LHIN CHSP Cardiac PAG. Submission Draft July 3, 2009

Transcription

1 LHIN CHSP Cardiac PAG Submission Draft July 3, 2009

2 Attendees: Meeting 1 Dr. Jim Bulger Ms. Barbara Busing Dr. Stuart Connolly Dr. Hugh Fuller Ms. Sue Gregoroff Dr. Murtaza Gulamhussein Dr. Doug Holder Dr. Ted Mitchell Dr. Khal Salem Mr. Brady Wood (Facilitator)

3 Attendees: Meeting 2 Dr. Jim Bulger Ms. Barbara Busing Dr. Hugh Fuller Ms. Sue Gregoroff Dr. Murtaza Gulamhussein Dr. Doug Holder Dr. Ted Mitchell Dr. Khal Salem Dr. James Velianou Mr. Brady Wood (Facilitator)

4 Attendees: Meeting 3 Dr. Jim Bulger Dr. Hugh Fuller Ms. Sue Gregoroff Dr. Doug Holder Dr. Ted Mitchell Dr. Khal Salem Dr. James Velianou Mr. Brady Wood (Facilitator)

5 Template 1: Strengths and Challenges within the Current System in Addressing Population Needs Strengths Collaboration among partners (e.g. LHIN Cardiac Working Group); willingness to modify practices Acute Infrastructure in place Full spectrum of care exists in LHIN Availability of Data (e.g. CATH, PCI, ICD, Wait Times) and Data sharing Strong Research (particularly Hamilton) and Innovation Education Programmes (e.g. fellows; primary care) Coordination timely access to CATH, Angio user-friendly; one number for interventional cardiology Availability of Angio Priority funded program EPS/ Cardiac surgery Specialty clinics CCN memberships Challenges ehealth Inftrastructure (e.g. shortcomings of EHR) Coordination (continuum; transitional; what can occur in the community v. in hospital) and Integration (v. fragmentation) Lack of integration of chronic care (e.g. management of chronic heart failure; primary/secondary rehab) Knowledge Translation and Delivery Research (e.g. best practices) Access (To cardiac rehab; to tilt-table tests) EMS Issues Transfer time Uniformity of training and skills Consistent quality of care Wait times No single wait list for cardiologists Limiting to routine cardiac care Data for outpatient cardiac Rural Access (distance from Rural communities to centres + disease burden) Role clarity (e.g. cardiac v. GIM) Resourcing under resourced in many areas Prevention and Wellness Patient automobile/driving issues (e.g lack of template)

6 Template 2: Factors most likely to increase / decrease future demand for health care: Describe the factor that will increase or decrease demand by 2013 Aging population (e.g. baby boomers) ; age demographics by community Shift to greater incidence of chronic disease with longer lifespan Manpower planning and declining enrollment (physicians, nurses) Increasing enrollment for cardiology Patient expectations; more informed consumer New technologies (e.g. 64 swlice CT/Angio; artificial heart); inappropriate use of technology Socio-economic correlates to heart health (lifestyle, aging, cultural) Under-serviced communities (in particular aboriginal) Chronic disease management could decrease demand Prevention initiatives could decrease demand Primary care models Economy growth of demand v. tax base Will this factor have a modest or significant impact on future demand? Significant Significant Modest Modest Significant Significant Significant Modest Modest Modest Modest Significant

7 Template 3: Components of an Ideal Service Delivery Model Component Services associated with this component Clinical and non-clinical interdependencies Linkages to community services Health Promotion/Disease Prevention Smoking cessation/education Parallel weight loss and nutrition Healthy environments Consciousness at planning tables Primary and secondary prevention Anti-obesity: community/med/surg Workplace programs Diabetes/metabolism/endocrine Fitness centres Weight loss programs/nutrition Primary Care City Hall/planning Primary Care Standard protocols Best practice information available Consistent approach to quality, breadth, and access to Cardiac and DI Clarity of expectations/ education/ guidelines Linkages to specialty care Counseling on prevention Early intervention approach LHIN-wide lab Full range of Acute Care EMS ERs Prevention and health promotion Laboratry EMS Hospitals Nutrition / weight loss Fitness centres Community labs Pre-hospital Care Consistent EMS standards, training and protocols Ability to collect and report data (portal) Centralized model Primary care Hospitals ERs LTC/Home Care Addiction and Wellness resources Acute Hospital Care Full range of acute cardiac -exists Equitable access to services of comparable quality Standardized protocols Enhanced dialogue and knowledge transfer between centres Rapid access to PCI Clinical connects portal; standard data collection Primary care between Hospitals ERs LTC/Home Care Prevention and health promotion Laboratory Prevention and health promotion EMS Hospitals Nutrition / weight loss Fitness centres Community labs LHIN Mental Health and Addictions linkages must be stronger

