Tuulonen Anja, Kataja Marko, Syvänen Ulla, Miettunen Sirpa, Uusitalo Hannu
Tays Eye Centre, Tampere University Hospital, Tampere, Finland.
Research and Development Centre for Ophthalmic Innovations (SILK), Department of Ophthalmology, University of Tampere, Tampere, Finland.
Acta Ophthalmol. 2016 Nov;94(7):730-735. doi: 10.1111/aos.13168. Epub 2016 Jul 16.
The report describes the concepts behind procedures implemented in Tays Eye Centre to enable improved access to care and improved productivity.
The strategy was developed in 2009 after hospital district decided to construct a new eye hospital which was opened in 2012. The following principles were implemented: (i) identification of high-volume patient groups: the 'big four' eye diseases accounting for 70% of patient visits and costs: age-related macular degeneration (AMD), glaucoma, retinal diseases and cataract; (ii) stratification and prioritization of patient care based on risk of permanent visual disability; (iii) standardization of services for low-risk patients; (iv) maximization of productivity; and (v) shared care. The impact of the new strategy on access to care and productivity is reported for years 2011-2015.
In 2011-2015, the total number of services provided increased 46% while the work contribution increased 15%. The number of referrals increased 76% and the number of outpatient appointments increased 2.5-fold. Simultaneously, the number of delayed follow-up visits decreased to zero. Age-related macular degeneration (AMD) injections increased 1.8-fold. However, after 50% yearly increase in Age-related macular degeneration (AMD) injections, a plateau was reached in 2014 with a 3% decline in 2014-2015 with no changes in treatment indications. In the beginning of 2016, the number of injections has started to increase again (+9% compared to 2015). The total number of surgical procedures increased 98%. The annual number of cataract surgeries increased 64% and bilateral surgeries from 11% to 39%.
Revised operational concepts and new facilities together with a 15% increase in work contribution led to a 46% increase in overall productivity, improved access to care and the clearance of delayed services. Efforts continue to further refine cost-effective care and to define the appropriate levels of services.
本报告阐述了泰斯眼科中心实施的一系列程序背后的理念，这些程序旨在改善医疗服务的可及性并提高生产力。
该策略于2009年制定，当时医院区决定建造一家新的眼科医院，该医院于2012年开业。实施了以下原则：（i）确定高流量患者群体：占患者就诊量和费用70%的“四大”眼科疾病：年龄相关性黄斑变性（AMD）、青光眼、视网膜疾病和白内障；（ii）根据永久性视力残疾风险对患者护理进行分层和优先排序；（iii）对低风险患者的服务进行标准化；（iv）生产力最大化；以及（v）共享护理。报告了2011 - 2015年新策略对医疗服务可及性和生产力的影响。
在2011 - 2015年期间，提供的服务总数增加了46%，而工作贡献增加了15%。转诊数量增加了76%，门诊预约数量增加了2.5倍。同时，延迟随访就诊数量降至零。年龄相关性黄斑变性（AMD）注射量增加了1.8倍。然而，在年龄相关性黄斑变性（AMD）注射量每年增加50%之后，2014年达到平稳状态，2014 - 2015年下降了3%，治疗指征没有变化。2016年初，注射量再次开始增加（与2015年相比增加了9%）。手术程序总数增加了98%。白内障手术的年度数量增加了64%。双侧手术从11%增加到39%。
修订后的运营理念和新设施，加上工作贡献增加15%，使整体生产力提高了46%，改善了医疗服务的可及性并消除了延迟服务。目前仍在继续努力进一步优化具有成本效益的护理，并确定适当的服务水平。
