OSS…….. Berggraaf, Elizabeth…………………………. Kloof Lucien……………. Marelva Strijdhaftig………………………… Dennis Caffe………………
Cure is still what we do, but the greatest benefit will be In prevention. Prevention of the burden of end-organ failure.
OSS • Mission: facillitating people living with NCD’s through innovative medical oriented solutions. • Vision: An integrated care center that makes a substantial contribution to improviong the current health and increasing the quality of life of people with diabetes and cardiovascular diseases
Strenght
Weaknesses
1integrated care 2 holistic approach 3 innovative medical solutions 4 out of hospital 5 education for client
1 new insurance system 2 overcrowded hospitals 3 long waiting time for appointment for the specialist
1 get integrated,holistic care paid
1 physical space 2 trained personnel
2basic medical care back to family physician
3 finance 4 policies
3 incentives for education
1 personnel that cannot adopt core values
1 establish reliable sustainable training for health workers and client
2 lack of higher trained professionals 3 time consuming training of personnel
4 growing NCD Health threats
4 no time for research
Opportunity’s
Threats
1 insurance paid for service means more personel and more locations 2 advocacy on ratifying protocols by MOH 1 preventive medicine must be basic insurance 2 cooperation with SPAOGS/BOG/RGD 3 develop research area
SWOT and TOWS matrix
OSS
Knowledge center , training, research, projects
• 3 pillars of the organisation • 1 annual screening (protocol DM + HIV) for prevention and high risk clients. • 2 woundroom and aftercare at the medical pedicure/podotherapist, if possible shoes, insoles and orthesis. • 3 Knowledge center, training, research, donorprojects
Knowledge center • Training for case managers • Training Eye-center, AZP, for retina pictures • Training podiatrist for personnel • On going training psychology for case manager • Education department • Data wound-room and Medical Faculty • MDO with Internal specialist, orthopedic surgeon, rehabilitation specialist, shoemaker, dietician.
• Collaboration with SPAOGS (CVRM) and Medical Faculty. • Nutritional status wound clients in collaboration with the medical faculty • Organization development. • Continuing development of Caricare • New training for case managers
Chronic care is life time care !
Knowledge center , training, research, projects
Tabel 2.total of CID clients divided into age groups and gender, 2013 Age group/ Gender
M
V
20 – 29
3
12
30 – 39
14
22
40 – 49
22
13
50 – 59
11
7
Total
50
54
Referred from COE, CID clients 2013
Social worker
51%
49%
M V
Referred from COE, CID clients 2013
Adherance counselor
36% 64%
M V
Chronic care is life time care !
Knowledge center , training, research, projects
The care standard in the care continuum Identification
Risk assessment
Risk profile
Individual care plan
Care modules
Smoking Overweight Alcohol Stress Hypertension Cholesterol DM2 Depression
Coaching patients
Visualize risk profile COPD exacerbations
COPD
Smoking
10
Exercise tolerance
Overweight Physical (in)activity
8
Pulmonary function / dyspnea
6
Nutrition
4
