As we transition from National Health. Strategy (NHS) .... of the six-year program is included in MOPH's NHS. 2011-2016
Special Feature Page 2 Looking Back: Reviewing aspects of NHS 2011-2016
Looking Forward
LOOKING BACK
Accountable Care
Page 6 Triple aim philosophy of NHS 2017-2022: An overview
Page 9 Diabetes pilot at Al Wakra presenting good results
THE BI-MONTHLY NEWSPAPER FOR THE NATIONAL HEALTH STRATEGY PROJECT COMMUNITY
ISSUE 9 COMMEMORATIVE EDITION
National Health Strategy – acknowledgement and transition
Moments from NHS 2011 - 2016
Health Matters is printed on recycled paper.
As we transition from National Health Strategy (NHS) 2011–2016 to the next, I want to congratulate all of you who have strived to transform healthcare. Thank you for your dedication and support. The NHS, launched in 2011, identified seven goals and an ambitious framework of 35 projects and over 100 outputs. In the last six years, we have expanded the program by seven new projects and doubled the outputs. Whilst NHS outputs are now over 80% complete, we will continue to focus on completing further outputs and closing remaining projects in the first half of 2017. Some of our achievements have included: • Comprehensive world-class healthcare system: The ambulance service achieved world-class response times; key frameworks have been developed for continuing care, oral health, mental health, cancer, and diabetes. • An integrated system of healthcare: The Diabetes Smart Clinic pilot at Al Wakra has been a great success; frameworks for National Laboratory Integration, e-Health and Data Management have been developed. • Preventive healthcare: Screening for breast and bowel cancer, and common mental health disorders introduced; new legislation to increase tobacco control measures, and a Public Health Stragey will be launched. • Skilled national workforce: Developed the first Qatar Health Workforce Plan 2013-2033; Qatar Council for Healthcare Practitioners has added additional scopes of practice; and training in areas like mental health and occupational health has expanded. • National health policy: Health Service Performance Agreements developed, the first National Clinical Guidelines
completed, and a new facilities licensing and accreditation system developed. • Effective and affordable services: The first Performance Based Budget for the whole public healthcare sector completed. • Healthcare Facilities Masterplan to guide health facilities development has been implemented. • High quality research: Health Research Governance law drafted; National Research Ethics Committee established; policies, models, and guidance have been developed on issues including ethics, research conduct, and research safety.
People have been at the heart of this journey and they shall continue to be…” Most importantly NHS 2011-2016 has proven that we are at our best when we work together, resulting in stronger project delivery and quality. People have been at the heart of this journey and they shall continue to be. The focus for the NHS 2017–2022 will be on “Better Health, Better Care, and Better Value”. The strategy is developing, but I expect key priorities to include: integrated healthcare; high quality services; improved public health; developing the national workforce and primary care; and implementing key frameworks and strategies such as e-health, diabetes, cancer, oral health, continuing care, and mental health. I look forward to continuing our journey. Her Excellency Dr. Hanan Mohamed Al-Kuwari Minister of Public Health
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LOOKING BACK
SPECIAL FEATURE
LOOKING BACK
2011
2016
In this special feature Health Matters looks at some keys aspects of National Health Strategy 2011-2016
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atar’s first National Health Strategy (NHS) which commenced in 2011, was set in motion with the aim of transforming healthcare across Qatar. The strategy was aimed at developing a world-class health system for the people of Qatar, who are at the heart of the NHS. As the first strategy winds up, it has laid in place a solid foundation with tangible improvements across the sector. The program’s primary stakeholders MOPH, PHCC, and HMC have delivered more than
80% of the NHS program outputs by the end of 2016. The figures attest to a unified and resilient public sector focused on delivering its national obligations for the people of Qatar. As the health sector transitions into the next strategy - NHS 2017-2022, work continues with pace and intent. Health Matters takes a look at the legacy of the last six years and what this has meant for the people at the heart of the journey - the public and patients, as well as the providers of healthcare.
WHERE WE ARE NOW: 80%
OUTPUTS COMPLETED
19
COMPLETED
23
19 of 42 projects closed by the end of 2016
REMAINING
23 remaining projects will be closed by the launch of NHS 2017-2022
A detailed summary of the impact and achievements of the six-year program is included in MOPH’s NHS 2011-2016 Transition Report.
HEALTH MATTERS 09-2017
QATAR'S VISION FOR A HEALTHY NATION The Qatar National Vision 2030 (QNV 2030) was published in 2008. It was committed to a healthy population, both physically and mentally, through the provision of "a comprehensive world-class healthcare system, whose services are accessible to the whole population”. Building on this foundation, MOPH developed the NHS 20112016 as its contribution to the National Development Strategy (NDS). Qatar’s first health strategy - NHS 2011-2016, was launched by Her Highness Sheikha Moza bint Nasser in April 2011, as a blueprint and guiding plan to develop Qatar’s health system across seven strategic goals.
Seven strategic goals of NHS 2011-2016
NHS Strategy 2011-2016: The Purpose
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eflecting the need for foundational level improvement across a broad range of areas, the National Health Strategy (NHS) included a range of projects. A third of the projects were dedicated to public health areas such as encouraging healthy lifestyles and promoting public health. The program also prioritized the provision of quality community-based care, as the basis of a successful and integrated world-class healthcare system. The NHS program was intended to address a number of specific challenges faced by the public health sector not limited to: • An imbalanced model of care which required delivering a full continuum of care, elevating
primary healthcare’s role as the first point of contact, and adding more community-based and primary care services. • Limited national integration requiring planning, monitoring, cohesion, and appropriate use of technology. • Changing morbidity and mortality patterns that reflect a high prevalence of noncommunicable diseases driven by lifestyle. • Rapidly increasing population with high turnover levels, causing increasing demands on the healthcare system. • Shortages in a quality workforce spanning the entire sector. • Strengthening the health sector’s regulatory and policy
framework in order to develop an effective, efficient, and safe system. Supporting these goals, a total of 35 projects were established to implement change and improvement across the system. The NHS Implementation Program needed to be flexible and to evolve to reflect the importance of public health and the changing national priorities. In 2013, a significant review was undertaken and 7 projects were added to tackle perceived gaps, including Oral Health and Diabetes. The growth of the program to 42 projects meant it encompassed twice as many outputs at the end, as when it was launched in 2011.
LOOKING BACK
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Foundations Laid Through NHS 2011-2016 S
ignificant progress has be made in enhancing the quality, availability, and quantity of healthcare services including a focus on strengthening Qatar’s health workforce. Public Health has also been a high priority, with significant progress made in influencing individual behaviors towards healthier lifestyles. Primary healthcare services have been expanded to help rebalance care delivery away from hospitals and into the community, with a focus on prevention and wellness.
7 Goals
42 Projects
Over 50 Stakeholder organizations
AREAS OF IMPROVEMENT ACHIEVED THROUGH NHS 2011-2016: FOR THE POPULATION OF QATAR
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HS stakeholders have delivered far-ranging programs and services to positively impact public health outcomes through: changing people’s perceptions of why mental and physical health are important; educating people on how to stay well; improving access to primary care, screening, and early intervention,when people are unwell; streamlining care pathways across providers; management of chronic conditions; and focusing on patient experience as a key measure of our success.
