Goaloriented care Setting the scene Pauline Boeckxstaens Jean

Goal-oriented care Setting the scene Pauline Boeckxstaens Jean Macq

THE TRAVEL AGENCY Afbeelding: wikimedia. org CC BY-SA 3. 0

THE HEALTH SYSTEM Afbeelding: wikimedia. org CC BY-SA 3. 0

30 conditions 439 indicators identified from the guidelines . 54. 9% compliance Quality indicators. Mc. Glynn EA, Asch SM, Adams J, Keesey J, Hicks J, De. Cristafaro A, Kerr EA. The quality of health care delivered to adults in the United States. NEJM 2003; 348: 2635 -45.

WHO SETS THE GOALS?

What if we agreed upon patientrelevant goals before considering possible strategies?

The need for a paradigm shift

WE NEED TO QUESTION OUR DEFINITION OF HEALTH 10

THE DEFINITION OF HEALTH? Abscence of disease State of complete physical, mental and social well being

Not only a story of negative modifiers.

The protective effect of a high a sense of coherence High SOC Low and intermediate SOC Boeckxstaens et al. A high sense of coherence as protection against adverse health outcomes in patients aged 80 years and older. Ann Fam Med. 2016 pag. 13

WE NEED TO CHANGE THE CONVERSATION 14

It’s not easy to identify patient goals

WE NEED A COMMON PHILOSOPHY OF CARE 16

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WE NEED TO BUILD OUR UNDERSTANDING OF GOAL ORIENTED CARE 18

Through the literature : Goal-Oriented Care Scoping Review

INCLUDED SCREENING IDENTIFICATION Scoping Review Records identified through database searching n = 18, 665 Records after duplicates removed n = 16, 976 Titles and abstracts screened n = 16, 976 Records excluded n = 16, 171 Full-texts screened n = 804 Full-texts excluded n = 591 Studies included n = 213

WITH PATIENTS AND PROVIDERS ON THE FIELD -> How can we change the conversation?

ASK DIFFERENT QUESTIONS AND BE CURIOUS

SUPPORTIVE TOOLS

CLOSELY RELATED STRATEGIES/PROCESSES OF CARE

WE NEED TO LEARN FROM EACH OTHER 30

The role of the health system

Go. C under a Belgian health system in transition Jean Macq UCL-IRSS Jean. macq@uclouvain. be

Go. C …. Not only a question of interaction « person » - provider

GOC will also depend of broader context • Belgian health (care) system is in transition • Improving « integrated care » is at the centre of different reforms • That raises questions at primary care level around: • The interprofessional collaboration and the place of lay-people, « patient » , person, … • The link between individual health/life and community health/development • The « position » on primary care with « secondary » / hospital care in the system • « Goal oriented care » could be put more « forward » in the reforms aiming at better intergrated care

Go. C in Belgian system in transition Example: • Project of reform • • Primary care Team? Or loose network of individual providers chosen by the person? Co. Ming (nurses and MD) P 3 (improving Qo. L for older frail people at home) • Settings: • • Maisons médicales Independant individual practionners Big nursing care organizations …. Provider of reference? Case manager? Proximity provider?

Go. C in Belgian system in transition Example: • Project of reform • Only individual health or combining community and individual health • Links individual curative (+ prev. And promotion) and community activities? • • Stop per capita payment in PC? Bundled payment and integreo « primary care » zones (territories) + neighboorhood approach Future of « territorialisation » in Wallonia

Go. C in Belgian system in transition Example: • Project of reform Centrality of PC in the system? • • • Gate-keeping role? Relation person – primary care – hospital and « secondary care » At home hospitals M-health ED reforms

GOC will also depend of broader context • Belgian health (care) system is in transition • Improving « integrated care » is at the centre of different reforms • That raises questions at primary care level around: • The interprofessional collaboration and the place of lay-people, « patient » , person, … • The link between individual health/life and community health/development • The « position » on primary care with « secondary » / hospital care in the system • « Goal oriented care » could be put more « forward » in the reforms aiming at better intergrated care

Goal oriented Care : Setting the scene Let’s summarize 1. Goal oriented care shifts the focus from what’s the matter with the patient to what matters to the patient 2. Goal oriented care asks for a paradigm shift 3. You can start tomorrow by beying curious and by asking other questions to your patient 4. We need to work together to find the strategies and tools and processes of care that are supportive to GOC 5. At the same time there needs to be attention to implementation and a change at the system level