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C - HOBIC

C - HOBIC. Canadian Health Outcomes for Better Information and Care. C-HOBIC. Overview Project Background WRHA Implementation RAI outcome measures Challenges and Lessons Learned Discussion. C-HOBIC. Background:

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C - HOBIC

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  1. C - HOBIC Canadian Health Outcomes for Better Information and Care

  2. C-HOBIC Overview • Project Background • WRHA Implementation • RAI outcome measures • Challenges and Lessons Learned • Discussion.

  3. C-HOBIC Background: National Research Project in partnership with Canadian Nurses Association Funded by Canada Health Infoway Provinces involved: Manitoba, Ontario, Saskatchewan

  4. Project Intent • Provide information to Health Care Professionals on clinical outcomes from information based on nurse sensitive indicators • Explore how the outcome information is integrated into the work flow • Utilization of the clinical data available • Describe how managers and front-line health care professionals use the information to further evidence informed practice and care planning for the clients/patients • Creation of reports

  5. Project Deliverables • Development of 3 reports for use by clinicians and managers • Provision of education on access to the reports • Provision of education on integration of the reports into care planning process • Provision of follow-up support to clinicians and managers • Facilitation of the evaluation of the Project in May 2009.

  6. Timeline • Project Start - Oct 08. • Report Requirements – Nov 08. • Report Development – Complete Jan 2009. • Staff Training – Jan 2009. • Implementation – Feb to Mar 09. • Follow-up Training & Support – Ongoing.

  7. Participants • Six PCHs. • Over 225 nurses. • Six Home Care Offices. • 60 Case Coordinators (professionals in a health related discipline)

  8. Participant Recruitment • Provided information on the C-HOBIC project. • Outlined commitment of regional staff to provide education. • Outlined site responsibility to provide ongoing education.

  9. Education Plan • Goal: to provide education about the use of reports in the care planning process including various RAI reports and the C-HOBIC report. • Wanted to show the value of the previous work done by staff in the completion of the RAI. They could now get information which would help in the delivery of care.

  10. Education • LTC - The Education Plan included a central launch session and two site based sessions. • HC - Staff were trained in small groups or individually. • Two hour PowerPoint presentation with hands on access to CHOBIC report. • Follow-up support.

  11. EducationalPresentation Outline C-HOBIC project. Outcome data: why is it important. Review of care plan requirements. Discussion of interdisciplinary team approach to care planning. Report integration into the care planning process when, who, how. Report review and access. RAI outcome measure reports and C-HOBIC report.

  12. Resident Assessment Instrument (RAI) • A standardized assessment tool; different versions for home care (HC) and long term care (LTC) • Completed on admission and quarterly in LTC • Completed on admission and annually in HC • Used to collect a minimum data set (MDS) with triggers for further assessment • Completed electronically

  13. RAI Outcome Measures • Each Measure evaluates a different aspect of the clinical status of the client. • Each Outcome Measure is based upon carefully selected items in the RAI-HC and RAI-LTC assessment. • Measures leads the clinician through an investigative process when reviewing the assessment, in creating the care plan and evaluating the care plan and client status.

  14. RAI Outcome Measures • IADL Difficulty (RAI-HC) • IADL Involvement (RAI-HC) • Cognitive Performance Scale • Depression Rating Scale • Pain Scale • Index of Social Engagement (RAI-LTC) • ADL Self-Performance Hierarchy Scale • CHESS Scale – Changes in Health, End-stage disease and Signs and Symptoms • MAPLe Score – Method of Assigning Priority Levels (RAI-HC)

  15. RAI Outcome Measures IADL Difficulty (RAI-HC) • Captures patterns of difficulty with the tasks of housework, meal preparation, and phone use. IADL Involvement (RAI-HC) • Measures performance patterns of the tasks of housework, meal preparation, and phone use. Cognitive Performance Scale • Measures cognitive status using daily decision-making skills, making self understood, short-term recall, and eating.

  16. RAI Outcome Measures Depression Rating Scale • Score of 3 or more suggests possible depression; based on Section E, Questions 1a – g. Pain Scale • Score based on two questions: pain frequency and pain intensity Index of Social Engagement (RAI-LTC) • Measure of level of participation in social activities • Score 0-6; higher score identifies increase in social activity ADL Self-Performance Hierarchy • Measures activities of daily living performance according to early, middle, and late stages of loss.

  17. RAI Outcome Measures CHESS Changes in Health and End-Stage Signs and Symptoms • Measures medical complexity and health instability. • Higher scores are associated with higher mortality, use of acute hospital services, pain, receipt of specialized treatments, and poor health outcomes.

  18. RAI Outcome Measures MAPLe (RAI-HC) Method of Assigning Priority Levels • Predictive of facility admission, caregiver stress, or a feeling by family or client that the client would be better off elsewhere. • Those clients in the Very High level are 10 times more likely to be admitted to a long term care facility within 3 months.

  19. C-HOBIC Outcome Measures Included in the WRHA Project: • ADL – Activities of Daily Living • Bladder Continence • Pain • Falls • Pressure Ulcers • IADL – Instrumental Activities of Daily Living (Home Care) Not Included in the Project: • Fatigue, Dyspnea, Nausea, Therapeutic Self-care

  20. C-HOBICIndividual Outcome Measure Report • Provides a detailed analysis of each client’s/patient’s outcome data for the specified indicators • Measures are intended to lead the clinician through an investigative process when reviewing the assessment, in creating the care plan, and evaluating the results of the care plan and client status.

  21. LTC - Individual Report

  22. HC - Individual Summary Report

  23. C-HOBIC Management Outcome Measure Report - Detailed Provides a detailed analysis of a specified caseload or office in Home Care or a specified unit within a facility or a facility in LTC with respect to the outcome data for the specified indicators

  24. Management Outcome Measure Report - Detailed • The data are collected from the total number of assessments completed in each specific category from each yearly quarter (Q) • Q1 = April, May, June • Q2 = July, Aug, Sept • Q3 = Oct, Nov, Dec • Q4 = Jan, Feb, Mar

  25. LTC - Management Detailed Report

  26. HC - Management Detailed Report

  27. C-HOBIC Management Outcome Measure Report - Summary • Provides average values of the outcome data within the specific community area for Home Care and for the unit and facility for Long Term Care

  28. LTC - Management Summary Report

  29. HC -Management Summary Report

  30. Lessons Learned Need to meet face to face with participants early on to ensure understanding of commitment and specific learning needs. Need to check and verify technology at each site before education begins. Investigate current technology solutions in use by clinical staff and define impact on the project.

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