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Can we overcome the current divorce between professionals and managers and find a common language able to
do health and management?.NEW CASE-MIX CLASSIFICATION FOR PROFESSIONALS,
AND MANAGERS.
TWO IN ONE.
Ángel Ruiz Téllez. CYMAP
Fernando A. Alonso López. CS Dobra Cantabria
+00 34 637.53.23.59
Contact:
Ángel Ruiz Téllez
www.cymap.es
& Ángel Ruiz Téllez in Linkedin
+00 34 637.53.23.59
spreads out along :
• 6 Regional Spanish Health Services,
• 200 Primary Care Health Centres,
• 2000 Family Practice or Paediatrician
• 2 Million people
ISIS Manager© Project ( Measure of Professional Excellence = Effectiveness + Efficiency )
ISIS Manager© Project
+00 34 637.53.23.59
1.-Do you know the existence of 7 Groups of Problems in Primary Care, that show the 7 qualities of a good Family Practice?:
2.-Do you know that the previous 7 groups are divided in other 24 Solving Basic Models SBM, that represent the 24 models of therapeutic homogeneous professional behaviour?
3.-How could we interpret the retrospective information when into a ICPC Code can exists very different clinical syndromes?
4.-How measure the Preventive Activity?
5.-Do you know that the relation between Activity and Costs is negative and not positive?.
6.- Do you know that the “Portfolio Services”, reach only the 10% of epidemiological reality?.
7.-Do you know that there are 14.000 Episodes Hoped, in a standard patient panel?.
8.-Would you know that we would find 4 areas of professional behaviour, in, more or less, a law of quarters?
On eight questions
ISIS Manager© Project
+00 34 637.53.23.59
Useful to any health record software if are observed next conditions:
•Systems with informatics health records,
•Working with, and around, the Episode of Attention.
•Items of Activity (pharmacy, referrals, laboratory values, diagnostic or therapeutic procedures, etc) Episode of Attention related.
( Measure of Professional Excellence = Effectiveness + Efficiency )
Previous conditions
1.-Do you know the existence of 7 Groups of Problems in Primary Care, that show the 7 qualities of a good Family Practice?:
+00 34 637.53.23.59
G.R.E. DESCRIPTIONA PROBLEMS OF COLLECTIVE ORIENTATIONB CONSUMTIVE OR DISABLING DISEASES
B1 SANITARY PROBLEM OF SOCIAL ORIGINC HEALTH PROBLEMS THAT TEND TO AN SPONTANEOUS RESOLUTIOND SPECIFIC PROBLEMS OF INDIVIDUAL HEALTH, DEPENDANT ON TECHNICAL ABILITIES.E HEALTH PROBLEMS OF LOW FEASIBILITY, IN PRIMARY CAREP HEALTH NEEDS WITH EFFECTIVE PREVENTION
G.R.E./NCC© Group Related Episodes by Need of Care Criteria ©
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
A B B1 C D E P
Hoped Ep
Seen Ep
Solved Ep
Whole annual professional activity evaluated:
1. The “Seen Episodes” with regard to the “Hoped Episodes”
2. The “Solved Episodes” in relation to the “Seen Episodes”
The chart shows the evaluation of the whole annual professional activity, distributed in such 7 groups, and, every one showing the 3 types of Episodes. The blueones (the Solved) , in relation to the red ones (the Seen) , and those ones with regard to the green ones (the Hoped)
1.-Do you know the existence of 7 Groups of Problems in Primary Care, that show the 7 qualities of a good Family Practice?:
+00 34 637.53.23.59
G.R.E. DESCRIPTIONA PROBLEMS OF COLLECTIVE ORIENTATIONB CONSUMTIVE OR DISABLING DISEASES
B1 SANITARY PROBLEM OF SOCIAL ORIGINC HEALTH PROBLEMS THAT TEND TO AN SPONTANEOUS RESOLUTIOND SPECIFIC PROBLEMS OF INDIVIDUAL HEALTH, DEPENDANT ON TECHNICAL ABILITIES.E HEALTH PROBLEMS OF LOW FEASIBILITY, IN PRIMARY CAREP HEALTH NEEDS WITH EFFECTIVE PREVENTION
G.R.E./NCC© Group Related Episodes by Need of Care Criteria ©
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
A B B1 C D E P
Hoped Ep
Seen Ep
Solved Ep
C
To solve the C Problems’ Group requires:
• Our older members...
