Revised, November 10, 2015 For Re-Submission on November 23, 2015

Transcription

1 Developing a Sustainable Rural Practice Community: Proposal to the Joint Standing Committee on Rural Issues, From the Mount Waddington Collaborative Working Group Preamble Revised, November 10, 2015 For Re-Submission on November 23, 2015 The proposal from the Mount Waddington Collaborative Working Group (MWCWG), presented to the Joint Standing Committee on Rural Issues (JSC) on September 15, 2015, was the result of six months of consultation between representatives of Island Health, the Northern Vancouver Island Rural and Remote Division of Family Practice, First Nations, First Nations Health Authority, elected municipal and regional government, the Mount Waddington Health Network, physicians and a local nurse practitioner. Additional community consultation was sought through a Mount Waddington Health Network forum and a Kwakwaka wakw Health Directors meeting. The CWG proposal presented in September, 2015 contained six recommendations, totaling $500,000 and spanning over a two-three year time frame. Our understanding of the JSC s response to the CWG proposal in September is as follows: The JSC was impressed by the level of community consultation and engagement that had taken place to produce the proposal, the comprehensiveness of the proposal and the attempt to meet Triple Aim objectives by affecting changes to the way health care is delivered on northern Vancouver Island. The JSC had the following concerns about the proposal: That the scope of the proposal was too broad to effectively implement within a two year time frame; 1 P a g e

2 That there were not sufficient financial resources or capacity within the region to implement the proposal within a two year time frame; That there was a need for measurable outcomes and indicators to be integrated in the proposal The CWG remains committed to its primary initiative to review, redesign and implement a new model of care in the Mount Waddington region that meets Triple Aim objectives, but acknowledges the concerns raised by the JSC and proposes to respond with a revised proposal as follows: The CWG s primary proposal will be to review, redesign and initiate a new model of care in the region that better meets Triple Aim objectives Recommendation 4 of the original proposal (The Interprofessional Rural Practice Pilot) will be removed and implemented separately Recommendation 2 of the original proposal (Patient Journey Information) will be incorporated as part of the collection of information that will be used to prepare a discussion paper that forms the foundation of a review of the current model of health care in the region Recommendations 3 (oncology care, pain management care, renal care and after hours X-ray for acute care), 5 (adult day programming) and 6 (maternity care using the SheWay model) will be run as pilot programs during the two year time frame and information gained from these pilots will be used to inform the redesign of the model on care in the region Anticipated and measurable outcomes (indicators) associated with the redesign of the model of care will be provided for the project as a whole and for the individual pilot projects associated with the primary initiative The CWG will use in house staff where possible to implement the proposal but acknowledges that, in view of the short time frame and existing workloads, much of the work will be contracted out to consultants with appropriate experience Information produced by the consultants and in house staff will be monitored and integrated into the primary initiative through the CWG membership and executive in collaboration with the CWG facilitator 2 P a g e

3 Mount Waddington Collaborative Working Group Work Revised Proposal to the JSC November 10, 2015 The Mount Waddington Collaborative Working Group proposes to initiate a review of the current health care delivery model, and redesign and initiate a new sustainable model of care that is based on enhanced patient experience, and affordable and accessible health care delivery in a rural setting. This will start with a review and analysis of the current health care delivery system including collection of statistics on acute care, community care and primary care and overall population health statistics, including key aboriginal population health data and data associated with the aboriginal health care delivery system with respect to home and community care and primary care; preparation of a discussion paper that offers recommendations regarding ways to change the current model of care so that it better meets Triple Aim objectives; implementation of a consultation process that engages community representatives (First Nation and non-first Nation), allied health care professionals, community organizations, residents and patients from throughout the region to review possible ways to change the current model of care so that it better meets Triple Aim objectives ; and the initiation of a new model of care that better meets Triple Aim objectives. Anticipated outcomes for this primary initiative are: enhanced patient and health care provider experience levels, reduced redundancy and more money in the existing regional budget to invest in primary and community health care, improved overall health of residents in the region The basic process for this review and redesign of the current health care system on northern Vancouver Island runs from November 15, 2015 to November 15, 2017 and the steps and associated inputs, budgets and indicators are as follows: 1. Collect statistics on current health care delivery system, including acute care, community care, primary care, and overall population health statistics Inputs: Island Health data division, Divisions data, First Nations Health Authority data, consultant to gather patient journey information Time Frame: November 15, 2015-January 15, P a g e

