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Experience with Platform-based Decision Support as plug-in for GP Information Systems. Leu M. eHealth week 2010 (Barcelona: CCIB Convention Centre; 2010)
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Experience with platform-
based decision support
as plug-in for GP
information systems
CompuGROUP Holding AG
Matthias Leu – Vice PresidentBarcelona, March 16st 2010
Doctors Information
Systems (DIS)
Doctors view at an „ordinary“
chronic disease patient
Chronic disease:
diabetes
10
Result: the patient is a
candidate for a disease-
management program e.g.
diabetes
Online – offline
patient registration
Doctors NEW view at an „ordinary“
chronic disease patient
The five aspects of AVplus
1. “real-time managed care” through structured medical data
2. suggested treatment patterns for physicians
3. special life-style modification programs motivate patients
4. evidence-based pathways support “at the moment of decision”
5. the better the physicians perform, the better the payment
1. “real-time managed care”
through structured medical data
- „patient scanner“ identifies suitable patients out of the DIS data base
- patient-data transferred automatically online to the “path-server”
- a centralized database on the “path-server” checks and steers all
processes
13
Recommondation for the patient:
Join special disease-management-program
Example of patient scanner in the doctors software
2. benchmarking – Only two values
represent the quality of treatment
1. diabetic:
HbA1c – below 7,0% (or reduction of 0,3% / quarter)
BP – below 135 mmHg (or reduction of 3 mmHg / quarter)
2. diabetic high risk patient:
Triglycerid – below 200 mg/dl (or reduction of 150 mg/dl / quarter)
BP – below 135 mmHg (or reduction of 3 mmHg / quarter)
- doctors surgeries are compared transparently to each other (ranking)
- significant under-performers have to be discussed in quality-circles
- the centralized database checks all steps –
and gives feedback
3. special lifestyle-modification
programs motivate patients
Anti smoking
Exercise therapie,
sports…
Nutrition Consulting
- personalized mailings and print-outs for patients.
Steering via doctors software and web portal.
- patient compliance is rewarded
- focus on educational programs for lifestyle-modification
AVplus patient web portal
4. Evidence-based pathways support
“at the moment of decision”:
- Accepted guidelines are the basis of every medical pathway – selected
and modified with the help of a medical board (manned with THE medical
experts e.g. the most famous diabetologist)
- Managed care company develops its own medical pathways
- the medical pathway supports with hints and recommendations via DIS
Our goal is simple:
Latest medical knowledge is available for the doctor at the moment of need.
Without complicated flow-charts.
Without learning by heart.
4a. Medical treatment paths
4a. Medical treatment path in DIS
including economic perspectiveWho? Share What?
Insurant 100,0% STARTShort test
members mag.
Customer
Receives
info
STOP
Med.
Aux. personnel
Offer-
primary
prevention
programme
Spec. Dr. 15.0%Screening
risk
Cardio.
diagnostics
DMP criteria
fulfilled no
yes no
GP 85.0%Screening
risk
Register
DMP & IC
preparation
Customer
consents to
DMP & IC yes
Undertake
DMP & IC
registration
DP centreProcess
TE/EWE
Health ins.
company
Prepare-
case
management
Weighting [%] 100% 95.0% 40.0% 60.00% 5.00% 35%
Best case [Days] 1 0 0 0 0
Worst case [Days] 5 5 0 3 15
Resources [Minutes] 10.00 30.00 2,00 5,00 5,00
Additional means [Aid Short questionnaire Screening tool Exertion ECG
; full body
status
TE/ EWE Information
brochure
TE/ EWE;
secure mail
Work time costs
[Euros]
€ 13,67
€ 41.00 € 2.73 € 2.50 2,50 EUR Meterial costs
[Euros]
-
- - € 2.00 - EUR One-off cost
[Euros]
€ 5.00
- - - 25,00 EUR Total costs
[Euros]/ Case €18.67 € € 41.00
€ 2.73 € 4,.50 27,50 EUR
4b. Evidence-based pathways support
“at the moment of decision”:
To-do-list for the steering process with precise instructions and information
for e.g. a necessary referral to specialist (in this example to a nephrology
clinic because the KREA-number is 2,6). The software shows also e.g. a list
of diabetes consultant centers (synchronized with GEO-data of the patient)
or exact information about other health providers.
