Building the Will to Make Change

1. Building the Will to Make Change Provincial Hip & Knee Arthroplasty Collaborative Learning Session Dr Heather Manson October 3, 2006

2. Vancouver Coastal Health Vision We are committed to supportinghealthy lives in healthy communitieswith our partners through care, education and research Dr. Heather Manson, Oct. 3, 2003

3. Our Starting Point • PEOPLE-CENTERED APPROACH • We are committed to building a person-centered continuum of care, to improve health outcomes for the people we serve. • We will: • Increase quality of life & longevity • Improve the “patient experience” • Promote informed choice, involvement and increased self-managed care Dr. Heather Manson, Oct. 3, 2003

4. Our Strategy:Building the Continuum of Care Acute Network Primary Health Care Network Community Care Network Mental Health & Addictions Health Outcomes Seniors Aboriginal Peoples Needs People with End of Life Needs People with High Prevalence Conditions- cardiovascular, diabetes, renal, cancer, and respiratory Well Population/ Children and Youth People Living with Disability Other groups - TBD Healthy Communities Dr. Heather Manson, Oct. 3, 2003

5. Our Strategy:Building the Continuum of Care Acute Network Primary Health Care Network Community Care Network Mental Health & Addictions Health Outcomes BC residents with arthritis 280,048 (2004/05) Seniors Aboriginal Peoples Needs People with End of Life Needs People with High Prevalence Conditions- cardiovascular, diabetes, renal, cancer, and respiratory Well Population/ Children and Youth People Living with Disability Other groups - TBD Healthy Communities Dr. Heather Manson, Oct. 3, 2003

6. “Continuums Approach” • Understanding the burden of illness • Identifying desired health outcomes • Mapping care needs across continuum • Service delivery model across continuum • Identifying opportunities improvement • Priorities for change Dr. Heather Manson, Oct. 3, 2003

7. Burden of Illness - BC Standardized Osteoarthritis Incidence and Prevalence Rates Dr. Heather Manson, Oct. 3, 2003

8. Burden of Illness - BC Residents Incident and Prevalent Osteoarthritis Cases Dr. Heather Manson, Oct. 3, 2003

9. Vancouver Coastal Residents Incident and Prevalent Osteoarthritis Cases Dr. Heather Manson, Oct. 3, 2003

10. Vancouver Coastal Residents Hip and Knee Arthroplasty Cases 1106 arthroplasties for 54,485 VCH residents (FY 2005) with OA = 2.0% Dr. Heather Manson, Oct. 3, 2003

11. Identifying Desired Health Outcomes • Inputs – Expert opinion • Patients and family members • Physicians, researchers, advocacy groups • Outputs - Desired Health outcomes • “Living well” – Arthritis Society • “Keep People moving” – BJD • Specific goal: 25% reduction of expected increase in joint destruction in joint diseases • “Decrease pain, improve function, stay productive, and lower health care costs.” - CDC Dr. Heather Manson, Oct. 3, 2003

12. Mapping Care Needs: Life-Course approach • Children & Youth – Healthy development • Healthy diet and exercise • Adult – Health maintenance • Adult & Older Adult – “Living well” • Early • Moderate • Severe disease Dr. Heather Manson, Oct. 3, 2003

13. Mapping Care Needs “Living well” with Arthritis • Physical activity • Physical activity as a way to manage arthritis pain, increase function and prevent further disability. • Self - management education • Understanding pain, appropriate exercise, appropriate use of medications, managing daily activities, communicating effectively with family, friends, and health professionals, nutrition, and, how to evaluate new treatments etc. • Team - based care • Family physician as part of a care team • Surgery • To relieve pain and restore function Dr. Heather Manson, Oct. 3, 2003

14. Building the Surgical Continuum of Care Self-management Self-management Primary Health Care Network Acute Network Community Care Network Health Outcomes People with High Prevalence Conditions- Arthritis Optimization of medical care by FP and team Needs Optimization of medical care by FP and team Optimization of surgical care Rehab and reintegration back into the community Screening for surgical appropriateness Post-op care and rehab Preparation for surgery Gap analysis Healthy Communities Dr. Heather Manson, Oct. 3, 2003

15. Building the Surgical Continuum of Care Exercise and strength training <$5000/QALY Self-management Primary Health Care Network Acute Network Community Care Network Health Outcomes People with High Prevalence Conditions- Arthritis Optimization of medical care by FP and team Needs Optimization of medical care by FP and team Optimization of surgical care $7500/QALY Hip $10000/QALY Knee Rehab and reintegration back into the community Screening for surgical appropriateness Post-op care and rehab Preparation for surgery Gap analysis Healthy Communities Dr. Heather Manson, Oct. 3, 2003

16. Improving the way we deliver care:Priority strategies in two categories Factors • Priority Strategies #1 • Clinical Process Improvement • Important improvements and enhancement to service delivery • Implemented at the operations level • Require minimal to moderate resources and time to make the changes • These “quick win” improvements are essential to improving health outcomes in the populations • Small focused implementation teams working with the respective operations/stakeholders can effect substantive change • Some of these are already underway Strategies to improve outcomes • Priority Strategies #2 • System Redesign Strategies • Fundamental service delivery and structural changes • Require broad based support and major funding or redeployment of resources • Networks and various stakeholders must be heavily engaged in agreeing, designing and implementing these redesign and transformational changes ...priorities must be identified and some gaps exist Dr. Heather Manson, Oct. 3, 2003

17. Process Improvement Strategies:BC Arthroplasty Collaborative Provincial Arthroplasty Collaborative • Develop provincial ‘standards of care’ to ensure best practice and a seamless continuum for stroke patients • Improve patient information about their condition, treatment & what to expect through all phases of care • Improve emotional and “non-clinical” support during the acute phase of treatment • Improve transitions across the continuum and prepare patient and care-giver for re-integrationand self-management into the community • Increase patient and caregivers involvement &choice in planning and care process Dr. Heather Manson, Oct. 3, 2003

18. System Redesign Strategies – OASIS+ • Enhance Prevention • Working with partners to promote joint health • Optimize self management • Optimize chronic health management • FP and care team • Optimize surgical management • Develop & resource specialized assessment clinics (OASIS) • Specialized surgical centers? • Integrated rehab response • Leadership and partnerships for improving outcomes Dr. Heather Manson, Oct. 3, 2003

19. “Living Well” with Arthritis: Overall Status • Many recommendations to enhance care • Derived from key projects and initiatives • Focused implementation now required • Clinical process improvement • Provincial Arhroplasty Collaborative already creating momentum • Systems redesign strategies e.g. OASIS • Prioritization process and focused implementation required • Leverage & connect with other key initiatives • MoH Service framework development Dr. Heather Manson, Oct. 3, 2003

20. Hopes for Today • Accelerate work underway to improve outcomes for people with arthritis • Build on excellence from across BC • Leverage provincial cooperation and coordination • Move to action! Dr. Heather Manson, Oct. 3, 2003