Operationalizing value in Chronic Care: The case of Swedish Rheumatology A research project involving Karolinska Institutet/Medical Management Center, Stockholm University School of Business, Karolinska University Hospital, Stockholm County Council and Harvard Business School.
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Operationalizing value in Chronic Care: The case of Swedish Rheumatology
A research project involving Karolinska Institutet/Medical Management Center, Stockholm University School of Business, Karolinska University Hospital, Stockholm County Council and
Harvard Business School.
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The cycle of disease: Rheumatoid Arthritis
REHAB- SERVICES
Lifestyle & self-medication
- SPECIALIST CARELAB TESTS
X-RAY
HOSPITALIZATIONS
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DAS28 (Disease Activity)
Time
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Disease cycle captured in the SRQ registry
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REHAB- SERVICES
Disease cycle captured in the SRQ registry
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Capturing the entire disease cycle
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Prioritizing measures based on the stage of the disease: defining two phases
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First phase of disease: reaching low or no disease activity
Early & aggressive treatment
Aims, phase 1
• Response by DAS28CRP or patients global
• Treatment to reach low or no disease activity
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Maintain low DAS28
•Aims, phase 2
•Low level of disease activity (Area under the curve, AUC), •Patient satisfaction with outcomes: trust in care, quality of life (EQ5D/QALY)
Second phase: long-term management and prevention
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Detect and curb flares
Second phase: long-term management and prevention
•Number, intensity and duration of recurrences (flares).
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RA outcome measures in the three tiers
Survival – Mortality Health / recovery – Patients global, EQ-5D, Work ability, Daily
function,DAS28, AUC Doctors global
Time to recovery – Time to remission, time to work ability regained
Disutility of care / Rx – Trust in care, Drug adverse events Continuity, empathy, access etc?
Sustainability of health / flares – Health / recovery AUC Long-term consequences of therapy – Patients global, EQ-5D,
Work ability, Daily function,DAS28, AUC Doctors global, adverse events, co-morbidities
Control for case-mix variables (gender, age, biomarkers, socio-economic status etc)