Download The development of cancer care in Sweden through innovation and

The development of cancer care in
Sweden through innovation and
triple-helix collaboration
Jörgen Larsson
Professor of Surgery
Director International affairs
Member of the Nobel Assembly 1996-2014
Karolinska University Hospital and
Karolinska Institutet
Agenda
• Sweden and Swedish health care
• Karolinska University Hospital and Karolinska
Institutet
• Quality registers in cancer
• Regional cancer centers
• Triple-helix innovation collaborations
• The Swedish test bed for Innovative
Radiotherapy
OECD – Better Life Index
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Some results for Sweden:
Life expectancy at birth: ~ 82 years (80)
Daily smokers: 14% (21)
Obesity rate: 13% (18)
Good health: 80% (69)
Satisfied with their lives: 85% (80)
•(OECD average in parenthesis)
Swedish health care
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The government
• establishes principles/guidelines
• distributes responsibilities
• supervises
• allocates government grants
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Decentralized system with 20 county
councils/regions
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Taxpayer-funded system
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Every county council/region provide its
residents health care of good quality and
promote good health in the entire population –
everyone has by law equal access to health
care services
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Costs ~10% of Gross Domestic Product (GDP)
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2010: 196 billion SEK (~23 billion Euro)
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Karolinska University Hospital – one
of the largest hospitals in Europe
1,6 million patient visits per year
15 500 employees
1,7 billion € turnover
2 500 researchers
2 400 scientific articles /year
in cooperation with KI
1 145 million SEK external R&D contributions
Karolinska University Hospital &
Karolinska Institute
• Close strategic partnership
• Creates added value for each other and partners
• An Academic Health care system including research
and education of the highest international quality
has been established
Karolinska University Hospital has a central
role to play in the development of
Stockholm’s life sciences sector
The role of quality registries in
improving health care
National Quality Registry for
colorectal cancer
• Prospectively registered data
• 1995 rectal cancer
• 2007 colon cancer
• 6000 patients / year
• All regions
•
>98 % coverage
• Steering committee
Improved treatment
1980-2013
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Preoperative radiotherapy
National Quality Registry
New surgical techniques
Multidisciplinary team assessment/care
Prerequisites for registries in Sweden
• Population 9.3 million
• Registration of newborn,
marriages and deaths since
400 years
• Church responsible
• Personal numbers since 1947
Quality control
Annual reports
• Patient and tumour
characteristics
• Treatment
• Mortality
• Complications
• Patology
• Longterm follow up
• Survival
Quality control
Annual reports
• Time trends
• Comparison between
hospitals and health care
regions
• Internal control
• Research
Ranking
Summary
The role of quality registries
• Time trends
• Comparison between hospitals and health care regions
• Internal control
• Research
Continuous improvement
Small, small steps lead to big leaps
Regional Cancer Centers
Some Swedish cancer data from 2011
 Malignant cancer cases diagnosed
 Individuals living with cancer, diagnosed
during 1958 – 2009
 Individuals dead in cancer
 Risk of developing cancer before age 75
57 226
411 338
21 646
30 %
Sweden comes out strong in most tumour groups…
Cancer survival in Australia, Canada, Denmark, Norway, Sweden, and the UK, 1995–2007 | The Lancet, 2011-12-22
Challenges in cancer care and research
 We are not doing enough in prevention
 We have long and variable waiting times
 We lack an optimal patient focus and overall perspective and
continuity
 We see a regional variation in patient care and results
 Patients are not sufficiently involved in care, relatives' role unclear
 In some aspects we have inequalities
 There is need for improved collaboration in cancer research
 Too few patients are enrolled in clinical trials

Collaboration suboptimal between experimental research and clinicians
Prevalence is a challenge
for the health care system
The number of visits to physicians increase more than the number of new patients diagnosed with cancer
Antalet läkarbesök ökar
mer än antalet nya cancerfall
300000
250000
200000
150000
100000
50000
0
1995
2009
Number of people living with cancer will more than
double to 2030
- Every new cancer patient leads to an increasing number of visits to
physicians and nurses due to an increased number of novel
treatment possibilities
A national cancer strategy for the
future
The
strategy is aiming at five overarching goals:
1. Reduce risk of developing cancer
2009
2. Improve the quality in taking care of cancer patients
from a patient´s perspective
3. Prolong cancer survival time and improve quality of life
after a cancer diagnosis
4. Reduce regional differences in survival time after a
cancer diagnosis
5. Reduce differences between population groups in
morbidity and survival time.
RCC - National Board
(liasion group)
Working/reference groups national collaboration is of
great importance;
• Screening
• level of structuring/
organisation/centralisation
• Novel drugs
• Quality issues
• National Guide lines (FU) IT and Data
• Clinical trials (national
network)
- Specific resources
- Biobanking
North
Uppsala Örebro
Stockholm Gotland
West
Southeast
South
From a national cancer strategy to
an evidence based cancer plan
2009
National
cancer strategy
Clear Guidelines Patients in focus
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Relatives
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Employees
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Caregivers
2011
Regional
cancer strategy
Regional Parliament
2013
Regional cancer
plan
To implement the
strategy
With a patient perspective on an equal
and fair cancer care
Cancer plan
2013 - 2015
In June 2013 the county council
declared unanimously the plan as the
steering document for future
development
• Contains up to date descriptions of all cancer
care pathways
• SWOT analyses
• Close to 150 actions needed to reach the goals
of RCC
Triple-helix Innovation
collaboration
Health care is in the driver seat within the triple helix
model at Karolinska University Hospital
Health Care
Business
Academia
Health Care
D
A
C
E-Health
Academia
Industry
Cell Therapy
National test bed (e-Health)
Research
Development Health Care Associated Infections (HAI)
Innovation Informatics test bed for future Heath care (ITH)
National Test bed for Innovative Radiation therapy
B
A: GAP
B: ANALYSIS
C: DESIGN
D: BENEFITS
Karolinska’s contribution in a partnership
Innovation
Center
Test beds
The eco system – multiple cross roads
National and
international
plattforms
The university
hospital’s full
capabilities
Academic
partners
The Karolinska
brand
What we believe an industry partner can contribute
Complementary
networks
Complementary
competencies
Increased
capabilities for
external funding
Fresh eyes and perspectives
Access to
prototype/ early
stage equipment
Complementary
methods
The Swedish test bed for
Innovative Radiotherapy
Swedish testbed for innovative radiotherapy
A gateway to all Swedish university hospitals
Partnership
for radiotherapy
of tomorrow
Norrlands
Linköping
Örebro
Akademiska
Sahlgrenska
Karolinska
Skånes
Swedish testbed for innovative radiotherapy
Test bed –
A common test environment
Healthcare, academy and industry working together
to develop innovations within radiotherapy
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products
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services
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organizational solutions
•
business models
Swedish testbed for innovative radiotherapy
Forming a triple helix consortia
– all university hospitals
• RCC
• 6 Companies
Swedish testbed for innovative radiotherapy
A gateway
to all Swedish university hospitals
Norrlands
Linköping
Örebro
Akademiska
National platform for
• innovative radiation therapy
• clinical multicenter studies
• medtech
Sahlgrenska
Karolinska
Skånes
Swedish testbed for innovative radiotherapy
What's in it for me ?
Test environment
MRI-based radiotherapy
Better images of the tumour
Quality assurance
QA for MRI-based radiotherapy
National database solution
Comparable radiotherapy data
Healthcare and industry driving innovation
Karolinska University
Hospital
Sharing Competence for Life
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