Renovation of Long-term Care Processes in the Home Environment
DOI:
https://doi.org/10.37886/ruo.2022.008Keywords:
long-term care, older adults, home care, community health care, process renovation, integrationAbstract
Research Question (RQ): What are the possibilities for the integration of long-term care processes, and what are their implications for the care of older adults in their home environment?
Purpose: The purpose is to identify opportunities to improve the quality and effectiveness of long-term care in the home environment through providing person-centred services. The aim is to analyse existing processes performed by formal caregivers. Based on the process inventory and analysis, opportunities for process integration will be created, and a hypothetical evaluation of the efficiency of the new process will be made.
Method: An inventory of processes was taken, and a proposal for an integrated long-term care process model was developed using the eEPC approach to process modelling.
Results: An inventory of home help and community health care processes was developed. A proposal for an integrated process of long-term care for people in their home environment was drafted, including some important orientations of the new law in the field of long-term care in Slovenia. With the integration of the processes, there has been a decrease in the number of initial and final events and events in the process, the number of activities and decisions. The evaluation of the financial impact of the integration of care processes is estimated based on a hypothetical case. The cost of care would decrease by almost 20% and the number of working hours of formal providers would decrease by 7 hours per month.
Organization: By integrating care services in the home environment and process renovation, it is possible to achieve higher quality of services, optimization of human resources, and greater cost efficiency.
Society: With a systematical approach to the research of care processes, integration, and optimization, it is possible to provide high-quality and continuous care that supports the independence of individuals in caring for themselves. This can have a positive impact on the quality of life of care recipients and their lay caregivers. This may also have a positive impact on social spending.
Originality: To the best our knowledge, no inventory of community health nursing or home care processes has been conducted yet. With the implementation of the Long Term Care Act in home settings in Slovenia, the proposal for the care process will be able to be verified and may be improved in the future.
Limitations/Future Research: The model has not been tested in practice. Its testing and use may reveal the shortcomings of the process model. Its continuous improvement, based in part on the exploration of individual elements of the process model, will ensure the long-term success of the model. It will also be useful to explore the actual financial and other implications of the proposed process model through structural indicators of the effectiveness of process renovation.
References
Albreht, T., Pribaković Brinovec, R., Jošar, D., Poldrugovac, M., Kostnapfel, T., Zaletel, M., … Maresso, A. (2016). Slovenia: Health system review. Health Systems in Transition, 18(3), 1–207. Pridobljeno na https://apps.who.int/iris/bitstream/handle/10665/330245/HiT-18-3-2016-eng.pdf?sequence=5&isAllowed=y
ARIS Community. (n.d.). ARIS Express. Pridobljeno na https://www.ariscommunity.com/
Bridges, J., Pope, C., & Braithwaite, J. (2019). Making health care responsive to the needs of older people. Age and Ageing, 48(6), 785–788. doi: 10.1093/AGEING/AFZ085
Bu, F., Zaninotto, P., & Fancourt, D. (2020). Longitudinal associations between loneliness, social isolation and cardiovascular events. Heart, 106(18), 1394–1399. doi: 10.1136/heartjnl-2020-316614
Christiansen, J., Lund, R., Qualter, P., Andersen, C. M., Pedersen, S. S., & Lasgaard, M. (2021). Loneliness, social isolation, and chronic disease outcomes. Annals of Behavioral Medicine, 55(3), 203–215. doi: 10.1093/abm/kaaa044
Corazzini, K. N., Anderson, R. A., Bowers, B. J., Chu, C. H., Edvardsson, D., Fagertun, A., … Lepore, M. J. (2019). Toward common data elements for international research in long-term care homes: advancing person-centered care. Journal of the American Medical Directors Association, 20(5), 598–603. doi: 10.1016/j.jamda.2019.01.123
Črnak Meglič, A., Drole, J., Kobal Tomc, B., Koprivnikar, B., Lebar, L., Nagode, M., … Toth, M. (2014). Podpora samostojnemu bivanju v domačem okolju in dolgotrajna oskrba: Analitsko poročilo DP5 projekta AHA.SI. Pridobljeno na http://www.staranje.si/files/upload/images/aha.si_dolgotrajna_oskrba_porocilo_v1.pdf
Duncan, M. (2019). Integrated care systems and nurse leadership. British Journal of Community Nursing, 24(11), 538–542. doi: 10.12968/bjcn.2019.24.11.538
EPC standard. (2021). Towards EPC standardization - EPC Standard. Pridobljeno na https://www.epc-standard.org/collaborate/index.php?title=Towards_EPC_standardization
Ferrante, S., Bonacina, S., Pozzi, G., Pinciroli, F., & Marceglia, S. (2016). A design methodology for medical processes. Applied Clinical Informatics, 7(1), 191–210. doi: 10.4338/ACI-2015-08-RA-0111
Guo, H. J., & Sapra, A. (2020). Instrumental Activity of Daily Living. V StatPearls. Treasure Island: StatPearls Publishing. Pridobljeno na https://www.ncbi.nlm.nih.gov/books/NBK553126/
Harika, A., Sunil Kumar, M., Anantha Natarajan, V., & Kallam, S. (2020). Business process reengineering: Issues and challenges. V D. Goyal, P. Chaturvedi, A. K. Nagar, & S. D. Purohit (ur.), Proceedings of Second International Conference on Smart Energy and Communication (str. 363–382). Singapore: Springer. doi: 10.1007/978-981-15-6707-0
He, W., Goodkind, D., & Kowal, P. (2016). An aging world: 2015: International population reports. Washington: U.S. Government Publishing Office. Pridobljeno na https://www.census.gov/content/dam/Census/library/publications/2016/demo/p95-16-1.pdf
Hvalič Touzery, S. (2007). Družinska oskrba starih družinskih članov (Doktorska disertacija). Univerza v ljubljani, Fakulteta za socialno delo, Ljubljana.