• owners of a large range of experience inuncertainty management
•Who can restrain, put a curb the excessive patients’ requests in the:
•“Non-Diseases”•Low Severity Problems
1.-Do you know the existence of 7 Groups of Problems in Primary Care, that show the 7 qualities of a good Family Practice?:
+00 34 637.53.23.59
G.R.E. DESCRIPTIONA PROBLEMS OF COLLECTIVE ORIENTATIONB CONSUMTIVE OR DISABLING DISEASES
B1 SANITARY PROBLEM OF SOCIAL ORIGINC HEALTH PROBLEMS THAT TEND TO AN SPONTANEOUS RESOLUTIOND SPECIFIC PROBLEMS OF INDIVIDUAL HEALTH, DEPENDANT ON TECHNICAL ABILITIES.E HEALTH PROBLEMS OF LOW FEASIBILITY, IN PRIMARY CAREP HEALTH NEEDS WITH EFFECTIVE PREVENTION
G.R.E./NCC© Group Related Episodes by Need of Care Criteria ©
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
A B B1 C D E P
Hoped Ep
Seen Ep
Solved Ep
D
•With a lot of expertise, skills on Diag-Therapeutic procedures:
•Injuries, wounds, pyelonephritis.....
To solve the D Problems’ Group requires:
• Our modern Doctors...
1.-Do you know the existence of 7 Groups of Problems in Primary Care, that show the 7 qualities of a good Family Practice?:
+00 34 637.53.23.59
G.R.E. DESCRIPTIONA PROBLEMS OF COLLECTIVE ORIENTATIONB CONSUMTIVE OR DISABLING DISEASES
B1 SANITARY PROBLEM OF SOCIAL ORIGINC HEALTH PROBLEMS THAT TEND TO AN SPONTANEOUS RESOLUTIOND SPECIFIC PROBLEMS OF INDIVIDUAL HEALTH, DEPENDANT ON TECHNICAL ABILITIES.E HEALTH PROBLEMS OF LOW FEASIBILITY, IN PRIMARY CAREP HEALTH NEEDS WITH EFFECTIVE PREVENTION
G.R.E./NCC© Group Related Episodes by Need of Care Criteria ©
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
A B B1 C D E P
Hoped Ep
Seen Ep
Solved Ep
B1B
•The known Community Medicine.
To solve the B&B1 Problems’ Group requires:
•Abilities to do a Family Therapeutic Orientation
1.-Do you know the existence of 7 Groups of Problems in Primary Care, that show the 7 qualities of a good Family Practice?:
+00 34 637.53.23.59
G.R.E. DESCRIPTIONA PROBLEMS OF COLLECTIVE ORIENTATIONB CONSUMTIVE OR DISABLING DISEASES
B1 SANITARY PROBLEM OF SOCIAL ORIGINC HEALTH PROBLEMS THAT TEND TO AN SPONTANEOUS RESOLUTIOND SPECIFIC PROBLEMS OF INDIVIDUAL HEALTH, DEPENDANT ON TECHNICAL ABILITIES.E HEALTH PROBLEMS OF LOW FEASIBILITY, IN PRIMARY CAREP HEALTH NEEDS WITH EFFECTIVE PREVENTION
G.R.E./NCC© Group Related Episodes by Need of Care Criteria ©
0%
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20%
30%
40%
50%
60%
70%
80%
90%
100%
A B B1 C D E P
Hoped Ep
Seen Ep
Solved Ep
P
•Avoiding the superfluous prevention.
To solve the P Problems’ Group requires:
Vocation towards the
Effectiveness Prevention
1.-Do you know the existence of 7 Groups of Problems in Primary Care, that show the 7 qualities of a good Family Practice?:
+00 34 637.53.23.59
G.R.E. DESCRIPTIONA PROBLEMS OF COLLECTIVE ORIENTATIONB CONSUMTIVE OR DISABLING DISEASES
B1 SANITARY PROBLEM OF SOCIAL ORIGINC HEALTH PROBLEMS THAT TEND TO AN SPONTANEOUS RESOLUTIOND SPECIFIC PROBLEMS OF INDIVIDUAL HEALTH, DEPENDANT ON TECHNICAL ABILITIES.E HEALTH PROBLEMS OF LOW FEASIBILITY, IN PRIMARY CAREP HEALTH NEEDS WITH EFFECTIVE PREVENTION
G.R.E./NCC© Group Related Episodes by Need of Care Criteria ©
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
A B B1 C D E P
Hoped Ep
Seen Ep
Solved Ep
E
•Able to manage, monitoring and coordinate Health Problems of low feasibility in PC, with:
•Hospital, •Second level•Social resources...
To solve the E Problems’ Group requires:
•our best “open minded” doctor...