5. the better the physicians perform,
the better the paymentV
ari
ab
leL
um
p-s
umExtr
a d
octo
r´s f
ee
Lump-sum per patient
patient
fixed salary
40,00€
per
Documentation
15,00€
variable
60,00€
1/3 of cost-reductions acrue to the doctors, 1/3 to health insurance, 1/3 to management company
Specialist
30,00€
per patient / per year
HbA1c
BP
Number of documentations
0
1000
2000
3000
4000
5000
6000
Nov. 07
Dez. 07
Jan. 08
Feb. 08
März 08
Apr. 08
Mai 08
Juni 08
Juli 08
Aug. 08
Sep. 08
Okt. 08
Nov. 08
Dez. 08
Jan. 09
Feb. 09
März 09
Apr. 09
Mai 09
Juni 09
Juli 09
Aug. 09
Sep. 09
Pilot region Hessen:
4.474 GPs and
6.09 mio. inhabitants.
Market share AOK
ca. 40%
Subscriber AVplus:
180 doctors (limited
by AOK) and
8.093 patients
(Feb. 2010).
45 AOK diabetic or
risk patient per
doctor.
Four main patient groups
Riskpatients not recognized
by insurance31%
= 1.976 patients Diabetics not recognized by
patient, insuranceand doctor
2,6%= 166 patients
Not recognizeddiabetics
by insurance3,5%
= 223 Patienten
Diabeticsrecognized
by insurance 62,4%= 3.928 patients
Evaluation by
By means of CG-Software
(e.g. patient scanner, find-rik-
form) the doctors identify
1.976 diabetes high risk
patients and other diabetes
sub groups.
Trend analysis AVplus - cost savings andthe increase of quality
The medical care of
patients in the
programme is
fundamentally more
favourable than in
the usual diabetes
treatment.
The patients in the
programme live
longer than a
“normal” diabetes or
risk patient.
=> Improve quality
for less money!
Source: Dresden International University, Dresden, November 2009 , [patients from AOK aktiv + vital: n=4.760]
Benchmarks – high risk patients
0,0% 1,3%2,9% 3,6% 2,7%
4,6%
0,0%
37,7%
44,4%47,0%
50,9%
54,9%
0,0%
43,5%
48,4%
55,2%
63,9%
60,2%
0,0%
10,0%
20,0%
30,0%
40,0%
50,0%
60,0%
70,0%
ED Q1 Q2 Q3 Q4 Q5
BMI
RR syst
Triglyceride
Starting situation:
We looking at the development
of the benchmarks from all risk
patients who had started in the
AVplus program below the
benchmarks of BMI, blood
pressure (RR syst.) und
Triglycerid (ED 0,0%).
Result after a period five quarter:
60 % of the risk patients reach
the Triglycerid benchmark (below
200 mg/dl). 55% reach the
benchmark RR syst. below 135
mmHg and 4,6% reach the
target range BMI between14,5
und 24,5.
Q = 3 month
Benchmarks - diabetics
0,0%2,5% 2,2%
3,6% 3,7% 3,6%
0,0%
22,4%
27,8%
32,9%30,9% 31,2%
0,0%
35,4% 35,4% 35,8%34,6%
40,4%
0,0%
33,7%
44,6%
47,8%46,4%
53,9%
0,0%
10,0%
20,0%
30,0%
40,0%
50,0%
60,0%
ED Q1 Q2 Q3 Q4 Q5
BMI
HbA1c
RR syst
Triglyceride
Starting situation:
We looking at the development of
the benchmarks from all diabetics
who had started in the AVplus
program below the benchmarks
of BMI, syst. blood pressure (RR
syst.) und Triglycerid and HbA1c
(ED 0,0%).
Result after a period five quarter:
54 % of the risk patients reach
the Triglycerid benchmark (below
200 mg/dl). 40% reach the
benchmark RR syst. below 135
mmHg, 31 % the HbA1c below
7% and 3,6% reach the target
range BMI between14,5 und
24,5.
Q = 3 month
Matthias Leu
Vice President
CompuGROUP Holding AG
Maria Trost 21
56070 Koblenz - Germany
Telefon: +49 (0) 261 8000 1906
E-Mail: [email protected]