8 Template 3 Continued: Components of an Ideal Service Delivery Model Component Services associated with this component Clinical and non-clinical interdependencies Linkages to community services Non-acute hospital care Nutrition services Rehabilitation CCU/CTU/ICU ER / Urgent Care Post-hospital Care CCAC assessment Home Care Primary Care Nutrition/wellness ER/Urgent Care Outpatient Cardiac Rehab CCU/CTU Other acute areas (surgical stepdown) CCAC and referral orgs. Home Care Nutrition/wellness Community-based Non-acute Care Outpatient Cardiac Rehab Home Care ER/Urgent Care CCU/CTU/ICU ER / Urgent Care CCACs Home Care Chronic Disease Multi-disciplinary hospital and community chronic disease management All acute care Primary Care Post-hospital stay LHIN-Wide EPortal Electronic Referral and Booking System Electronic Records System-wide LHIN-Wide approach to Quality / Assessment and Standardization of Cardiac Diagnostics Including Standardized protocols Data quality control for Cardiac diagnostics Formalized patient feedback Multidisciplinary Ambulatory Care Centres with Cardiology Teams Delivering services outside of hospital settings Multi-disciplinary team approach Principles for development Primary Care Acute Care Specialists Offices CCAC Mental Health and Addictions (e.g. Depression, anxiety, smoking cessation resources)

9 Khal s Diagram

10 Diagram: LHIN 4 Cardiac Services Ideal State Principle: equitable access to services of comparable quality across the LHIN Based on: Current LHIN-Wide Centre Provision Model Page 6 PAG Reviews Document Quaternary : Hemodynamically stable; Monitoring only

11 Diagram: LHIN 4 Cardiac Services Ideal State Overarching Quality, Safety and Best Practice Framework, driven by Quaternary Centre, in dialogue with Other Facilities Quaternary

12 Diagram: LHIN 4 Cardiac Services Ideal State LHIN-Wide EPortal (Records and Referral System) Long- Term Care Outpt Cardiac Rehab Quaternary CCAC One Stop Outpt

13 Diagram: LHIN 4 Cardiac Services Ideal State Local Services SUPPORTS Academics: robust hub/spoke dialogue and knowledge translation Quality: centralized approach to quality and performance data Primary Care Amb Care Centre(s) Long- Term Care Outpt Cardiac Rehab LHIN-Wide EPortal (Records and Referral System) Prevention and Early Detection Approach -Comprehensive Smoking Cessation Program - Parallel Obesity and Nutrition Strategy (e.g. Provincial) -Parallel Aboriginal Health Strategy (e.g. Provincial) CCAC Home One Stop Outpt Lifestyle Mgmt Standardization: standardization of practices across the continuum EMS

14 Diagram: LHIN 4 Cardiac Services Ideal State Organization Cardiac Prevention Alliances Post Angiography Post CABG Post MI Primary prevention for >1 risk factors Obesity Management Heart failure rehab Cardiac Rehab Intake sessions Risk factors assessment Smoking cessation Dietician Intake questionnaire Exercise prescription Graduation Weight management Weight Manageme nt/ Ontario bariatric stat One Stop Outpatient CCAC Potential free/subsidized membership Stress tests Holters LOOPs Follow-up on CHF Fitness Centre (E.G. ymca) Potential free/subsidized membership Outpatient intake assessment (questionnaire and measurement) Home exercise program assistance Heart failure management partnership weighing and liaison with physicians at the cardiac rehab

15 Khal s Evaluation Tool

16 Template 4: Assess the recommended model against the criteria Cardiac PAG DOMAIN CRITERIA ASSESSMENT DESCRIPTION Strategic Fit Alignment with LHIN priorities for health improvement Aging At Home: restoring people to health as soon as possible and returning to outpatients; specialty clinic support (e.g. heart function); Linkages with CCAC (transitional care for heart failure and COPD); chronic disease management ER/ALC: reduce LOS, standardization protocols /discharge plans (AMI), management, EMS transport improvement for primary PCI/other emergency cardiac care; defer admissions via ER through robust primary care services Mental Health and Addictions: need for increased resources for acute cardiac patients including psychiatry, addictions, smoking cessation Right Care, Right Place, Right Time: move patients to less resource intensive environments where possible (i.e. focus on prevention, ambulatory and outpatient settings); enhances coordination and resources for Primary Care and other areas of the system Alignment with trends in health care needs and system transformation ehealth: consistent/progressive Enhances collaboration and integration between providers Adds much needed infrastructure, and wellness programs Management of Cardiac patients: In comparison to template 2, the model addresses the significant factors

