P5SE Model by Tays Eye Centre, Pirkanmaa Hospital District, Finland
Tays Eye Centre is part of the Pirkanmaa Hospital District which is a joint authority of 23 municipalities with 527,000 residents. Tampere University Hospital provides services for one million inhabitants. The regional health care system faces a major challenge presented by the Finnish government's move towards value-based health care through the integration of social and health care by January 2019. This is expected to generate efficiencies estimated at €100 million for the region by 2030 (€3 billion across the entire Finland). The Reference Site initiative of Tays Eye Center fits perfectly into the national policy reforms under way. The reason for applying to become a Reference Site of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA) was to demonstrate how a well thought-out regional eye care strategy can be integrated across national and international (EU) policies.
The P5SE model developed by Tays Eye Centre consists of prioritisation (P) of eye diseases on the basis of those causing permanent visual impairment; stratification (S1) of patients on the basis of risk for visual disability; standardization (S2) of care pathways; streamlining (S3) decision processes; shared care (S4) in multidisciplinary teams; sustainability (S5) by adjusting service production to resource; and continuous evaluation (E) at patient and system level to ensure cyclical improvements. The innovative principles for prioritizing permanently blinding eye diseases have now been adopted by all public eye hospitals in Finland.
Since 2011, the implementation of P5SE model in Tays Eye Centre has led to a 46% increase in productivity and 15 % increase in at-work participation rates. During that time, the number of referrals increased 76%, the number of out-patients appointments increased 2.5-fold and the total number of surgical procedures increased 98%. Simultaneously the number of delayed follow-up visits decreased to zero.
The efforts for enabling improved well-being more efficiently continue. The main long-term goals include the electronic collection and analysis of ‘big data’ for evaluation of cost-effectiveness and outcomes of every-day care both in the national and European level. Tays Eye Centre is considering the adoption of a policy to request every citizen to fill in a new "health related quality of life questionnaire" (HRQoL) once a year for the national data base regardless of their disease status. This initiative would create invaluable data not only about the impact of health and social care interventions but also data about the influence of ageing on the well-being.
The potential for scalability and transferability of the principles of the eye care strategy to other specialties has been suggested to the Ministry of Social Affairs and Health in Finland, as an example of a strategic steering model for adjusting limited resources in a way that simultaneously improves health equity and well being. This is the focus of a draft legislation currently under consultation. Tays Eye Centre is currently a partner in the B3 Action Group on Integrated Care