive broschures, simulations, smart objects, ”the digital doctor”

Benefits patient participation, handle information overload

Problems: conservative, silent knowledge,integration with patients and organisation

Page 28: Rama Nurse Public Policy

Imaging

Scanning + fast visualization+ information fusion

Non-invasive exploration Direct information to doctors Shorten the treatment chain,

reduce sidetracks Requires change in routines

Page 29: Rama Nurse Public Policy

Sensors and Telemedicine

Trends More conditions measurable, smaller, cheaper, plentiful, more functions per chip More intimate and biological, both non-invasive and implanted Active ”smart” sensors/actuators, wireless communication

Pathogen sensors, automated medication

Moves the location of diagnosis and treatment to the periphery

Information overload, privacy, security, training

Page 30: Rama Nurse Public Policy

Cybersurgery Surgery supported by information

technology Remote surgery Direct visualisation Augmented reality Robotics

Economy? Stumbles on organisation issues

Page 31: Rama Nurse Public Policy

Minimal Access Surgery

More and more applications Faster recovery Faster surgery redistributes medical

personell Need of a new kind of operating

theatre? Strong link to VR and robotic surgery

Page 32: Rama Nurse Public Policy

Biotech medicine

Regenerative medicine Rational drug design Bionics Genetic testing Vaccines Enhancing medicine

Page 33: Rama Nurse Public Policy

The New Pharmacology

Rational design Based on genomics, simulation and

knowledge of basic processes Generics threatened, business

models in pharma threatened Blurs the borders between palliative,

curative, preventative and enhancing medicine

Page 34: Rama Nurse Public Policy

Prosthetics and Neurointerfaces

Neurointerfaces rapid development (~300 electrodes, permanent)

Prosthetic research underfinanced Large gains for small groups

Page 35: Rama Nurse Public Policy

Genetic Testing

Cheap, fast genetic tests many conditions

How many wants to test? How does the health system respond?

Benefits: More individually adapted, good for preventative medicine and pharmacogenomics

Problems: Interpretation, too much faith in genetics, diagnosis develops faster than treatment, breaks information monopolies

Page 36: Rama Nurse Public Policy

Reproductive Medicine

Reproduction as a right? We are willing to spend enormous

sums on our children and their health

Genetic testing, preventative medicine

Perinatal medicine

Page 37: Rama Nurse Public Policy

The New Vaccines

Vaccines for treatment instead of just prevention

Immune system control Vaccines against

Allergies Diabetes Autoimmune illnesses Metabolic illnesses Cancer Narcotics

Page 38: Rama Nurse Public Policy

Neurotechnology

The brain/mind increasingly visible New pharmacology + understanding

of brain leads to treatment of many mental disorders

Hybrid therapies

Page 39: Rama Nurse Public Policy

Nanotech medicine NBIC convergence Enhancement of previous

technologies Reduced price Increased effectiveness Increased portability Active and smart devices and drugs

Development gradual and enabled byprevious technologies.

Page 40: Rama Nurse Public Policy

Chronic Care Model กั�บกั�รพ�ฒน�นโยบ�ยส�ธ�รณะ

Epping-Jordan, J E et al. Qual Saf Health Care 2004;13:299-305 Copyright ©2004 BMJ Publishing Group Ltd.

Page 41: Rama Nurse Public Policy

Components of Chronic Diseases Management

Population ScreeningUsing claims/clinical data to identify patients for disease management

Patient Risk ManagementSurveying patients about disease status/burden to identify for disease management

Team-Based CareUsing formalized teams to increase collaboration of care

Alternative EncountersProviding opportunities outside of the face-to-face encounter for relationship

Cross-Consortium CoordinationManaging across sites and settings to improve care continuity

Patient EducationTeaching patients about their disease

Outreach/Case ManagementTracking patients and their status proactively

Decision Support At the Point of CareTranslating disease management guidelines to patients-specific recommendations for clinicians.

