integrating ami care across a healthcare service system safer healthcare now national webex october...
TRANSCRIPT
Integrating AMI Care Across a Healthcare Service System
Safer Healthcare NowNational WebEx
October 19th, 2009Diane Shanks and Leila Lavorato
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Regionalization
• Occurred in 1995• Influenced “systems” approach to care delivery
– Identified gaps– Provided opportunities to address gaps through
collaborative approach and processes
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Program Management
• Regional administrative and quality oversight– Facilitated the standardization of policies, protocols, and
equipment– Facilitated a regional approach to data collection/management
and analysis• Provided clinical expertise• Provided a strong collaborative network of clinical experts to
support a health “system” approach to care
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Multidisciplinary Committee
• Membership included key departments/services/individuals influencing care delivery to the AMI patient population
• Representation from across the continuum from pre-admission to community care
• Regional representation
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Strategies
• Clinical Pathway• Standardized physician order sets/forms• Staff education and training• Indicator collection and analysis
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Performance/Quality Indicators
• Challenges of data collection– Multiple sources/care environments/sites– Resource limitations– Timeliness
• Variety of indicators required– Utilization– Quality– Performance
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Approach and Heart Alert
• Electronic databases for the collection of clinical data of acute coronary syndrome patients admitted to a healthcare facility for coronary care and procedures
• Established in Alberta, but has expanded across Canada
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Approach and Heart Alert
• Provided the opportunity:
to capture data in one system
to contribute to Provincial/National database
to improve the continuity and timely exchange of vital patient information between referral regions
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Implementation
• Developed processes for data collection and entry in a timely manner
• Implemented region wide• Implemented within current resources• Developed (with the support of Approach resources)
administrative reports for our own organizational purposes
Implemented October 1, 2007
BUILDING HEALTHY LIFESTYLES CARDIAC REHAB PROGRAM
Our Patient’s Journey
Presented October 19, 2009Leila Lavorato
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• Referral
– Automatic - ACS pathway
– Health Care provider
– Self / Family
• Initial Intervention
– Inpatient visit / introduction
– Education Package
– Intervention screening
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• Education Series– Heart CHEC
• “What Now?”• “What Next?”
– BHL Class Calendar – free, no referral needed• Generic• Disease specific topics
• Assessment– Program Nurse– Coaching model / Motivational interviewing– Set SMART goals / Develop action plans– Consult programs / services
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• Exercise testing/screening
– BHL program referral / Pre Requisite / Physician approval
– Pre Testing / Screening
• 6 Minute Walk Test
• Timed Up and Go
• Body Composition
– Establish Exercise Level I, II, III
– Identify activity tolerance / physical limitations
– Determine Site or Home based
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• Exercise programming
– COMMUNITY SITE • Emergency procedures • Levels I, II, III• Mixed groups• Led by RN, RT, EP• 2 / week for 3 months + home exercise• Structured, monitored moving to self managed activity• Aerobic, Muscle Strength, Stretching exercises
- HOME BASED • Fit and Functional Class / Lifestyle Journal• Regular check- ins• Same follow up and testing
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• Follow up – 3, 6, 12 months– Exercise Testing– Cardiac Rehab specific Group Visit
FOR MORE INFORMATION
BUILDING HEALTHY LIFESTYLES CARDIAC REHAB PROGRAM CALL TOLL FREE 1 866 506 6654 or direct 1 403 388 6329
BUILDING HEALTHY LIFESTYLESPROGRAM MODEL
Patient/Family Health Care Provider Physician
Building Healthy LifestylesReferral to home base - NAVIGATED
Secondary / Tertiary PreventionPrimary Prevention
Disease Specific Programs - Assessments – Education - Management
Building HealthyLifestyle
Group Classes
DISEASESPECIFICPROGRAM
OUTCOMES
THERAPEUTIC EXERCISE REFERRAL
PRE REQUISITION COMPLETIONPHYSICIAN APPROVAL
EXERCISE TESTING
FIT & FUNCTIONAL
HOME EXERCISE Levels I, II or III - Endurance - Muscle Strength - Flexibility
Level I
Level II
Level III
- Incident Report
- Progress Report
3 month POST PROGRAM OUTCOMES
COMMUNITY/HOME6 Month & 12 MonthTesting & Follow Up
Diabetes
Heart FunctionClinic / Network
Clinical Nutrition
Acute CoronarySyndrome - Cardiac
ChronicRespiratory
Risk Factor MxWeight Loss