IBD: optimising the patient pathway

98 Pages·2016·3.02 MB·English

Optimising the Patient Pathway:
Perspectives on the Principles of High-Quality Care in Inflammatory Bowel Disease
Findings from Australia, Japan and South Korea
© 2015 KPMG LLP, a UK limited liability partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity. All rights reserved.
GBL/HUG/1015/0697 0
This study was commissioned and solely funded by AbbVie as part of their QUANTUM initiative.
AbbVie had no role in the design and conduct of the study, collection, management, analysis and
interpretation of data, or preparation, review and approval of this report.
© 2015 KPMG LLP, a UK limited liability partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity. All rights reserved.
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CONTENTS
4 19 25 66
EXECUTIVE SUMMARY OUR APPROACH KEY FINDINGS DETAILED SITE VISITS
The Royal Adelaide Hospital –
Australia 67
St Vincent’s Melbourne –
Australia 72
Fukuoka University
Chikushi Hospital –
Japan 77
Toho University
Sakura Medical Centre – Japan 82
Asan Medical Centre –
Korea 87
Yonsei University
Severance Hospital –
Korea 92
© 2015 KPMG LLP, a UK limited liability partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity. All rights reserved.
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Glossary
ASC Acute severe colitis SC Subcutaneous
CT Computed tomography SMS Short message service (text message)
ED Emergency department TUSMC Toho University Sakura Medical Centre
EMR Electronic medical record TB Tuberculosis
Europe Europe and Canada UC Ulcerative colitis
& Can
YSUH Yonsei Severance University Hospital
FTE Full-time employee
GI Gastrointestinal
GP General practitioner/primary care physician
HCP Healthcare professional
IBD Inflammatory bowel disease
IBS Irritable bowel syndrome
IT Information technology
IV Intravenous
MDT Multi-disciplinary team
ME Middle East countries: Dubai, Kuwait, Qatar
and Saudi Arabia
MRI Magnetic resonance imaging
RAH Royal Adelaide Hospital
© 2015 KPMG LLP, a UK limited liability partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity. All rights reserved.
© 2015 KPMG LLP, a UK limited liability partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity. All rights reserved.
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EXECUTIVE
SUMMARY
© 2015 KPMG LLP, a UK limited liability partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity. All rights reserved.
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EFXIRESTC SUYTMIPVTEO MSSUMMARY
DIAGNOSIS
Several sources were used to meet the objectives of this project
Build on themes developed during Vita 1
BUILD ON THEMES INTEGRATION PATIENT AGE APPROPRIATE PSYCHOLOGICAL
OF CARE CENTRICITY CARE SUPPORT
IDENTIFIED IN PREVIOUS
REPORT FROM EIGHT CENTRES
MULTIDISCIPLINARY REGIONAL EDUCATIONAL TEAM MORALE
ACROSS EUROPE & CANADA APPROACH NETWORKS FOCUS AND CULTURE PROJECT OBJECTIVES
Building on our previous
RESEARCH AND INNOVATIVE TECHNOLOGY work, develop a thorough
CLINICAL COLLABORATION MODELS
understanding of the
Visit sites in Australia, Japan and South Korea
IBD patient pathway
in different areas of
INITIATION OF MAINTENANCE
VISIT TWO SITES EACH IN Royal Adelaide the world
TREATMENT Hospital
AUSTRALIA, JAPAN & Reflect specific findings
SOUTH KOREA of the IBD patient
pathway from sites in
Inflexion points along the patient pathway
Australia, Japan and
South Korea
SURGERY MANAGEMENT  Identify examples of
OF FLARES successful interventions
MAP THE PATIENT along the IBD patient
PATHWAY & RELEVANT CONTINpUatOhUwSa yP ATIENT CARE
INTERVENTIONS
© 2015 KPMG LLP, a UK limited liability partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity. All rights reserved.
© 2015 KPMG LLP, a UK limited liability partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity. All rights reserved.
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During our first project in Western Europe and Canada we developed three main themes
of great care, which contained several sub-themes
PATIENT-
CENTRED CARE INTEGRATION PATIENT AGE APPROPRIATE PSYCHOLOGICAL
OF CARE CENTRICITY CARE SUPPORT
COLLABORATIVE APPROACH
MULTI-DISCIPLINARY REGIONAL EDUCATIONAL TEAM MORALE
APPROACH NETWORKS FOCUS AND CULTURE
FORWARD-THINKING
MINDSET RESEARCH AND INNOVATIVE TECHNOLOGY
CLINICAL COLLABORATION MODELS
© 2015 KPMG LLP, a UK limited liability partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity. All rights reserved.
