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Improving P atient- centred Chronic Care through Collaboration in Atlantic Canada

Improving P atient- centred Chronic Care through Collaboration in Atlantic Canada. Jenn Verma, Sr. Director , Collaboration for Innovation & Improvement , CFHI (for Vickie Kaminski, President & CEO, Eastern Health , NL) IHI-BMJ Forum. April 9, 2014.

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Improving P atient- centred Chronic Care through Collaboration in Atlantic Canada

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  1. Improving Patient-centred Chronic Care through Collaboration in Atlantic Canada Jenn Verma, Sr. Director, Collaboration for Innovation & Improvement, CFHI (for Vickie Kaminski, President & CEO, EasternHealth, NL) IHI-BMJ Forum April 9, 2014

  2. Atlantic Healthcare Collaboration for Innovation and Improvement in Chronic Disease Chartersigned by all health regions in Atlantic Canada CFHIis a not-for-profit organization funded by the Government of Canada No conflicts of interest to report 2

  3. How can we close the gap, to make best practice, the common practice? MIND THE GAP > Healthcare improvement

  4. Healthcare spending: PacManof provincial budgets (40% of public spending) • New mantra: cost containment, waste reduction, efficiency gains, value for money • Hospital care: dependency is high; difficult to enter & exit!

  5. 17health regions + CFHI 4 provinces 10 Improvement projects Newfoundland & Labrador Multi-morbidity Diabetes Mental Health COPD * Self-management System design Decision support Community action *Based on the Expanded Chronic Care Model

  6. How can we reach young adults with mental illness and help them to thrive? • 1.2 million Canadian youth have a mental illness • < 20% receive the care they need * * Saint John Halifax 6

  7. Age- & culturally appropriate programming Upstream investment Working at the edges of the system healthcare, social services, mental health & addictions PEER 126 (Peers Engaged in Education & Recovery) Horizon Health team lead, Sue Haley-Lajoie 7

  8. How can we prioritize dignified, proactive chronic care and reduce reliance on hospital care? • 12%of Ontarians with COPD account for 1 in 4 ER and hospital visits • 16 million (1 in 2) Canadians have a chronic disease • 49% of adults 65-79 years of age and 59% of adults 80 years and older report having at least two chronic diseases * Gander/ Grand Falls * Halifax 8

  9. INSPIRED COPD model of care >60% fewer ER visits, hospital admissions and days in hospital $900,000 in indirect ‘cost-savings’ Patients at end-of-life had lower LOS & were more prepared (advance care plans) Patient with Capital Health INSPIRED Medical Director, Dr. G. Rocker 9

  10. Communityoutreach pilot with 3 patients complete 9-monthadultambulatoryrespiratory care pathwaydeveloped INSPIRED-like COPD model of care • 60% of care maps/standard patient order sets developed • April 1stset to implement standard care maps & accept ambulatory referrals Central Health team lead, Valerie Pritchett (3rd from left) 10

  11. How can we deliver care that’s truly centred around the person and their family, not their disease(s)? 11 Capital Health team leads, Tara Sampalli and Lynn Edwards

  12. How can we deliver care that’s truly centred around the person and their family, not their disease(s)? • 1 in 7 has a high-impact, high-prevalence chronic illness • Self-managementsupportprovided by a trained health professional can ↓ healthcare use and • ↑ health status Prince Edward Island 12

  13. Supporting Realistic Behaviour Change 10community providers developing new skills to help patients 14facilitatorsteaching providers theseskills 4.8, 3.99, 4.76scores (out of 5) for provider changes in attitude, use of new skills and training • Increased confidence in delivering new skills (14-point improvement) Health PEI team lead, Donna MacAusland (3rd from left) 13

  14. “meeting with our academic mentor andimprovement coach has proven invaluable. The amount of knowledge transfer, on the spot decision-making and the ability to get things done…has given us great ability to move things.” 16

  15. Workshop on the Rock June 9-10, 2014 St. John’s, NL Contact: Jennifer Verma, Senior Director, Collaboration for Innovation and Improvement, CFHI T: 613-728-2238 (x.348) C: 613-618-1639 jennifer.verma@cfhi-fcass.ca @CFHI_FCASS 17

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