1.-Do you know the existence of 7 Groups of Problems in Primary Care, that show the 7 qualities of a good Family Practice?:
+00 34 637.53.23.59
G.R.E. DESCRIPTIONA PROBLEMS OF COLLECTIVE ORIENTATIONB CONSUMTIVE OR DISABLING DISEASES
B1 SANITARY PROBLEM OF SOCIAL ORIGINC HEALTH PROBLEMS THAT TEND TO AN SPONTANEOUS RESOLUTIOND SPECIFIC PROBLEMS OF INDIVIDUAL HEALTH, DEPENDANT ON TECHNICAL ABILITIES.E HEALTH PROBLEMS OF LOW FEASIBILITY, IN PRIMARY CAREP HEALTH NEEDS WITH EFFECTIVE PREVENTION
G.R.E./NCC© Group Related Episodes by Need of Care Criteria ©
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
A B B1 C D E P
Hoped Ep
Seen Ep
Solved Ep
A
•able to treat problems of collective orientation, for their epidemiological, economical o social significance, with the best effectiveness and efficiency like:
•transmissible diseases, Ischemic heart diseases, mental illness, etc
To solve the A Problems’ Group requires:
•High competent professional
1.-Do you know the existence of 7 Groups of Problems in Primary Care, that show the 7 qualities of a good Family Practice?:
+00 34 637.53.23.59
G.R.E. DESCRIPTIONA PROBLEMS OF COLLECTIVE ORIENTATIONB CONSUMTIVE OR DISABLING DISEASES
B1 SANITARY PROBLEM OF SOCIAL ORIGINC HEALTH PROBLEMS THAT TEND TO AN SPONTANEOUS RESOLUTIOND SPECIFIC PROBLEMS OF INDIVIDUAL HEALTH, DEPENDANT ON TECHNICAL ABILITIES.E HEALTH PROBLEMS OF LOW FEASIBILITY, IN PRIMARY CAREP HEALTH NEEDS WITH EFFECTIVE PREVENTION
G.R.E./NCC© Group Related Episodes by Need of Care Criteria ©
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
A B B1 C D E P
Hoped Ep
Seen Ep
Solved Ep
All of seven groups define a
good generalist
And the professionals can check out their profiles
1.-Do you know the existence of 7 Groups of Problems in Primary Care, that show the 7 qualities of a good Family Practice?:
+00 34 637.53.23.59
G.R.E. DESCRIPTIONA PROBLEMS OF COLLECTIVE ORIENTATIONB CONSUMTIVE OR DISABLING DISEASES
B1 SANITARY PROBLEM OF SOCIAL ORIGINC HEALTH PROBLEMS THAT TEND TO AN SPONTANEOUS RESOLUTIOND SPECIFIC PROBLEMS OF INDIVIDUAL HEALTH, DEPENDANT ON TECHNICAL ABILITIES.E HEALTH PROBLEMS OF LOW FEASIBILITY, IN PRIMARY CAREP HEALTH NEEDS WITH EFFECTIVE PREVENTION
G.R.E./NCC© Group Related Episodes by Need of Care Criteria ©
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
A B B1 C D E P
Hoped Ep
Seen Ep
Solved Ep
All of seven groups define a
good generalist
And the professionals can check out their profiles
2.-Do you know that the previous 7 groups are divided in other 24 Solving Basic Models SBM, that represent the 24 models of therapeutic homogeneous professional behaviour?:
+00 34 637.53.23.59
SBM© Solving Basic Models©
0%
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80%
90%
100%
A0
1
A0
2
A0
3
A0
4
A0
5
B0
1
B0
2
B1
1
C0
1
C0
2
C0
3
C0
4
C0
5
D0
1
D0
2
D0
3
D0
4
E01
E02
E03
E04
P0
1
P0
2
P0
3
Solved Ep Seen Ep Hoped Ep
SBM DESCRIPTION
A01 TRANSMISSIBLE DISEASESA02 RISK HABITSA03 RISK FACTORS A04 HEALTH PROBLEMS OF HIGH MORBIDITY OR MORTALITYA05 HEALTH PROBLEMS OF HIGH SOCIOECONOMIC INFLUENCEB01 CONSUMTIVE DISEASESB02 DISABLING ILLNESSESB11 SANITARY PROBLEMS OF SOCIAL ORIGINC01 SPECIFIC SYNDROMES THAT TEND TO AN NATURAL RESOLUTION C02 CHRONIC SYMPTOM/COMPLAINT OF LOW RISK OR LOW UNCERTAINTYC03 ACUTE AND BANAL HEALTH PROBLEMS
C04SYMPTOM/COMPLAINT OF POTENTIAL RISK AND UNCERTAINTY IN A SHORT TERM
C05SYMPTOM/COMPLAINT OF HIGHER POTENTIAL RISK AND UNCERTAINTY IN A LONG TERM
D01 SPECIFIC PROBLEMS WITH MODERATE SEVERITY/COMPLEXITY
D02SPECIFIC PROBLEMS WITH MODERATE SEVERITY AND MINOR COMPLEXITY
D03SPECIFIC PROBLEMS WITH MINOR SEVERITY AND MODERATE COMPLEXITY
D04 SPECIFIC PROBLEMS WITH MINOR SEVERITY AND COMPLEXITY
E01SPECIALIZED PROBLEMS OF LOW THERAPEUTIC FEASIBILITY-LTF IN PRIMARY CARE-PC
E02 SPECIALIZED PROBLEMS LTF-PC WITH SHARED CONTROLE03 SPECIALIZED PROBLEMS LTF-PC DIAGNOSED IN PC
E04SPECIALIZED PROBLEMS LTF-PC THAT CAN BE DIAGNOSED IN PC & WITH SHARED CONTROL
P01 SANITARY EDUCATION ABOUT HEALTH DOUBTSP02 PROMOTION OF HEALTHY LIFE STYLESP03 SCREENING AND SECONDARY PREVENTION OF PREVALENT DISEASES
And, so, in an only chart, the professionals, quickly, can observe his o her profile, in the 24 SBM, understanding their
strength and weakness around each one of them.