Guidelines/ProtocolProviding information to clinicians on recommended clinical management

Performance FeedbackMeasuring performance in delivering desired care and achieving improved outcomes

Page 42: Rama Nurse Public Policy

Full Integration: Population Based and Chronic Care Case Based Model

Lifestyle interventions

Low risk At riskDisease

ManagementDiseaseSymptomsEarly Signs

Preventive Services Case Management

Screening

Primary and SecondaryPrevention

Acutetreatment

DiseaseManagement

HEALTH IMPROVEMENTDISEASE MANAGEMENT

HEALTH MANAGEMENT

POPULATION-BASED CASE-BASED

Page 43: Rama Nurse Public Policy

Chronic Illness and Medical Care

Primary care dominated by chronic illness care

Clinical and behavioral management increasingly effective BUT increasingly complex

Inadequate reimbursement and greater demand forcing primary care to increase throughput—the hamster wheel

Unhappy primary care clinicians leaving practice; trainees choosing other specialties

Loss of confidence in primary care by policy-makers and funders

But, there are new models of primary care and growing interest in changing physician payment to encourage and reward quality

Page 44: Rama Nurse Public Policy

People-centred care

World Health Report: 2008

Page 45: Rama Nurse Public Policy

โรงพย�บ�ลส/งเสร�มส�ขภ�พติ�บลTambon Health Promotion Hospital

Coordinate with other partners - central government + local authority + community + private sector,

Working in community – home ward, Proactive, outreach services based on

community health needs, Care coordination – horizontal and

vertical levels and case management system

Page 46: Rama Nurse Public Policy

What Patients with Chronic Illnesses Need

A “continuous healing relationship” with a care team and practice system organized to meet their needs for:

Effective Treatment (clinical, behavioral, supportive),

Information and support for their self-management,

Systematic follow-up and assessment tailored to clinical severity,

More intensive management for those not meeting targets, and

Coordination of care across settings and professionals

Page 47: Rama Nurse Public Policy

Toward a chronic care oriented system

Reviews of interventions in other conditions show that practice changes are similar across conditions

Integrated changes with components directed at:

i use of non-physician team members,i planned encounters, i modern self-management support,i Intensification of treatment i care management for high risk

patientsi electronic registries

Page 48: Rama Nurse Public Policy

Informed,ActivatedPatient

ProductiveInteractions

Prepared,ProactivePractice Team

Improved Outcomes

DeliverySystemDesign

DecisionSupport

ClinicalInformationSystems

Self-Management Support

Health System

Resources and Policies

Community Health Care Organization

Chronic Care Model

Page 49: Rama Nurse Public Policy

What distinguishes good chronic illness care from usual care?

Informed,ActivatedPatient

ProductiveInteractions

PreparedPractice Team

Page 50: Rama Nurse Public Policy

Assessment of self-management goal attainment and confidence as well as clinical status

Adherence to guidelinesTailoring of clinical management by stepped

protocol (Treat to target)Collaborative goal-setting and problem-solving

resulting in a shared care planPlanning for active, sustained follow-up

Informed,ActivatedPatient

ProductiveInteractions

PreparedPractice Team

How would I recognize aproductive interaction?

Page 51: Rama Nurse Public Policy

What characterizes an “informed, activated patient”?

Informed,ActivatedPatient

They have goals and a plan to improve their health, and the motivation, information, skills, and confidence necessary to manage their illness well.

Page 52: Rama Nurse Public Policy

Self-Management Support

Goal

To help patients take a more active

role and be more competent

managers of their health and

healthcare.

Page 53: Rama Nurse Public Policy

Community Resources and Policies

Goal

To help patients access effective and

useful services and resources in the

surrounding community.

Page 54: Rama Nurse Public Policy

What characterizes a “prepared” practice team?

PreparedPractice Team

Practice team and interactions with patientsorganized to help patients reach clinical targets and self-management goals..

Page 55: Rama Nurse Public Policy

Delivery System DesignGoal

To organize practice staff, schedules

and other systems to assure that

all patients receive planned,

evidence-based care.

Page 56: Rama Nurse Public Policy

Decision Support

Goal

To assure that clinicians and other

staff have the training, scientific

information and system support to

routinely provide evidence-based

(adhere to guidelines) and patient-

centered care.

Page 57: Rama Nurse Public Policy

Clinical Information System

Goal

To assure that clinicians and other

staff have ready access to patient

information on individuals and

populations to help plan, deliver

and monitor care.

Page 58: Rama Nurse Public Policy

Health Care OrganizationGoal

To assure that practices within the

organization have the motivation,

support and resources needed to

redesign their care systems.