4 Budget 1 : In kind Contribution from Island Health and $20,000 to gather patient journey information (consultant fees) Person Responsible For Ensuring This Work is Done: Alison Mitchell, Island Health 2. Engage a consultant to prepare a discussion paper that: a) analyzes the information collected in Step 1 above, b) creates a future, idealized, standardized patient journey that will inform the pilot projects, and c) outlines how the health care delivery system could be redesigned to better meet the goals of Triple Aim. The consultant will then develop communications tools and resources that put key elements of the discussion paper into, for example, PowerPoint presentation, social media, website, formats for use in the engagement strategy, and then implement an engagement strategy for the Mount Waddington Region (including First Nations), allied health care professionals, within Island Health and Divisions of Practice and directly with users of the health care system to gain feedback on the discussion paper s outline of how the health care delivery system could be redesigned to better meet the goals of Triple Aim in the region. Inputs: Prepare a Terms of Reference and engage a consultant to prepare the discussion paper and communications tools, and to implement the engagement strategy Time Frame (for discussion paper): January 15, March 31, 2017 Budget: $60,000 (Consultant fees) Time Frame (for development and implementation of engagement strategy): April 1, 2017-June 30, 2017 Budget: $60,000 (Consultant fees and costs for promotion and use of community venues) Person Responsible For Ensuring This Work is Done: Annemarie Koch 3. Initiate a new health care delivery model that could be piloted in the region Inputs: Prepare a Terms of Reference and engage a consultant to initiate and oversee a model of health care delivery for the region that better meets Triple Aim objectives. Time Frame: July 1, November 15, 2017 Budget: $60,000 (Consultant fees and covering costs for seconding health professionals) Persons Responsible For Ensuring This Work is Done: Alison Mitchell and Prean Armogam 1 General budget categories will be provided in parentheses in this document. Overhead and administration are included in each budget figure presented in this proposal. Further budget detail for each initiative will be provided as projects are initiated. 4 P a g e

5 Indicators Associated With Initiation of a New Model of Care for the Region: 5% decline in number of hospital admissions (use of acute care beds) in the region after one year of initiating changes to the health care system; Reduction in duplication of services across the region one year of initiating changes to the health care system Overall enhancement of patient experience one year after initiating changes to the health care system Improved stakeholder engagement Data Collection Requirements Associated With Indicators: Baseline statistics on hospital admissions supplied by Island Health (Administrative Data Review) Baseline statistics, including resource allocation comparisons, on current levels of inpatient, laboratory services, acute care facilities and staff, mental health care services (Administrative Data Review) Baseline survey of patient experience at beginning of initiative, followed by a survey one year after new model of care is implemented (Patient Survey: Pre/Post measurement design) Stakeholder engagement survey to obtain feedback on process and communications tools 5 P a g e

6 Based on input provided by members of the Mount Waddington Collaborative Working Group, we have identified the following pilot projects to implement as part of this JSC initiative, but it is understood that additional pilots may be identified, and priorities for implementation may shift as the process unfolds. In any case, there will be ongoing collaboration with the CWG to determine which projects are priorities for the region and information derived from all of the pilots will be used as a basis for developing a better rural model of access to care that contributes to Triple Aim objectives and is consistent with Island Health policy directives. Pilot projects which will be carried out during the two year time frame, and inform the redesign and implementation of a new model of care for the region are as follows: A. Provision of oncology services locally wherever appropriate and possible through training of local staff and through bringing in specialists in person and via Telehealth; provision of after-hours diagnostic services, most specifically in X-ray, locally wherever appropriate and possible, through cross-training of local staff; design and initiation of a more effective and holistic approach to pain management that is delivered locally wherever appropriate and possible; provision of renal care services locally wherever appropriate and possible through team-building and training of local staff, investing in appropriate equipment and bringing in specialists in person and via Telehealth Inputs: Prepare a Terms of Reference and hire a consultant to coordinate and oversee implementation of this initiative Time Frame: January 15, March 31, 2017 Budget: $100,000 (Consultant fees and fees for seconded health professionals who will coordinate the pilot projects and feed information into the discussion paper) Person Responsible for ensuring this work is done: Alison Mitchell Anticipated outcomes for this pilot project: enhanced local provision of and access to oncology services, renal care and pain management, more timely X-ray diagnostics resulting in more effective treatment of acute patients, reduced real cost to access oncology, renal care and pain management services, enhanced and appropriate use of Telehealth, reduced use of narcotics for pain management in the region, enhanced level of satisfaction by health care providers with pain care management, delivery of a rural model of access to care, and implementing the rural patient journey into specific care areas Indicators specific to this pilot project: 5% reduction in costs to patients in the region for access to renal care following pilot initiation Enhanced patient experience with level of renal care in the region following pilot initiation Overall increase in number of local health professionals cross trained X-ray diagnostics following pilot initiation 6 P a g e