EXAMPLES OF PUBLIC HEALTH WORK PRODUCED UNDER THE NHS: • The National Primary Health Care Strategy 2013-2018 was developed to put in place a robust primary care system that will form the foundation for a future, people-centered health system. • Primary Health Care Corporation (PHCC) opened 6 new health centers including three state of the art ‘Health and Wellness’ centers. Four new health centers are planned for 2017, with ten more to be confirmed and scheduled for 2018-2021. • Qatar National Nutrition and Physical Activity Action Plan 2017-2022 and Qatar National Dietary Guidelines provide advice and information to support people to lead active lives while eating healthy. • Qatar’s first National Mental Health Strategy 2013-2018 is transforming the perception and approach to mental healthcare with access to the right care, at the right time, and in the right place. • Screening has been established for breast and bowel cancer, as well as common mental health disorders, led by PHCC. • The Qatar National Diabetes Framework was launched with the vision ‘Preventing Diabetes Together’; the goal is to improve
prevention and management of diabetes. • Successful implementation of the National Cancer Strategy program has brought widespread improvements including a 48hour referral time - amongst the fastest in the world. • A draft Oral Health Strategy developed. Good oral health in children has been promoted through oral health initiatives. • Tobacco Cessation services expanded and a new Tobacco Law introduced. • National Continuing Care Framework developed. It details the practical steps necessary to achieve an effective and efficient continuing care system. • The HMC Ambulance Service has achieved and maintained world-class response times, more than three years ahead of schedule. • The National Health Emergency Management Plan will ensure the population of Qatar is protected in case of an emergency. The Plan includes a preparedness program, response and recovery plan, and contingency plans. • Qatar’s first Public Health Strategy 2017-2022 (launching in 2017) is set to fundamentally change how people perceive and manage their health and wellbeing.
122 Targets
217 Outputs
80%
42 Project teams And hundreds of thousands of man hours
of outputs completed across the NHS program to achieve one vision – improving health outcomes for the people of Qatar
FOR QUALITY IMPROVEMENT
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he establishment of quality improvement policy, regulation and monitoring to improve patient safety, and the contribution to continuous improvement is the legacy of the first NHS.
TO IMPROVE CLINICAL PRACTICE AND QUALITY: National Clinical Guidelines have been launched to provide practitioners with evidence-based, localized guidance on treatment of conditions. This will ensure consistent care as people transition between healthcare settings leading to improvement in standards of care. Patients will also able to access and familiarize themselves on treatment protocols. NEW POLICIES AND STANDARDS: • Patient Bill of Rights (BoR) introduced. It assures the healthcare system is fair and works to meet patients’ needs. It gives patients and providers a way to address problems and resolve them accordingly. • Facilities licensing standards developed based on international standards, leading to an improvement in the quality of healthcare facilities available in Qatar. • Health Service Performance Agreements (HSPA’s) developed and implemented. These provide a set of standardized key performance
indicators for hospitals, polyclinics, and primary health centers. They allow the MOPH to monitor the performance of providers to ensure quality and accountability in the healthcare system and promote evidence-informed health policy decisions. • The Qatar National Formulary (QNF) offers clinicians and patients online access to information about approved drugs, to standardize/ regulate the quality of pharmaceuticals. • International licensing of tobacco cessation service providers being provided, through a partnership with the world-renowned Mayo Clinic. ENHANCED SYSTEMS: • The National Cancer Registry that has been developed, will enable the tracking of outcomes for all cancer patients while proving vital for research and the design of future services. • The electronic Clinical Information System implemented across all PHCC and HMC facilities greatly enhances continuity of patient care.
[email protected]
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LOOKING BACK CONTD...
FOR THE HEALTH SECTOR WORKFORCE
BUILDING BLOCKS FOR FUTURE PROGRESS
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elivering world-class standards of healthcare calls for building a motivated, educated, and skilled workforce. ‘Skilled National Workforce’ was identified as Goal 4 of the NHS, while other projects also achieved improvements in the way the health sector workforce operates.
TRAINING AND DEVELOPMENT DELIVERY: • The Qatar Council of Healthcare Practitioners (QCHP) established as a single authority for the licensing and regulation of all healthcare practitioners in Qatar, contributing to increased confidence in the delivery of healthcare. Several improved patient safety practices were put in place, including the introduction of a mandatory Continuing Professional Development (CPD) and Continuing Medical Education (CME) system for all licensed practitioners in Qatar. • Over 400 family physicians at PHCC trained in mental health, with training and education plans for all mental healthcare staff in PHCC being developed. • Advanced training for Accident & Emergency staff. • PHCC Management and Leadership
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he ongoing development of health services and the healthcare sector are being enabled by a number of deliverables from projects. Published frameworks and plans are being put in place to improve health; most of the frameworks below are either starting or about to enter intense periods of implementation across the healthcare sector.
program in place to develop the next generation of senior Qatari managers. WORKFORCE PLANNING: • First Qatar Health Workforce Plan 2013-2033 developed. • Sector-wide, joint Human Resources Committee in place to ensure healthcare professionals are provided with clear career pathways and opportunities for development. FOR CONTINUOUS IMPROVEMENT The NHS program brought about benefits in the way change in healthcare is managed. According to stakeholders, through the NHS project work there is increased development of project and program leadership as well as management skills. There has also been improvement in governance, while stakeholder expertise in developing and delivering projects has advanced.
HEALTH FRAMEWORKS AND PLANS: • Public Health Strategy 2017-2022 developed, supporting the shift in the focus of care from treatment to prevention, while identifying initiatives to strengthen the public health system. • Plan developed to establish a Food Safety Authority to provide efficient, integrated food safety services to worldclass standards. • Continuing Care Design Strategy developed, which details the practical steps necessary to achieve an effective and efficient system. • Tobacco Cessation Action Plan produced to increase awareness of the harmful effects of tobacco and provide increased cessation support services. • Qatar Health Facilities’ 20-year Strategic Master Plan 2013-2033 published. • The National Laboratory Integration and Standardization Framework published. • Launch of a National Cancer Registry will provide national data on all cancer
cases diagnosed each year. • The National E-Health and Data Management Framework completed to enable online personal health accounts. • The Qatar Community Pharmacies Framework successfully developed to serve as a blueprint for future implementation of promoting better health and for providing high quality pharmaceutical services in local areas. PERFORMANCE ENHANCEMENT • New governance in place for MOPH. • The Performance Management System provides organizational effectiveness and efficiencies by reviewing, monitoring, and tracking each department's KPI’s quarterly and ensuring they align with the corporate strategies. • Sector-wide aligned budgeting and health planning achieved. The new budgeting process enables monitoring and controls of costs and supports the delivery of effective clinical and healthcare related services.
Feedback & comments Dr. Mohamed Al-Thani Director of Public Health MOPH
The National Health Strategy provided the health sector with a clear direction. This resulted in being able to better engage stakeholders, identify synergies within the sector, and deliver improvements more quickly than we could have done before. Our experience in delivering projects and programs has prepared us to address the new challenges that will come up in NHS 2017-2022.”