Page 59: Rama Nurse Public Policy

Challenges in Implementing the CCM

Practices spent considerable time searching for/developing tools

Some practices felt intimidated by taking on the whole model – asked for a sequence

Many changes were made in ways that were not sustainable logistically or financially (e.g., double data entry)

CCM elements implemented as “special events” rather than part of routine care

Many achieve process improvements but outcomes don’t change

Page 60: Rama Nurse Public Policy

Self-Management Supportand Community Resources

Page 61: Rama Nurse Public Policy

Ecological Model of Health Behavior

Community, Environment, Policy

Systems, Organizations, Businesses

Family, FriendsPeer Groups

Individual

Page 62: Rama Nurse Public Policy

Clinical Information Systems and Decision Support

Page 63: Rama Nurse Public Policy

A Model for Effective Chronic Illness Care

Self-ManagementSupport

DeliverySystemDesign

DecisionSupport

ClinicalInformationSystem

Health SystemOrganization of Health Care

CommunityResource and Policies

Informed,Activated Patient

Prepared,ProactivePractice team

Productive

Interaction

Functional and Clinical Outcomes

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Clinical Information Systems

Provide reminders for providers and patients.

Identify relevant patient subpopulations for proactive care.

Facilitate individual patient care planning.

Share information with providers and patients.

Monitor performance of team and system.

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Barriers to CIS use

Lack of perceived valueCompeting business and

productivity demandsLack of office flow expertiseLack of information supportLack of leadership support

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What is the Issue?

Functionality!

Whatever you use should be able to deliver information that supports:

population planningclinical summaries at the visit individual care planningremindersperformance feedback

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Necessary functions for chronic care

be organized by patient; not disease, but responsive to disease populations

contain data relevant to clinical practice

assist with internal and external performance reporting

guide clinical care first, measurement second!

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Everyone, including senior leadership understands the clinical utility and supports the time involved in upkeep.

Data forms are clear, data entry role is assigned, data review time allotted.

Data entered and retrieved are clinically relevant, and used for patient care first, and measurement second.

Data can be shared with patient to improve understanding of treatment plan.

Keys to Success from Others That Have Implemented Registries

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The Implications of Social Media

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The Networked World

Investors

Customers

Prospects

Press/AnalystsPartners

Employees

Potential Employees

Influencers

MESSAGES

Competitors

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No. Rank Country

Number of Facebook

users March 2009

Number of Facebook users 31st

March 2010

12 month growth %

4 8 Philippines 1,026,300 11,561,74

0 1027%

5 15 India 1,561,000 7,809,800 400%

6 19 Malaysia 1,197,560 5,552,660 364%

7 23Thailand

284,340

2,895,320

918%ศ�นย$เทคโนโลย2ส�รสนเทศและกั�รส��อส�รส�น�กัง�นปล�ด้กัระทรวงคมน�คม

Facebook usage statistics - March 2010 (with 12 month increase figures)

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จ�นวนผ��ใชู� Facebook ท��วโลกั465,562,160 คน

จ�นวนผ��ใชู� Facebook ในประเทศไทย3,757,340 คน ค�ด้เป<น 0.81% ของท��วโลกัFemale

2,069,44055.8%

Male 1,636,040

44.2%

Thailand Male / Female

ศ�นย$เทคโนโลย2ส�รสนเทศและกั�รส��อส�รส�น�กัง�นปล�ด้กัระทรวงคมน�คม

Facebook usage statistics - March 2010

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<= 1336,220 (1.8%)14 – 17271,980(13.1%)18 – 24778,400(37.6%)25 – 34714,840(34.5%)35 – 44189,680(9.2%)45 – 5454,820(2.6%)55 – 6413,660(0.7%)65+ 9,780

(0.5%)

Thailand Age Distribution

ศ�นย$เทคโนโลย2ส�รสนเทศและกั�รส��อส�รส�น�กัง�นปล�ด้กัระทรวงคมน�คม

Facebook usage statistics - March 2010

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2 side to consider

18 file and OPD individual record

HCIS , JHCIS, HosXP, etc.