Above those SBM we have the whole classification, in detail, with around 1.000 Modulated Episodes, each one
allocated[to one specific SBM.
3.-How could we interpret the retrospective information when into a ICPC Code can exists very different clinical syndromes?.
+00 34 637.53.23.59
Modulated Episodes©ModEp DESCRIPTION SBM
R74.01 UPPER RESPIRATORY INFECTION ACUTE (<1 YEAR) D01
R74.02UPPER RESPIRATORY INFECTION ACUTE WITHOUT RESPIRATORYPROBLEMS (1-13 YEAR)
C01
R74.03 UPPER RESPIRATORY INFECTION ACUTE WITH RESPIRATORY
PROBLEMS (1-13 YEAR)C04
…….
R74
Modulation Engine
SC1
RC1
SC2
RC2
SC3
RC3
Creating different subgroups of Episodes, allocated to one o more ICPC , according to therapeuticalorientation.
Let’s see one example around the ICPC Code R74- UPPER RESPIRATORY INFECTION ACUTE
It isn’t the same a Cold in a breast-fed baby, or in a child with Asthma or without. There are three different problems, with the same code, with three Selection Criteria, and with three Resolution Criteria, that need to be allocated in their respective SBM.
Because we analyse informatics records retrospectively, is impossible discriminate and interpret the information without doing groups of problems depend on the Selection Criteria , what will allow us to state the Resolution Criteria to analyze the Effectiveness.
So, you will be able to understand that was needed to allocate each one to different Groups of SBM , and so, Managers and Professionals will have a common language.
3.-The Modulated Episodes ( ± 1000, each one allocated to one specific SBM )
+00 34 637.53.23.59
Modulated Episodes©ModEp DESCRIPTION SBM
R74.01 UPPER RESPIRATORY INFECTION ACUTE (<1 YEAR) D01
R74.02UPPER RESPIRATORY INFECTION ACUTE WITHOUT RESPIRATORYPROBLEMS (1-13 YEAR)
C01
R74.03 UPPER RESPIRATORY INFECTION ACUTE WITH RESPIRATORY
PROBLEMS (1-13 YEAR)C04
…….
R74
Modulation Engine
SC1
RC1
SC2
RC2
SC3
RC3
Above those SBM we have the whole classification, in detail, with around 1.000 Modulated Episodes, each one allocated to one specific SBM.
SC: Selection Criteria RC: Resolution Criteria
SBM DESCRIPTION
A01 TRANSMISSIBLE DISEASESA02 RISK HABITSA03 RISK FACTORS A04 HEALTH PROBLEMS OF HIGH MORBIDITY OR MORTALITYA05 HEALTH PROBLEMS OF HIGH SOCIOECONOMIC INFLUENCEB01 CONSUMTIVE DISEASESB02 DISABLING ILLNESSESB11 SANITARY PROBLEMS OF SOCIAL ORIGINC01 SPECIFIC SYNDROMES THAT TEND TO AN NATURAL RESOLUTION C02 CHRONIC SYMPTOM/COMPLAINT OF LOW RISK OR LOW UNCERTAINTYC03 ACUTE AND BANAL HEALTH PROBLEMS
C04SYMPTOM/COMPLAINT OF POTENTIAL RISK AND UNCERTAINTY IN A SHORT TERM
C05SYMPTOM/COMPLAINT OF HIGHER POTENTIAL RISK AND UNCERTAINTY IN A LONG TERM
D01 SPECIFIC PROBLEMS WITH MODERATE SEVERITY/COMPLEXITY
D02SPECIFIC PROBLEMS WITH MODERATE SEVERITY AND MINOR COMPLEXITY
D03SPECIFIC PROBLEMS WITH MINOR SEVERITY AND MODERATE COMPLEXITY
D04 SPECIFIC PROBLEMS WITH MINOR SEVERITY AND COMPLEXITY
E01SPECIALIZED PROBLEMS OF LOW THERAPEUTIC FEASIBILITY-LTF IN PRIMARY CARE-PC
E02 SPECIALIZED PROBLEMS LTF-PC WITH SHARED CONTROLE03 SPECIALIZED PROBLEMS LTF-PC DIAGNOSED IN PC
E04SPECIALIZED PROBLEMS LTF-PC THAT CAN BE DIAGNOSED IN PC & WITH SHARED CONTROL
P01 SANITARY EDUCATION ABOUT HEALTH DOUBTSP02 PROMOTION OF HEALTHY LIFE STYLESP03 SCREENING AND SECONDARY PREVENTION OF PREVALENT DISEASES
+00 34 637.53.23.59
R74
Modulation Engine
SC1
RC1
SC2
RC2
SC3
RC3
R74.01
Modulated Episodes©ModEp DESCRIPTION SBM
R74.01 UPPER RESPIRATORY INFECTION ACUTE (<1 YEAR) D01
R74.02UPPER RESPIRATORY INFECTION ACUTE WITHOUT RESPIRATORYPROBLEMS (1-13 YEAR)
C01
R74.03 UPPER RESPIRATORY INFECTION ACUTE WITH RESPIRATORY
PROBLEMS (1-13 YEAR)C04
…….