HEALTH MATTERS 09-2017
Dr. Mariam Ali Abdulmalik Managing Director, PHCC
An excellent primary care service is required to significantly improve health outcomes and achieve a healthy population. The NHS set out a vision for primary health care to become the foundation of the health system in Qatar, which led to the establishment of our Corporation. We strive to dramatically improve health, becoming the first and continuing point of contact for patients and their families, and focusing on prevention, screening, and wellness. Primary Care has now grown stronger, more comprehensive and better integrated, and is a model of excellence of which Qatar can be proud.”
David Highton Executive Director, Corporate Development, HMC
The NHS 2011-16 provided the strategic framework within which HMC could enter a period of intense transformation and quality improvement. Although there were a number of specific deliverables to be achieved through multiple projects at Ministry level, the NHS also provided a clear direction of travel and a spirit of ambition and improvement. HMC was able to work closely with the grain of the NHS to deliver a whole series of improvements while enabling functions such as the Cerner system. HMC will look to NHS 2017-2022 to provide the framework for even more ambitious transformation in the next 5 years.”
Lord Darzi of Denham, on behalf of the National Cancer Committee & Vice Chair of the Board of Governors, Sidra Medical and Research Center NHS 2011-2016 put Qatar National Vision 2030’s commitment to a healthy population into practice by establishing the foundations, regulations, and systems needed to provide a comprehensive worldclass healthcare system. During the implementation of the National Cancer Strategy, the team relied on the infrastructure laid out by the NHS. Similarly, in creating Sidra Medical and Research Center, teams were able to depend on the quality of healthcare practices and functions demanded by the strategy. NHS 2011-2016 made and will continue to make a difference to Qatar’s healthcare system.”
Gary Needle Acting Director of Health Activities Policy Planning Department at MOPH
NHS 2011 -2016 involved six years of work focused on building the foundations for a high performing health care system. We have seen the emergence of QCHP; new approaches to licensing and accreditation of facilities and healthcare products regulation; and the development of the Qatar Health Facilities Masterplan. National service strategies are also being implemented in important areas such as cancer, mental health and diabetes. From a solid platform we can now anticipate the acceleration of focused health care policy activity designed to further strengthen the system for the benefit of patients and citizens.”
LOOKING BACK - LOOKING FORWARD
The
NHS A
s the NHS 2011-2016 program transitions into NHS 20172022, it is important to acknowledge that while over 80% of the outputs of the NHS have been achieved, there is still much to be completed. Although projects are by definition finite, it is also essential that what they deliver are used effectively, maintained, monitored, and their full benefit realized. The Program Management Office will continue to work with project leads and teams throughout 2017 to help with project closure and transition activity. There is a phased pipeline for
closing the remaining 21 projects by the end of the second quarter of 2017, in agreement with Project Managers. Analysis of every NHS project has been completed. It encompasses: • Completed project deliverables – for example: frameworks, plans, tools or guidelines that now require implementation. • Incomplete project deliverables – those which are important but that may, due to various factors such as timing, resource, or capability, have not been fully completed. • Areas or issues that have arisen during the implementation of a project but that may have been
NHS 2011-2016 CARING FOR THE FUTURE
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Program Transition
outside the scope of the original project – for example new needs identified that were not anticipated in project design. Some of these activities will be taken forward as part of NHS 20172022, but only where the activity is in alignment with the renewed strategic focus. Rather than affect the continuity between the first and the second NHS, this approach will result in NHS 2017-2022 drawing on the achievements of the NHS 20112016 projects and specific project deliverables. The development of the second
NHS will take into account the current state of the health sector, changed external environment, new information, and issues that have emerged over the last six years – Qatar has changed significantly in many ways. NHS 2017-2022 will therefore be the opportunity to build on what has been achieved to date, complete unfinished business, but also to take a fresh approach and set new priorities where necessary. Therefore existing projects will be closed, and new programs of work will be created, while revising objectives and determining how best to deliver them.
NHS WEBSITE To reflect the transition from NHS 2011-2016 to NHS 2017-2022, the NHS website www.nhsq.info is going through a consolidation process. The website will be updated with information, to summarize the progress achieved by the strategy thus far and the status of the transition to the next; details of each NHS project in terms of progress and next steps will also be available. The updated website will stand as an online source of information to the health community and the public in general, providing details of the transition process.
NHS 2017-2022 OUR HEALTH, OUR FUTURE
Was project and output focused
Will be program and outcome focused
Contained 35 and later 42 projects
Comprises fewer, larger Strategic Programs of work
Outputs were detailed in NHS Project Initiation Documents (PIDs)
Takes a more thematic approach; departments to develop detailed Annual Implementation Plans
Based on broad stakeholder inputs
Reflects the key strategic priorities of the health sector
Structured under 7 goals
Follow the Triple Aim Framework: Better Health, Better Care, Better Value.
[email protected]
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LOOKING FORWARD
National Health Strategy 2017 – 2022: An Overview The National Health Strategy (NHS) 2011- 2016 introduced fundamental reforms across the health sector through 42 projects, to support the achievements of the Qatar National Vision (QNV) 2030. It laid a strong foundation on which the next strategy can be built. As the nation transitions into this next phase, we remain focused on supporting a healthy and vibrant population. To this end, National Health Strategy 2017-2022 continues our work towards offering citizens and residents a comprehensive world-class healthcare system whose services are accessible to the whole population, with a focus on preventive healthcare, based on the triple aims of: Better Health, Better Care, and Better Value. These aims will work together to complement the achievements of NHS 2011-2016 and drive us forward with a greater purpose and focus.
OVERALL AIM OF THE EMERGING STRATEGY In a conversation with Health Matters, Dr. Juliet Ibrahim, Deputy Chair, National Health Strategy Committee, MOPH, offered an overview of the strategy development, its aims, outcomes, differences, and similarities. “The overarching context of National Health Strategy 2017-2022 remains the same as National Health Strategy 2011-2016, as the National Health Strategy continues to be one of the sector strategies for the National Development Strategy (NDS), and we seek to work towards achieving the QNV 2030. This continuing overall aim is to make the population healthier and when they require care, we must provide them the best possible care. “This must be accomplished within and reflect the current national context: we now work with increased financial constraints requiring a greater need to prioritize aims, while focusing on areas where we can get the best return on investment; we have a better understanding of health outcomes that need to be achieved and the priority segments of the population that need to be reached; and there is a clear understanding of what has been achieved through the first strategy which will form the firm foundation on which the next strategy is being built.” Referring to some of the initial challenges faced with the first strategy Dr. Ibrahim added: “In 2011, the idea of a national strategy was new and the concept fresh, and wasn't necessarily well understood. A major effort was required to engage our stakeholders to understand the importance and institute joint working with the Ministry of Public Health. Communication and coordination was easier in developing the new strategy. We currently have governmental, semi-governmental, NGOs, private, educational and charitable institutions coming together to jointly develop the strategy.”