© 2015 KPMG LLP, a UK limited liability partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity. All rights reserved.
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We have now added to these themes based on our wider experiences from additional
centres in Australia, Japan and South Korea
Sub-themes refined based on
centre visits in 2015
PATIENT-
CENTRED CARE INTEGRATION AGE-APPROPRIATE PSYCHOLOGICAL
CULTURALLY
OF CARE CARE SUPPORT PATIENT CENTRICITY APPROPRIATE CARE
COLLABORATIVE APPROACH
MULTI-DISCIPLINARY REGIONAL EDUCATIONAL TEAM MORALE PEER -TO-
APPROACH NETWORKS FOCUS AND CULTURE PEER CHALLENGE
FORWARD-THINKING
RESEARCH AND INNOVATIVE MODELS TECHNOLOGY FOR TECHNOLOGY FOR
MINDSET CLINICAL COLLABORATION PATIENTS CENTRES
© 2015 KPMG LLP, a UK limited liability partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity. All rights reserved.
© 2015 KPMG LLP, a UK limited liability partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity. All rights reserved.
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We have refined our insights on patient-centred care, in particular in terms of the role of
culture and how it can influence patient centricity and psychological support
PATIENT-CENTRED CARE
PATIENT CENTRICITY CULTURALLY APPROPRIATE CARE PSYCHOLOGICAL SUPPORT
 Great care has to go beyond being  Perhaps most notably in Japan, we  Addressing the psychological aspects
patient-centred, and truly empower recognised that great care is not only age of IBD care remains a key theme of
patients to be active partners in their appropriate but also culturally good care
disease management appropriate  Culturally, psychological support can be
 However, the degree to which patients  Culture can have a strong influence on very hard to accept
want to influence decisions about their the expected roles of the doctors, nurses  In South Korea, the stigma of accepting
care does vary depending on culture and other IBD team members psychological support prevents many
 For example, Australian patients tend to  Patient behaviours are equally influenced patients from formally engaging with this
want to be involved in treatment by cultural backgrounds, in particular aspect of care
decisions whereas Japanese patients the willingness to share symptoms  This means that it becomes even more
may want their doctor to make decisions openly with a treating doctor and the important that the IBD team address
on their behalf acceptance towards psychological care any psychological issues as part of
– Patient centricity in Japan is,  This has implications for both patient their somatic treatment interactions
however, demonstrated by their use empowerment and psychological with patients
of publications that rank the support
quality of the care delivered by
specialists to enable patients to
select the best doctors
© 2015 KPMG LLP, a UK limited liability partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity. All rights reserved.
© 2015 KPMG LLP, a UK limited liability partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity. All rights reserved.
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We collected additional insights on the theme of collaborative approach including MDT
interactions and the culture of peer-to-peer challenge within the IBD team
COLLABORATIVE APPROACH
TEAM MORALE AND CULTURE PEER-TO-PEER CHALLENGE
 Team morale stems from a culture of mutual respect and  A strong team morale and collaborative culture enables doctors
collaboration between colleagues and nurses to provide respectful peer-to-peer challenge to
 Different strategies have been observed when it comes to their colleagues
facilitating collaboration between different specialists  Furthermore it guarantees a high standard of care and enables
 Of key relevance is to create an ambience of trust that enables a team to go through a continuous learning and quality
specialists to have regular ad-hoc consultations with each other review process
 However, the degree of formality when interacting with  Peer-to-peer challenge is considered a key element in delivering
colleagues varies between countries, e.g.: patient-centric care across different countries, but differences
– Japanese and South Korean specialists prefer to be between countries can be observed
formally consulted and invited for multi-disciplinary team  For example, in South Korea many hospitals have a formalised
meetings, whereas Australian doctors adopt a more peer-review process that doctors consider a key reason for their
informal approach success in becoming a leading IBD centre
 However in Japan and Australia peer-to-peer review is less
formalised and often takes place spontaneously
© 2015 KPMG LLP, a UK limited liability partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity. All rights reserved.
© 2015 KPMG LLP, a UK limited liability partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity. All rights reserved.
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