Rehabilitative Care Alliance Provincial Webinar January 10, 2018 12:00 1:00 p.m. For audio, you must call in by phone: (416) 764-8673 or Toll Free: 1-888-780-5892 Passcode: 7677451# Telephone lines open at 11:50 a.m. and will be muted Webinar begins at 12:00 p.m.
How to participate in the webinar For audio, you must call in by phone: (416) 764-8673 or Toll Free: 1-888-780-5892 Passcode: 7677451# Telephone lines are muted The webinar is being recorded and will be posted to the RCA website within 1 week Questions may be entered into the chat function here for discussion www.rehabcarealliance.ca 2
Agenda Welcome and Overview Rehab Care Alliance QBP Best Practices Frameworks for Hip Fracture and Total Joint Replacement What the frameworks mean for you New quick reference guides to guide clinical practice A new self-assessment process for programs to help improve care Outpatient/ambulatory minimum data set pilot - Phase II What we learned and next steps An opportunity to participate in Phase II testing of the Community Rehab Assessment tool to measure functional outcome Discussion Charissa Levy Executive Director, RCA Kelly McIntyre Muddle Project Manager, RCA Rebecca Ho Project Manager, RCA All www.rehabcarealliance.ca 3
RCA Mandate Work with LHINs, provincial stakeholders, client and caregiver representatives to strengthen and standardize rehabilitative care in Ontario, through: o Better planning o Improved performance management and evaluation o Increased integration of best practices across the care continuum www.rehabcarealliance.ca 4
RCA Initiatives Definitions Assess & Restore/ Frail Seniors Capacity Planning System Evaluation QBP Best Practices Outpatient/Ambulatory Implement standardized levels of rehabilitative care across the province Develop care pathways/processes to standardize best practice rehab care for frail older adults Apply a standardized approach to capacity planning for rehabilitative care Standardize evaluation of rehabilitative care services Implement Address data standardized gap to help rehabilitative inform contribution care best to practices bundled for care hip & fracture support capacity and TJR planning Address Implement a data standardized gap to help rehabilitative inform care contribution best to practices bundled for care hip & fracture support and capacity TJR planning www.rehabcarealliance.ca 5
QBP Best Practice Initiative Implementing the Best Practice Frameworks & Self-Assessment Opportunity
Initiative Goal Hip Fracture and TJR QBP Best Practice Frameworks Establish and support implementation of standardized rehabilitative care best practices for hip fracture and primary hip & knee replacement. www.rehabcarealliance.ca 7
Key Activities 1 Develop tools/resources to support implementation of the RCA rehabilitative care best practice frameworks for patients with hip fracture and TJR. Hip Fracture and TJR QBP Best Practice Frameworks 2 Develop self-assessment tools for organizations, across the care continuum, to evaluate practices relative to frameworks. 3 Undertake a voluntary self-assessment of crosssectoral practices, relative to the best practice frameworks. www.rehabcarealliance.ca 8
Why Implement the RCA Best Practice Frameworks? Supports System and Organizational Priorities Supports organizations in ensuring they meet evidence-based best practices for rehabilitation services Supports implementation of QBPs and bundled care Supports continuous quality improvement by identifying practice changes that can improve care and optimize outcomes www.rehabcarealliance.ca 9
Why Implement the RCA Best Practice Frameworks? By improving patient outcomes and optimizing patient engagement and education, implementing the frameworks will support efforts to improve performance on priority Quality Improvement Plan (QIP) indicators, including: i. Doyle, Cathal, Laura Lennox, and Derek Bell. "A systematic review of evidence on the links between patient experience and clinical safety and effectiveness." BMJ open 3.1 (2013): e001570. 10
Tools and Resources for Implementing the Best Practice Frameworks www.rehabcarealliance.ca 11
Implementation/ Knowledge Translation Toolkit Background information and links to Best Practice Frameworks Referral Decision Trees Quick Reference Guides Instructions and links to Assessment Tools Self- http://www.rehabcarealliance.ca/qualitybased-procedures-qbp www.rehabcarealliance.ca 12
Quick Reference Guides The frameworks describe detailed clinical best practices for different levels of rehabilitative care, including TJR preoperative care and hip fracture rehab in long-term care. The quick reference guides provide a concise overview of the recommendations for each level of care. Red notations indicate where detailed information on a particular recommendation or topic can be located in the framework. www.rehabcarealliance.ca 13
