The Case for Change
Qatar’s growing, changing and aging population is creating a shift in the healthcare landscape. Patients, families and healthcare providers are impacted by this changing environment. A national continuing care system will facilitate the development of strategic and sustainable solutions to meet current and future challenges.
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Qatar’s Shifting Healthcare Landscape
Qatar’s healthcare system is designed to deliver primary, secondary and tertiary care. Public healthcare delivers primary care services through a network of primary health centers, while public hospitals deliver over 80% of secondary and tertiary care services. Private sector healthcare provision is expected to increase significantly as opportunities for investment are identified.
For the majority of patients, the healthcare journey involves multiple referrals between primary healthcare and the hospital system, where patients receive the care they need and are then discharged. The current healthcare system is arranged around organizational boundaries and assumes that patients follow a linear path from primary care to hospitals and then home. Although heavily burdened, this system design has provided care for those with short term acute conditions.
Qatar’s population is growing, aging and changing, as outlined in Table 2. This shifting healthcare landscape makes a compelling case for change.
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Current Continuing Care System
Qatar’s shifting healthcare landscape, outlined in Table 2, will increasingly expose any system inefficiency and capacity and workforce shortages. The healthcare system is tackling these challenges by heavily investing in the expansion of existing services, which in turn have introduced numerous plans to support continuing care as the volume of patients requiring ongoing care increases (see Figure 4). This will bring initial benefits by easing operational pressures on individual organizations, however, these benefits are unsustainable given that they are largely uncoordinated. These developments do not present a cohesive strategic solution to deliver a proactive, effective or contemporary national continuing care system.
The effectiveness of current continuing care delivery was evaluated by conducting a concurrent, focused review utilizing an evidence-based, clinical utilization review tool: Managing Care Appropriately for Patients8 (MCAP®).
A demand model was developed to project the need for healthcare services across the entire health system. The model incorporated the MCAP® review findings to estimate how the demand for healthcare services can be redistributed if alternative levels of care and settings were made available (see Figure 6).
This would ultimately improve service quality, release ED capacity and reduce hospital bed shortages.
Patients experience healthcare as a journey; the journey may be short, long or frequently made. Patient journeys are becoming more complex and influenced by increasingly high expectations. Patient and family engagement is important in the future design of health services.
Initial engagement of patients in Qatar9 would support the case for change; the need for a cohesive national solution to deliver a proactive, person centered continuing care system. Patient feedback, see Figure 7, suggests that easier access to services, care closer to home, better coordination and integration of services and greater patient empowerment would be highly desirable.
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The Healthcare Provider Perspective
Healthcare providers play a fundamental role in the design and implementation of healthcare systems and services. Extensive engagement with public and private healthcare providers, the national insurance provider and the regulatory body supported the need for rebalancing of the healthcare system while paying particular attention to the needs of patients with complex and chronic conditions.
There was significant consensus between all public and private stakeholders regarding the following:
- There is a need to modernize the continuing care system in line with international best practice while preserving the unique cultural sensitivities
- Care coordination is needed at a national level to bridge provider and organizational boundaries
- The expansion of care into community settings is urgently needed to meet growing demand
- The continuing care system must be designed to adapt to unique patient needs as a one-size-fits-all solution will not provide optimum outcomes
- A population health approach should be utilized in developing new services to ensure local community needs are addressed
- Funding is a major enabler and appropriate incentives must be developed to allow the private sector to launch continuing care services
The current state assessment of continuing care delivery in Qatar indicates that insufficient and inadequate services and systems are in place to tackle the changing healthcare landscape. To provide a coordinated and integrated system of care for patients with continuing care needs, the following challenges will need to be addressed as part of a connected framework of improvement:
- There is a significant lack in alternative care settings, innovative care models and integrated patient pathways, leading to an unbalanced demand across the care system. A comprehensive care continuum remains absent and undefined across Qatar. Having a defined health care continuum gives clarity to the range and scope of services available to patients as they experience their journey through the health care system.
- Patient transitions between levels of care and navigation through the healthcare system are constrained and difficultPhased movements across levels of care can increase bed capacity and support clinicians to actively identify continuing care patients and plan for their needs. The delays in transitioning patients may impact on their plan of care or compromise access to appropriate treatment.
- A significant portion of patients with ongoing care needs, particularly those with multiple and complex conditions, are receiving reactive episodic careContinuing care delivery requires a broad range of service inputs that may be most appropriately delivered through multiple providers. The development of a shared, single, coordinated plan of care both supports professional collaboration and patient and family experience.
- There is a lack of predictive tool usage and risk stratification to support the identification of patients requiring continuing care A continuing care process needs to start with the proactive identification and assessment of patients with on-going needs and actively support their access to appropriate treatment and services. A system wide application of evidence-based assessment tools supports health professionals in the clinical decisions they need to make.
- Community and home based services are minimal and unable to meet the current demand or respond to new service development opportunities. A proactive assessment of population health needs driving the design of associated community services could significantly extend the care continuum and add important new levels of care to support both the step up and step down of patients across the health system.