Better coordination beyond purely medical aspects: the National Research Programme "Smarter Health Care" (NRP 74) of the Swiss National Science Foundation shows how resources in the health sector can be used more efficiently.
A focus on people - patients, professionals, relatives
Switzerland's health care system faces major challenges ranging from a growing incidence of chronic diseases to digitalization to cost pressures. To meet these challenges, the National Research Programme "Smarter Health Care" (NRP 74) examined real-world processes by means of 34 projects, developed concrete solutions and tested many of them in practice. A particular focus of the NRP was care of patients with chronic diseases, whose number is constantly increasing due to aging of the population.
We will need to bring care even more closely into line with the needs of these people in the coming years."
Milo Puhan, President of the NRP 74 Steering Committee
According to the findings of the NRP, achieving this goal will require better coordination among the many professionals involved in care. Moreover, the NRP recommends greater involvement of the family and personal environment of chronically ill patients. "The good news is that this change is possible with the human resources already available in health care," says Puhan. "But we need to use them more efficiently. That applies to medical and nonmedical professionals as well as to patients' personal environment." Now, the findings of numerous research projects show how it can be done.
Rethinking coordination
Interprofessional cooperation plays a key role in many innovative care models. For example, one project shows that nursing staff in care homes can provide a stronger link between general practitioners (GPs), hospitals and other medical specialists than was previously the case. In a real-world study, several nursing homes implemented an appropriate model and provided the necessary skills through targeted training. Consequently, the number of unplanned hospital admissions fell.
Another project focused on planning the discharge of elderly vulnerable patients from hospital. The researchers developed an online tool to prepare such events interprofessionally, with the participation of doctors, nurses and social workers. The social workers primarily clarify organizational questions that arise when patients return home. As it turned out, patients could be discharged earlier without the increased readmission to hospital that is so often the case with this group of people.
Involving the personal environment - friends, family, community
A further success factor for many innovative care concepts is including patients' personal environment. This was shown, for example, in a novel option for psychiatric care at home that was introduced as a replacement following closure of a department in a psychiatric clinic in Ticino and that was followed systematically. Intended for acute mental illnesses, this concept promotes new forms of interaction between patients, relatives and professionals. The researchers observed that the new alternative encouraged participation of patients and their family members and at the same time increased the satisfaction of all caregivers involved. From a clinical perspective, this type of care was on a par with inpatient care, but cost less.
The personal environment can also be mobilized beyond relatives. For example, researchers in the municipalities of Münsingen, Belp and Obfelden as well as in the Schwamendingen district of Zurich have set up care networks consisting of professionals, volunteers and political representatives. These efforts have served to strengthen care capacity at the local level and to create inclusive, age-friendly neighborhoods in which people can live well cared for and socially embedded at home despite health constraints.
From successful concepts to practice
"Research shows that good solutions often emerge on a small scale," says Puhan. When it comes to the whole health system, however, the question is whether and how innovative solutions can be applied to other institutions, municipalities and cantons. "For that to succeed, we need to closely monitor the impact of innovative models not only on health but also on the use of resources." For this reason, NRP 74 researchers have also developed solutions that improve access to health data and that advance measurement of care quality. In one project, for example, they investigated the conditions under which family doctors are willing to share and analyze routine clinical data in a common database. In this way, the researchers were able to greatly expand the FIRE database, the most authoritative platform in this field. During the project, the number of participating doctors increased from 200 to over 700, which corresponds to about 10 per cent of all GPs working in Switzerland. Not least, the expanded database makes it possible to test new approaches in a representative and systematic way. "The program provides innovative models for improving interprofessional cooperation and orienting health care more strongly towards the totality of people's lives," says Puhan. "At the same time, it shows ways in which care can be continuously evaluated and adapted."
NRP 74: Research for smarter health care
Switzerland's health care system faces major challenges. In particular, an aging population means that more and more older people suffer from several chronic diseases simultaneously. The Swiss health care system, which until now has strongly emphasized treatment of acute illnesses, thus requires a shift in orientation. To this end, the Swiss National Science Foundation was mandated by the Federal Council to carry out the National Research Programme "Smarter Health Care" (NRP 74).
Focused on application-oriented health services research, NRP 74 investigated a wide variety of aspects of the Swiss health system by means of 34 projects over a period of 5 years. The programme's results and analyses provide a scientifically sound basis for further developing Switzerland's health care system to meet current and future challenges. The program summary of NRP 74 has now been published and presents the most important findings.
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