title: Right services to right patients at right time in right setting in Tays Eye Centre.
abstract: OBJECTIVE
  The report describes the concepts behind procedures implemented in Tays Eye Centre to enable improved access to care and improved productivity.
  
  
  METHODS
  The strategy was developed in 2009 after hospital district decided to construct a new eye hospital which was opened in 2012. The following principles were implemented: (i) identification of high-volume patient groups: the 'big four' eye diseases accounting for 70% of patient visits and costs: age-related macular degeneration (AMD), glaucoma, retinal diseases and cataract; (ii) stratification and prioritization of patient care based on risk of permanent visual disability; (iii) standardization of services for low-risk patients; (iv) maximization of productivity; and (v) shared care. The impact of the new strategy on access to care and productivity is reported for years 2011-2015.
  
  
  RESULTS
  In 2011-2015, the total number of services provided increased 46% while the work contribution increased 15%. The number of referrals increased 76% and the number of outpatient appointments increased 2.5-fold. Simultaneously, the number of delayed follow-up visits decreased to zero. Age-related macular degeneration (AMD) injections increased 1.8-fold. However, after 50% yearly increase in Age-related macular degeneration (AMD) injections, a plateau was reached in 2014 with a 3% decline in 2014-2015 with no changes in treatment indications. In the beginning of 2016, the number of injections has started to increase again (+9% compared to 2015).  The total number of surgical procedures increased 98%. The annual number of cataract surgeries increased 64% and bilateral surgeries from 11% to 39%.
  
  
  CONCLUSIONS
  Revised operational concepts and new facilities together with a 15% increase in work contribution led to a 46% increase in overall productivity, improved access to care and the clearance of delayed services. Efforts continue to further refine cost-effective care and to define the appropriate levels of services.
authors.affiliation: Tays Eye Centre, Tampere University Hospital, Tampere, Finland. Anja.Tuulonen@pshp.fi.
authors.forename: Anja
authors.initials: A
authors.lastname: Tuulonen
authors.affiliation: Tays Eye Centre, Tampere University Hospital, Tampere, Finland.
authors.forename: Marko
authors.initials: M
authors.lastname: Kataja
authors.affiliation: Tays Eye Centre, Tampere University Hospital, Tampere, Finland.
authors.forename: Ulla
authors.initials: U
authors.lastname: Syvänen
authors.affiliation: Tays Eye Centre, Tampere University Hospital, Tampere, Finland.
authors.forename: Sirpa
authors.initials: S
authors.lastname: Miettunen
authors.affiliation: Tays Eye Centre, Tampere University Hospital, Tampere, Finland.|Research and Development Centre for Ophthalmic Innovations (SILK), Department of Ophthalmology, University of Tampere, Tampere, Finland.
authors.forename: Hannu
authors.initials: H
authors.lastname: Uusitalo
mesh_terms: D001071:Appointments and Schedules; D003695:Delivery of Health Care / Q000458:organization & administration*; D005387:Finland; D006284:Health Plan Implementation; D006297:Health Services Accessibility / Q000458:organization & administration*; D006301:Health Services Needs and Demand / Q000458:organization & administration*; D006782:Hospitals, Special / Q000458:organization & administration*; D006801:Humans; D009313:National Health Programs; D013508:Ophthalmologic Surgical Procedures / Q000706:statistics & numerical data; D009885:Ophthalmology / Q000458:organization & administration*; D011787:Quality of Health Care; D012017:Referral and Consultation / Q000706:statistics & numerical data
keywords: costs; efficiency; priority setting; segmentation; shared care; standardization