Ambulatory and Primary Care Related Patient Groups (APR)

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1 Ambulatory and Primary Care Related Patient Groups (APR)

2 Defining products in ambulatory primary care APR based measurement of primary care activities helps us to evaluate the need of the population s s health care services allocate and organise resources efficiently APR groups all patient related activities to clinically meaningful entities Integrates the total process of care in each episode of illness covers the activities of all employee groups in primary care health centres

APR groups all patient related activities to clinically meaningful entities Integrates the total process

3 APR measures an episode of care APR encompasses a total process of care which may consist of several and separate activities of various professionals to cure a specific illness or health problem The pricing of APR based products is straightforward by summing up the costs of individual activities

professionals to cure a specific illness or health problem The pricing of

4 APR example: Hypertension Suspected hypertension First visit to registered nurse RR measurement at home Follow up visit to RN Pressure is still high 3 months Follow up visit to physician 1 month First visit to physician Follow up visit to RN Visits, encounters and activities= intermediate products

3 months Follow up visit to physician 1 month First visit to physician

5 Ambulatory and Primary Care Related Patient Groups VISIT TYPE and CHARACTERISTICS APR TM AGE and SEX ACTIVITIES Classification of activities (CAAP TM ): Physician Registered nurse Child and maternity clinics HC for school children Physiotherapy Mental care Occupational HC REASON for VISIT Classification of diseases (CDAP TM )* 42 classes *Possible to translate from ICPC and ICD 10

and maternity clinics HC for school children Physiotherapy Mental care Occupational HC REASON

6 Potential use of APR More detailed description of prevailing diseases, patient case mix and severity adjustments Description of treatment practices Productivity calculations and efficiency comparisons Evaluation of population based need for services Description of total episodes of care including specialized hospital (secondary and tertiary) care

calculations and efficiency comparisons Evaluation of population based need for

7 Further examples of APR use Productivity and treatment practise comparisons across employees, units and health centres Benchmarking Performance measurement in time series Productivity differences can be explained by looking more closely at the differences in treatment practices Allocation of resources and identification of required changes in the treatment practices

Productivity differences can be explained by looking more closely at the differences in

8 Further examples of APR use Evaluation of changes in the treatment processes Continuous monitoring of health centre performance APR grouping creates a natural basis for Cost accounting Measuring the effectiveness of care Identification of high risk patients

performance APR grouping creates a natural basis for Cost

9 Profile for disease groups Reasons for encounters in Jyväskylä city health centres at October and November 2002 Jyväskylän tk:n potilaskontaktit sairausluokittain Encounters loka marraskuussa 2002 Encounters Classification of diseases, CDAP PhysiciansR Potilaskontaktit nurses Total Classification of diseases, CDAP Physicians Potilaskontaktit R nurses Total Simple infections Sairausluokka, ASL TM Lääkärit Hoitajat Yhteensä Depression Sairausluokka, ASL TM Lääkärit 442 Hoitajat Yhteensä 442 Hypertension Verenpainetauti Muu Allergic tauti reactions tai sairaus Healthy Terve Nivelrikko Urethritis, cystitis or nephritis Skin Helppohoitoiset diseases infektiot Depressio Alcohol or drug abuse Diabetes wkomplikaatioineen ith or w ithout complications Muu Other neurologinen neurological sairaus diseases Injury, Oireet intoxication ja tarkemmin or määrittelemättömät poisoning oireistot Iskeeminen Blood or blood sydänsairaus organ diseases ja sydäninfarkti Other Ihosairaus musculoskeletal diseases Dementia Heart failure ja vanhuudenheikkous or other cardiac diseases Female Vamma genitourinary tai myrkytys diseases Veren Cardiac ja arrhythmia verta muodostavien elinten sairaudet Ear, Muu nose tuki ja and liikuntaelinsairaus throat diseases Sydämen Eye diseases rytmihäiriöt Symptoms Korva, nenä and ja other kurkkutauti non specific conditions Silmäsairaus Dementia or senility Gastrointestinal Muu endokrinologinen disorders sairaus Sydämen Neoplasms vajaatoiminta (malignant diseases) ja muut sydänsairaudet Mahavaivat Pregnancy, childbirth and complications of those Pahanlaatuinen Peripheral vascular kasvain disease Naisten Other endocrinological virtsa ja sukupuolielinsairaus diseases Aivoverenkiertohäiriö Life threatening infections Metabolinen Other diseases oireyhtymä or illnesses Lasten Stroke (thrombotic ja nuorten psyyken or haemorrhagic) ja kehityksen häiriöt Reuma Male genitourinary ja sidekudossairaus diseases Ääreisverenkierron Child psychiatric or sairaudet physiatric development disorders Selkä Metabolic ja kaularangan syndrome sairaudet Henkeä Other infections uhkaavat infektiot Krooninen Rheumatoid keuhkosairaus arthritis or connective tissue disease Muut Gall bladder tartuntataudit disease Päihteiden Chronic pulmonary väärinkäyttö disease Kehitysvamma Mental retardation ja epämuodostumat or congenital disorder Miesten Ischemic virtsa heart disease ja sukupuolielinsairaus including myocardial infarction Lonkkamurtuma Schizophrenia Allergiaoireet Back and neck diseases Skitsofrenia Complications of the perinatal period Muu Arthrosis psyyken sairaus Sappirakon Hip fracturesairaudet Virtsatieinfektio Other mental illnesses ja munuaistulehdus Perinataaliajan Total ongelmat

