1990-92Feasibility
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Scand. J. of Primary Health Care 2004;22:174-17C9a.rlsson L, Strender L-E, Fridh G, Nilsson GH Clinical categories of patients and encounter Rates in primary health care – a three-year study in defined populations. BMC Public Health 2006;6:35
2007 European ACG Conference, Karlskrona, Sweden 18-19 Sep, 2007
Pilot projects
(1999 - 2005)
Dalarna -05
- Mell. distr.
Halland -03
- Kungsbacka
Skåne -04
- Sample PHCCs
Västerbotten
- Holmsund
Uppsala
- Möllan - Bålsta
Stockholm
- Vaxholm - Segeltorp
Östergötland
- Ryd
2007 European ACG Conference, Karlskrona, Sweden 18-19 Sep, 2007
Östergötland
- Ryd -03 - Ödeshög -03
2007 European ACG Conference, Karlskrona, Sweden 18-19 Sep, 2007
ACG – introductory years
1994
Gråbo 1990-92:
Feasibility PHCC
ACG – implementing period
1995
Gagnef 1993-94:
PHCC and Public Health
…
1998
Gagnef (Tibro) 1996-97: Quality Improvement
…
2005
Blekinge 2003-05: County Council level
Lennart Carlsson
2007 European ACG Conference, Karlskrona, Sweden 18-19 Sep, 2007
SoS Pilot study
1999-2000
Dalarna
- Gagnef
Värmland
- Arvika
Bohuslän
- Stenungsund
Lennart Carlsson
2000-07 - complexity
Organising health care system Performance and competition Drugs and financing
Primary level First tier and specialty care Shortage of staff (budgeting limit)
…
ACG at County Councils Coding inaccuracies Allocation of resources vs quality aspects
Lennart Carlsson
2007 European ACG Conference, Karlskrona, Sweden 18-19 Sep, 2007
2007 European ACG Conference, Karlskrona, Sweden 18-19 Sep, 2007
ACG in Sweden
Facts and findings
Lennart Carlsson
2007 European ACG Conference, Karlskrona, Sweden 18-19 Sep, 2007
Coding quality
…
2007
Skaraborg (25 years): Longitudinal health care
…
2008
Stockholm 2007:
Drugs
2007 European ACG Conference, Karlskrona, Sweden 18-19 Sep, 2007
On-going contract
(Sept 2007)
(Dalarna) (2008 - -)
Halland 2004 - -
Blekinge 2003 - -
2007 European ACG Conference, Karlskrona, Sweden 18-19 Sep, 2007
Carlsson L, Börjesson U, Edgren L. Patient based ‘burden-of-illness’ in Swedish primary health care. Applying the Johns Hopkins ACG Case-mix System in a retrospective study of electronic patient records. International Journal of Health Planning and Management 2002;17:269-282.
Comparison between clinics and hospitals
Ambulatory care
Costs AND performance (still at hospitals)
Primary Care
Access to care!
How to organise?
…
ACG at Primary Health Care Centre
Sectors of interest
Hospitals In-patient care at hospitals In-patient and out-patient care at hospitals In-patient and out-patient care at hospitals In-patient and out-patient care at hospitals In-patient and out-patient care at hospitals Primary care Primary health care
Health Economics Drugs … ACG at Primary Health Care Centres
Feasibility! Validity?
Lennart Carlsson
2007 European ACG Conference, Karlskrona, Sweden 18-19 Sep, 2007
Nynäshamn 1991-92: Time window
Sorunda 1991-92: Seasonal variations
1995
S Ryd (Skövde) 1992: Coding routines
Iceland 1991:
Computer systems
Lennart Carlsson
Developing period
1993 - -
Dalarna
- Gagnef -96--06
Skaraborg
- Södra Ryd -94 - Tibro -99
Älvsborg
- Gråbo -94
Iceland
EUproject
Stockholm
- Nynäshamn -94 - Sorunda -94 - Norrtälje -06--
Engström SG, Carlsson L, Östgren C-J, Nilsson GH, Borgquist, LA. The importance of comorbidity in analysing patient costs in Swedish primary care. BMC Public Health 2006;6:36
ACG in Sweden - Summing up …
Hospital sector dominance Growing ambition to developing PHC ACG for profiling … at PHC Centre level ACG for allocation of resources … in PHC
Carlsson L, Strender L-E, Fridh G, Nilsson G. Types of morbidity and categories of patients in a Swedish county. Applying the Johns Hopkins Adjusted Clinical Groups System to encounter data in primary health care.
Gävleborg -04
- Sandviken
Västmanland -02
- Public PHCCs (50%)
Stockholm -99
- Södertälje
Blekinge -01
- Public PHCCs (90%)
2007 European ACG Conference, Karlskrona, Sweden 18-19 Sep, 2007
Lennart Carlsson
2007 European ACG Conference, Karlskrona, Sweden 18-19 Sep, 2007
1980-89 – the DRG intro
Hospitals – in-patient care Medical departments Surgery Geriatric care? Psychiatric care?
Feasibility?
Lennart Carlsson
2007 European ACG Conference, Karlskrona, Sweden 18-19 Sep, 2007
1995-99 – Health care system
Primary care reforms Family physician Health care team
2007 European ACG Conference, Karlskrona, Sweden 18-19 Sep, 2007
ACG – research initiatives
2006
Kungsbacka 2005: Primary-secondary care
2007
Norrtälje 2005:
Hospitals – out-patient care Costs! Performance?