Retinopathy
Alcohol
2 0
Neuropathy
Stress
Diabetic foot
Depression
Glucose
DIABETES MELLITUS
LIFESTYLE
Anxiety
Nefropathy Blood pressure
Somatisation Cholesterol
T0
PSYCHOLOGICAL COMPLAINTS
T1
VASCULAR RISK 9/3/2015
eb/sdes/oss
15
jaartal
1e scr
2013
totaal
2escr
3e scr
totaal
619
Screenings total 2013 -2015
619
2014
723
364
1087
2015
432
171
116
719
1774
535
116
2425
62% female
38% male
Age groups in percentages divided by gender 35.00
30.00
25.00
20.00
15.00
10.00
5.00
0.00
Blue = male Orange= female
8--17
18--27
28--37
38--47
48--57
58--67
68--77
78--87
88--97
Screeningen 2013 - 2015 8166
9000 8000 7000 6000 5000 4000 3000 2000 1000 0 Totaal aantal patienten
573
718
906
986
1002
843
656
448
476
472
688
1583 1446 398 1606
100% 201 195 177 154 133 130 128 97 96 91 76 Totaal verwezen disciplines 19% 196 152 143 143 137 121 118 95 93 93 80 75 Retina 18% 208 198 178 175 145 120 118 113 97 88 87 791014688 Pedicure 20% 91 84 73 69 67 Dietiste 57 49 46 45 41 36 30 8% 141 139 136 123 76 74 72 63 Pre-dialyse 61 49 43 37 636 12% 83 76 76 69 Med. Pedicure 60 522425 25 435 51 40 38 34 32 8% 69 Fysiotherapeut 51 49 42 41 36 35 33 24 258 20 19 16 5% Psycholoog 38 33 26 24 23 23 19 18 17 461 13 12 12 3% 65 62 Podotherapeut 52 51 45 43 34 32 23 20 19 15 6% Educatie 39 9 8 5 3 3 3 2 2 2 2 0% 0 0 315 313 256 252 206 204 178 171 146 142 137 105 Maatschappelijkwerker Totaal aantal patienten januari Februari Maart April Mei Juni Juli Augustus Septemb Oktober Novemb Decemb Totaal Percenta er er er ge 146 204 252 313 315 256 206 142 171 137 178 105 2425 105
Maatschappelijkwerker
2
2
2
0
0
5
3
2
9
3
8
3
39
0%
Educatie
43
62
52
65
45
51
19
15
23
20
34
32
461
6%
Podotherapeut
12
13
12
23
33
23
26
18
24
19
38
17
258
3%
Psycholoog
41
49
69
51
33
35
36
19
20
16
42
24
435
5%
Fysiotherapeut
60
76
83
76
69
40
51
34
38
32
52
25
636
8%
Med. Pedicure
61
74
123
141
136
139
76
43
49
63
72
37
1014
12%
Pre-dialyse
41
49
67
84
91
69
57
46
36
45
73
30
688
8%
Dietiste
113
145
178
208
198
175
118
87
88
97
120
79
1606
20%
Pedicure
95
118
143
143
196
152
137
93
93
80
121
75
1446
18%
Retina
105
130
177
195
201
154
133
91
96
97
128
76
1583
19%
Totaal verwezen disciplines
573
718
906
986
1002
843
656
448
476
472
688
398
8166
100%
Chronic care is life time care !
Knowledge center , training, research, projects
woundroom
5%
HA
37%
WI
57%
chir
blacks
hindstani
jav
others
Age and gender LEEFTIJD PATIËNTENPOPULATIE
Women 51%
Men 49%
men
women
“LOST TO FOLLOW-UP”
n
Gemiddeld
Mediaan
n
Gemiddeld
Mediaan
Man
43
57.6
56
10
61.8
64
Vrouw
41
57.2
58
10
61.2
62
Beide geslachten
84
54.4
56.5
20
61.5
63
Mannen ouder dan vrouwen p= 0,67/p= 0,81 Mannen zijn niet jonger in beide groepen p= 0,66 Vrouwen zijn niet jonger in beide groepen p= 0,73 Op het totaal niet significant jonger p= 0,57
BMI BMI PATIËNTENPOPULATIE
“LOST TO FOLLOW-UP”
n
Gemiddeld
Mediaan
n
Gemiddeld
Mediaan
Man
35
25.4
24.5
6
30.1
28.4
Vrouw
30
31
31.4
4
25.3
24.4
Beide geslachten
65
28
26.6
10
28.2
26.4
Overzicht gemiddelde en mediane BMI (kg/m2) Uit de tabel blijkt dat de mannen uit de patiëntenpopulatie een significant lager gemiddelde BMI (p=0.01) hebben dan de vrouwen.