3.-The Modulated Episodes ( ± 1000, each one allocated to one specific SBM )
SBM DESCRIPTION
A01 TRANSMISSIBLE DISEASESA02 RISK HABITSA03 RISK FACTORS A04 HEALTH PROBLEMS OF HIGH MORBIDITY OR MORTALITYA05 HEALTH PROBLEMS OF HIGH SOCIOECONOMIC INFLUENCEB01 CONSUMTIVE DISEASESB02 DISABLING ILLNESSESB11 SANITARY PROBLEMS OF SOCIAL ORIGINC01 SPECIFIC SYNDROMES THAT TEND TO AN NATURAL RESOLUTION C02 CHRONIC SYMPTOM/COMPLAINT OF LOW RISK OR LOW UNCERTAINTYC03 ACUTE AND BANAL HEALTH PROBLEMS
C04SYMPTOM/COMPLAINT OF POTENTIAL RISK AND UNCERTAINTY IN A SHORT TERM
C05SYMPTOM/COMPLAINT OF HIGHER POTENTIAL RISK AND UNCERTAINTY IN A LONG TERM
D01 SPECIFIC PROBLEMS WITH MODERATE SEVERITY/COMPLEXITY
D02SPECIFIC PROBLEMS WITH MODERATE SEVERITY AND MINOR COMPLEXITY
D03SPECIFIC PROBLEMS WITH MINOR SEVERITY AND MODERATE COMPLEXITY
D04 SPECIFIC PROBLEMS WITH MINOR SEVERITY AND COMPLEXITY
E01SPECIALIZED PROBLEMS OF LOW THERAPEUTIC FEASIBILITY-LTF IN PRIMARY CARE-PC
E02 SPECIALIZED PROBLEMS LTF-PC WITH SHARED CONTROLE03 SPECIALIZED PROBLEMS LTF-PC DIAGNOSED IN PC
E04SPECIALIZED PROBLEMS LTF-PC THAT CAN BE DIAGNOSED IN PC & WITH SHARED CONTROL
P01 SANITARY EDUCATION ABOUT HEALTH DOUBTSP02 PROMOTION OF HEALTHY LIFE STYLESP03 SCREENING AND SECONDARY PREVENTION OF PREVALENT DISEASES
+00 34 637.53.23.59
R74
Modulation Engine
SC1
RC1
SC2
RC2
SC3
RC3
R74.02
Modulated Episodes©ModEp DESCRIPTION SBM
R74.01 UPPER RESPIRATORY INFECTION ACUTE (<1 YEAR) D01
R74.02UPPER RESPIRATORY INFECTION ACUTE WITHOUT RESPIRATORYPROBLEMS (1-13 YEAR)
C01
R74.03 UPPER RESPIRATORY INFECTION ACUTE WITH RESPIRATORY
PROBLEMS (1-13 YEAR)C04
…….