17 Template 4 continued: Assess the recommended model against the criteria Cardiac PAG DOMAIN CRITERIA ASSESSMENT DESCRIPTION Population Health Health Status (clinical outcomes and QOL) Prevalence Health promotion and disease prevention Outcomes should improve e.g. via heart failure clinics, improve access/quality of diagnostics, more robust prevention Monitoring via CIHI, ICES, CCN LHIN-Wide quality approach suggested Data is an opportunity for improvement in the current model LHIN 4 Cardiac Working Group Smart AMI Project principles could be applied more broadly LHIN 4 is ahead of the curve due to existing communication and collaboration Funding for quality insurance is an area for improvement Prevalence will be increasing; model recognizes this and suggests a model to mitigate Prevalence may also be seen as an indication of success (people living longer) Alliance (one stop) Room for improvement with better application of guidelines to target (diabetes, hypertension) i.e. Knowledge translation Cost of drugs as area for improvement (e.g. better use of generics) Working poor in our area Clear integration with CCAC Informing public policy (e.g. linkages to medical profession and government)

18 Template 4 continued: Assess the recommended model against the criteria Cardiac PAG DOMAIN CRITERIA ASSESSMENT DESCRIPTION System Values Patient-Focus Partnerships Community Engagement Innovation Equity Efficiency (operational) One stop/ ambulatory principles EMS strategy improve access at time they need it most\ Proximity to service v. need identified and strengthened external linkages Communication/referral through e-portal Local and provincial systems (CCN, ICES) One of most robust research programs Learners across system Universities, colleges, and med schools (McMaster, Brock, Michener, Mohawk) Relations between hospitals Patient education Specialty clinics in communities Primary PCI Need for explanation of decision making and mechanisms for citizen engagement and feedback Research and knowledge translation Communication (E-Portal) Largest Primary PCI program in country; largest advanced cardiac care provincially/nationally Integrated community partnerships Patient-focused and assessment (cultural) (e.g. PAVR, endovascular management, minimally invasive approaches e.g. mitral valve surgery) One stop cardiac Founding principle of our work Consistent care reinforced by LHIN-Wide quality approach Aboriginal strategy Protocols to avoid duplication to streamline care as appropriate LHIN-wide quality management

19 Template 4 continued: Assess the recommended model against the criteria Cardiac PAG DOMAIN CRITERIA ASSESSMENT DESCRIPTION System Performance Access Quality Sustainability Integration Enhanced via E-Portal referral and records system Free up acute resources by treating in outpatient and ambulatory for appropriate cases More coordinated and central approach focused on care continuum and value for patients Includes enhanced LHIN-wide approach to quality and safety, synched with academic programs to ensure best practices and knowledge translation Also includes formal monitoring and feedback mechanisms Resource-intensive model, however costs are likely to be found in acute care centres after the implementation of One Stop Outpatients and Ambulatory Teams ehealth infrastructure is likely to be costly, but should be funded centrally; must include eportal for both records/di and referrals Requires pooling of Quality infrastructure from multiple organizations to ensure consistent approach Builds on success hub-and-spoke model in place today; good/enhanced synergies between academic and clinical (knowledge translation) Enhanced through common approach to quality and measurement Common system for records/di and referrals Supported by linkages with primary care and ambulatory teams

20 Template 5: Descriptions of Pre-requisites, Enablers, and Challenges to Implementation CATEGORY PRE-REQUISITES ENABLERS CHALLENGES POLICY Government rural hospitals group (e.g. examining levels of service for rural communities) Change Public Hospitals Act re: nurse practitioners and nurses Obesity/Nutrition and Smoking Cessation EMS funding inadequate (via municipalities) Expeditedprocess re: driving LEGISLATION N/A N/A N/A Current financial downturn Potentially lacking political will as we head into campaigning year AVAILABILITY of RESOURCES Obesity / Nutrition and Smoking Cessation Funding for specialized advanced cardiac procedures /surgeries Hear failure clinics Cardiac Rehab Mental Health and Addictions sync critical Quality and Standardization and Assessment Political will Commitment by administrators and clinicians to realign resources in support of enhanced cardiac model Willingness on part of clinicians to find efficiencies in their practice Current financial downturn Potentially lacking political will as we head into campaigning year READINESS E-Health resources which are currently not in place willingness on the part of clinicians to practice in different ways prevention focus at the Provincial and Federal level (i.e. cannot have adequate prevention without a convincing smoking cessation or weight loss program) Political will for large effective expenditure for electronic infrastructure Administration of different healthcare corporations Health human resources E-Health infrastructure EMS Funding limits / financial downturn LINKAGES E-Health Infrastructure (Records/DI and Referral System) Mental Health and Addictions colleagues Diagnostic Imaging colleagues Administration of different healthcare corporations Primary care leadership E-Health Infrastructure OTHER: