the “help” program introducing case management approaches to hiv services in lithuania professor...

The “HELP” program

Introducing case management approaches to HIV services in Lithuania

Professor Malcolm WhitfieldSheffield Hallam University, UK

The problem

• Potentially fatal disease• Potentially vulnerable patient groups• Potential public health risk• Potentially catastrophic effects from

poor adherence to treatment• High cost

The complex case

• Physical needs• Psychological needs• Social needs• Spiritual needs

The healthcare continuum

Well

Population Health Management

D i s a b l i n g C o n d i t i o n sD i s a b l i n g C o n d i t i o n s

85% population = 15% cost85% population = 15% cost

At RiskAcuteIllness

Chronic Illness

Complex Care

• Complex Case Management

• Predictive Modeling

• Health Advice• Social support• Psychological

support• Expert patients• Treatment

• DiseaseManagement

• Empowering Education/ Support

• Preventing complications

• Health Risk Assessment

• Lifestyle Modification Programs

• Prevention• Screenings

15% population = 85% cost

Disease Management

Risk/Cost stratification

Primary Care

Intermediate Care

Hospital Care

Self & home carePrevention

General public services

GP CareTreatmentDiagnosis

Step downRehab.Rapid responseRespite care

Am

bula

tory

car

e

Diag

nostic services

Elective

Acute

Walk-Self Care

Primary Care

Intermediate Care

Hospital Care Emergency Care

Self & home carePreventionSocial services

Family Doctor CareTreatmentDiagnosis

PalliativeRehab.Rapid responseRespite care

Am

bula

tory

car

e

Diag

nostic services

Elective

Acute

Social care

Population Risk Stratification

Cost £

Current Service Settings

1%Episodic

Care

15% Disease Management

14% CaseManagement

10%

15%

25%

50%

70% Population Health Management

Intra-organisational networks

Two areas of research literature:

• Social network analysis – (organisations)

• Team working – (individuals)

Mapping the literature

Networks TeamsIndividual performance in Organisational networks

Individual performance in team networks

Organisational performance in Inter-organisational networks

Team performance in intra-organisational networks

The organisation of organisational networks

The organisation of team networks

The organisational of inter-organisational networks

The organisation of intra-organisational networks

Examples of initiatives

• Joint assessment protocols• Referral criteria • Rapid response agreements• Care pathways• Treatment protocols• Case conferences• Joint management• Formal co-ordination

Formal networks in the UK

• Cancer networks• Cardio-networks• Sexual health networks• Child protection networks

Key features

• Devolved decision making• Pooling of resources• Common goals• Shared learning and organisational

development• Formal co-ordination and

management

Objectives of the program

• To introduce the core aspects case management• To promote a significant emphasis on prevention both

of infection and re-infection • To develop inter-disciplinary, inter- organisational and

inter-agency working / collaboration• To improve the quality of life of people who are

infected along with their family and friends

Participants

• 60 participants in total allocated to teams of around five people

• Where possible teams were multi-disciplinary with a combination of practitioners from policy, health and social care functions

• All team members were expected to participate in all activities

• Graduation from the programme was dependant on the successful completion of a project

The development process

• Time was allocated in each module for work on projects

• Faculty members were be available during these sessions to give advice and support as requested

• A randomly selected number of teams were expected to present their progress at the end of each module

• All projects will were made available to all participants at the end of the course as a learning resource

Project Work

• Defining the problem• Setting the project goals• Finding information (literature searching)• Implementation (application of tools or

techniques)• Evaluation• Conclusion

Example project topics

• Developing a multi-disciplinary assessment tool for use by all members in the team

• Adapting a quality of life measurement tool for use in monitoring service impact

• Developing a patient satisfaction tool for evaluating service quality

• Designing a case management protocol advising practitioners on the most appropriate local resource for specific problems