3.-The Modulated Episodes ( ± 1000, each one allocated to one specific SBM )
SBM DESCRIPTION
A01 TRANSMISSIBLE DISEASESA02 RISK HABITSA03 RISK FACTORS A04 HEALTH PROBLEMS OF HIGH MORBIDITY OR MORTALITYA05 HEALTH PROBLEMS OF HIGH SOCIOECONOMIC INFLUENCEB01 CONSUMTIVE DISEASESB02 DISABLING ILLNESSESB11 SANITARY PROBLEMS OF SOCIAL ORIGINC01 SPECIFIC SYNDROMES THAT TEND TO AN NATURAL RESOLUTION C02 CHRONIC SYMPTOM/COMPLAINT OF LOW RISK OR LOW UNCERTAINTYC03 ACUTE AND BANAL HEALTH PROBLEMS
C04SYMPTOM/COMPLAINT OF POTENTIAL RISK AND UNCERTAINTY IN A SHORT TERM
C05SYMPTOM/COMPLAINT OF HIGHER POTENTIAL RISK AND UNCERTAINTY IN A LONG TERM
D01 SPECIFIC PROBLEMS WITH MODERATE SEVERITY/COMPLEXITY
D02SPECIFIC PROBLEMS WITH MODERATE SEVERITY AND MINOR COMPLEXITY
D03SPECIFIC PROBLEMS WITH MINOR SEVERITY AND MODERATE COMPLEXITY
D04 SPECIFIC PROBLEMS WITH MINOR SEVERITY AND COMPLEXITY
E01SPECIALIZED PROBLEMS OF LOW THERAPEUTIC FEASIBILITY-LTF IN PRIMARY CARE-PC
E02 SPECIALIZED PROBLEMS LTF-PC WITH SHARED CONTROLE03 SPECIALIZED PROBLEMS LTF-PC DIAGNOSED IN PC
E04SPECIALIZED PROBLEMS LTF-PC THAT CAN BE DIAGNOSED IN PC & WITH SHARED CONTROL
P01 SANITARY EDUCATION ABOUT HEALTH DOUBTSP02 PROMOTION OF HEALTHY LIFE STYLESP03 SCREENING AND SECONDARY PREVENTION OF PREVALENT DISEASES
+00 34 637.53.23.59
R74
Modulation Engine
SC1
RC1
SC2
RC2
SC3
RC3
R74.03
Modulated Episodes©ModEp DESCRIPTION SBM
R74.01 UPPER RESPIRATORY INFECTION ACUTE (<1 YEAR) D01
R74.02UPPER RESPIRATORY INFECTION ACUTE WITHOUT RESPIRATORYPROBLEMS (1-13 YEAR)
C01
R74.03UPPER RESPIRATORY INFECTION ACUTE WITH RESPIRATORY PROBLEMS (1-13 YEAR)
C04
…….
3.-The Modulated Episodes ( ± 1000, each one allocated to one specific SBM )
SBM DESCRIPTION
A01 TRANSMISSIBLE DISEASESA02 RISK HABITSA03 RISK FACTORS A04 HEALTH PROBLEMS OF HIGH MORBIDITY OR MORTALITYA05 HEALTH PROBLEMS OF HIGH SOCIOECONOMIC INFLUENCEB01 CONSUMTIVE DISEASESB02 DISABLING ILLNESSESB11 SANITARY PROBLEMS OF SOCIAL ORIGINC01 SPECIFIC SYNDROMES THAT TEND TO AN NATURAL RESOLUTION C02 CHRONIC SYMPTOM/COMPLAINT OF LOW RISK OR LOW UNCERTAINTYC03 ACUTE AND BANAL HEALTH PROBLEMS
C04SYMPTOM/COMPLAINT OF POTENTIAL RISK AND UNCERTAINTY IN A SHORT TERM
C05SYMPTOM/COMPLAINT OF HIGHER POTENTIAL RISK AND UNCERTAINTY IN A LONG TERM
D01 SPECIFIC PROBLEMS WITH MODERATE SEVERITY/COMPLEXITY
D02SPECIFIC PROBLEMS WITH MODERATE SEVERITY AND MINOR COMPLEXITY
D03SPECIFIC PROBLEMS WITH MINOR SEVERITY AND MODERATE COMPLEXITY
D04 SPECIFIC PROBLEMS WITH MINOR SEVERITY AND COMPLEXITY
E01SPECIALIZED PROBLEMS OF LOW THERAPEUTIC FEASIBILITY-LTF IN PRIMARY CARE-PC
E02 SPECIALIZED PROBLEMS LTF-PC WITH SHARED CONTROLE03 SPECIALIZED PROBLEMS LTF-PC DIAGNOSED IN PC
E04SPECIALIZED PROBLEMS LTF-PC THAT CAN BE DIAGNOSED IN PC & WITH SHARED CONTROL
P01 SANITARY EDUCATION ABOUT HEALTH DOUBTSP02 PROMOTION OF HEALTHY LIFE STYLESP03 SCREENING AND SECONDARY PREVENTION OF PREVALENT DISEASES
+00 34 637.53.23.59
Modulated Episodes©Solving the classification of Prevention : The Modulated Episodes
G.R.E./NCC©
G.R.E./NCC©
SBM
SubSBM
Mod Episode
4.-Do you know that the “Portfolio Services”, reach only the 10% of epidemiological reality?.
