Ruben Diaz, MD, PhD Secretary General

European Childrens Hospital’s Organisation (ECHO)

The Smart Specialised Paediatric Hospital of the

Future

16th May 2019 ERN Hospital Managers Mtg (Paris)

Conflict of interest

I have no actual or potential conflict of interest in relation to this presentation

Pediatric population is decreasing due to decreasing birth rates representing a smaller fraction of the population

Source: OECD 2018

Impact of population aging and increased incidence of chronic illness on healthcare spending puts the focus on allocating resources for the older population

Pediatric Hospital Model

Standalone Hospital University Hospital Pediatric Center

University Hospital Pediatric Center Standalone Hospital

Models of pediatric clinical care favor an environment amenable to children and their families in a setting where there is concentration of medical and nursing expertise

The evolution of a Children´s hospital

Concentration of pediatric tertiary care increases the overall complexity in

children’s hospitals

Impact of Rare Diseases

Rare Disease (RD) Patients vs. the remaining case load

0%

20%

40%

60%

80%

100%

Número de Pacients Utilització de Recuros

Resta

MM

Patients 8%

Resources 30%

Remaining Caseload RD

SJD Case Study

80% of rare diseases have a genetic component and often the diagnosis is made in childhood, placing the weight of diagnosis and clinical care in tertiary pediatric centers

Tertiary Care Profile (Present and Future)

Multidisciplinary clinical teams with high degree of

specialization Evidence-based medicine

focused on outcomes

• Training of pediatric medical and nursing specialists • New competencies in clinical care • Simulation methodology

Human Resources

• Lack of comparable peers within each EU country to benchmark operations and results adapted to pediatric care models. Need for pediatric hospital networking to compare operations and share best practices

• Development of well-established clinical and patient-reported pediatric centered outcomes.

Clinical Operations

• Introduction of patient experience metrics in the design and evaluation of clinical services

Patient/Family centered care

Infrastructures to accommodate for high

complexity and incorporate and evaluate different treatment

modalities

Tertiary Care Profile (Present and Future)

• Increase in high acuity spaces for complex care • PICU beds • Operating rooms

• Digitalization and development of AI capability to track and analyze patient data

Infrastructures

• Incorporate capacity for • Cell-mediated therapy • Gene therapy • High resolution imaging • ……….

• Value-assessment (Value-based care)

High Technology Treatments

• Development of clinical research units to run academic and pharma-sponsored clinical trials • EU-funded c4c platform

Clinical Research

Tertiary Care Profile (Present and Future)

Expanding referral area & outreach capacity

• Development of patient portals • Telemedicine

Patient Access

• Physician-Physician teleconsultations • High-level acuity telemonitorization

• ICU monitoring

Specialized Consultations

6.998 14.627

23.711 29.631

39.500

2,9%

5,8%

9,1% 10,7%

13,8%

0,0%

2,0%

4,0%

6,0%

8,0%

10,0%

12,0%

14,0%

16,0%

0

5.000

10.000

15.000

20.000

25.000

30.000

35.000

40.000

45.000

2014 2015 2016 2017 Prev2018

Highlights • Faced with a decreasing birth rate across Europe, tertiary care children’s hospitals

are consolidating their mission by concentrating complexity and expertise and becoming reference centers. A bigger challenge is financing the high cost of care for their patient mix within the different payment models across the EU.

• Diagnosis and treatment of rare diseases is a high cost enterprise

• Clinical care requires specialized clinical training highly in demand and often not easily available.

• Quality improvement and benchmarking requires collaborative work among peer hospitals of similar profile to identify best outcomes and help hospitals improve value. There is increased focus on improving patient experience as a measure of increase value for patients.

• By becoming tertiary care hubs, the implementation of high level technology can be cost-effective. A culture of innovation is promoted to improve clinical care.