FRAMEWORK The new strategic framework will be based on an internationally recognized quality improvement
HEALTH MATTERS 09-2017
framework of the triple aim philosophy: Better Health, Better Care, and Better Value. This is both a conceptual model and operational framework, which will help individuals stay grounded in the aim and purpose behind the whole initiative. The seven goals of National Health Strategy 2011 -2016, map neatly into the new framework. While improving the efficiency of the system, the triple aims keep the focus on the basic questions: “Why do we do what we do? Will this program or activity improve the health of the population, their care, or create value from the system?” The main difference in approach between the two strategies will be in making things more outcomes focused as opposed to being project-focused – calling for more integration, while allowing people to work together more broadly, towards achieving an identified outcome.
BETTER HEALTH Emphasis will be on population health, which is the right and responsibility of every individual. Improving the health (both physical and mental wellbeing) of the population requires strong and aligned leadership that sets shared goals, and works in partnership with the community in defining their needs. Achieving better health entails a ‘health in all policies’ approach, and necessitates strong cross-governmental as well as crosssectoral communication and collaboration. In striving to keep people healthier, focus will be on health promotion and prevention of diseases; encouraging healthy behavior and a lifestyle which leads to better health; and empowering people to become more active and productive members of society. While it is important that individuals take ownership of their health, the health system will need to ensure that people have the knowledge, access, and tools to make healthy choices regarding their lives. Improving health awareness and literacy of the population will be a priority. While working towards a healthy population, longterm goals will include focusing on the environment as well as on the settings where they live, work, play, and
LOOKING FORWARD
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The Strategy works towards Better Health, Better Care, and Better Value for all
learn. Working on these areas will eventually lead to the idea of healthy cities. This can only be done through strong collaborative efforts between multiple sectors and government agencies. In order to fulfill the role of protecting the health of the people it is important to ensure a healthy, safe, and harm-free environment; access to clean drinking water; and healthy food that is safe to eat.
BETTER CARE Focus will be on the patient journey. Efforts will be on further improving integration and coordination, and ensuring the patient is at the center of what is being delivered. The strategy will stress the importance of different care providers working within the system together, and more cohesively, placing the patients’ needs above organizational boundaries. Emphasis will be on the patients receiving a continuum of care, rather than being labeled as belonging to a certain organization and being treated accordingly. Patients should not see boundaries, they expect care to be seamless wherever they enter the system, with systems being held accountable particularly when they pass between health providers. Focus will also be on providing evidence-based, safe care.
BETTER VALUE The idea of value doesn’t just apply to sector costs and investment. In fact, the basic idea is to ensure that what the patient receives from the system is of value. In terms of delivering quality and value from a Ministry and regulator perspective for the health system, a healthy balance must be achieved between the value provided to the patient, and the amount of investment required, to support the standards. Investment must be in the right people and activities;
efficient investment and effective use of resources will be the key to delivering value to patients and meeting health sector priorities. The model of sustainable financing must support a model of care that ensures patients get better health, better care, and better value. Priorities will be based on identified groups / segments of the population in greatest need, looking at better health, better care and better value for each group.
achieving those with the greatest impact. There will be multiple people from varied sectors, experiences, and entities working towards a desired outcome, but they will contribute from different angles towards implementation of common plans and goals.
CONSULTATION
Health is one of 8 sectors delivering a renewed vision through the next round of National Development Strategies. ‘Health in all policies’ across Qatar will be encouraged. Good public health cannot be achieved by the health sector alone, as almost 80% of health determinants lie outside of health care. These are within the public’s owns hands, in the community, and in the environment in which we work and live. A high degree of cross-governmental and community collaboration and leadership will be sought. Roles of different government entities and social agencies will require clear definition in terms of commitment, direction, accountability, management, and to understand the opportunities for health coalitions that already exist here in Qatar. The coordination role of the Ministry of Development Planning and Statistics (MDPS) will support cross-governmental clarity and ensure cooperation. The aim of ‘health in all policies’ will be promoted towards achieving our triple aim of: Better Health, Better Care and Better Value. With a system-wide perspective being planned to transform healthcare in Qatar for the benefit of all sectors of society, greater progress can be expected as government, ministries, healthcare organizations, healthcare providers and public work in tandem. The journey continues – good health for everyone in Qatar.
Similar to the process of developing the first strategy, we are conducting a wide consultation to receive inputs and feedback, and these will serve to contribute towards, and inform, the new strategy. THE MULTIPLE INPUTS INCLUDE: • Seven subgroups and task teams comprising membership from across the health sector (and other sectors - as relevant), who work around related content themes. • Set of strategic interviews held to collect input from key individuals, including executives and senior clinicians especially those involved in patient care. • Surveys sent out to government ministries and key stakeholders. • Team members collecting the opinions of NGOs and support groups in the community. • Analyzing available public opinion obtained from questionnaires and surveys conducted.
PRIORITIES Prioritizing across the sector and the programs of work will be key. The aim is to provide greater clarity and help people focus and achieve. Priorities will be set specifically and deliberately in each area and efforts will be focused on
CROSS-GOVERNMENTAL COLLABORATION
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LOOKING FORWARD CONTD…
The new strategic framework and vision National Health Strategy 2017-2022 will be guided by the Triple Aim philosophy and the vision 'Our Health, Our Future'
N
ational Health Strategy 2011-2016 helped highlight On 13 December 2016, the IHI visited the Ministry of public health as an important national issue; it Public Health as part of the official mission, and delivered also enabled Qatar to have a stronger presence an informative session to introduce the philosophy of the at regional and international levels. The health Triple Aim framework. While sharing case studies they Health of sector is now transitioning towards National Health explained key enablers for success such as: getting to Population Strategy 2017-2022 under the direction and vision know the target population intimately, understanding (Better Health) of Her Excellency, Dr. Hanan Mohamed Althe purpose in relation to the population, and Kuwari, the Minister of Public Health structured promoting healthcare as a second language to around the Triple Aim of: Better Health, Better build widespread support and coalitions. Care and Better Value. The Triple Aim has been widely used The IHI introduction highlighted five around the world for almost a decade and accelerators that successful organizations comes from the Institute for Healthcare typically adopt: Improvement (IHI), an independent • Demonstrating effective leadership not-for-profit organization based • Integrating data systems to support in the USA. IHI is internationally performance improvement recognized for their work in health • Building robust improvement and healthcare improvement. infrastructure The organization has worked • Engaging providers and closely with HMC in recent community stakeholders and years building critical care design Patient Reducing per knowledge of how to apply • Leveraging payment models Experience capita cost the framework tenets within a to achieve clinical and financial (Better Care) (Better Value) local context. targets.
Triple Aim
Qatar Public Health Strategy 2017 – 2022 harnessing public participation Health Areas MOPH’s new PHS will invite the public to provide feedback through an online survey
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he Qatar Public Health Strategy 2017 – 2022 (PHS), an output of the National Health Strategy, is set to fundamentally enhance public health awareness and wellbeing. The strategy, which aims to improve the health of the nation’s population, focuses on 16 health objectives and 4 strategic enablers; it is the result of many months of consultation and research. The strategy will be launched online to coincide with the first stage of public engagement. Prioritizing consultation with the people of Qatar, the MOPH is encouraging the public to visit the website (when available) and complete the health survey as part of a coordinated engagement plan. THE GOALS ARE: • Invite the public to start thinking HEALTH MATTERS 09-2017
about their health and wellbeing, and what they need to stay well • Encourage the public to feel part of the strategy, have their say and contribute towards its success • For the MOPH Public Health team, to analyze public feedback and compare against the objectives and goals of the strategy • For the final, publicly endorsed strategy to be officially launched with or close to NHS 2017-2022, later in 2017 The PHS will serve as a platform to strengthen health protection mechanisms, support Qatar’s population to live healthily, increase the length of people’s lives, and tailor approaches to population needs. It lays out the vision for a ‘comprehensive, dynamic and collaborative public health system, working together to improve the health and prosperity of Qatar’.
