IMPLEMENTING VALUE BASED STROKE CARE

AT VALL D’HEBRON HOSPITAL IN SPAINMartinez-Ibañez V. Cossio-Gil Y. Gutierrez–San Miguel M. Watson C. Molina C. Borrás B.

Peña C. Cortés S. Aurin E. Romea S. Ochoa de Echagen A.

Hospital Universitario Vall d’Hebron

Context / Background

Vall d’Hebron and the

European Alliance of university

hospitals (EUHA) working

together to improve results

that matter to the patients in

Europe.

2. Economics department calculated

the costs.

3. BI department set up a platform

that automatically distributes

allocates the right PROMS at the

right moment. Also a dashboard in

which the IPU will lean on was built

(administrative data, workflow

metrics, clinical outcomes and

case-mix variables were integrated

in our Electronic Medical Record

Vall d’Hebron is committed to gradually implement VBHC in order to

improve the quality of care as well as lowering costs, and we look

forward to maximising patients’ wellness by sharing experiences

and challenges.

What did we do?

• The pathway re-organization has allowed a better team

coordination and communication, procedures standardization,

eliminating non value tasks and enhancing professional’s

satisfaction.

• At the moment, the IPU clinicians are using the PROMs results on

Impact of changeWe started this project on September 2017 and followed our VBHC

stroke roadmap:

Europe.

The CHECK PHASE started and

were based on monthly meetings

of the working group to keep on

feeding the continuous

improvement and watching how

the patient outcomes react to the

changes in the pathway

The ACT PHASE consisted in assessing all the

projects for improvement in order to improve all

the PROMs and PREMs. PDCA cycles.

in our Electronic Medical Record

(EMR)

4. Communication department led

the patients session.

• Cultural change to integrate a Value-based healthcare (VBHC)

clinical practice is essential to success. For that, all pathway

changes need to be proposed from the care practitioners and

been led with change management methodology.

• The Board of Directors support is imperative from the start.

• As we are dealing with outcomes that matters to patients,

patients must be included as active agents in the design of the

pathways , outcome set and project follow-up.

• Information Technology support is essential for the successful

implementation of VBHC.

• The design of data visualization, built in a co-creation process

with de IPU, is essential for integrate the use of PROMS in the

routine care

Lessons learned

• At the moment, the IPU clinicians are using the PROMs results on

the follow-up clinical visits; this may potentially increase the

shared decision-making perception while patient engagement is

being fostered.

PLAN PHASE consisted in naming a Stroke pathway leader and

setting up a multidisciplinary stroke working group where all the

profiles were represented.

0 2 4 6 8 10 12 14

Alteraciones en la marcha

Limitaciones en la …

Problemas laborales/ en la productividad

Dificultades para realizar deportes …

Poblemas en la vida sexual/ de pareja

Depresión

Soledad

Alteraciones de la Sensibilidad cutánea

Desórdenes de movimiento

Incontinencia urinaria

Alteraciones del gusto

Problemas cognitivos (memoria, …

Cambios en la apariencia física

Fatiga física

Caídas

Miedo a la dependencia a la medicación

Miedo a la dependencia a la atención …

Rabia/ frustración

Pérdida de privacidad

Influencia calidad asistencial Impacto en el paciente Frecuencia

In the DO PHASE several departments of

the hospital started to work on:

1. Process Department made a training

workshop on value based pathway

re-design, VSM, new STD of care,

PROM&PREM questionnaire

selection session (based on the

outcome from the patients sessions)