C - HOBIC

Canadian Health Outcomes for

Better Information and Care

C-HOBIC

Overview• Project Background• WRHA Implementation• RAI outcome measures• Challenges and Lessons Learned• Discussion.

C-HOBIC

Background: National Research Project in partnership

with Canadian Nurses AssociationFunded by Canada Health InfowayProvinces involved: Manitoba, Ontario,

Saskatchewan

Project Intent• Provide information to Health Care Professionals on

clinical outcomes from information based on nurse sensitive indicators

• Explore how the outcome information is integrated into the work flow– Utilization of the clinical data available

• Describe how managers and front-line health care professionals use the information to further evidence informed practice and care planning for the clients/patients – Creation of reports

Project Deliverables• Development of 3 reports for use by clinicians

and managers• Provision of education on access to the

reports• Provision of education on integration of the

reports into care planning process• Provision of follow-up support to clinicians

and managers• Facilitation of the evaluation of the Project in

May 2009.

Timeline

Project Start - Oct 08. Report Requirements – Nov 08. Report Development – Complete Jan 2009. Staff Training – Jan 2009. Implementation – Feb to Mar 09. Follow-up Training & Support – Ongoing.

Participants

Six PCHs. Over 225 nurses.

Six Home Care Offices. 60 Case Coordinators (professionals in a health related

discipline)

Participant Recruitment

Provided information on the C-HOBIC project. Outlined commitment of regional staff to

provide education. Outlined site responsibility to provide ongoing

education.

Education Plan

• Goal: to provide education about the use of reports in the care planning process including various RAI reports and the C-HOBIC report.

• Wanted to show the value of the previous work done by staff in the completion of the RAI. They could now get information which would help in the delivery of care.

Education

LTC - The Education Plan included a central launch session and two site based sessions.

• HC - Staff were trained in small groups or individually. • Two hour PowerPoint presentation with

hands on access to CHOBIC report. Follow-up support.

EducationalPresentation Outline

C-HOBIC project. Outcome data: why is it important. Review of care plan requirements. Discussion of interdisciplinary team approach to care

planning. Report integration into the care planning process– when, who, how.

Report review and access.– RAI outcome measure reports and C-HOBIC report.

Resident Assessment Instrument (RAI)

• A standardized assessment tool; different versions for home care (HC) and long term care (LTC)– Completed on admission and quarterly in LTC– Completed on admission and annually in HC

• Used to collect a minimum data set (MDS) with triggers for further assessment

• Completed electronically

RAI Outcome Measures• Each Measure evaluates a different aspect of the

clinical status of the client.• Each Outcome Measure is based upon carefully

selected items in the RAI-HC and RAI-LTC assessment.

• Measures leads the clinician through an investigative process when reviewing the assessment, in creating the care plan and evaluating the care plan and client status.

RAI Outcome Measures • IADL Difficulty (RAI-HC)• IADL Involvement (RAI-HC)• Cognitive Performance Scale• Depression Rating Scale• Pain Scale• Index of Social Engagement (RAI-LTC)• ADL Self-Performance Hierarchy Scale• CHESS Scale – Changes in Health, End-stage disease and

Signs and Symptoms• MAPLe Score – Method of Assigning Priority Levels (RAI-

HC)

RAI Outcome MeasuresIADL Difficulty (RAI-HC)

• Captures patterns of difficulty with the tasks of housework, meal preparation, and phone use.

IADL Involvement (RAI-HC)• Measures performance patterns of the tasks of

housework, meal preparation, and phone use.

Cognitive Performance Scale• Measures cognitive status using daily decision-

making skills, making self understood, short-term recall, and eating.

RAI Outcome MeasuresDepression Rating Scale

• Score of 3 or more suggests possible depression; based on Section E, Questions 1a – g.

Pain Scale• Score based on two questions: pain frequency and pain intensity

Index of Social Engagement (RAI-LTC)• Measure of level of participation in social activities• Score 0-6; higher score identifies increase in social activity

ADL Self-Performance Hierarchy• Measures activities of daily living performance according to early,

middle, and late stages of loss.

RAI Outcome MeasuresCHESSChanges in Health and End-Stage Signs and

Symptoms• Measures medical complexity and health instability.• Higher scores are associated with higher mortality,

use of acute hospital services, pain, receipt of specialized treatments, and poor health outcomes.

RAI Outcome MeasuresMAPLe (RAI-HC)Method of Assigning Priority Levels

• Predictive of facility admission, caregiver stress, or a feeling by family or client that the client would be better off elsewhere.• Those clients in the Very High level are 10 times

more likely to be admitted to a long term care facility within 3 months.

C-HOBIC Outcome MeasuresIncluded in the WRHA Project:– ADL – Activities of Daily Living– Bladder Continence – Pain– Falls– Pressure Ulcers– IADL – Instrumental Activities of Daily Living (Home Care)

Not Included in the Project:– Fatigue, Dyspnea, Nausea, Therapeutic Self-care

C-HOBICIndividual Outcome Measure

Report

• Provides a detailed analysis of each client’s/patient’s outcome data for the specified indicators

• Measures are intended to lead the clinician through an investigative process when reviewing the assessment, in creating the care plan, and evaluating the results of the care plan and client status.

LTC - Individual Report

HC - Individual Summary Report

C-HOBIC Management Outcome Measure Report - Detailed

Provides a detailed analysis of a specified caseload or office in Home Care or a specified unit within a facility or a facility in LTC with respect to the outcome data for the specified indicators

Management Outcome Measure Report - Detailed

• The data are collected from the total number of assessments completed in each specific category from each yearly quarter (Q)

• Q1 = April, May, June• Q2 = July, Aug, Sept• Q3 = Oct, Nov, Dec• Q4 = Jan, Feb, Mar

LTC - Management Detailed Report

HC - Management Detailed Report

C-HOBIC Management Outcome Measure Report - Summary

• Provides average values of the outcome data within the specific community area for Home Care and for the unit and facility for Long Term Care

LTC - Management Summary Report

HC -Management Summary Report

Lessons Learned

Need to meet face to face with participants early on to ensure understanding of commitment and specific learning needs.

Need to check and verify technology at each site before education begins.

Investigate current technology solutions in use by clinical staff and define impact on the project.