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• W201219991 abstract "Introduction/problem descriptionOne of the major problems in health care is the lack of coordination between hospitals and follow-up care.They work independently, which results in fragmentation and inefficiency (van der Linden, et al., 2000).Integrated care focuses on the cooperation between caregivers and is specified as: care attuned to the needs ofthe patient, provided on the basis of cooperation between primary and specialized caregivers, with sharedoverall responsibility and the specification of delegated responsibilities (National council for public health &National board for hospital facilities, 1995). Managing the cooperation between those various caregivers is areal challenge. In Medisch Spectrum Twente (MST), patients deal with long access times to follow-up care aftermedical treatment in the hospital.ObjectiveIn this study we focus on one specific patient group: hip fracture patients who need short term rehabilitationcare after medical treatment in MST. The study focuses on hospital MST and nursing homes AriensZorgpaletlocation Eschpoort (AZP Eschpoort) and Zorggroep Sint Maarten location Oldenhove (ZGS Oldenhove). Weprovide a detailed description of the integrated care process of hip fracture patients at MST and at the nursinghomes, identify and analyze factors that influence the integrated care process and access time to follow-upcare, and formulate recommendations.ApproachWe base our process description mainly on interviews with the involved employees. The performance analysisis based on data collection from four databases: X-care, Transferpunt database, and databases of the twonursing homes. The data spans the period January 2008 to August 2009. The process and performance analysisconsiders 8 phases: patient arrival at MST, admittance, treatment, post treatment, discharge from MST,admittance into nursing home, rehabilitation, and discharge from nursing home. From this process descriptionwe identify process factors that negatively influence the integrated care process. To predict medical treatmentduration in the future, we describe characteristics of hip fracture patients that influence the integrated careprocess: functional decline, delirium, malnutrition by using three measuring instruments: Identification ofSeniors at Risk (ISAR), Delirium Observation Scale (DOS), and Short Nutritional Assessment Questionnaire(SNAQ). We also describe the age of patients related to the medical treatment duration in MST and the lengthof stay in the nursing homes. To categorize the bottlenecks and the corresponding recommendations wepropose a planning and control model that addresses three main areas of integrated care: demand planning,information and communication coordination and network coordination.Results287 (60% at the surgery- and 40% at the orthopaedic department) hip fracture patients are admitted in 2008,and 208 (66% at the surgery- and 34% at the orthopaedic department) in the period of January to august 2009.3Of the 287 admitted patients, 153 patients (53%) are applied for short term rehabilitation care after medicaltreatment in MST. Of the 208 admitted patients, 118 patients (57%) are applied.Hip fracture patients are mostly elderly people with multiply care problems. According to the ISAR-score, 92%of the screened patients are regarded as vulnerable. The DOS-score shows that for 26% of the screenedpatients symptoms of delirium are present. Malnutrition, tested by SNAQ-score, is present for 21% of thescreened patients. All those percentages of the hip fracture patients are higher than the percentages of otherpatients treated by the surgery and orthopaedic department.MST strives to apply patients within 2 days after arrival at the hospital. The time to apply a patient for shortterm rehabilitation care from the moment of admittance takes too long. The average registration time is 8.05days in 2008 and 6.23 days in the first eight months of 2009 for all hip fracture patients applied for short termrehabilitation, due to lack of routine for nurses.MST strives for medical treatment duration of 6 days. In 2008, the average medical treatment for all hipfracture patients applied for short term rehabilitation takes 12.13 days. In 2009, this takes 10.02 days. MST hasno univocal criteria to assess whether a patient no longer needs medical treatment. The rehabilitation time innursing homes varies highly from 11 days to 485 days. Patients at nursing home AZP Eschpoort in general needshorter rehabilitation time than patients at nursing home ZGS Oldenhove. However, patients from ZGSOldenhove are mostly discharged to their home and patients from AZP Eschpoort are sooner transferred toother types of care.For a proper information flow between the various caregivers a proper information system is required. In theintegrated care process MST uses two main database systems: X-care and Transferpunt database. Transferpuntdatabase is a separate system to arrange follow-up care for patients after medical treatment in MST.Unfortunately those systems cannot be linked, which results in evaluating problems when describing the wholeprocess from admittance in the hospital till discharge to follow-up care. Within the Transferpunt database atotal overview per diagnoses group is not available. One can only search per follow-up care type. The systemsrequire manual data entry. As nursing homes are typed in many different ways, analysis becomes very difficult.There are insufficient beds for patients who need short term rehabilitation care at a nursing home. During thewriting of this report, MST and AZP Eschpoort have been negotiating about reserving a number of bedsespecially for hip fracture patients discharged from MST. Only the number of required beds is not known. Wehave proposed a simulation model that can be used to analyze the optimal number of beds.RecommendationsHip fracture patients face high variability in the duration of medical treatment as a result of age, physicalcondition, and other health problems. Creating homogeneous sub groups by evaluating and monitoring thecharacteristics of patients following the clinical pathway can lead to a better prediction of the duration ofmedical treatment in the hospital as well as the rehabilitation time in nursing homes.4To use criteria to determine what type of follow-up care a patient needs.To determine rules for the moment a patient needs to be applied for follow-up care.To use control instruments to determine whether application of a patient for follow-up care is actuallyapplied and as a result reduces the time for registration.To implement drop-down-lists to create an overview per patient group and reduce manual input of data.This improves the possibility to evaluate and monitor the data.We propose a simulation model to analyze the optimal number of beds that must be reserved for hipfracture patients discharged from MST. We have implemented two strategies: with blocking and noblockingo With blocking, in case no bed is available, the patient will be directly applied to another careorganization. Reserving 33 beds for hip fracture patients at AZP Eschpoort leads to a bed occupation of81.47% for AZP Eschpoort, and only 3.72% of the patients are refused and must be discharged to otherfollow-up care organizations.o No blocking, regardless of availability of beds, all patients wait for discharge to AZP Eschpoort.Reserving 36 beds for hip fracture patients at AZP Eschpoort leads to a bed occupation of 78.08% forAZP Eschpoort and only 4.4% of the patients must wait for an available bed.To use a planning and control model to determine at what management level and management areabottlenecks are present. Management action is first of all mainly required on the tactical level and thedecision made on the tactical level must be followed-up on the operational level. This concerns medical,demand and information coordination planning. Network coordination planning is an importantmanagement area in the future, when collaboration between MST and AZP Eschpoort is started." @default.
• W201219991 created "2016-06-24" @default.
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• W201219991 date "2010-01-01" @default.
• W201219991 modified "2023-09-26" @default.
• W201219991 title "Optimization of the integrated care process of hip fracture patients at Medisch Spectrum Twente" @default.
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