Karhof, A., Jannaber, S., Riehle, D. M., Thomas, O., Delfmann, P., & Becker, J. (2016). On the de-facto standard of event-driven process chains: Reviewing EPC implementations in process modelling tools. Lecture Notes in Informatics (LNI), Proceedings - Series of the Gesellschaft Fur Informatik (GI), P254, 77–91. Pridobljeno na https://www.omg.org/spec/BPMN/2.0/PDF
Kerbler, B., Sendi, R., & Filipovič Hrast, M. (2017). Odnos starejših ljudi do dóma in domačega bivalnega okolja. Urbani izziv, 28(2), 18–31. doi: 10.5379/urbani-izziv-2017-28-02-002
Krajnc, A. (2016). Preventivna in kurativna dejavnost v patronažemem varstvu. V J. Ramšak-Pajk & A. Ljubič (ur.), Priporočila obravnave pacientov v patronažnem varstvu za diplomirane medicinske sestre (str. 22–27). Zbornica zdravstvene in babiške nege Slovenije Zveza strokovnih društev medicinskih sester, babic in zdravstvenih tehnikov Slovenije, Strokovna sekcija medicinskih sester in zdravstvenih tehnikov v patronažni dejavnosti. Pridobljeno na https://www.zbornica-zveza.si/publikacija/priporocila-obravnave-pacientov-v-patronaznem-varstvu-za-diplomirane-medicinske-sestre/
Kramar, Z., & Bregar, B. (ur.). (2021). Kadrovski standardi in normativi v zdravstveni in babiški negi. Ljubljana: Zbornica zdravstvene in babiške nege Slovenije Zveza strokovnih društev medicinskih sester, babic in zdravstvenih tehnikov Slovenije.
Lebar, L., Ramović, S., Vidrih, N., & Nagode, M. (2017). Izvajanje pomoči na domu: Analiza stanja v letu 2016, končno poročilo. Ljubljana: Inštitut Republike Slovenije za socialno varstvo. Pridobljeno na https://www.irssv.si/upload2/Izvajanje%20PND%20za%20leto%202016_3.pdf
Mendling, J., Reijers, H. A., & van der Aalst, W. M. P. (2010). Seven process modeling guidelines (7PMG). Information and Software Technology, 52(2), 127–136. doi: 10.1016/j.infsof.2009.08.004
Ministrstvo za zdravje. (2020). Izvedba pilotnih projektov, ki bodo podpirali prehod v izvajanje sistemskega zakona o dolgotrajni oskrbi. Pridobljeno na https://www.gov.si/zbirke/projekti-in-programi/izvedba-pilotnih-projektov-ki-bodo-podpirali-prehod-v-izvajanje-sistemskega-zakona-o-dolgotrajni-oskrbi/
Monaro, S., White, M., & West, S. (2015). A community of practice as a model of nurse-led wound prevention and management. Wound Practice & Research, 23(4), 167–174.
Nagode, M., Zver, E., Marn, S., Jacović, A., & Dominkuš, D. (2014). Dolgotrajna oskrba - uporaba mednarodne definicije v Sloveniji. Delovni zvezki UMAR, 23(2), 49. Pridobljeno na https://www.umar.gov.si/fileadmin/user_upload/publikacije/dz/2014/DZ_02_14p.pdf
OECD, Eurostat, & WHO. (2017). A System of Health Accounts: Revised edition. Paris: OECD Publishing. doi: 10.1787/9789264270985-en.