+00 34 637.53.23.59
0
10
20
30
40
50
60
70
80
90
100
Doctor A Doctor B Doctor C Doctor D
Activity
Activity
Roof “Portfolio Services” ?
As excellent as invisible Doctors
Ship adrift
•Which will be our excellent professionals?
•When we control the 10% of the direction of the ship....?
We need to measure the
100% Activity & Manageable
Costs
5.-Do you know that there are 14.000 Episodes Hoped, in a standard patient panel?.
+00 34 637.53.23.59
Seen Episodes
Hoped Episodes
Solved
Episodes
Supply Rate = SEEN Episodes / HOPED Episodes
SR = Seen / Hoped = 60/100 = 0.6100
60
40
Effectiveness Rate = SOLVED Episodes / SEEN Episodes
ER = Solved / Seen = 40/60 = 0.66
Social Profitability Rate = SOLVED Episodes / HOPED Episodes
SPR = Solved / Hoped = 40/100 = 0.4
Efficiency Rate
€R = SPR / €osts
SPR = SR x ER = 0.6 x 0.66 = 0.4
The Supply isn’t a whole number.
+00 34 637.53.23.59
Supply Rate = SEEN Episodes / HOPED Episodes
SR = Seen / Hoped = 60/100 = 0.6
Effectiveness Rate = SOLVED Episodes / SEEN Episodes
ER = Solved / Seen = 40/60 = 0.66
Social Profitability Rate = SOLVED Episodes / HOPED Episodes
SPR = Solved / Hoped = 40/100 = 0.4
Efficiency Rate
€R = SPR / €osts
SPR = SR x ER = 0.6 x 0.66 = 0.4
5.-Do you know that there are 14.000 Episodes Hoped, in a standard patient panel?.
Seen Episodes
Hoped Episodes
Solved
Episodes
100
60
40
The Supply isn’t a whole number, but a Rate of Seen Needs / Hoped Needs.
Our model allows us to measure the rest of the Rates:
•Effectiveness•Social Profitability
•Efficiencycreating an environment of quality that provoke one
positive bias
6.-Do you know that the relation between Activity and Costs is negative and not positive?.
+00 34 637.53.23.59
Activity
Costs
Real Linear Regression
Professionals
More x Less
Less x More
•There is a proportion of professionals thatmake more activity by less costs and viceversa.
•They are our excellent and transparentprofessionals.
•Our invisible professionals.
7.-Would you know that we would find 4 areas of professional behaviour, in, more or less, a law of quarters?
+00 34 637.53.23.59
X Diagram Téllez-Alonso Each dot, an annual professional data
- Costs +
Act
ivit
y
+
A B
C D
A:
B:
C:
D:
Activity Costs
Let’s compare the difference of
weighed professional
activity and costs, against these both
average values, sited in the middle
of the chart, ...
7.-Would you know that we would find 4 areas of professional behaviour, in, more or less, a rule, a law of quarters?
+00 34 637.53.23.59
X Diagram Téllez-Alonso Each dot, an annual professional data
- Costs +
Act
ivit
y
+
A B
C D
A:
B:
C:
D:
Activity Costs
7.-Would you know that we would find 4 areas of professional behaviour, in, more or less, a rule, a law of quarters?
+00 34 637.53.23.59
X Diagram Téllez-Alonso Each dot, an annual professional data
- Costs +
Act
ivit
y
+
A B
C D
A:
B:
C:
D:
Activity Costs
Excellent &
Invisible
7.-Would you know that we would find 4 areas of professional behaviour, in, more or less, a rule, a law of quarters?
+00 34 637.53.23.59
X Diagram Téllez-Alonso Each dot, an annual professional data
- Costs +
Act
ivit
y
+
A B
C D
A:
B:
C:
D:
Activity Costs
7.-Would you know that we would find 4 areas of professional behaviour, in, more or less, a rule, a law of quarters?
+00 34 637.53.23.59
X Diagram Téllez-Alonso Each dot, an annual professional data
- Costs +
Act
ivit
y
+
A B
C D
A:
B:
C:
D:
Activity Costs
7.-Would you know that we would find 4 areas of professional behaviour, in, more or less, a rule, a law of quarters?
+00 34 637.53.23.59
X Diagram Téllez-Alonso Each dot, an annual professional data
- Costs +
Act
ivit
y
+
A B
C D
A:
B:
C:
D:
Activity Costs
Logical&
Warriors
7.-Would you know that we would find 4 areas of professional behaviour, in, more or less, a rule, a law of quarters?
+00 34 637.53.23.59
X Diagram Téllez-Alonso Each dot, an annual professional data
- Costs +
Act
ivit
y
+
A B
C D
A:
B:
C:
D:
Activity Costs
7.-Would you know that we would find 4 areas of professional behaviour, in, more or less, a rule, a law of quarters?
