CITY OF ESPOO, FINLAND - (HealthTech Wire / PremiumPro) - Over the last couple of years, the city of Espoo, Finland, has implemented a digitally supported model of integrated care and self care with a special focus on the chronically ill. Recent data illustrates that this approach is highly cost-effective and markedly improves communication between patients and professionals.
- Finland’s second largest city implemented a digitally supported model of integrated care and self care with a special focus on the chronically ill
- Number of diabetes patients with an HbA1c of below 7.5% increased by 10% in 4 years
- “Self care support using a joint electronic information system not only improves care and management of chronic conditions, but also provides low-cost QALY gain”
With 250,000 inhabitants, Espoo is the second largest city of Finland. Around 40,000 of its citizens are on permanent medication due to some chronic disease. Espoo has been a forerunner in digital care for decades: “We switched from paper to an electronic health register system more than 25 years ago,” said Tuomo Lehtovuori, Chief GP of the city of Espoo, during a presentation at the European eHealth Week 2011 in Budapest last month.
In recent years, improving the care of chronically ill patients has been high on the city's agenda. A new integrated care model with a strong emphasis on self care was introduced. Patients were grouped into three categories: those who can manage their disease largely by themselves, those who need only a little support and those who require regular assistance. To fit the needs of the different patient groups, various digital tools have been made available through Tieto, the leading healthcare and welfare ICT provider, including services for self assessment and self monitoring and a transparent electronic patient record that not only stores data, but also works as a tool to improve communication between doctors and patients.
Self-care project with benefits for patients and professionals alike
Espoo self-care services and electronic health records are now available to patients on the internet, providing they meet certain authentication criteria (see www.espoo.fi/omahoito). The homepage is translated into three languages and explains the system carefully to patients. For self care, the site offers information in lay language on selected healthcare-related topics and on healthy lifestyle. There are several measurement tools available that help the patient to track, for example, BMI, waist circumference and blood pressure and to document the data in the EHR. Tools for risk assessment are also provided.
When it comes to the EHR, usability and understandability for the patients were main focus areas. “We need to change our culture and make things understandable for patients,” Lehtovuori emphasised. Both professionals and patients look at the same data. But there are different views on making it easier for patients to understand the EHR-content. A message center is an important part of the EHR: Here the patient can communicate digitally with and ask questions of his care givers. And the care givers can inform a patient about, for example, necessary changes in medication.
“Using this system we have been able to generate benefits for patients and professionals alike,” said Lehtovuori. Patients experience a better control of their chronic disease, and the number of unplanned office visits decreases considerably. Professionals, in turn, are better informed about what happens in between office visits. They can also improve their time management.
Highly cost-effective improvement in diabetes care
For diabetes, the effects of the digitally assisted Espoo chronic care model have been evaluated in more detail. Lehtovuori gave a brief insight into the data in Budapest. When the project started in 2006, 72% of the diabetes patients attained an HbA1c of below 7.5%, indicating a good control of glucose metabolism. Four years later this share had increased to 82%.
In the same time span, Hospital District of Helsinki and Espoo (HUS) medical department's monthly healthcare costs had decreased slightly. And, as Lehtovuori pointed out, this decrease in overall costs in the medical department correlates nicely with a marked decrease in hospital days per month of diabetics in the HUS district.
Based on a population of 6300 diabetic patients treated within the Espoo chronic care model between 2006 and 2010, the costs of a quality-adjusted life year (QALY) were calculated. A QALY is an established measure of disease burden that includes both quality and quantity of life lived. In health care economics, a treatment is usually considered cost-effective when costs per QALY are in the range of 20,000 to 50,000 Euros.
In the literature on diabetes, an average decrease in HbA1c-level of 0.5% leads to a reduction of complications and to an average increase of 0.3 QALY per person. Given that the Espoo Self Care Project generated total costs of 2 million Euros for the years 2006 to 2010, the average cost per QALY was as low as 1080 Euros. “This shows that self care support using a joint electronic information system not only improves care and management of chronic conditions, but also provides low-cost QALY gains,” Lehtovuori summarised.
Success needs information management and a close look at processes
For Arto Ryymin, Executive Vice President of Tieto’s healthcare and welfare business, the Espoo project is an excellent example of enlightened chronic care in times of increasing digitalisation and increasingly self-empowered patients: “Patients are not just objects for treatment anymore. They are active participants in and even masters of their own treatment. They can communicate with professional caregivers 24/7. They become free from the physical place restrictions: all that is needed is an internet connection. And they have access to key information, including their own EHR. This really is a paradigm shift.”
This shift, Ryymin argued, was only possible with tight integration of patient needs and professionals' work processes, enabled by integrated, intelligent and flexible information management to fulfill the needs of all those involved: “As an example, what patients get to see of their own health record is a carefully selected view of relevant documents presented in a way that is easy for them to understand.”
There are many challenges involved in adapting processes in a way that makes an integrated, digitally assisted care model possible. “Employment issues, legal issues, reimbursement issues and suchlike can slow down the development and even lead to resistance. And because of this, it can be tempting to find excuses not to move forward.” To gain acceptance among professionals, said Ryymin, it is critical that eServices do not lead to extra work but actually reduce workload. “Espoo is an excellent example of how this can be achieved to the benefit of all parties involved.”
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Source: HealthTech Wire