Pravilnik o standardih in normativih socialnovarstvenih storitev. (2021, 24. december). Uradni List RS št. št. 45/10, 28/11, 104/11, 111/13, 102/15, 76/17, 54/19, 81/19, 203/21. Pridobljeno na http://www.pisrs.si/Pis.web/pregledPredpisa?id=PRAV10060
Statistični urad republike Slovenije (2021). Prebivalstvo po starosti in spolu, občine, Slovenija, polletno. Pridobljeno na https://pxweb.stat.si/pxweb/dialog/statfile2.asp
Šušteršič, O., Rajkovič, V., & Kljajić, M. (2000). Nova kakovost, ki jo prinaša strukturiran zapis v dokumentiranju zdravstvene nege. Obzornik zdravstvene nege, 34(5–6), 185–192. Pridobljeno na http://www.obzornikzdravstvenenege.si/Celoten_clanek.aspx?ID=6a6a1614-1085-46ba-b82a-04c47ca92947
Urh, B., Krhač, E., Roblek, M., & Kern, T. (2018). Ocena učinkovitosti prenove procesa na podlagi strukture procesa. Uporabna informatika, 26(1), 3–14. doi: 10.18690/978-961-286-020-2.97
Urh, B., Zajec, M., Kern, T., & Krhač, E. (2019). Structural indicators for business process redesign efficiency assessment. V A. Hamrol, M. Grabowsk, D. Maletic, & R. Woll (ur.), Advances in Manufacturing II. MANUFACTURING 2019. Lecture Notes in Mechanical Engineering (str. 14–32). Cham: Springer. doi: 10.1080/10798587.2001.10642807
Vogelsang, E. M., Raymo, J. M., Liang, J., Kobayashi, E., & Fukaya, T. (2019). Population aging and health trajectories at older ages. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 74(7), 1245–1255. doi: 10.1093/GERONB/GBX071
Vujica Hercog, N. (2010). Business process reengineering and measuring of company operations efficiency. V A. Gunasekaran & M. Sandhu (ur.), Handbook on Business Information Systems (str. 117–145). World Scientific Publishing. doi: 10.1142/9789812836069_0006
Xu, X., & Chen, L. (2019). Projection of long-term care costs in China, 2020–2050: based on the Bayesian quantile regression method. Sustainability, 11(13), 3530. doi:10.3390/su11133530
Zakon o dolgotrajni oskrbi. (2021, 9. december). Uradni list RS, št. 196/2021. Pridobljeno na https://www.uradni-list.si/glasilo-uradni-list-rs/vsebina/2021-01-3898?sop=2021-01-3898
Zakon o socialnem varstvu. (2019, 25. april). Uradni list RS, št. 3/07 – UPB, 23/07, 41/07, 61/10 – ZSVarPre, 62/10 – ZUPJS, 57/12, 39/16, 52/16 – ZPPreb-1, 15/17 – DZ, 29/17, 54/17, 21/18 – ZNOrg, 31/18 – ZOA-A, 28/19. Pridobljeno na http://www.pisrs.si/Pis.web/pregledPredpisa?id=ZAKO869&d-49683-s=1&d-49683-p=1&d-49683-o=2&d-49685-p=2
Zakon o zdravstvenem varstvu in zdravstvenem zavarovanju. (2021, 30. september). Uradni list RS, št. 72/06 – UPB, 114/06 – ZUTPG, 91/07, 76/08, 62/10 – ZUPJS, 87/11, 40/12 – ZUJF, 21/13 – ZUTD-A, 91/13, 99/13 – ZUPJS-C, 99/13 – ZSVarPre-C, 111/13 – ZMEPIZ-1, 95/14 – ZUJF-C, 47/15 – ZZSDT, 61/17 – ZUPŠ, 64/17 – ZZDej-K, 36/19, 189/20 – ZFRO, 51/21, 159/21. Pridobljeno na http://pisrs.si/Pis.web/pregledPredpisa?id=ZAKO213
Zakon o zdravstveni dejavnosti. (2020, 4. junij). Uradni list RS, št. 23/05 – UPB, 15/08 – ZPacP, 23/08, 58/08 – ZZdrS-E, 77/08 – ZDZdr, 40/12 – ZUJF, 14/13, 88/16 – ZdZPZD, 64/17, 1/19 – odl. US, 73/19, 82/20. Pridobljeno na https://www.uradni-list.si/glasilo-uradni-list-rs/vsebina/2020-01-1233?sop=2020-01-1233
Zavod za zdravstveno zavarovanje Slovenije. (2017). Splošni dogovor za pogodbeno leto 2017. Pridobljeno na https://www.zzzs.si/zzzs/info/egradiva.nsf/o/82D005B0A48C9A75C1258164002781BA
Zavrl Džananović, D. (2016). Razmere v patronažnem varstvu Slovenije in predlogi za spremembe. Ljubljana: Nacionalni inštitut za javno zdravje. Pridobljeno na https://nijz.si/sites/www.nijz.si/files/uploaded/podatki/podatkovne_zbirke_raziskave/pv_ugotovitve_2_analiz_in_predlogi_za_spremembe.pdf