Sosiaali- ja terveydenhuollon kustannusvaikuttava ja tehokas ohjaus

STM asetti ajalle 19.11.2015 - 20.1.2016 selvityshenkilöt arvioimaan sosiaali- ja terveydenhuollon ohjauksen kehittämistarpeet vaikuttavan ohjauksen mallin kehittämiseksi. Toimeksiannon mukaisesti rahoitus ja sisällöllinen ohjaus sovitetaan mallissa yhteen edistämään hyvinvointi- ja terveyserojen kaventamista kustannusvaikuttavalla tavalla. Raportin tietoa käytetään sosiaali- ja terveydenhuollon järjestämis- ja itsehallintoaluelakien valmistelussa. Selvityshenkilöt toteavat, että uudistuksen onnistuminen edellyttää julkisen hyvinvointi- ja terveysvastuun kantamista sekä samaan aikaan julkisten varojen rajallisuuden ymmärtämistä ja hyväksymistä jokaisella toiminnan tasolla. Toimialan rakenteita, voimavarojen kohdentamista ja sisällöllistä ohjausta on muutettava. Ohjauksen tulee olla selkeää, vaikuttavaa ja tietoon perustuvaa. Valtion ohjausroolia on vahvistettava. Normi-, resurssi- ja informaatio-ohjauksen lisäksi tarvitaan rakenteellista ohjausta ja tutkimuksellista kehittämisohjausta. Toimiva vastuun-, työn- ja resurssien jako sekä arviointi varmistavat tavoitteiden saavuttamista. Selvityshenkilöt ehdottavat kansallisen strategisen sote-yksikön organisoimista sosiaali- ja terveysministeriöön. Yksikön johtamat vastuualueet ovat palvelut, resurssit ja arviointi. Itsehallintoalueille perustetaan vastaavat alueelliset strategiset sote-yksiköt. Palvelujen tuottajilta edellytetään vastaavaa strategista organisoitumista. Toiminnan tueksi perustetaan viisi itsehallintoalueiden yhteistä alueellista sosiaali- ja terveydenhuollon tutkimus- ja kehittämisyksikköä

Arkivaikuttavuuden arviointi yhdellä mittarilla

Terveystaloustiede.Suomessa kehitetty 15D on jo levinnyt laajaan käyttöön. Kokemukset Husista ja Taysista osoittavat sen käyttökelpoiseksi yleisen elämänlaadun mittariksi arkivaikuttavuuden arviointiin

Arkivaikuttavuuden arviointi yhdellä mittarilla

Suomessa kehitetty 15D on jo levinnyt laajaan käyttöön. Kokemukset Husista ja Taysista osoittavat sen käyttökelpoiseksi yleisen elämänlaadun mittariksi arkivaikuttavuuden arviointiin.publishedVersio

A comprehensive model for measuring real-life cost-effectiveness in eyecare : automation in care and evaluation of system (aces-rwm (TM))

This paper describes a holistic, yet simple and comprehensible, ecosystem model to deal with multiple and complex challenges in eyecare. It aims at producing the best possible wellbeing and eyesight with the available resources. When targeting to improve the real-world cost-effectiveness, what gets done in everyday practice needs be measured routinely, efficiently and unselectively. Collection of all real-world data of all patients will enable evaluation and comparison of eyecare systems and departments between themselves nationally and internationally. The concept advocates a strategy to optimize real-life effectiveness, sustainability and outcomes of the service delivery in ophthalmology. The model consists of three components: (1) resource-governing principles (i.e., to deal with increasing demand and limited resources), (2) real-world monitoring (i.e., to collect structured real-world data utilizing automation and visualization of clinical parameters, health-related quality of life and costs), and (3) digital innovation strategy (i.e., to evaluate and benchmark real-world outcomes and cost-effectiveness). The core value and strength of the model lies in the consensus and collaboration of all Finnish university eye clinics to collect and evaluate the uniformly structured real-world outcomes data. In addition to ophthalmology, the approach is adaptable to any medical discipline to efficiently generate real-world insights and resilience in health systems.Peer reviewe

The Northern Finland Birth Cohort Eye Study: Design and baseline characteristics

Peer reviewe

Glaucoma progression in patients receiving intravitreal anti-VEGF treatment for neovascular age-related macular degeneration