- Health Objectives
16 HEALTH OBJECTIVES
Cardiovascular Disease
Respiratory Respiratory Disease Disease
Maternal & Child Health
Diabetes Diabetes
Health lifestyle
Road safety
Mental health
Tobacco
Vision
Occupational Health
Cancer
Communicable Disease
Environmental Health
Food Safety Musculoskeletal
Oral Health
SLIDE 1
REGULAR FEATURE
INNOVATION IN ACTION
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Adapting accountable care principles in Qatar The Accountable Care Pilot for Diabetes at Al Wakra is helping improve care while avoiding costly complications
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he concept of Accountable Care was introduced in Qatar through the office of the World Innovation Summit for Health (WISH), an initiative of Qatar Foundation. The principles of Accountable Care Organizations (ACO) encourage providers to take on a shared responsibility for the care of a defined population of patients, while assuring active management of the quality, timely access, and cost of that care. As diabetes care and diabetes prevention are high public health priorities in Qatar, an Accountable Care diabetes-focused pilot was initiated in January 2016 between Al Wakra Health Center and HMC. As a result a SMART Clinic was initiated, to give patients individualized healthcare plans depending on their classification as pre-diabetic or diabetic. The project is the first of its kind in the region, and is set to help Qatar alleviate the diabetes epidemic in the nation. The pilot has presented an opportunity to improve care and potentially avoid costly complications. It was initiated as a collaboration between PHCC, HMC, and MOPH working together with a focus on identifying the risk factors for diabetes, engaging patients early, and delivering coordinated care throughout the whole spectrum of care needs that a diabetic patient might have. Commenting on the pilot, Egbert Schillings, CEO of WISH
said: “Accountable Care is one way of describing a fundamental shift taking place in healthcare all around the world. The old model of healthcare—a reactive system that treats acute illnesses after the fact—is evolving to one that is more centered on patients, prevention, and the ongoing management of chronic conditions. This evolution is essential and is driven by an aging population and the increasing incidence of behaviorally induced chronic conditions, such as diabetes. Health systems are innovating on the delivery side to meet this challenge through a growing emphasis on primary care, integrated care models, and payfor-value reimbursement. The care itself and the incentives to provide the right kinds of interventions must be aligned around the patient and if you get that model right, the prevention and management of all non-communicable diseases will transcend its current limitations and truly help create health at a population level.” Rationalizing the choice of diabetes for the pilot, Schillings added: “Diabetes was the logical place to start, given the increasing prevalence in the community, the truly terrible co-morbidities and resulting costs to the system. For WISH, Accountable Care is more than a concept or a report at the summit – it is testament to the program’s contribution to the local health economy. Working with
9,823 registered patients at Al Wakra Health Center
1,525
Qatari patients with known diagnosis of diabetes prepilot
4,317
Patients invited for screening
1,532 (35%) patients
agreed to be screened
1,499 (98%) 948 (63%) NORMAL
PRE-DIABETIC
results available
492 (33%)
59 (4%)
NEWLY DIAGNOSED CASES OF DIABETES
Outcome of SMART diabetes screening at Al Wakra Health Center
our partners at the MOPH, HMC, and PHCC, we convened local stakeholders and international experts to start transforming the way diabetes care is delivered in Qatar. It is also a best practice example of embracing innovation and adapting it to the local context. The results that the SMART Clinic has been able to achieve speak for themselves - identification of previously undiagnosed diabetics (4% of the screened population), decreases in core KPIs such as BMI and cholesterol, as well as better management of HbA1C. The clinical staff and their leadership have shown that successful change initiatives in this key area of population health, are both achievable and scalable.” Stating the role of PHCC in executing the project, Dr. Samya Al-Abdulla, Executive Director of Operations, PHCC said: “The overarching objective of the SMART initiative was to design and model a locally relevant system of integrated healthcare for a target cohort, in order to improve their care and health outcomes as efficiently as possible in terms of resources. Considering the principles of population health management and accountable care, PHCC and HMC worked collaboratively to restructure care pathways to improve health outcomes, quality of care, and value for money using diabetes as an entry point because of the known benefits associated with delivering coordinated care to chronic disease patients. This initiative successfully identified a number of patients who were previously undiagnosed with diabetics, in line with predicted prevalence rates, and a significantly high number of pre-diabetic patients for whom early intervention and personalized care plans have been introduced. Parallel to SMART clinics, PHCC has developed, and is introducing Wellness Services and other screening programs such as cancer screening and general health checks. The next steps for PHCC includes the implementation of a comprehensive health check model (wider than diabetes screening) which includes the most valuable elements of the pilot, such as availability of lifestyle services support and expertise from joint MDTs, to help the community maintain their health and adherence to treatment plans.”
OUTCOMES In addition to screening, statistics, KPIs and targets have been established to measure health outcomes such as reduction in HbA1c levels, BMI (body mass index) and BP (blood pressure) over time. Support has also been provided by dieticians and health educators to help prediabetic and diabetic patients manage weight loss. MULTIDISCIPLINARY TEAM (MDT) The joint primary and secondary care MDT has been established and functions on a monthly basis, with representation from PHCC and HMC. FINANCE Besides improved health outcomes, the program helps reduce the cost of care. For pre-diabetic patients this could include expensive long-term medication and treatment, while for diabetic patients it can help reduce the need for high cost hospitalization. NEXT STEPS Future plans include expanding screening to more patients and widening the scope of the screening to include full health checks, integration with different strategic initiatives such as electronic referrals and discharge management, and increased joint multidisciplinary working.
PHCC is linking the SMART clinics with the Wellness concept to incorporate the ideals of weight management, healthy lifestyle changes, and core responsibility to manage chronic diseases for the population across Qatar. Evidencebased, person-centered Wellness services support PHCC’s patients to make sustainable, healthy lifestyle choices. Wellness services are preventative in nature and aim to minimize the four main risk factors of ill health in Qatar namely: smoking, obesity, lack of physical activity, and unhealthy eating habits. Comprehensive SMART health checks, focused more holistically than on diabetes alone, are being introduced at Leabaib and Rawdat Al Khail health centres to provide proactive prevention services designed to empower patients to take control of their health and wellbeing. GLOSSARY: • HbA1c levels - Hemoglobin A1c levels. • Pay-for-value reimbursement - A system where the hospital/ physician gets paid for the benefit/ worth of the service provided, rather than the service itself. It incentivizes high-quality care (keeping people healthy and outside hospitals rather than it being beneficial for the doctor to have their patient be re-admitted).
