Investing in Healthcare: breaking down

the silos

Brussels, 16 October 2013

With the endorsement of the Lithuanian Presidency of the Council of the EU

In partnership with the European Economic and Social Committee

Co-chaired by Antonyia Parvanova MEP & Gianni Pittella, Vice-President, EP

Follow us on Twitter @FfWEurope

Check our website www.fitforworkeurope.eu

Take a look at our blog www.blog.fitforworkeurope.eu

Professor Paul Emery and Professor Juan Jover

Social Return on Investment:

The results of the Early Intervention Clinic in Spain.

The concept of the Fit for Work Early Intervention

framework In Europe.

Rheumatic and Musculoskeletal Diseases

More than 200 diseases

• Joints

• Connective Tissue

• Spine

• Soft tissue

• Bone

High Disease Burden

• High incidence and prevalence

• Chronic course

• High use of Health System resources

• High impact in quality of life: Pain and Disability

Burden of diseases in Canada, 2000

http://www.phac-aspc.gc.ca/ph-sp/preveco-01-eng.php#fig1

Adapted from IHE, 2008; data from the Public Health Agency of Canada

Spain´s National Budget. 2005

20%

Musculoskeletal

Temporary Work Disability

Temporary Work Disability

Subsidies an Other Economic

Benefits of Social Security

10.000.000.000 euros

Health System Process

- Individual factors

- Collective

- Public Health

- Health Care System - Primary Care

- Specialized Care

- Inspection

Occupational Process

- Economic Activity

- Employers

- Unions

- Occupational Health Administrative Process

Social Security Institute

- Compensation

- Laws

- Control

- Fraud

- Inspection TWD

PWD What if…?

The complexity of Work Disability

Inclusion: 12 months Follow-up: 12 months

• Three health districts in Madrid

• Randomized study

• Voluntary program

• Patients maintained their group

• Intention to treat analysis

MSD-TWD Program (98-01)

• Early Intervention

• Protocolized clinical management

• Patient Education

• Self-management

• Administrative Duties

Control

Intervention

Results

• Days of TWD

• Patients with PWD

• Direct Costs

• Indirect Costs

• Cost/efficacy

• Cost/benefit

TWD initiation due

to MSDs

(13.000 non-

selected episodes)

Control Intervention

Days

0

25

50

75

100

0 30 60 90 120 150 180 210 240 270 300 330 360

% o

f p

atie

nts

ba

ck to

wo

rk

Research: a clinical approach to MSD-WD

• 39 % reduction of TWD duration (days)

• 50% reduction of PWD (cases)

• Increased patient satisfaction

• Positive Economic evaluation

• Decreased direct and indirect costs

• Benefit/cost at two years: 11 euros

• Extension of the Program (1998-2004)

• > 38.000 processes

• >1 million days off-work saved

Scientific Publications

Rheum Int . 2012 Dec; 32(12)3831-9

Rheum Int . 2011 Dec; 31(12) 1549-54 Diagnostic concordance between primary care physicians

and rheumatologists in patients with work disability related

to musculoskeletal disorders.

Candelas G, Abásolo L, León L, Lajas C, Loza E, Revenga M,

Bachiller J, Collado P, Richi P, Blanco M, Jover JA.

Prognostic Factors for Long-Term Disability Due to

Musculoskeletal Disorders LYDIA ABÁSOLO, LETICIA LEÓN, LORETO CARMONA, CRISTINA LAJAS, GLORIA

CANDELAS, MARGARITA BLANCO, AND JUAN A. JOVER1

Policy Makers and Administrators

• Senate

• Ministry of Health

• Autonomous Communities

Social Security and Labour

• Nat. Institute of Social Security

• Employers, Unions, Occ. Health

Health Professional Body

• Spanish Society of Rheumatology

• Primary Care Societies

• NHS Inspection Services

Dissemination and Partnerships

National Rheumatic and Musculoskeletal

Diseases Strategy

TWD Early Intervention Programs

Policy Makers and Administrators

• Senate

• Ministry of Health

• Autonomous Communities

Social Security and Labour

• Nat. Institute of Social Security

• Employers, Unions, Occ. Health

Health Professional Body

• Reumatology Units

• Primary Care

• NHS Inspection Services

FfW early intervention clinics

Dissemination and Partnerships

FfW Early Intervention Clinics

Efficacy 32%

Efficacy 27%

Health

Service

Research

Access Health

Results Health Care Reengineering

Very early Specific and Specialized Decreased

TWD-PWD

TWD

FfW EIC Concept

Professor Paul Emery

FfW Early Intervention

European Task Force

European Early Intervention for RMDs

Task Force Working Group

• Chaired by Professor Paul Emery and Professor Juan Jover

• Membership applies to European clinicians committed and interested

in developing early intervention programmes/clinics in their country for

people with RMDs

• Secretariat: Patient Central contracted by The Work Foundation

• Current Membership: Professor Emery (UK), Professor Jover

(Spain), Professor Matucci (Italy), Professor Faustino (Portugal),

Professor Fitzgerald (Ireland), Dr Steve Brennan (UK)

