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