PREVALENCE OF DIABETES IN QATAR The World Health Organization (WHO) currently estimates the prevalence rate for diabetes in the entire Qatari population at 12.8% or about 17% when adjusted for age. A similar prevalence was obtained
in different surveys and field studies among Qatari adults. However, many individuals with diabetes in Qatar are undiagnosed, which indicates that the prevalence of diabetes is likely to continue to rise.
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10 QCHP
REGULAR FEATURE
QCHP: A journey towards improved patient safety and continuous innovation The council takes stock of its progress while looking at future plans and challenges
T
he QCHP establishment and launch phases have been completed and significant progress has been made towards realizing its mandate of ensuring licensing, regulation, and high quality education of the health workforce in Qatar. Looking back over the last 12 months, Dr. Samar Aboulsoud, Acting Chief Executive Officer, QCHP, discussed with Health Matters the milestones achieved and ongoing improvements planned for the future. LOOKING BACK Health Matters: What are the essential enabling elements that have ensured success for QCHP over the last year in delivering its ambitious plans? QCHP: I believe that QCHP, its governance, staff, health and educational partners, and practitioners, have all contributed to building a very special and unique culture. There is strong affiliation at all levels to our core principles and to the culture of innovation, collaboration, and transparency. Governance The governing board comprises leaders in healthcare who have an excellent understanding of QCHP’s
vision, objectives, initiatives, and challenges, and they govern in a very empowering way. Teamwork The organizational culture encourages cross-functional collaboration and pollination. This approach is embedded in our daily work. While there are diverse functions assigned to the different departments, they are all accountable to collaborate together to complement each other’s work, whilst maintaining a clear understanding of each other’s roles. In other words, while the scope of work maybe different, everyone works towards one aim. Teamwork is a must and produces higher quality work product for all. Engagement Investment in stakeholder engagement is a major supporting element in progressing the projects and programs of work, ensuring full commitment and robust communication with the right people at the right time, to get ideas and feedback. We also stress that working in alignment with the overarching aims of the health sector is imperative, to ensure plans maintain the right focus and relevance, to support national priorities.
LOOKING AHEAD Health Matters: As you transition from NHS 2011-2016 to NHS 2017-2022 what are the challenges on the road ahead? QCHP: The NHS objectives served as the guiding framework initially. Maturing from an NHS project has meant that QCHP has now developed a strategic plan that will guide and prioritize our work. All projects proposed in the QCHP Five Year Strategic Plan reflect the organization’s strategic growth to enhance its capacity in improving the health sector workforce, quality, and patient safety. Adherence to the alignment of developments with all major organizations and providers is also ensured. STRATEGIC THEMES AND PROGRAMS FOR 2017 SUSTAINABLE GROWTH As a new and developing organization, there is a requirement for review, revision, and restructuring to match resources to future plans. This helps to ensure the council has the right people to maintain sustainable growth and achieve its vision and ambitious goals.
EXCELLENCE AND QUALITY QCHP aims to introduce a quality management system in 2017, to ensure a structured approach to management and process improvement. A suitable international quality framework will be adopted and tailored to localized requirements. PARTNERSHIP AND ENGAGEMENT QCHP has partnered effectively and successfully with several regional and international bodies and will continue to build more such affiliations. Priority will be the continued, effective engagement with the local stakeholders to deliver excellence. HIGH PERFORMING ORGANIZATION Any high-performing organization should be supported by strong IT initiatives. The
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current registration system is a good example where we plan to completely digitize the accreditation system. The QCHP website was updated to incorporate several new functionalities with advanced and user-friendly features, making the web experience more efficient. E-archiving of the database and the development of a mobile app for Continuing Professional Development (CPD) registration, are other examples of steps planned to match international standards. The Qatar Council for Healthcare Practitioners (QCHP) was established by Emiri Decree in March 2013, as the authority responsible for regulating all healthcare practitioners (both governmental and private sector) working in Qatar. The council functions through three departments working in collaboration to improve healthcare quality and ensure patient safety: • Healthcare Practitioner Registration & Licensing Department • Accreditation Department • Fitness to Practice Department
Highlights of Recent Achievements The CPD Program is now globally recognized. The national CPD accreditation system is now recognized by the Royal College of Physicians and Surgeons of Canada (RCPSC) and the Accreditation Council for Continuing Medical Education (ACCME); the credit system is recognized by the American Medical Association (AMA) and the American Academy for Family Physicians (AAFP). QCHP’s national CPD accreditation system has been recognized by the Royal College of Physicians and Surgeons of Canada (RCPSC).
We are pleased to award substantial equivalency to our colleague accreditor, the Qatar Council for Healthcare Practitioners (QCHP). I commend
QCHP for its dedication to building international collaboration and advancing the quality of CME/CPD. QCHP’s accreditation system assures that CME/CPD is based on the needs of healthcare professionals, measured for its effectiveness, meets standards of scientific integrity, and is independent of commercial influence. With this achievement, QCHP demonstrates its commitment to promoting consistent, high-quality education for individual healthcare professionals and inter-professional healthcare teams. We look forward to working together to achieve QCHP’s ultimate goal of improving the health of patients in Qatar.” Graham McMahon, MD, MMSc, President and CEO, ACCME
QCHP by the Numbers REGISTRATION AND LICENSING DEPARTMENT • 36,769 Licensed healthcare practitioners to date • 2 International affiliations achieved • 6 Healthcare professions licensed in Qatar (including Physicians, Dentists, Allied Healthcare Practitioners, Pharmacist, Nurses, Complementary Medicine) • 10 New healthcare professions recognized & 6 scopes updated
HEALTH MATTERS 09-2017
FITNESS TO PRACTICE DEPARTMENT • 169 Issues / complaints raised in 2016 • 125 Actions taken in response
ACCREDITATION DEPARTMENT • 27,285 Healthcare practitioners’ CPD e-portfolio accounts created • 325,478 CME/CPD activities completed by healthcare practitioners • 813 Accredited activities offered across Qatar • 2 Memberships - international affiliations / accreditations • 4 Agreements - international affiliations / accreditations • 12 accredited QCHP accredited CPD providers in the State of Qatar (including academic institutions, governmental healthcare providers and private healthcare providers)
REGULAR FEATURE
QUALITY IMPROVEMENT 11
Antimicrobial Resistance a growing global concern Qatar works on a national action plan bringing together experts from various sectors to fight the threat
A
ntibiotic / Antimicrobial resistance (AMR) is the ability of microbes to resist the effects of medicines. Bacteria inevitably evolve resistance to antibiotics and these are often referred to as ‘super bugs’. Action is needed to prevent new resistance from developing and to stop the spread of resistance that already exists. AMR is a global issue that is putting strain on the healthcare sector and is costing lives. AMR causes increased health care cost, lengthier stays in hospitals and need of more intensive care. Infections with resistant organisms are difficult to treat, requiring costly and sometimes toxic alternatives. The sixty-eighth World Health Assembly in May 2015 endorsed a global action plan to tackle resistance to antimicrobial medicines. This year both - the World Health Organization (WHO) and the World Innovation Summit for Health (WISH) held in Doha in November 2016, highlighted the urgent need for coordinated global action.
