Since the year 2000, Dutch hospitals have begun to register data by episode, starting with a referral to a medical specialist at a hospital. At that moment, within the IT systems, a care-trajectory record is created for the specific health issue. The information at the level of the episode is used to support the physician during the care process, but it is also gathered into management databases at the institutional level. With this information, profiles can be created at different levels of aggregation, for example, for individual patients, at the provider level, at the level of diseases treated, and for many other ad hoc views.
By the structural linking of the data to the health issue of the patient, described by both care request and diagnosis, a new dimension has been created in the resource management of hospitals. Since the shift in the funding of hospitals from budgeting to contracting will be completed in 2012, hospitals need to change their information management strategies. In the presentation, examples of this newly developed management information will be presented.
The next step in the process of health reform dealt with chronic diseases. This was partially driven by the spectacular growth expectations in this area for the coming decades. To prevent a long-term care crisis in 2025, action was needed. An important development was the introduction of the concept of the care standard, which describes good care for chronic-care patients based on guidelines and protocols.
The Dutch Diabetes Federation developed the first care standard in 2003. The care standard describes three main aspects of the prevention of and care for chronic diseases: the care, the organization, and the indicators of quality. One other principle of the care standard is the individual care plan, which will be coordinated for and with the patient as well as by a multidisciplinary team of care providers.
The care group was introduced as a new entity to contract, in one market, the different care providers involved in chronic disease management and, in a second, the insurance companies. After the pilot, the contracting of disease management programs for diabetes was nationally covered. One important element of the program is the development of software to not only exchange information between providers, but also manage the treatment plan.