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Luca Valerio

Assessing Clinical Governance in Primary Care. Results of a diagnostic review in an Italian Local Health Trust. Luca Valerio. European Forum of Primary Care Pisa 2010. Primary Care and Clinical Governance. Primary Care and Clinical Governance. But it was not easy.

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Luca Valerio

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  1. Assessing Clinical Governance in Primary Care. Results of a diagnostic review in an Italian Local Health Trust Luca Valerio European Forum of Primary Care Pisa 2010

  2. Primary Care and Clinical Governance

  3. Primary Care and Clinical Governance But it was not easy. how to evaluate the degree of implementation of Clinical Governance in Primary Care?

  4. An instrument for the evaluation of the degree of implementation of the tools of Clinical Governance in a specific setting of Primary Care What is DistriCARE It should: Be reproducible Evaluate both global consistency with Clinical Governance and consistency with single areas Result in an operational plan for improvement

  5. Development of DistriCARE • Literature search • Expert Panel (DELPHI approach) • Software templates

  6. The areas DistriCARE analyzes Areas of Clinical Governance Structural and Functional Prerequisites

  7. Areas 1 to 6: the CG roots Planning and control Research & Development Institutional Marketing Organization Information Technology Culture to Learn

  8. Areas 7 to 24: the CG Areas

  9. Areas 7 to 24: the CG Areas MATERNAL-CHILD CARE CHRONIC DISEASES DRUG AND ALCOHOL ELDERLY CARE

  10. The DistriCARE methodology Results development Preparation Survey Stage 1 Stage 2 Stage 3

  11. The DistriCARE methodology

  12. The DistriCARE methodology

  13. The DistriCARE methodology

  14. The DistriCARE methodology

  15. Project Team: • experts of CG with a medical background • experts of governance and business management • in partnership with an inter-professional working group pertaining to Regional authorities. Who interviews?

  16. 3 different levels of interviews: • LHT level interviews: 11 forms • A, B, C, D, E, F, D • 1A, 2A, 3A, 4A, 5A • HD level interviews: 9 forms (1D, 2D, 3D, 4D, 5D, 6D, 7D, 8D, 9D) • Areas of Need: 4 forms (1AB, 2AB, 3AB, 4AB) Who is interviewed? • 24 analysis areas (6 CG roots and 18 CG branches), usually requiring separate interviews

  17. Health Authority Level District and Need Areas Level Who is interviewed? Direzione Sanitaria Direzione Amministrativa dei Distretti Programmazione e politiche di budget Controllo di gestione Ufficio Qualità Risk Management Sistema informativo direzionale Sistemi informatici Ufficio epidemiologico OSRU e Ufficio Formazione Ufficio relazioni con il pubblico Direzioni di Distretto Referente Dip. Materno Infantile Responsabile UVG Distretto di Cuneo Responsabile S.S. Psicogeriatria Responsabile Dipartimento di Patologia delle Dipendenze Responsabile S.S.D. Endocrinologia – Area Diabete Further consultations Direttore Dipartimento DSM Dipartimento Prevenzione (two representatives)

  18. What are they asked? • 478 items (single or multiple answer)

  19. The first application of DistriCARE

  20. The first application of DistriCARE

  21. The first application of DistriCARE

  22. - 22 interviews (11 board level, 11 other professionals) - Average duration: >70 minutes The first application of DistriCARE

  23. The first application of DistriCARE:Results for CG Prerequisites (roots) Planning and control Culture to Learn Research & Development Information Technology Institutional Marketing Organization

  24. The first application of DistriCARE:Results for CG Areas - 1 1A-Analysis of needs – HA level 1D-Analysis of needs – District level 2A-Performance evaluation 5D-Evaluation & improvement 4D-Audits-District level

  25. The first application of DistriCARE:Results for CG Areas - 1 2D-Evidence Based Practice 7D-Citizen info&involvement 4A-Quality Systems 3D - Accountability 5A-Risk Management 6D-Risk Management 9D-Social and Healthcare integration 8D-Continuity of Care 3A-HTA

  26. The first application of DistriCARE:Results for Areas of Need 1AB-Healthcare integration and continuity – MATERNAL-CHILD 2AB-Healthcare integration and continuity – CHRONIC DISEASES 3AB-Healthcare integration and continuity – ELDERLY CARE 4AB-Healthcare integration and continuity – DRUG AND ALCOHOL

  27. The first application of DistriCARE 1D-Analysis of needs 2D-Evidence Based Practice 5D-Evaluation improvement 7D-Citizen info&involvement 9D-Social and Healthcare integration 3D - Accountability 6D-Risk Management 8D-Continuity of Care 4D - Audit

  28. The first application of DistriCARE Borgo Dronero Savigliano-Fossano Ceva Cuneo Mondovì Saluzzo

  29. Output: a 17-point operational plan, including four types of actions: • E = Education and training; • I= Information technologies; • O = Organisational review (roles, processes, activities); • T = new Tools and working methods. • All 17 points were included in the Health Trust’s 2010 Strategic Plan, 6 in the short term, 11 in the medium/long term The first application of DistriCARE

  30. The first application of DistriCARE S F O

  31. Conclusions From description to action

  32. Conclusions Thank you

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