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Operationalizing value in Chronic Care:  The case of Swedish Rheumatology ,[object Object]
Defining the care cycle
DAS28 (Disease Activity) Time
Measuring outcomes  over the full cycle of care over the full cycle of care
Disease cycle captured in the SRQ registry
Prioritizing measures based on the stage of the disease: defining two phases
First phase of disease: reaching low or no disease activity Early & aggressive treatment  ,[object Object],[object Object],[object Object],[object Object],[object Object]
Second phase:  long-term management and prevention Maintain low DAS28 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Second phase:  long-term management and prevention Detect and curb flares  ,[object Object],[object Object]
This guy wants no medication. Because they reduce his immune defense. He wants to be medication free in order to be able to see his grandchildren without fearing to catch their cold.
Measuring costs over the full cycle of care
 
Direct costs - Stockholm County Council data sources: In-patient and out-patient data and cost per patient (CPP).  Cost per patient  -  RA 2009, KUH Cost per patient  -  RA 2009, KUH ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Indirect costs at macro level: Sick leave days/year level out with biologics Sick leave days/year level out with biologics
Sick leave days/year level out with biologics Controls
Risk adjustment ,[object Object],[object Object],[object Object]
Tasks and issues ahead ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Value-based reimbursement? ,[object Object],[object Object]
Decisions to be made ,[object Object],[object Object],[object Object],[object Object],[object Object]
Complexities related to outcomes-based reimbursement ,[object Object],[object Object]
Plan - reimbursement model ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Thank You! ,[object Object]
Improvement of patients global health 6 months after diagnosis, 1994 - 2008
National result & per county
RA outcome measures in the three tiers ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

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Operationalizing Value in Swedish Rheumatology

Editor's Notes

  1. Vi kan från start till döden CO-morbitiites: hjärt och kärl, osteoporosis, KOL, cancer, lymfom, malignt melanom. Hypothesis based on the literature, these conditions higher frequence among RA population. Well known co morbidities. They may not be influencing the outcomes or costs significantly.side effects of medication.
  2. Öppna jämförelser av alla landsting är också möjligt