safe transitions in care

Download Safe transitions in care

Post on 13-Jun-2015

61 views

Category:

Health & Medicine

2 download

Embed Size (px)

DESCRIPTION

Presentation from Canada's Forum on Patient Safety and Quality Improvement 2014

TRANSCRIPT

  • 1. 1Safe Transitions in CareLinda Woodhouse PT, PhDAssoc. Prof. University of AlbertaHolder of Dr. David Magee Endowed Chair in MSK ResearchScientific Director, AHS Bone and Joint Health Strategic Clinical NetworkPresident-Elect, Canadian Physiotherapy AssociationResearch Affiliate, McCaig Institute for Bone and Joint HealthDr. Donald Dick (Medical Director) ,Lynne Mansell (Vice President),Mel Slomp (Executive Director),Leah Phillips (Asst. Scientific Director),&Core Committee BJHSCNOur Vision: Becoming the best Bone & Joint System in providing evidence based patient care

2. DisclosureConsultant & Advisory Board Member toEli Lilly & Lilly (Global) Monoclonal anti-myostatin antibody 3. 3Challenge #1:Physician AAgency FService 1Service 179Primary Care Group Physician WService 467Service 311For Profit Rehab.Agency YPublic Rehab.Service 222Delays = Poor Outcomes, Waste, Frustration 4. 4Challenge # 2 5. 5Challenge # 3Data in Health Care 6. 6Strategic Clinical NetworksGoal: to create asustainable healthsystem (withevidence) thatcreates thehealthiestpopulation andbest healthoutcomes inCanada 7. 7Balancing the Needs of Health + Health CareCOST(lowest cost possible)ACCESS(satisfactory or not)QUALITY(all dimensions) 8. 8All Around One TablePrimary CarePhysiciansResearchersAdministratorsPolicy MakersSpecialistsPatientsAlliedHealthEconomistsFinance 9. Evidence Based PracticeClient ValuesBest ResearchEvidenceClinicalExpertiseGuyatt et al. 268(17):2420 JAMA, 1992 10. 10Patient Engagement ResearchPatients Matter: Engaging Patientsas Collaborators to Improve OACare in AlbertaFunded by: Canadian Foundation for HealthcareImprovement in partnership with AHS, University of Calgary,Arthritis Society, Institute for Public Health; and ConsumerAdvisory Council of the Canadian Arthritis NetworkOutputs:21 PERS completed training and internship program5 research studies carried out involving 125 patients3 Research Reports pertaining to Arthritis PatientsExperiences1) Experience of Living with Chronic Joint Pain2) Experience of Waiting for Help with Osteoarthritis3) Oh! Canada: Southeast Asian Immigrants Experience ofOA Surgery 11. 11Evidence Based CarePhysician AAgency FService 1Service 179Primary Care Group Physician WService 467Service 311For Profit Rehab.Agency YPublic Rehab.Service 222Delays = Poor Outcomes, Waste, Frustration 12. 12New Model of Care TKA & THAT1-T2YESInpatientSeven Key Model ElementsT0-T11. Provincial care path based on evidence2. Central intake clinics multidisciplinary teams3. Case managers manage each patient uniquely4. Accountable patients patient contracts5. Data informed quality measured by Institute6. Resources aligned beds, ORs, staff7. Case rate funding clinic and surgical carePatientPrimary Care PhysicianInstituteResearchFeedbackRemediation&EducationNOAssessment SpecialistHealthcareInfrastructureRecoveryEND GOALPositive Patient &System Outcomes 13. 13Measure to Improve 14. 14T1-T2YESInpatientSeven Key Model ElementsT0-T11. Provincial care path based on evidence2. Central intake clinics multidisciplinary teams3. Case managers manage each patient uniquely4. Accountable patients patient contracts5. Data informed quality measured by Institute6. Resources aligned beds, ORs, staff7. Case rate funding clinic and surgical carePatientPrimary Care PhysicianInstituteResearchFeedbackRemediation&EducationNOAssessment SpecialistHealthcareInfrastructureRecoveryEND GOALPositive Patient &System OutcomesNew Model of Care 15. 15Quality Framework 16. 16Quality Improvement TKA & THA~20,000 patients/yr, 9600 Sx; 2005-2013 17. 17Quality Improvement TKA & THA~20,000 patients/yr, 9600 Sx; 2005-2013 18. 18Becoming the Best: EfficiencyMore hip and kneereplacementsperformed but fewerbeds neededDoing More With the Same Productivity gains:73% more surgeries5% bed use increase Increased volume havehelped reduce wait timesby 11%BalancedScorecard 19. 19Balanced Scorecard 20. Scorecards and Individual Physician Reports being Used20QUALITYDIMENSIONS:EFFICIENT SAFE APPROPRIATE ACCESSIBLE ACCEPTABLE EFFECTIVESELECTEDMEASURE:(Length ofStay - LOS)(Note 1)OR TimeOut(Note 2)% of PatientsMobilized Day 0(Note 3)Time to Surgery(T0 - T2)(Note 4)PatientSatisfaction(H-CAHPS PainControl Responses)(Note 5)Date ofDischarge/Predicted date(Note 6)TARGETEDIDEAL (Level 10):Full compliance to established standards;non-negotiableIdeal target based on what can realistically beachieved in two years; negotiablePERFORMANCELEVEL: 10(Targeted Ideal)4.2 daysor less100%compliance100%400 daysor less90% or higherfor Always Score0% 109 4.3 95% 90% 450 Days 88% 0. 5% 98 4.5 90% 82% 500 Days 86% 1% 87 4.7 85% 75% 550 Days 85% 2% 76 4.9 80% 68% 600 Days 82% 4% 65 5.1 70% 61%675 Days79% 6% 54 5.3 65% 54%775 Days76% 8% 43(AS IS at Start)5.5CurrentCompliance60%47%896 Days63.5%for Always Score(See Note 5)10% 32 5.7 55% 40% 1000 Days 60% 12% 21 5.9 50% 30% 1200 Days 55% 15% 1WEIGHTING (%) 20 15 20 10 15 20 = 100 (%)OPTIMIZATIONSCORE:(Level x Weight)140 150 140 70 45 20 TOTAL SCORE = 565 21. 21Fragility and Stability ProgramContinuum of Care Program supporting Albertans from preventionof Hip Fractures to post-surgery support 22. 22COMMUNITYCOMMUNITYHOMEWith Follow-up10%LONG TERM CARE20%Non Weight Bearing 5%Often >28 days post opFUNCTIONAL RECOVERYNON-ACUTE CARELONG TERMCAREPATIENT /FAMILY SELF CARE5-28 days post op 75% Pts returnto pre livingHipFractureSURGERY IMMEDIATE CAREIn Acute Hospital0-5 dayspost op28 days post opPREVENTION OF FUTURE FRACTURE - OSTEOPOROSIS, FALLS MANAGEMENT 23. 23Hip Fracture Program38.777.939.31009080706050403020100TargetActualAccessibilitySx < 24 hrsAccessibilitySx < 48 hrsEfficiencyLOS < 7 days% of Patients 24. Contact InformationLinda Woodhouse PT, PhDAssociate Prof. University of AlbertaDavid Magee Endowed Chair in MSK Clinical ResearchScientific Director, AHS BJHSCNPresident-Elect, Canadian Physiotherapy AssociationFaculty of Rehabilitation Medicine3-10 Corbett Hall, Edmonton, Alberta, Canada T6G 2G4Tel. Office 780.492.9674Email: linda.woodhouse@ualberta.ca 25. Thank You 26. Any Questions?

Recommended

View more >