Report for claim

New media , Social network

Tele consultation

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The Social Media Ecosystem Blogs Wikis Facebook , twitter Podcasts Videocasts / Vlogs Moblogs MMS Internet telephony

i.e. skype™

Tools that facilitate:

Communication Engagement Transparency Trust

Tools that are: Complementary to

traditional communication activities

Used by organizations who recognize the social characteristics of effective communication

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What’s Social About Health Behavior?

Asymptomatic Screenings Lifestyle Modifications Cessation of Addictive Behaviors Medical Regimen Compliance Precaution Adoption

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e-Health Tools and Functions Health

Information Behavior change Self-

management On-line

communities

Decision support

Disease management

Healthcare tools

Office of Disease Prevention and Health Promotion, DHHS. Expanding the Reach and Impact of Consumer e ‑Health Tools. 2006.

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e-Health Tools: Behavior Changes

Improve dietary habits Increase physical activity levels Reduce heavy drinking Decrease disordered eating

behaviors Improve adherence to treatment

protocols Impact on health care utilization and

costs?Office of Disease Prevention and Health Promotion, DHHS. Expandingthe Reach and Impact of Consumer e ‑Health Tools. 2006.

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Mobile Technologies for Change: m-Change and Obesity

The appropriate model for obesity and weight management is tailored information according to design principles suggested by Social Cognitive Theory and the Social Marketing Model.

The health behaviors to target are self-monitoring of diet and physical activity.

The devices are Web-enabled “smart” cellular telephones and wireless PDAs.

JT Tufano & BT Karras. Mobile eHealth Interventions for Obesity:A Timely Opportunity to Leverage Convergence Trends. Journalof Internet Medical Research 2005;7(5):e58).

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ล�กัษณะโปรแกัรมส�หร�บใชู�ง�น

ล�าดำ'บเต�ยงผิ1�ป็<วย

ฟอร2มในการลงข�อม1ล

ห่น�าต$างฟอร2มต$างๆ

ข�อม1ลผิ1�ป็<วย

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Decision Support

Embed evidence-based guidelines into daily clinical practice.

Integrate specialist expertise and primary care.

Use proven provider education methods.

Share guidelines and information with patients.

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What is evidence-based medicine?

Evidence-based medicine is an approach to health care that promotes the collection, interpretation, and integration of valid, important and applicable evidence.

The best available evidence, moderated by patient circumstances and preferences, is applied to improve the quality of clinical judgments.

McMaster University

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Evidence-based practice

Customize guidelines to your setting Embed in practice: able to influence real

time decision-making Flow sheets with prompts Decision rules in EMR Share with patient Reminders in registry Standing orders

Have data to monitor care

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Stepped Care

Often begins with lifestyle change or adaptation (eliminate triggers, lose weight, exercise more)

First choice medication Either increase dose or add second

medication, and so on Includes referral guideline

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Going beyond consultation: integrating specialist expertise

Shared care agreements Alternating primary-specialty visits Joint visits Roving expert teams On-call specialist Via nurse case manager

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Effective educational methods

Interactive, sequential opportunities in small groups or individual training

Academic detailing Problem-based learning Modeling (joint visits)

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Effective educational methods Build knowledge over time Include all clinic staff Involve changing practice, not just

acquiring knowledge

Evans et al, Pediatrics 1997;99:157

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The Patient as Partner

Principles of CIS &DS

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Other Choices for Patient Decision Support

PBGH Evaluation of Consumer Decision Support Tools June 2007

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Ways to share guidelines with patients

Stoplight tools Expectations for care Wallet cards Web sites Workbooks

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Informed,EmpoweredPatient

ProductiveInteractions

Prepared,ProactivePractice Team

Improved Outcomes

DeliverySystemDesign

DecisionSupport

ClinicalInformationSystems

Self-Management Support

Health System

Resources and Policies

Community Health Care Organization

Chronic Care Model

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Specifics of System Design

Workforce Development Up front training and Admin Support Professional development

Integration of Complementary Medicine

Micro system optimization

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Micro System Optimization

Clinical Doctor, Nurse Case Manager Support groups Behavorist Pharmacist, Nutrition, H. Ed.

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Demand* Complex health problem*Explosion of

knowledge and technology

*Health care reform*Expand the scope of

nursing

Supply *Shortage of health

care personnel, both

quantity and quality

*Malutilization especially

nurse

Unsafe both nurses and patients/clients

Paradox

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