Purpose: The purpose of this study was to investigate how often glaucoma and neovascular age-related macular degeneration (nAMD) occur in the same patient and to evaluate whether glaucoma progression is faster in eyes treated with intravitreal anti-VEGF medications for nAMD. Methods: This single-centre retrospective real-world data (RWD) consists of medical records of 6314 glaucoma and 2166 nAMD patients treated in 2008–2017 in Tays Eye Centre, Finland. To study glaucoma progression, changes in visual fields (mean deviation [MD], dB/year), IOP (mmHg/year) and fundus photographs (progression, yes/no) were compared in glaucoma eyes with and without anti-VEGF treatment for nAMD and ≥1 year follow-up. Results: During the 10-year period, 147 patients with glaucoma received intravitreal anti-VEGF treatment for nAMD corresponding to 2% of glaucoma and 7% of nAMD patients. The mean change in MD was −0.70 dB/year (SD 1.8) vs. −0.27 dB/year (SD 1.7) (p = 0.027) in glaucoma eyes with (n = 37) and without (n = 4304) anti-VEGF injections, respectively. In patients with bilateral glaucoma and unilateral nAMD treated with anti-VEGF injections (n = 20), MD declined at −0.62 dB/year (SD 1.9) vs 0.33 dB/year (SD 1.5) (p = 0.654), and glaucoma progression was detected in 14/20 vs 10/20 (p = 0.219) fundus photographs in eyes with anti-VEGF treatment compared with their untreated fellow eyes. Conclusion: nAMD and glaucoma were found co-existing in the same eye at rates that were similar to the age-corrected prevalence of the two diseases in the general population. Our results suggest that intravitreal anti-VEGF treatment for nAMD may accelerate glaucoma progression.publishedVersionPeer reviewe

The usefulness of routine photography in a myopic patient treated for glaucoma : 36-year follow-up

Peer reviewe

A comprehensive model for measuring real-life cost-effectiveness in eyecare: automation in care and evaluation of system (aces-rwm™)

This paper describes a holistic, yet simple and comprehensible, ecosystem model to deal with multiple and complex challenges in eyecare. It aims at producing the best possible wellbeing and eyesight with the available resources. When targeting to improve the real-world cost-effectiveness, what gets done in everyday practice needs be measured routinely, efficiently and unselectively. Collection of all real-world data of all patients will enable evaluation and comparison of eyecare systems and departments between themselves nationally and internationally. The concept advocates a strategy to optimize real-life effectiveness, sustainability and outcomes of the service delivery in ophthalmology. The model consists of three components: (1) resource-governing principles (i.e., to deal with increasing demand and limited resources), (2) real-world monitoring (i.e., to collect structured real-world data utilizing automation and visualization of clinical parameters, health-related quality of life and costs), and (3) digital innovation strategy (i.e., to evaluate and benchmark real-world outcomes and cost-effectiveness). The core value and strength of the model lies in the consensus and collaboration of all Finnish university eye clinics to collect and evaluate the uniformly structured real-world outcomes data. In addition to ophthalmology, the approach is adaptable to any medical discipline to efficiently generate real-world insights and resilience in health systems

A prototype protocol for evaluating the real-world data set using a structured electronic health record in glaucoma

Purpose: As the first step in monitoring and evaluating day-to-day glaucoma care, this study reports all real-world data recorded during the first full year after the implementation of a prototype for glaucoma-specific structured electronic healthcare record (EHR). Methods: In 2019, 4618 patients visited Tays Medical Glaucoma Clinic at Tays Eye Centre, Tampere University Hospital, Finland, that serves a population of 0.53 M. Patient data were entered into a glaucoma-specific EHR by trained nurses to be checked by glaucoma specialists. Tays Eye Centre follows the Finnish Current Care Guideline for glaucoma in which glaucoma is defined using a ‘2 out of 3’ rule, that is, ≥2 findings evaluated as glaucomatous in optic nerve head (ONH), retinal nerve fibre layer (RNFL) and visual field (VF). Results: The clinical evaluations of ONH, RNFL and VF were recorded in 95%–100% of all eyes. ONH was evaluated as glaucomatous more often (44%) than RNFL (33%) and VF tests (30%). Progressive changes in any of the three tests were recorded in 35% of the ‘≥2/3 glaucoma group’ compared to 2%–9% in the other groups. The mean IOP at visit was 15 mmHg. The mean target IOP was 17 mmHg, and it was recorded in 94% of eyes. Conclusion: The developed structured data presentation enables comparisons between different population-based real-world glaucoma data sets and glaucoma clinics. Compared to a data set from the UK, the proportion of glaucoma suspicion-related visits was smaller in Tays Eye Centre and test intervals were longer.Peer reviewe

Immediate sequential bilateral cataract surgery : A 13-year real-life report of 56 700 cataract operations

Background/aims: To assess the frequency of immediate sequential bilateral cataract surgery (ISBCS) and endophthalmitis during 13-year period in Tays Eye Centre, Tampere University Hospital, Tampere, Finland. Methods: All cataract surgeries performed between 1 January 2008 and 31 December 2020, and all endophthalmitis cases during the same period were searched from electronic patient records. Numbers and frequencies of ISBCS, and complications, including endophthalmitis and vitreous loss, were recorded and compared with unilateral operations. Results: The study included 56 700 cataract surgeries in 34 797 patients of whom 39% (n=13 445) had ISBCS. The median age of the patients was 75 (IQR 68-80, range 0.08-99) years at the time of surgery. The proportion of ISBCS patients increased from 4.2% in 2008 to 46% in 2020. Vitreous loss occurred in 480 (0.9%) of cataract surgeries. There were no postoperative endophthalmitis after cataract surgery (n=0) during the 13-year period. Conclusion: The proportion of patients undergoing ISBCS increased from 4.2% in 2008 to 46% in 2020. No endophthalmitis were found to be associated with ISBCS.publishedVersionPeer reviewe