Lennart Carlsson
2007 European ACG ห้องสมุดไป่ตู้onference, Karlskrona, Sweden 18-19 Sep, 2007
1990-95 – DRG peak
Hospital departments
2007 European ACG Conference, Karlskrona, Sweden 18-19 Sep, 2007
Pilot projects
(1999 - 2005)
Dalarna -05
- Mell. distr.
Halland -03
- Kungsbacka
Skåne -04
- Sample PHCCs
Västerbotten
- Holmsund
Uppsala
- Möllan - Bålsta
Stockholm
- Vaxholm - Segeltorp
Östergötland
- Ryd
2007 European ACG Conference, Karlskrona, Sweden 18-19 Sep, 2007
Östergötland
- Ryd -03 - Ödeshög -03
2007 European ACG Conference, Karlskrona, Sweden 18-19 Sep, 2007
ACG – introductory years
1994
Gråbo 1990-92:
Feasibility PHCC
ACG – implementing period
1995
Gagnef 1993-94:
PHCC and Public Health
…
1998
Gagnef (Tibro) 1996-97: Quality Improvement
…
2005
Blekinge 2003-05: County Council level
Lennart Carlsson
2007 European ACG Conference, Karlskrona, Sweden 18-19 Sep, 2007
SoS Pilot study
1999-2000
Dalarna
- Gagnef
Värmland
- Arvika
Bohuslän
- Stenungsund
Lennart Carlsson
2000-07 - complexity
Organising health care system Performance and competition Drugs and financing
Primary level First tier and specialty care Shortage of staff (budgeting limit)
…
ACG at County Councils Coding inaccuracies Allocation of resources vs quality aspects
Lennart Carlsson
2007 European ACG Conference, Karlskrona, Sweden 18-19 Sep, 2007
2007 European ACG Conference, Karlskrona, Sweden 18-19 Sep, 2007
ACG in Sweden
Facts and findings
Lennart Carlsson
2007 European ACG Conference, Karlskrona, Sweden 18-19 Sep, 2007
Coding quality
…
2007
Skaraborg (25 years): Longitudinal health care
…
2008
Stockholm 2007:
Drugs
2007 European ACG Conference, Karlskrona, Sweden 18-19 Sep, 2007
On-going contract
(Sept 2007)
(Dalarna) (2008 - -)
Halland 2004 - -
Blekinge 2003 - -
2007 European ACG Conference, Karlskrona, Sweden 18-19 Sep, 2007
Carlsson L, Börjesson U, Edgren L. Patient based ‘burden-of-illness’ in Swedish primary health care. Applying the Johns Hopkins ACG Case-mix System in a retrospective study of electronic patient records. International Journal of Health Planning and Management 2002;17:269-282.
Comparison between clinics and hospitals
Ambulatory care
Costs AND performance (still at hospitals)
Primary Care
Access to care!
How to organise?
…
ACG at Primary Health Care Centre
Sectors of interest
Hospitals In-patient care at hospitals In-patient and out-patient care at hospitals In-patient and out-patient care at hospitals In-patient and out-patient care at hospitals In-patient and out-patient care at hospitals Primary care Primary health care
Health Economics Drugs … ACG at Primary Health Care Centres
Feasibility! Validity?
Lennart Carlsson
2007 European ACG Conference, Karlskrona, Sweden 18-19 Sep, 2007
Nynäshamn 1991-92: Time window
Sorunda 1991-92: Seasonal variations
1995
S Ryd (Skövde) 1992: Coding routines
Iceland 1991:
Computer systems
Lennart Carlsson
Developing period
1993 - -
Dalarna
- Gagnef -96--06
Skaraborg
- Södra Ryd -94 - Tibro -99
Älvsborg
- Gråbo -94
Iceland
EUproject
Stockholm
- Nynäshamn -94 - Sorunda -94 - Norrtälje -06--
Engström SG, Carlsson L, Östgren C-J, Nilsson GH, Borgquist, LA. The importance of comorbidity in analysing patient costs in Swedish primary care. BMC Public Health 2006;6:36
ACG in Sweden - Summing up …
Hospital sector dominance Growing ambition to developing PHC ACG for profiling … at PHC Centre level ACG for allocation of resources … in PHC
Carlsson L, Strender L-E, Fridh G, Nilsson G. Types of morbidity and categories of patients in a Swedish county. Applying the Johns Hopkins Adjusted Clinical Groups System to encounter data in primary health care.
Gävleborg -04
- Sandviken
Västmanland -02
- Public PHCCs (50%)
Stockholm -99
- Södertälje
Blekinge -01
- Public PHCCs (90%)
2007 European ACG Conference, Karlskrona, Sweden 18-19 Sep, 2007
Lennart Carlsson
2007 European ACG Conference, Karlskrona, Sweden 18-19 Sep, 2007
1980-89 – the DRG intro
Hospitals – in-patient care Medical departments Surgery Geriatric care? Psychiatric care?
Feasibility?
Lennart Carlsson
2007 European ACG Conference, Karlskrona, Sweden 18-19 Sep, 2007
1995-99 – Health care system
Primary care reforms Family physician Health care team
2007 European ACG Conference, Karlskrona, Sweden 18-19 Sep, 2007
ACG – research initiatives
2006
Kungsbacka 2005: Primary-secondary care
2007
Norrtälje 2005:
Hospitals – out-patient care Costs! Performance?
Lennart Carlsson
2007 European ACG ห้องสมุดไป่ตู้onference, Karlskrona, Sweden 18-19 Sep, 2007
1990-95 – DRG peak
Hospital departments