Summary of Rehabilitative Care Best Practices Rehabilitative Care Best Practice Framework for Patients with Hip Fracture Quick Reference Bedded Rehabilitative Care Bedded Rehabilitative Care for Patients with Hip Fracture Initiation Duration Frequency Upon admission initiate range of motion, strengthening, mobility and balance activities Target length of stay is 24-28 days; average length of stay is dependent on patient need Patients should receive daily PT and/or OT, seven days a week Use structured assessments to identify and differentiate between delirium /dementia /depression (3 Ds). Symptoms of the 3 Ds can be superficially similar *8-11 All individuals with a fragility fracture of the hip should be considered at high risk for osteoporotic fractures. Provide exercises, as per BONEFIT principles. *15 Assess transfers and mobility; provide education on the safe use of gait-aids; provide gait and stair training; progress safe mobility & independence with ADLs to improve function and reduce risk for falls; work towards safe, independent discharge. *17-18 Engage patient/family in ongoing communication to review treatment program and discharge plan. Provide patient and family with education on falls risk *19 Evaluate risk of readmission and revise care and discharge plans as required. *19-21 When planning for discharge, educate patient and family that changes in cognition, changes in medication, and reduced physical function can increase the risk of motor vehicle accidents and injury, among older adult drivers. Provide written individualized care and discharge plans to patients primary care provider and other community providers within 24 hours of discharge * Refer to page #(s) indicated, in the RCA Hip Fracture Framework, for more information 14
Using Self-Assessments Sector-specific self-assessment tools have been developed to support organizations and programs identify how well their practices align with the best practices in the framework. The self-assessment tools allow organizations to identify practice areas where implementing a change in practice could improve care. The tools automatically generate a list of priority areas for quality improvement. www.rehabcarealliance.ca 15
Self-Assessment Process 1) Identify the appropriate self-assessment tool(s) for your organization or program Depending on the services provided by your program, you may want to complete either the Hip Fracture Self-Assessment or the Total Joint Replacement Self Assessment, or both. Individual self-assessment tools have been developed for: Hip Fracture: Bedded Rehabilitative Care Ambulatory Rehabilitative Care In-Home Rehabilitative Care Rehabilitative Care in Long Term Care Primary Hip & Knee Replacement: Pre-operative Care Bedded Rehabilitative Care Ambulatory Rehabilitative Care In-Home Rehabilitative Care www.rehabcarealliance.ca 16
Self-Assessment Process 2) Plan a meeting to complete the self-assessment To accurately complete the self-assessment, be sure to include the following individuals: Director, Manager or Coordinator of program being assessed Representative from each discipline of the interprofessional team Professional practice lead/representative where applicable Nursing professional (especially for bedded rehabilitative care) Where available, consider also involving a quality improvement specialist and a patient and/or caregiver representative. www.rehabcarealliance.ca 17
Self-Assessment Process 3) Answer each question by indicating whether your program's current practice is aligned, partially aligned or not aligned with each of best practice statements. Aligned: Most team members/staff would say we do this consistently Partially Aligned: Staff/team members do not agree on how consistently we do this, or it s still a work in progress with opportunities for improvement Not Aligned: Most staff/team members would say we do not do this practice to the extent described www.rehabcarealliance.ca 18
Name of Organization: Self-Assessment Process Self-Assessment of Alignment with the RCA's Rehabilitative Care Best Practice Framework for Patients with Hip Fracture Bedded Rehabilitative Care LHIN: For each of the following best practice statements, please indicate (by choosing from the drop-down list) whether your organizational practices are aligned; partially aligned; or not aligned with this best practice. Assessment/Monitoring Choose from Drop Down List Comments Nursing assessments are completed within 24 hours of admission Aligned OT/PT assessments are initiated within 24 hours of admission Partially Aligned Skin and wound assessment is completed, using a standardized tool (e.g., Braden Scale); Preventative strategies are identified and Aligned implemented Falls risk assessment (as per organization/program protocol) on admission Aligned Pain is assessed at least every 4 hours (Q4H) Aligned Assessments are completed to determine behavioural, cognitive, and functional status Partially Aligned Rehab goals are established and documented, with patient and family, taking into consideration baseline cognitive and physical functioning, Not Aligned and with www.rehabcarealliance.ca the goal of maximizing function and safety at discharge 19