Task Force

Purpose and short-term objectives

• Support the production and expert endorsement of material that allows

the development of early intervention for RMDS:

• Produce Evidence Base (in short-term based on Spanish early

intervention programme with input in longer term from UK model)

• Clinical and financial analysis of Jover data: Key principles, learnings

and outcomes

• Collation and analysis of data and activity from wider Spanish Early

Intervention Programme

Early Intervention Toolkit

For clinicians interested in setting up EI clinics:

• The rationale for early intervention – key principles

• How to set-up early intervention clinics – lessons from

Spain and UK

• Further elements to be informed by:

- The Working Group’s meeting at EULAR 2014

- Follow-up from Summit and FfW ambassadors – their needs

Early Intervention Clinic Principles

• Rapid referral

• Rapid assessment

• Expert assessment:

- Confirm diagnosis

- Confirm appropriate management

- Simple intervention for 90% of patients referred

- Patient education and engagement

- Early discharge to return to work

Model: Early Intervention for RA

• Early intervention now established as effective in

preventing disability and work loss

• Early arthritis clinics routine

• Ambition remission-induction

• Disease prevention now on agenda

Effect of RA Disease Duration on

Inflammation and Function

Interventions

Time

Severity

Inflammation

Function

Emery P. Ann Rheum Dis. 1995;54:944

Early Intervention: UK

Introduction

• Project to

• demonstrate early intervention reduces work disability

in musculoskeletal patients

• demonstrate early intervention improves patient

outcomes and increases patient satisfaction

• deliver unique UK data on early intervention and work

disability to drive a cost-effectiveness model

• deliver a model for treating high volume

musculoskeletal problems and associated work

disability

Enhancing the MSK Service: Leeds

Current Service

Leeds Musculoskeletal Service receives 25,000 referrals

per year; 90% are seen by physiotherapists.

• Accessed by three CCGs (450 GPs in Leeds)

• 6-8 weeks waiting time to see a physiotherapist

• No strict criteria or protocols relating to referral – based

on GP judgement

Enhancing the MSK Service: Leeds

Enhanced service

• Rapid confirmation of diagnosis (within 5 days of being signed

off sick)

• Rapid assessment and initiation of appropriate management

(within 5 days of being signed off sick from work)

• Earlier and structured initiation of patient education, self-

management/coping strategies plan

• Provision of simple, psychological assessment

• The small numbers who may need further specialist assessment

and investigations will get earlier referral

• Discharge plan based on fit for work status or permanent disability

Enhancing the MSK Service

in Leeds

GP

Refers on first

issue of unfit to

work certificate

(Med 3)

Cohort

Randomised

1,500

Level 2

Formal

Rehabilitation

Diagnostics

4-8 weeks ( 3 )

Level 3

Diagnostics

Onward Specialist

Referral

Level 1

750

Education, Self

management,

basic investigations

4-6 weeks ( 2 )

Control

Group=750

Permanent Disability

Return to work

Permanent Disability

Return to work

Permanent Disability

Return to work

Enhancing the MSK Service in Leeds

Local-Buy In and Project Steering Group

• Service Enhancement Project Steering Group formed (supported by

the Director of Public Health, Dr Ian Cameron). A process of

stakeholder engagement undertaken to identify and confirm support

and contribution of the necessary collaborators to deliver project

• Managerial Representatives of Leeds Community Health Care Trust

• Transformational Lead for 3 CCGs in Leeds – Dr Chris Mills

• Clinical Lead: Dr Steve Brennan

• Academic Lead: Professor Paul Emery

• Project Lead: Rhonda Siddall

Project Phases

Phase I:

Configuring an enhanced service

Phase II:

Delivering an enhanced service

Phase III:

Assessing the value of an

enhanced service

Phase IV:

Producing the service

enhancement model template +

communicating the results

Phase II: Delivering an enhanced

service

Service Model:

• 6 dedicated clinics per week over 2-3 sites owned by Leeds

Community Healthcare Trust

• Clinics run by MSK Physician Steve Brennan (Leeds Community

Healthcare Trust)

• IT and Administrative Support Provided by Leeds Community

Healthcare Trust

• Service Data System compatible with GP system (System 1) via a

shared access agreement

Phase III: Assessing the value of

an enhanced service

• Project Period: 18 months

• Number of Patients: 750 (compared to control group of 750;

control managed by GPs)

• Process:

- Data Capture: Integrated System 1

- Interrogation and Analysis: done by Leeds Community Healthcare Trust and

Dr Steve Brennan

• Outcomes Assessed:

- Impact on temporary work disability (TD)

- Impact on permanent work disability (PD)

- Patient Satisfaction

- Impact on onward referral and investigation costs

Thank you for attending the Fit for Work

Summit 2013.

Follow us on Twitter @FfWEurope

Check our website www.fitforworkeurope.eu

Take a look at our blog www.blog.fitforworkeurope.eu