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  • Barcelona, February 23th 2016

    Why clinicians should take into account patient experience?

    Joan Escarrabill, MD PhD

    Chronic Care Program. Hospital Clnic (Barcelona)

    Master Plan for Respiratory Diseases (PDMAR) & Home Respiratory Therapies Observatory (ObsTRD). FORES. Ministry of Health (Catalonia)

  • 2

    J A Muir Gray. Lancet 2013;382:200-1

    Effectiveness

    Quality

    Safety

    Value

    Paradigm shifts

    Decisions for the patient, without

    the patient

    From the patient's

    perspective

    The driver is the patient, not the doctor

  • 3

    Shifts are more likely to result from new ways of

    thinking rather than new technologies

    J A Muir Gray

    J A Muir Gray. Lancet 2013;382:200-1

  • 4

    Value =Outcomes

    Cost

    NEJM 2010;363:2477-81

  • Outcomes that mattered to patients

    5

    Clinical status Functional status

    Survival curve Lab tests

    vs

    Disabilities / Disutilities Cognitive disorders

    Time Full health care process (medical conditions), not isolated procedures

    A good car without wheels is useless

  • 6

    Wolf JA et al Pat Exp J 2014;1:7-19

  • How can clinicians usethe patient experience?

    7

    1 2 3Service design Patient empowermentQuality (Value)

    Information Education Life style Shared decision BMJ 2015;350:g7714

    lack of evaluation of other approaches makes comparisondifficult

  • Immediateresponse

    As in the treatment of postoperative pain

    Collecting data on patient experience is not enough: they must be used to

    improve care

    8Adapted from G Antoja & J Escarrabill

    Looking back

    Identify opportunities for improvementPrioritizing

    Define key questionsMonitoring

    Systematic

    New actions

    A Coulter. BMJ. 2014;348:g2225

  • Patient experience: focus groups

    9

    Long-term oxygen therapy

    Arch Bronconeumol 2015 (in press)

    Continuous subcutaneousinsulin infusion (CSII)

    Improve educational strategy and adapt the pace of learning

    Recommendations to manufacturers

    Psychological impact

    Impact in daily life

    CPAP for sleep disorders

    Low participation in decision-making

    Good information from nurses

    Bariatric surgery

    Psychological aspects

    Adapt the educationalprogramme to surgery time

    Sedation in gastric endoscopy

  • 10

    XPA-Patient Experience (Barcelona) is a community ofpractice (CoP) to:

    Share knowledge.

    Promote cross-disciplinary projects (use cases).

    Identify and define an ICT model to collect thisexperience objectively.

    Learning from best practices.

    With the support:

  • Challenges

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    1 The role of technology

    2 What do we mean by participation?

    3 How to involve all health professionals?

    Cultural alignment = We are all caregivers

    Everyone Must Participate, Even the Doctors

  • The Emancipated Consumer

    12

    Driverless cars and Doctorless Patients?

    Patients will play a crucial role in the acceleration of changes

  • Health Care organizations should play as Barcelona FC

    13

    SimpleAuthomatic

    Good enough

  • Thank you very much for your atention

    14

    ESCARRABILL@clinic.ub.es

    @jescarrabill

    @XPA_BCN

    mailto:ESCARRABILL@clinic.ub.es