Self-Assessment Process Once all of the questions have been answered, the tool will automatically generate a list of quality improvement priorities to support your organization in planning short-term, mid-range and long-term quality improvement goals Example: Summary of Priority areas for Quality Improvement Assessment - Overall Alignment with Best Practice Delirium/Dementia/Depression - Overall Alignment with Best Practice Interprofessional Intervention - Overall Alignment with Best Practice Patient & Family Education - Overall Alignment with Best Practice Transition Planning - Overall Alignment with Best Practice Secondary Priority for Improvement Secondary Priority for Improvement Well Aligned Well Aligned High Priority for Improvement 20
Sharing the Results Organizations are asked to confirm participation and submit completed self-assessments to RCA. RCA will collate, analyze and share results with each LHIN. Specific organizations will not be identified. www.rehabcarealliance.ca 21
LHIN Level Analyses: Sharing the Results o Common areas where current practice is not aligned with best practice, within each sector (bedded; ambulatory; in-home) o Common barriers to providing best practice care; both within sectors an across sectors (i.e., system-level barriers within LHIN) System Level Analysis: o Common areas, across the province, where current practice is not fully aligned with best practice o System-level gaps in providing best practice care (gaps and barriers related to care transitions/common gaps across sectors) o Innovative models of providing best practice care www.rehabcarealliance.ca 22
Next Steps January 2018: Health service providers will receive communication from LHINs regarding the self-assessment opportunity (See RCA website for self-assessment materials) February 9 th, 2018: Organizations to respond to RCA, Charissa.Levy@uhn.ca, to confirm intention to participate May 4 th, 2018: Deadline to complete and submit selfassessments to RCA October 2018: RCA will provide LHIN-level analyses of selfassessment results to LHINs www.rehabcarealliance.ca 23
Questions? Please enter questions/comments in the chat window of the webinar www.rehabcarealliance.ca 24
Outpatient/Ambulatory Minimum Data Set Opportunity to Participate in Phase II Pilot
Initiative Goal Outpatient / Ambulatory Address a data gap in this part of continuum to help inform outpatient rehab contribution to bundled care and HSFR; inform LHINs how to optimize use of resources to improve and maintain functional status of people in the community. www.rehabcarealliance.ca 26
Key Activities Outpatient/ Ambulatory 1 2 Report the findings from the provincial proof of concept including ICES analysis of resource utilization in relation to pilot data. Develop a strategy for broader roll out of the outpatient/ambulatory minimum data set that reflects the recommendations from the provincial proof of concept and includes refined reporting parameters. www.rehabcarealliance.ca 27
WatLX Patient Experience Measure What We Learned in Phase I The process for collecting patient experience data was easy to implement and did not require significant staff training. WatLX will be offered by NRC Health as part of the OHA contract to all hospital-based outpatient clinics, beginning April 2018 NACRS Clinic Lite The data collected was useful but the time for web-based data entry is too long. Electronic file submission significantly reduced the time to complete and submit a record. Proposed to CIHI a 2 record version of NCL (admission and discharge) vs. the 1 record per visit version Engaging with vendors for an electronic file submission solution www.rehabcarealliance.ca 28
Community Rehab Assessment What We Learned in Phase I Functional improvement can be measured in many rehab populations. Patients demonstrated substantial improvement in instrumental activities of daily living (IADL), mobility, social activities and improvement symptoms such as pain and fatigue. The burden of data entry was high Reduced the number of questions on the self-report with the ability to skip some questions as appropriate. Reduced the number of questions on the in-clinic assessment Streamlined the in-clinic assessment so that admission and discharge is reported on the same page; clinicians can see the effect immediately www.rehabcarealliance.ca 29