TM Lääkärit 4 034 Hoitajat 1 408 Yhteensä 5 442 Depression Sairausluokka, ASL TM Lääkärit 442 Hoitajat Yhteensä 442 Hypertension Verenpainetauti 51 404 360 11 2 873 356 16 4 233 760 Muu Allergic

10 Encounter comparisons Encounters due to hypertension in Jyäskylä city health centres at October and November 2002 KY KE HU KU SA Jkl tot. Visit type Visit Physician R P RN P RN P RN P RN Physici R characte nurse an nurse r istics Visit Emergency Visit First Visit Follow up Phone consultation Emergency Phone consultation First Phone consultation Follow up Total Encounters / 1000 habitants 14,1 32,4 21,8 33,9 45,0 11,5 10,4 22,8 14,9 30,3 19,2 28,5

11 8 1 338 189 Visit Follow up 194 625 354 914 31 77 69 328 25 96 673 2 040 Phone consultation Emergency 1 1 10 0 12 0 0 0 0 0 23 1 Phone consultation First 9 0 1 0 4 0 2 0 1

11 Comparing activities Activities (CAAP) by phys icians due to hypertens ion in Jyväskylä health ce ntres at October and Novem ber 2002 KY KE HU KU SA Jkl tot. Activities Number Index Number Index Number Index Number Index Number Index Number Index No activity , , ,3 70 2,4 32 9, ,2 New visit time scheduling 152 6, ,3 43 5,1 80 2,8 13 3, ,2 Prescribing or changing medication 162 6, ,5 53 6,3 96 3,3 20 5, ,1 Phone time scheduling 115 4, ,9 29 3,4 62 2,1 22 6, ,0 w orker 13 0,5 50 1,7 10 1,2 14 0,5 9 2,6 96 1,2 Large examination 8 0,3 46 1,6 0,0 11 0,4 2 0,6 67 0,8 Measurement during visit 5 0,2 31 1,1 6 0,7 5 0,2 0,0 47 0,6 Administrative procedure 11 0,5 14 0,5 5 0,6 12 0,4 1 0,3 43 0,5 Health education 12 0,5 17 0,6 1 0,1 3 0,1 3 0,9 36 0,4 Electrocardiography (emergency) 6 0,2 20 0,7 3 0,4 1 0,0 0,0 30 0,4 Patient monitoring 3 0,1 24 0,8 1 0,1 2 0,1 0,0 30 0,4 Consultation (other HC w orker) 7 0,3 15 0,5 2 0,2 3 0,1 2 0,6 29 0,4 Referral to private provider 3 0,1 20 0,7 1 0,1 3 0,1 1 0,3 28 0,3 Injection/ puncture / evacuation 1 0,0 15 0,5 2 0,2 8 0,3 0,0 26 0,3 Referral to specialist care 9 0,4 6 0,2 1 0,1 1 0,0 1 0,3 18 0,2 care 0,0 11 0,4 0,0 0,0 2 0,6 13 0,2 Therapeutic discussion 2 0,1 4 0,1 1 0,1 4 0,1 0,0 11 0,1 Total , , , , , ,4 Activities / encounter 2,4 2,3 0,7 2,3 2,1 1,9 Index = activities / 1000 inhabitants

5,1 80 2,8 13 3,8 586 7,2 Prescribing or changing medication 162 6,7 246 8,5 53 6,3 96 3,3 20 5,8 577 7,1 Phone time scheduling 115 4,8 257 8,9 29 3,4 62 2,1 22 6,4 485 6,0 w orker 13 0,5 50 1,7 10

12 Productivity comparisons Productivity of physician labour in Jyväskylä health center 2002 (October November) Unit Output Input Efficiency index(%) Increase/decrease potential in output Increase/decrease potential in input Case mix weighted visits Working hours for physicians (h) Output / input HU 2320,3 197, ,5 23,0 KJ 1194,3 114, ,4 25,0 KM 1733,7 121, ,6 9,0 KS 2816,8 179, ,4 32,2 KU 3376,6 254, ,0 1,4 KY 2445,9 174, ,4 8,9 LH 2851,5 209, ,2 4,3 NM 2041,2 178, ,3 25,0 SA 774,0 47, ,5 11,0

(h) Output / input HU 2320,3 197,0 88 271,5 23,0 KJ 1194,3 114,5 78 260,4 25,0 KM 1733,7 121,0 107 128,6 9,0 KS 2816,8 179,0 118 506,4 32,2

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