Introduction of Network-Based Healthcare at Kaiser Permanente.

BACKGROUND: Early 2014, Kaiser Permanente decided to adopt an innovative model for network-based allied healthcare for persons with Parkinson's disease (PD), based on the principles of the Dutch ParkinsonNet. OBJECTIVE: We present the interventions that were performed to implement this method at Kaiser Permanente and we show the first outcomes based on these interventions. METHODS: In this study, 57 physical therapists, 18 speech therapists and 20 occupational therapists, as well as 13 medical centers across the state of California were included. Nine interventions were performed more or less simultaneously, including training and education of healthcare providers and patients, a train the trainer curriculum, organizing IT, streamlining referral processes and building networks. RESULTS: At the start, less than 30% of the patients within the Southern California Region received specialized allied health treatment (consisting of, i.e., gait training, voice training or guidance in activities of daily life). After one year, almost 55% of patients received specialized allied health treatment. In the second year, this number increased to just under 67%, suggesting a sustained concentration of care (the second core component of networked care). This can be seen as a first indicator for successful implementation of the ParkinsonNet network at Kaiser Permanente. CONCLUSIONS: The importance of these findings lies in the fact that a healthcare innovation that proved effective in one country can be transferred successfully to another country and to another healthcare system.

The Voice of the Parkinson Customer.

BACKGROUND AND OBJECTIVES: To improve the care for patients with chronic neurological conditions like Parkinson's disease, identifying the core needs of patients is crucial. In this article, we present the Voice of the Customer approach (originally developed in the field of industry to probe the clients' needs), a novel methodology to identify these needs. METHODS: A group of 12 discussants carried out in depth interviews to patients (n = 20), relatives (n = 12) and healthcare professionals (n = 11). The interviewers combined the most informative quotations into a comprehensive video, which was used as feedback to the interviewees. The interviewees then identified the most important needs in a consensus meeting. RESULTS AND CONCLUSIONS: The approach revealed that patients were more concerned about the impact of Parkinson's disease on their daily lives than about the bio-medical aspects of the disease. Their top unmet needs were: (1) more self management; (2) better interdisciplinary collaboration between different healthcare professionals; (3) more time to discuss the future and possible scenarios; and (4) a healthcare professional acting as a single point of access, acting as personal case manager, either to solve problems directly or to direct patients to the professional best equipped to address the problem at hand. These results can now be used to further optimize the care for patients with Parkinson's disease.

ParkinsonNet: A Low-Cost Health Care Innovation With A Systems Approach From The Netherlands.

ParkinsonNet, a low-cost innovation to optimize care for patients with Parkinson disease, was developed in 2004 as a network of physical therapists in several regions in the Netherlands. Since that time, the network has achieved full national reach, with 70 regional networks and around 3,000 specifically trained professionals from 12 disciplines. Key elements include the empowerment of professionals who are highly trained and specialized in Parkinson disease, the empowerment of patients by education and consultation, and the empowerment of integrated multidisciplinary teams to better address and manage the disease. Studies have found that the ParkinsonNet approach leads to outcomes that are at least as good as, if not better than, outcomes from usual care. One study found a 50 percent reduction in hip fractures and fewer inpatient admissions. Other studies suggest that ParkinsonNet leads to modest but important cost savings (at least US$439 per patient annually). These cost savings outweigh the costs of building and maintaining the network. Because of ParkinsonNet's success, the program has now spread to several other countries and serves as a model of a successful and scalable frugal innovation.