DM duration in years
DM DUUR IN JAREN PATIËNTENPOPULATIE
“LOST TO FOLLOW-UP”
n
Gemiddelde
Mediaan
n
Gemiddelde
Mediaan
Man
40
14.3
12.5
8
10.9
6.0
Vrouw
36
15.1
15.0
7
11.4
9.0
Beide geslachten
76
14.7
14.0
15
11.1
7.0
Verschil in duur tussen de groepen is Niet significant p=0,58
Other clinical aspects PATIËNTENPOPULATIE
“LOST TO FOLLOW-UP”
n
%
n
%
Charcot voet
---
84
18
20
20
Ulcus in het verleden
---
49
65.3
10
80
Amputatie in het verleden
Minor amputatie Major amputatie
84
Major + minor amputatie Hypertensie Vaattoestand
Nefropathie*
Geen indicatie voor echo-doppler
79.7
77
13 16.9
Trifasisch
3.9
Geen nefropathie (>100)
10.5
CNI stadium 2 (60- 90)
57
7 36.8
35 0 5
12
66.2
Bifasisch
CNI stadium 1 (90- 100)
HbA1c bij aanmelding (in %)
1.2
20
1.2 69
Monofasisch
38.1
83.3
55 20
15 30 0
12.5 8
0 50
CNI stadium 3 (30- 60)
38.7
37.5
CNI stadium 4 ( 15- 30)
7
0
≤7 >7
59
11.9 88.1
7
57.1 42.9
*aan de hand van de renale klaring (ml/min.)
WONDEN n Soort wond
Nieuw Recidief
Wagner classificatie
Graad 3
133
n
18
125
24 13.6
% 91.3
23
62.4
Graad 4 Lokalisatie
% 82
Graad 1 Graad 2
“LOST TO FOLLOW-UP”
8.7 84.2
19
10.5 5.3
0
0
Voorvoet
33.8
19.2
Hallux
18.4
30.7
Middenvoet plantair
13.2
15.4
11
15.4
Overige digiti Hiel
136
6.6
26
11.5
Dorsum
5.9
7.7
Voetrand lateraal
5.9
0
Interdigitaal
2.2
0
Ter plekke oude amputatie
1.5
0
Voetrand mediaal
0.7
0
Multipel
0.7
0
Healed and not healed
Reason for hospitalisation
• Education, started in the waitingroom is now a department where everybody is submitted too. • 12 weeks of sessions on diabetes and stimulating them through lifestyle too self management • There is a pre-and posttest • At the end an certificate that is well celebrated
Dams.E, internist 2014
9/3/2015
eb/sdes/oss
36
Costs OSS planning 2014 Operationele kosten over de afgelopen 12 maanden
Overhead
Screening
74,824.00
Patientgebonden directe kosten Patientgebonden indirecte kosten Medische kosten
209,550.00 Case manager Toezichthoudende arts
27,260.00
HIV
27,260.00
8,862.00
6,240.00
129,344.00
132,360.00
132,360.00
174,210.00
383,760.00
289,200.00
Verpleegkundige Pedicure
Wondverzorging
289,200.00 8,862.00
8,862.00
26,586.00
321,120.00
321,120.00
19,968.00
26,208.00
Podotherapist
13,520.00
13,520.00
Dietist
19,500.00
19,500.00
Psycholoog
68,640.00
68,640.00
Maatschappelijk werkster
23,049.00
49,200.00
Fysiotherapeut
49,200.00 0.00
HIV- Counselers
104,400.00
Onderzoek en Ontwikkeling
237,850.00
201,000.00
231,000.00
669,850.00
Voorlichting en Educatie
252,110.00
118,000.00
182,000.00
552,110.00
1,128,521.00
975,520.00
602,722.00
2,706,763.00
OSS 2014 US= 3.4 SRD
In Suriname a Chronic wound 3-5 yr going weekly to the surgical clinic 156 to 260 outpatient visits Consult SRD 120,- + wondbeh 6,- srd SRD 46.800,- – 28.080,- srd
• Duration healing of an ulcer: 2 to 5 months • Suriname: Diabetes Population: 15% or 75 000 • 2005 Netherlands: 3% of the population had a diabetic foot ulcer; • 3% from 75,000 is 2250 ulcers. 15% of these ulcers ended in amputation= 337
• According to IDF (DF blog), the annual incidence of diabetic ulcers between 2 and 32% of the diabetic population (source Boulton, Armstrong et al Diabetes Care 2008)? That is 1500 to 24.000 ulcers
• Sweden: Cost of ulcer € 17,000,-- Cost of ulcer ending in an amputation: € 32,000,• Starting from 5 months and outpatient visit three times a week comes down to € 283.33 per visit (1331.65 SRD) • In an amputation it comes down to 32000/60 = € 533.33 (2506.66 SRD)
OSS ..a challenge…..
..But worth it....
