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Presented at the ICN NP/APN Conference, South Africa, June 30, 2006

The Toronto Rehab NP Study: ”Improving access, continuity & quality of primary health care for a community of patients with complex complex continuing care needs” . Presented at the ICN NP/APN Conference, South Africa, June 30, 2006 Linda Dacres, RN(EC), NP-PHC, BScN,

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Presented at the ICN NP/APN Conference, South Africa, June 30, 2006

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  1. The Toronto Rehab NP Study:”Improving access, continuity & quality of primary health care for a community of patients with complex complex continuing care needs” Presented at the ICN NP/APN Conference, South Africa, June 30, 2006 Linda Dacres, RN(EC), NP-PHC, BScN, MHSc (Family & Community Medicine), PhD (c) Consultant, Primary Health Care and Ambulatory Innovations, NP Role Integration Nurse Practitioner, Complex Continuing Care - Toronto Rehabilitation Institute

  2. Introduction • The Primary Health Care Nurse Practitioner (NP) Study explores the extent to which the NP role is implemented at the Toronto Rehabilitation Institute in Complex Continuing Care • Evaluate the NP’s impact on the access, continuity and quality of primary health care

  3. Principal Investigators • Principal Investigators • Karima Velji • Vice President, Patient Care & Chief Nursing Executive - Toronto Rehabilitation Institute • Dr. Souraya SidaniProfessor, Faculty of Nursing, University of Toronto Funding: • Health Canada • Primary Health Care Transition Fund

  4. Outline • Context: Toronto Rehab Institute • NP Role • NP study • Preliminary findings • Next steps • Discussion

  5. MR

  6. Mandate Vision • To advance rehabilitation and enhance quality of life. Mission • We partner with individuals, their families and • supporting communities in innovative, effective adult • rehabilitation and complex continuing care. In affiliation • with the University of Toronto, we lead the integration of • service, research and education, and the development • of a coordinated rehabilitation system.

  7. Clinical Programs • Cardiac Rehabilitation & Secondary Prevention • Complex Continuing Care Program • Geriatric Rehabilitation Program • Musculoskeletal Rehabilitation Program • Neuro Rehabilitation Program • Spinal Cord Rehabilitation Program • Long Term Care Program

  8. Patient Care Education Research Vision To advance Rehabilitation and enhance quality of life Mission We partner with indivi-duals, their families and supporting communities in innovative, effective adult rehabilitation and complex continuing care. In affil-liation with the University of Toronto, we lead the inte-gration of service, research and education, and the development of a co-ordinated rehabilitation system. Values We are committed to: Caring Discovery Learning Collaboration Accountability Advocacy Toronto Rehabilitation Institute Patient Care (Professional Practice)Pillars + Best Practice Education Professional Excellence Spiritual Care Ethics Best Practice/Advanced Practice Leaders Education Leaders Clinical Educators Corporate Practice Leaders Bioethicist Chaplains • S. Solway (BP Leader) • N. Foster (Cardiac) • D. Driver (CCC) • B. Trentham (CCC) • N. Boaro (Neuro) • L. Spanjevic (Geriatrics) • M. McGlynn (MSK) • J.Ibrahim (Emotional Care) • Vacant (Pain) • Heather Flett (Spinal) • L. Sinclair (IPE -Leader) • L. Inness (PT) • L. Korkola (Nursing) • D. Hebert (OT) • C. Steele (SLP) • L.Ruttan (Psychology) • T. Dion (TR) • N. Rave (Chiropody) • J. Huth (Chaplaincy) • J. Stretton (SW) • E. Rolko (Pharmacy) • D. Wildish (Dietitian). • G. Tardif (Medicine) • B. Secker • J. Huth • P. Stevens • S. Walters • J. Kim (Nur - CCC) • W. Kiersnowski (Nur- G) • M. Gibson (Nur-S) • L. Keats (Nur-S) • T. John (Nur-M) • S. Ram (Nur – N) • K. Brunton (PT) • J. Howe (PT) • D. Hebert (OT) • M. Lowe (OT) • R. Mabrucco (SW) • P. Gairy (Nur- CCC) (Jan 5, 2005)

  9. Collaborative Practice • Clinical Programs • Best Practice • Education • Professional Excellence • Ethics + Spiritual Care

  10. Impetus for NP Study • Limited physician access • Improve continuity of care, quality & access to primary health care services • Enhance communication – interdisciplinary & families • Increase response time - decrease emergency transfers & costs incurred to health care system

  11. Purpose of NP Study • To describe the extent to which the NP role is implemented as designed in a CCC setting • To identify the enablers and deterrents for a successful implementation of the NP role in CCC setting, including the collaboration between FP physician and NP • To evaluate the NP contribution to improved a) Access to PHC for residents in CCC b) Quality of technical and interpersonal aspects of care provided to residents and families in CCC c) Communication and coordination of care among membersof the interdisciplinary health care team.

  12. Complex Continuing Care • 224 beds – 6 clinical units • Recent re-structuring • Complex acute and chronic medical and functional neurological needs • 10 bed palliative care unit • Multiple & demanding 24/7 health care requirements

  13. NP Role • Utilizes full scope of RN(EC) practice • Provision of PHC and specialized services to residents &. • Hub of interdisciplinary health care team • Liaison and communications • Counselling and health education • Best-practice implementation • Illness prevention • End-of-life care

  14. Study Design • Mixed quantitative & qualitative pre-post design • Data collection from multiple sources • 12-month NP implementation period • One CCC unit

  15. PRE-TEST

  16. POST-TEST

  17. Preliminary Findings 1. Implementation of NP role • (6) Self assessment and observation of role components derived from the literature 2. Enablers and deterrents • (25) Qualitative interviews

  18. Preliminary Findings cont’d NP contribution to improved: 3. Access to PHC for residents in CCC • Unit communication logs 4. Quality of technical and interpersonal aspects of care provided to residents and families in CCC • MDS indicators • Standardized encounter tool • Individualized Care Index (van Servellen,1988 5. Communication and coordination of care • Communication and coordination subscales (Shortell et al., 1991)

  19. Next Steps • Complete data analysis and report • Dissemination of results • Consultant, Primary Health Care & Ambulatory Innovations, Nurse Practitioner Role Integration        Nurse Practitioner - Complex Continuing Care • NP role implementation in 4 clinical programs

  20. Study Team • Karima Velji, Toronto Rehabilitation Institute (PI) • Dr. Souraya Sidani, Faculty of Nursing, University of Toronto (PI) • Dr. James Edney, Toronto Rehabilitation Institute • Dr. John Masgoret, Toronto Rehabilitation Institute • Kathy McGilton,Toronto Rehabilitation Institute • Dr. Gaetan Tardif, Toronto Rehabilitation Institute • Marnie Bowser, Toronto Rehabilitation Institute • Dr. Mary Van Soeren • Moyra Vande Vooren

  21. Acknowledgements • Primary Health Care Transition Fund Program of the Ontario Ministry of Health and Long Term Care Demonstration Project # G03-05577 • Toronto Rehabilitation Institute • University of Toronto • Alba DiCenso – McMaster University • Michelle Clifford-Middel- Healthpositive

  22. For further Information • Contact Karima Velji (PI) velji.Karima@torontorehab.on.ca • Contact Souraya Sidani (PI) s.sidani@utoronto.ca • Contact Linda Dacres, NP dacres.linda@torontorehab,on,ca

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