QATAR’S RESPONSE Qatar observed World Antibiotics Awareness Week in November 2016 and held a seminar to highlight international concerns and their impact on national priorities. Activity is being led by the Healthcare Quality and Patient Safety, and Public Health Departments within the MOPH, along with colleagues at HMC and consultants from the WHO Eastern Mediterranean Regional Office. AMR is a multi-sector problem that places a huge burden on human and animal health as well as the economy. Qatar is taking a “One Health” approach to develop a national action plan, bringing experts from the healthcare sector together with representatives from the livestock and agriculture departments of the Ministry of Municipality and Environment, and the Ministry of Economy and Commerce. Antibiotic stewardship, including addressing the appropriate way of prescribing, dispensing, and the usage of antibiotics, will form part of the Qatar National Plan; this is also being addressed through the development of National
Clinical Guidelines. The correct use of antibiotics and adherence to prescription instructions, as well as guidance on the prevention and spread of infection will be
underpinned through multisector education programs that will include healthcare providers, patients, and general community/public.
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DEVELOPMENT OF NEW PATIENT EXPERIENCE SURVEYS FOR HOSPITALS, PRIMARY HEALTH CENTERS, AND POLYCLINICS Health Service Performance Agreements (HSPAs) have been developed in collaboration with healthcare providers in Qatar. Implementation for all hospitals and primary healthcare centers started on January 1st 2016, with the pilot period for selected polyclinics commencing on the same date. HSPAs will enable the MOPH to monitor and measure the overall performance of the healthcare system using a standard and comparable set of performance indicators. Data is collated by MOPH with feedback to providers in order to improve the quality
of healthcare services. Provider feedback during the pilot period specifically requested that standard Patient Experience Surveys be developed. The MOPH Healthcare Quality and Patient Safety Department responded by facilitating focus groups to gather views on how to measure patient experience. This has resulted in improvements to the previous patient experience measures to make data collected comparable and consistent, to increase compliance, and improve the reliability statistical benchmarks. The overall benefit is to have an effective patient experience
survey that is evidence-based, easy to use, and relevant in the Qatar context and culture. The inpatient and outpatient surveys have been piloted at 17 facilities (3 Inpatient, 4 Outpatient, 2 PHCCs and 10 Polyclinics) in order to test and refine them to better fit the context of healthcare organizations in Qatar. The final surveys and supporting materials for all healthcare settings will be implemented in the first half of 2017. Monitoring of patient experience as part of the HSPAs will allow MOPH to continue on its path to improving the quality of the patient experience.
5 Quick Facts About HSPAs • HSPAs are contractual agreements between MOPH and health facilities in Qatar • HSPAs help the Ministry to strengthen its policy and regulatory capacity by monitoring clinical quality and accountability across the healthcare system • HSPAs enable providers to use a common framework for measurement and assessment of patient experience data and will enable the establishment of benchmarks • There are currently 28 KPIs (Key Performance Indicators) for hospitals, 16 KPIs for primary health centers, and 14 KPIs for polyclinics • Patient experience surveys are one measure included in the HSPAs.
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12 DRIVING QUALITY IMPROVEMENT
QATAR'S NATIONAL CLINICAL GUIDELINES: RAISING QUALITY OF CARE The National Clinical Guidelines give healthcare providers enhanced access to up-to-date international best practice and evidence. This will lead to patients receiving consistent, high-quality treatment wherever they are treated within the healthcare system.
BENEFITS TO PRIMARY CARE PROVIDERS • Accessibility to evidence-based guidance that is localised to Qatari context • Reduces unwarranted variation in care • Facilitates appropriate referral to secondary care • Optimises primary healthcare resources
Pathways for
Acute Asthma in Children Background information
Updates to this care map
BENEFITS TO SECONDARY CARE PROVIDERS • Standardized care delivered for appropriately referred patients • Effective use of secondary care resources • Better patient outcomes • Improved staff & patient satisfaction • Standardized clinical quality measures
I have read and reviewed the Clinical Guidelines for type 1, 2 Diabetes. Great job. I expect it will be the perfect guide to all healthcare providers dealing with children and adolescents, with type 1, 2 Diabetes.” Nurse Educator
Abbreviations used in this care map
“ A robust system ensuring up-to-date, evidence-based practice relevant to Qatar 's needs is put in place; this fosters a critical component of clinical governance which ensures high quality, safe, and reliable healthcare.” Huda Amer Al-Katheeri Acting Director, MOPH-Healthcare Quality & Patient Safety Department
Red Flag! Early referral to Paediatric Emergency Centre
Refer to Paediatric Emergency Centre R
Life-threatening asthma exacerbation
Severe asthma exacerbation
Mild to moderate asthma exacerbation
Initial management of life-threatening asthma exacerbation
Initial management of severe asthma exacerbation
Management of mild to moderate asthma exacerbation
Poor response
Consider referral to PICU
Good response
R
Indications for PICU admission
Follow up in primary care
The high quality, evidence-based National Clinical Guidelines are the result of many hours of rigorous scientific discussions by valued healthcare practitioners and Stakeholder Representative Group members.” Dr. Ilham Omer Guideline & Standardization Specialist, National Clinical Guidelines Project, MOPH – HQPS
Go to SCH - Asthma in children - Chronic
Subsequent management
Inpatient admission criteria
An integration culture, where medical care across all organizations is governed by similar standards can only be beneficial, when all organizations contribute.” Physician Secondary care provider
Key recommendations of the care map
• Reduced national healthcare costs • Progression of National Health Strategy projects • Basis to implement framework of clinical governance • Improved disease prevention • Effective allocation of healthcare resources
Management of an acute exacerbation of asthma
I find the guidelines that span Primary and Secondary care are very beneficial especially during the referral process.” Physician (Public) Primary care provider
Adopting localised evidence-based practice guidelines will benefit both practitioners and patients.” Physician (Private) Primary care provider
BENEFITS TO MOPH
Observation care criteria
Goal length of stay
Extended stay criteria
BENEFITS TO PATIENTS • Access to quality information • Improved patient satisfaction and confidence that they are receiving care from more knowledgeable healthcare providers • Reduced need for hospital referral/admission • Better health outcomes
I am a betterinformed patient.” Mariyah Mohamed
Readmission-risk
Consider discharging the patient
Follow up in primary care
Go to SCH - Asthma in children - Chronic
“I feel more confident visiting doctors in Qatar, knowing my illness will be managed according to the latest international standards. Traveling abroad for treatment is not for me anymore.” Yusuf Hassan
WE BELIEVE
A CLOSER LOOK
GLOSSARY
The latest evidence-based guidelines will help ensure our clinicians deliver the best in care to all in need.
Clinical guidelines online: www.moph.gov.qa/clinical-guidelines Pathways from Map of Medicine: meapp.mapofmedicine.com/ mom/251/index.html The pathways are currently available in English.
The Institute of Medicine defines Clinical Guidelines as "statements that include recommendations, intended to optimize patient care, informed by a systematic review of evidence."
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The Pathways are decision trees based on the guideline content, presented in a user-friendly manner, accessible at the point of care.