+00 34 637.53.23.59
X Diagram Téllez-Alonso Each dot, an annual professional data
- Costs +
Act
ivit
y
+
A B
C D
A:
B:
C:
D:
Activity Costs
7.-Would you know that we would find 4 areas of professional behaviour, in, more or less, a law of quarters?
+00 34 637.53.23.59
X Diagram Téllez-Alonso Each dot, an annual professional data
- Costs +
Act
ivit
y
+
A B
C D
A:
B:
C:
D:
Activity Costs
Prudent&
Calm
7.-Would you know that we would find 4 areas of professional behaviour, in, more or less, a rule, a law of quarters?
+00 34 637.53.23.59
X Diagram Téllez-Alonso Each dot, an annual professional data
- Costs +
Act
ivit
y
+
A B
C D
A:
B:
C:
D:
Activity Costs
7.-Would you know that we would find 4 areas of professional behaviour, in, more or less, a rule, a law of quarters?
+00 34 637.53.23.59
X Diagram Téllez-Alonso Each dot, an annual professional data
- Costs +
Act
ivit
y
+
A B
C D
A:
B:
C:
D:
Activity Costs
7.-Would you know that we would find 4 areas of professional behaviour, in, more or less, a rule, a law of quarters?
+00 34 637.53.23.59
X Diagram Téllez-Alonso Each dot, an annual professional data
- Costs +
Act
ivit
y
+
A B
C D
A:
B:
C:
D:
Activity Costs
Generous
8.-Would you know that we would find 4 areas of professional behaviour, in, more or less, a rule, a law of quarters?
+00 34 637.53.23.59
X Diagram Téllez-Alonso Each dot, an annual professional data
- Costs +
Act
ivit
y
+
A B
C D
A:
B:
C:
D:
Activity Costs
7.-Would you know that we would find 4 areas of professional behaviour, in, more or less, a rule, a law of quarters?
+00 34 637.53.23.59
X Diagram Téllez-Alonso Each dot, an annual professional data
- Costs +
Act
ivit
y
+
A B
C D
7.-Would you know that we would find 4 areas of professional behaviour, in, more or less, a rule, a law of quarters?
+00 34 637.53.23.59
X Diagram Téllez-Alonso Each dot, an annual professional data
- Costs +
Act
ivit
y
+
A B
C D
•That is possible because the upper ones have a bigger clinical applied competence, perhaps because they know a little bit more medicine.
7.-Would you know that we would find 4 areas of professional behaviour, in, more or less, a rule, a law of quarters?
+00 34 637.53.23.59
X Diagram Téllez-Alonso Each dot, an annual professional data
- Costs +
Act
ivit
y
+
A B
C D
And the upper left ones, moreover, have a bigger organizationalcompetence.
•That is possible because the upper ones have a bigger clinical applied competence, perhaps because they know a little bit more medicine.
7.-Would you know that we would find 4 areas of professional behaviour, in, more or less, a rule, a law of quarters?
+00 34 637.53.23.59
X Diagram Téllez-Alonso Each dot, an annual professional data
- Costs +
Act
ivit
y
+
A B
C D
And the upper left ones, moreover, have a bigger organizationalcompetence.
•That is possible because the upper ones have a bigger clinical applied competence, perhaps because they know a little bit more medicine.
350% better
Cost-Effectiveness
with regards to
the rest
Summarizing, what can ISIS Manager© Project do?:
+00 34 637.53.23.59
Can create an environment of Excellence ( Effectiveness + Efficiency ) across the “peer-review”, with controlled bias towards more activity by less costs.
The first stage is to have a “Valuable Information System”, according a Valuable, too, Worthy and Challenging Goal of Reference,
“To Solve the bigger number of Epidemiological Needs with the best Effectiveness and Efficiency”
The second stage is to avoid the mistrust, after reading the information data:
•Standardizing Data (weighed social, population, epidemiological conditions of each Doctor patients’ Panel)
•Guaranteeing the ‘Quality Data’ across a method of certification of the Records Reliability ( ISIS Manager© use 100 steps control along the ‘data chain’, included the Certification in ICPC Professional Codification).
Activity
Costs
Model trend
A B
C D
CONCLUSIONS:
+00 34 637.53.23.59
•The “peer-review” is the one of most powerful methods of professionalmotivation, but must observe , fulfil, the next conditions:
•Must evaluate 100% activity and 100% manageable costs.•Must evaluate the Effectiveness•To avoid the mistrust around the professional comparison, the datamust be standardized and certificated in Records Reliability.•The Information System have to create an environment withcontrolled bias, controlled slant towards the “more activity by lesscosts”.
• A classification like our GRE/NCC© allows, quickly,• to the professionals:
•To Know his professional profile and•To learn around their strength and weakness
•To the Managers:•To know the reality and act consequently.
