Moderated by Prof. Mahmood Adil, public health director at NHS Scotland, the session around ‘International Outlook on Community-Based Care’ featured two renowned experts from the Kingdom of Saudi Arabia (KSA) and the US: Dr Nasser Aljehani, family medicine consultant physician and chief medical information officer at King Fahad Medical City, and Dr Jeffrey Hoffman, clinical associate professor and chief medical information officer at Nationwide Children’s Hospital – the second largest children’s hospital system in the USA. The session highlighted global trends for community-based care and then focused on how they applied to the new models of care being currently developed in the Kingdom.
Dr Hoffman highlighted that care started in the community in the first place, with most medical treatment being dispensed in patients’ homes and most physicians being general practitioners. Technology was one reason health systems became hospital-centric as physicians started to convene around expensive equipment and knowledge centres that allowed them to specialise. As a result, in the USA between the 1920’s and 1980’s, the number of general practitioners dropped from 75% to 14% of all physicians and the number of house calls to fewer than 1%.
“The latest advances in medical knowledge and technology, which ironically forced health care behind hospital walls in the first place, has now given us the tools to extend care back beyond the hospital walls, into homes and communities like never before”, stated Dr. Hoffman. This shift is about integrating primary, secondary and social services to include hospitals as part of a broader digital continuum of care that is more patient-centric and spans across wellness, prevention, early detection, acute and post-acute care.
Dr AlJehani, also model of care lead for the Second Health Cluster in the Kingdom’s Central Region at the Ministry of Health, focused his address on the Saudi strategy to extend care beyond hospital walls. He started by describing a radically new organisation for health and care in the Kingdom.
While the roles of payer, regulator and provider have historically been concentrated in the hands of the Ministry, the Kingdom is now working on separating these roles: in the future, PHAP (Saudi’s national health insurance authority) will be the payor, the Health Holding Company (still owned by the government) will be the provider, and the Ministry will focus on the role of regulator. This reorganisation includes a complete redesign of care models and the implementation of five specific pathways addressing five specific needs and objectives: Keep Me Well, Planned Care, Maternal Care, Urgent Care, Chronic Care and End of Life.
The new Saudi model starts with an empowered and engaged citizen at the very centre of the health system. The next ‘circle’ of health and care is healthy communities, nurtured to support activated citizens. When additional assistance is needed, the next escalation circle is virtual care. General hospital care and specialised hospital care are respectively the last two circles, when previous ones have proven insufficient. From activated citizens to specialised hospital care, an integrated personal record aims to support the entire continuum.
Of course, the new health system will need to provide essential knowledge and skills to empower and engage citizens. However, 70% of the Kingdom’s population is under 30 and already tech-savvy, and will most likely help with this challenge. Dr AlJehani also recognised that primary care had been a weak link in the Kingdom and its development is now a core objective of the digital transformation strategy, creating a well-distributed primary care network with centres located within short distances from each other and from citizens.
WHY IT MATTERS
With ageing populations and the increasing burden of chronic conditions, sustainability is a common challenge for health systems around the world. Keeping patients in their homes for as long as possible will be key to reducing costs. Nationwide highlighted their use of AI-powered advanced analytics and predictive models to identify populations at risk, detect any needs for early interventions, but also to anticipate which patients would be more open to care coordination and outreach programmes.
These algorithms, developed in-house, have allowed the hospital group to increase care coordination by 300% (without increasing outreach attempts), reduce emergency department visits by 40%, and decrease the average number of in-patient hospitals days by 65% – all this in only two years. Self-monitoring tools, medical adherence solutions or early detection programmes will allow a much-needed shift from acute to preventive care and a continuous monitoring of patients in between consults, which will also improve clinical and financial outcomes.
THE LARGER TREND
Survey data shows most patients prefer to be treated, for as long as possible, from the comfort of their homes. From this point of view, community-based care should improve the patient experience and place citizens back at the centre of health services. It will also increase health professionals’ awareness of any specific individual situations and help address any social determinants of health such as mental wellness, food insecurity, isolation or abuse.
Prof. Adil highlighted five key trends in healthcare around the world: shifting balances from care to health, from patients to populations, from data to health intelligence, and finally from treatment to prevention. This is not unique to KSA or the USA, as it is clearly a global trend for many health systems trying to enhance the patient experience while improving clinical and financial outcomes.
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