12
تعزيز جهود تحسين الجودة
المبادئ اإلرشادية السريرية الوطنية: رفع مســتوى جودة الرعاية الصحية
تسهم المبادئ اإلرشادية السريرية الوطنية في تعزيز وصول مزودي خدمات الرعاية الصحية ألفضل الممارسات واألساليب العالمية الحديثة ،األمر الذي ينعكس إيجا ًبا على المرضى ويعزز حصولهم على خدمات رعاية صحية متسقة عالية الجودة على مستوى نظام الرعاية الصحية بأكمله. الفوائد التي تعود على مقدمي خدمات الرعاية األولية • الو�صول �إىل �إر�شادات قائمة على الأدلة مت توطينها لتتما�شى مع ال�سياق القطري. • خف�ض معدالت التنوع غري امل�ضمون يف الرعاية ال�صحية. • ت�سهيل الإحالة الطبية املنا�سبة للرعاية الثانوية. • اال�ستخدام الأمثل ملوارد الرعاية الثانوية. • • أجد أن المبادئ اإلرشادية • التي تشمل الرعاية األولية • والثانوية مفيدة جدً ا وال • سيّما في أثناء عملية اإلحالة”. • مقدم خدمات رعاية صحية أولية • • • "إن اتباع إرشادات • • الممارسة القائمة على • األدلة والمتوائمة مع • السياق المحلي سوف يفيد كل من الممارس الصحي والمريض”. • طبيب رعاية صحية أولية • • • • • • الفوائد التي تعود على مقدمي خدمات الرعاية الثانوية • رعاية �صحية ذات معايري موحدة للمر�ضى الذين يتم حتويلهم ب�شكل منا�سب. • ا�ستخدام فاعل ملوارد الرعاية الثانوية. • خمرجات �أف�ضل للمري�ض. • حت�سني معدالت الر�ضا لدى كل من املمار�سني ال�صحيني واملر�ضى. • معايري جودة �سريرية موحدة.
مسارات الربو الحاد لدى األطفال Abbreviations used in this care map
Updates to this care map
Key recommendations of the care map
Background information
Management of an acute exacerbation of asthma
• خف�ض تكاليف الرعاية ال�صحية الوطنية. • تقدُّم م�شروعات اال�سرتاتيجية الوطنية لل�صحة. • �أ�سا�س لتطبيق �إطار مراقبة تطوير املبادئ الإر�شادية. • حت�سني معدالت الوقاية من الأمرا�ض. • التخ�صي�ص الفاعل ملوارد الرعاية ال�صحية. أصبح من المتاح الوصول إلى نظام قوي يتضمن أفضل الممارسات الموثوقة الخاصة بدولة قطر والتي تخضع للتحديث المستمر .من شأن ذلك أن يسهم بقوة في تعزيز السلطة الخاصة بمراقبة تطوير المبادئ اإلرشادية السريرية بما يضمن توفير خدمات رعاية صحية موثوقة وآمنة وعالية الجودة”.
Red Flag! Early referral to Paediatric Emergency Centre
Refer to Paediatric Emergency Centre R
Mild to moderate asthma exacerbation
Severe asthma exacerbation
Life-threatening asthma exacerbation
Management of mild to moderate asthma exacerbation
Initial management of severe asthma exacerbation
Initial management of life-threatening asthma exacerbation
Follow up in primary care
Poor response
Good response
Go to SCH - Asthma in children - Chronic
Subsequent management
Observation care criteria
Inpatient admission criteria
Extended stay criteria
•
هدى عامر الكثيري مدير إدارة جودة الرعاية الصحية وسالمة المرضى بالوكالة ،وزارة الصحة العامة
تعد المبادئ اإلرشادية السريرية الوطنية عالية الجودة والمستلهمة من التجارب ثمرة ساعات طويلة من العمل الدؤوب والنقاشات العلمية بين مقدمي خدمات الرعاية الصحية المرموقين وأفراد المجموعة الممثلة لألطراف المعنية بالمشروع”.
الدكتورة إلهام عمر أخصائي المعايير واإلرشاد ،مشروع المبادئ اإلرشادية السريرية الوطنية، وزارة الصحة العامة
• • • الفوائد التي تعود على المرضى • الو�صول �إىل معلومات موثوقة. • حت�سني معدل ر�ضا املري�ض وثقته ب�أنه يح�صل على الرعاية ال�صحية من مزودي خدمات رعاية �صحية ميتلكون املعرفة الالزمة. • خف�ض احلاجة �إىل دخول امل�ست�شفيات والتحويل �إليها. • خمرجات �صحية �أف�ضل. أنا مريضة مطلعة بشكل أفضل”.
Readmission-risk
مارية محمد
قرأت وراجعت المبادئ اإلرشادية السريرية الوطنية الخاصة بداء السكري من النوعين األول والثاني. إنه ً حقا عمل رائع .آمل أن تمثل هذه المبادئ الدليل اإلرشادي المتكامل والشامل لكافة مزودي خدمات الرعاية الصحية الذين يقدمون خدماتهم لألطفال واليافعين المصابين بداء السكري من النوع األول والثاني”.
Consider discharging the patient
Follow up in primary care
Go to SCH - Asthma in children - Chronic
معلمة تمريض
المبادئ اإلرشادية السريرية الوطنية المبنية على الممارسات واألدلة الحديثة ستساعد مزودي الرعاية السريرية على توفير الرعاية الصحية المثالية لكل من هم في حاجة إليها.
Indications for PICU admission
Goal length of stay
مقدم خدمات رعاية صحية ثانوية
نؤمن بأن
Consider referral to PICU R
تتحقق الفائدة من ثقافة التكامل التي تخضع من خاللها جميع المؤسسات الصحية لمعايير متشابهة عندما تساهم كافة المؤسسات وتؤدي الدور المنوط بها”.
أصبحت أشعر بقدر أكبر من الثقة عند زيارتي لألطباء في دولة قطر، لعلمي بأن حالتي سيتم التعامل معها وفق أعلى المعايير العالمية .لم يعد السفر للخارج من أجل الحصول على العالج أمرًا واردً ا بالنسبة لي”.
يوسف حسن
نظرة عن كثب الوصول إلى المسارات عبر موقع ( )Map of Medicineعبر الرابط: www.moph.gov.qa/clinical-guidelines
المسارات متاحة حاليًا باللغة اإلنجليزية. للمزيد
[email protected] :
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الفوائد التي تعود على وزارة الصحة العامة
مصطلحات /تعريفات
مسارات الرعاية السريرية :رسوم توضيحية ً تمثل ترجمة المبادئ اإلرشادية السريرية إلى خطوات مبسطة بحيث يسهل على الطبيب أو الممارس الصحي اتباعها عند عالج حالة مرضية تقدم بشكل سهل االستخدام وتكون متاحة عبر منصة تقديم الرعاية الصحية. يعرف معهد الطب المبادئ اإلرشادية السريرية بأنها نصوص تتضمن توصيات تبنى على المراجعة المنهجية لألدلة السابقة الغرض منها تحسين الرعاية المقدمة للمرضى نحو ما يمكن للممارس الصحي /الطبيب اتباعه في عالج حالة مرضية معينه وفق أفضل ما توصل له العلم في هذا المجال .