Call for Participation: Phase II Community Rehab Assessment www.rehabcarealliance.ca 30
Why Participate? Access to valuable data for evaluation and planning: Most outpatient rehabilitation clinics struggle to gather and report meaningful data for use in evaluation and planning. The pilot will provide you with data to demonstrate the value of outpatient rehabilitation to senior leaders in your organization and in the health care system. www.rehabcarealliance.ca 31
Why Participate? Opportunity to play a leadership role: Standardized, comparable data is critical at a system level to improve understanding of the role of outpatient rehabilitation in an integrated, efficient system. By participating, you have the opportunity to shape a tool that may be used province-wide in the future. www.rehabcarealliance.ca 32
What is Required? Participating sites must capture data for a minimum of 15 patients from the same population group who are admitted and discharged from your program during the nine-month pilot period. In particular, we hope to capture data for patients receiving outpatient rehab due to an acquired brain injury, total joint replacement (TJR), neurological issue, stroke, or an orthopedic need (other than TJR or hip fracture). www.rehabcarealliance.ca 33
What is provided? All participating sites will receive training and ongoing support from the RCA. This includes: Provincial webinar on January 25 th, 3:30pm-5:00pm: provides training on the processes and tools. You may wish to train one or two staff who can then train others. Site start-up training: The RCA secretariat to provide a site-specific teleconference for one or two lead staff from your site on more detailed logistics and procedures. Optional site-specific training: The RCA is also available to do an additional training session for your front line staff on the clinical and data collection aspects of the Community Rehab Assessment. www.rehabcarealliance.ca 34
What is provided? Data analysis: The RCA provides data analysis and reporting. You will receive a report on functional outcome data specific to your site, and a comparison of your results to those of participating sites across the province. This is a unique opportunity to measure your performance across populations and against other programs using standardized, comparable data. www.rehabcarealliance.ca 35
Pilot Logistics Data will be collected on paper surveys until such time as an electronic solution can be procured, if it can be procured Personal health information cannot be submitted to the RCA CRAs will be identified through a random patient number. Sites will maintain a log of patient numbers, with patient identifiers like name, birthdate, and health card number Completed CRAs get batched and submitted to the RCA for data entry Paper copies of the CRA should be kept in patient charts If a patient discontinues therapy, only send the completed CRAs and a note that patient discontinued therapy www.rehabcarealliance.ca 36
Proposed Pilot Timelines Call for participation December 2017 Deadline to express interest in participation Mid to late January 2018 Distribution of all pilot materials to sites End of January 2018 Provincial webinar training January 25, 2018 Rolling training and startup in the pilot February to April 2018 Enrollment, batch submission of data to RCA February - September 2018 Last patient enrolled (12 week episode of care) Early September 2018 All data submitted to the RCA Early December 2018 www.rehabcarealliance.ca 37
Responding to the Call for Participation This FAQ (https://tinyurl.com/yb3mvemw) provides more information on the pilot. Sites may also register for the January 25 th informational/training webinar to learn more before making their decision. If you are interested in participating in the pilot, the webinar or have more questions, please email Rebecca Ho, Project Manager (rebecca.ho@uhn.ca). All participating sites must be enrolled in the pilot by January 31. www.rehabcarealliance.ca 38
Questions? Please enter questions/comments in the chat window of the webinar www.rehabcarealliance.ca 39
Next Information Webinar April 26 th, 12:00 1:00 p.m. Please complete feedback survey: https://www.surveymonkey.com/r/ja n10rcawebinar www.rehabcarealliance.ca 40
Stay Informed Sign up to receive: RCA newsletter Announcements of new resources/tools Opportunities to engage in RCA initiatives To sign up, visit http://rehabcarealliance.ca/subscribe You can unsubscribe at any time. Please encourage others in your organization to sign up, in order to stay informed about the work of the Rehabilitative Care Alliance www.rehabcarealliance.ca 41