Transcript Developing a System of Care

Developing a system of care
Robert D. Reid
University of Ottawa Heart Institute
[email protected]
A brief history…
No. of Participants
Regional network
7000
6000
6000
5000
4000
3000
Add: 0.5 FTE
nurse
IP program
Open OP Clinic
2000
1000
0
Institutional
approach
“Tickers”
0
'92
New leader,
1.0 FTE nurse
1600
586 482 333 315 324
576 604 595 602 835
235
'93
'94
'95
'96
'97
'98
'99
Year
'00
'01
'02
'03
'04
'05
What changed to allow for
dramatic growth in capacity?
Success comes from…
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doing ordinary things extraordinarily well…
in a systematic way…
at the right time…
using effective interventions…
with measured outcomes…
within a network of care…
and a culture of prevention.
Projected Outcomes of Preventive Interventions
Intervention
Smoking Cessation
Lipid Lowering
BP Control
ACE Inhibitors (CHF)
ß Blockers (MI)
ASA (MI)
Coumadin (A.Fib)
Lives Saved
328,400
132,777
63,282
11,000
17,023
10,365
3,418
NNT
9
34
31
N/A
120
143
2,014
Doing ordinary things,
extraordinarily well…
IMPACT =
REACH *
EFFECTIVENESS
The Untapped National Potential
• 2,770,128 inpatient hospitalizations in Canada (02/03)
If 20% hospitalized pts. smokers
= 550,000 patients
“I rob banks because that’s where
the money is”
Willie Sutton
In a systematic way…
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Documentation of smoking status of every
patient admitted to University of Ottawa Heart
Institute
Intervention for every smoker
The University of Ottawa Heart
Institute In-Patient Smoking
Cessation Program
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> 6500 admissions/year
>1300 smokers identified (20%)
Cessation counseling provided to 90%
An absolute increase of 15% in long term cessation
rates
195 new quitters
At the right time
Percent of sample
Readiness to change
70
60
50
40
30
20
10
0
60
59
33 30
10
PC
Population sample
Cardiac-In-hospital
8
C
P
Stage of change
Prev Med 2003; 36(6):710-20
Using effective interventions…
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Brief or intensive counseling
Pharmacotherapy
Self-help materials
Follow-up contacts
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Interactive voice response (IVR) technology
Linked to community resources/programs
The Power of a Brief
Intervention
Ask
Advise
Assess
Assist
Arrange
“A health professional’s advice to stop smoking increases
the rate of smoking cessation by approximately 30 percent.”
Within a network of care…
Hospitals
1o Care
Providers
Public Health
Community
Agencies
“A thousand ways to make love
but no lovers”
With measured outcomes…
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To demonstrate value for money
To provide feedback and motivation
To fine-tune your program
To benchmark
…and great stories that bring
your program to life
A Culture of Prevention
Smoking Cessation
… single most powerful prevention
Intervention in clinical practice
Types of influence for change
Organizational
Policy
Social
Social influences
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Champions
Culture of prevention
Feedback on performance
Policy influences
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Smoking cessation as a quality indicator
Inclusion on care maps
Standard orders
Allocation of human resources
Organizational influences
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Documentation of smoking status (a vital sign)
Staff training
Availability of self-help materials
Availability of pharmacotherapy
Follow-up
Data tracking
Links to community resources
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Provincial quit line
Referral to tobacco cessation specialists
Checklist
Policy
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Quality indicator?
Care map(s)?
Standard orders?
Designated people?
Organization
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Documentation?
Training?
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Self-help materials?
Pharmacotherapy?
Follow-up?
Data management?
Links?
Social
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Champion?
Culture of prevention?
Feedback?
Success comes from…
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doing ordinary things extraordinarily well…
in a systematic way…
at the right time…
using effective interventions…
with measured outcomes…
within a network of care…
and a culture of prevention.