7 Overall reduction in real costs to community for oncology following pilot initiation 5% reduction in use of narcotics in the following pilot initiation Increased level of satisfaction by health care providers involved in pain management in the region following pilot initiation Data collection requirements associated with indicators: Baseline data on costs to community for renal care collected at the beginning of the project Survey renal care patients in the region at the start of the program and again after one year Report out on any existing health care staff who have received cross training in the areas of after-hours diagnostics, training data to be collected by relevant local managers Calculation of relative costs a year later Collect baseline and follow-up data from pharmacies in the region or track use for a specific pain clinic Pre and post survey of health care providers involved in pain management B. Work with Divisions to support their adult day programming initiative Inputs: Phase One and Two Materials for Port Hardy ADP Initiative Time Frame: November 15, March 31, 2017 Budget: $55,000 (certified therapeutic recreation specialist, community health workers, and supplies and travel costs for programs) Person Responsible For ensuring this work is done: Patti Murphy Anticipated outcomes for this pilot project: reduced number of hospital admissions and re-admissions for participants in the adult day program in the region, reduced burnout of caregivers in the region, increased opportunity for cluster care for older residents in the region Indicators specific to this pilot project: Caregivers express satisfaction with reduced level of burnout after initiation of the ADP Overall decrease in number of hospital readmissions in the region for participants in the ADP after initiation of the ADP 7 P a g e

8 Data collection requirements associated with indicators: Survey caregivers (using an established caregiver survey: Zarit) at beginning of project to acquire baseline data and then survey the same group again after the program is administered Baseline and follow-up statistics on hospital re-admissions provided by Island Health C. Establish a 4-6 month pregnancy outreach program similar to SheWay to keep young mothers with their babies and attempt to reduce child apprehension and contribute to harm reduction. Working in partnership with the First Nations Health Authority, this pilot would complement the services of the (newly implemented) Kwakwaka wakw Primary Maternal, Child and Family Collaborative Team, to provide health and social service support to pregnant women and women with infants/children who are dealing with drug, alcohol, violence, trauma and mental health issues in order to promote healthy pregnancies and positive early parenting experiences. Inputs: Hire a coordinator to research, develop and deliver the SheWay program Time Frame: January 15, March 31, 2017 Budget: $120,000 (consultant, RN, social worker, 2 support staff, & meals and supplies for participants) Persons Responsible for ensuring that this work is done: Arlene Clair and Alison Mitchell Anticipated outcomes for this pilot project: increased school attendance by children at risk, increased health outcomes for children at risk, reduced child apprehension levels, greater number of young mothers able to keep and raise their babies, reduction of harm to young babies at risk of abuse and neglect, enhanced experience for mothers participating in the initiative, healthier births and babies for program participants, reduction in number of families actively engaged with MCFD, reduction in family violence, and reduction in substance and domestic abuse Indicators specific to this pilot project: 5% increase in school attendance by children at risk following initiation of the pilot 5% increase in completion of routine health screening at primary care levels by children at risk following initiation of the pilot 5% reduction in child apprehension levels in the region a year after the program is in operation following initiation of the pilot Overall reduction in number of babies at risk of abuse and neglect following initiation of the pilot Enhanced experience for mothers following initiation of the pilot 8 P a g e

9 Data collection requirements associated with indicators: Baseline and tracking data from the local school district Baseline and tracking data from Public Health, Primary Care and MCFD Baseline and tracking data from Island Health and MCFD Baseline data from MCFD, measure relative numbers a year later Baseline survey taken of mothers participating in the program at the beginning and then one year after initiation of the program Total request for funds from JSC over the two year time frame: $475,000 9 P a g e