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Strategic Clinical Networks & Clinical Care Pathways: Creating & Managing

Quality in Alberta Health Services

CEO Forum Feb 6, 2013Montreal

Dr Tom Noseworthy

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Alberta Health Services

• One health care delivery system for an entire Province• The ‘third way’ in Canada• Largest health care system in Canada- 3.7 million people• Budget $12B, 100,000 employees, 7500 doctors• Formed in 2008, 5 Zones added in 2010, Networks in 2012• Nine clinical networks launched to date• Up to six more planned• We aspire to being the best in Canada

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How will the Provincial Clinical Mandate of AHS be Accomplished?

• Strategic Clinical Networks• Clinically-led change• Performance measurement, research & best

evidence drive practice• Clinical care pathways• Clinical variance management & peer review

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Goals of Clinical Networks?

• Achieve the best outcomes• Practice the highest quality of clinical care• Seek the greatest value from resources used• Engage clinicians in all aspects of this work

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Why Clinical Networks?

• Networks are positive ways for all partners along a broad continuum to be involved in planning & improving care & service delivery

• Networks have been shown to be an effective mechanism to ensure collaboration, joint decision-making and shared learning

• Networks are a proven model to promote the use/uptake of clinical experience, knowledge and evidence-based clinical pathways to reduce clinical variation & improve care

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What are Strategic Clinical Networks (SCNs)?

• Collaborative clinical teams with a provincial strategic mandate to improve quality & outcomes

• Led by clinicians, driven by clinical needs, focused on outcomes & based on best evidence

• Comprised of an all-inclusive membership, with 25 core members (community & specialty clinicians, patients, policy-makers, researchers) & leadership (0.5 Senior Medical Director, 0.5 Strategy Vice-President & 0.3 Scientific Director)

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How do SCNs Work?

• Broad mandate:– Specific populations: seniors, women's health, children– High impact: cardiovascular disease & stroke– High burden: diabetes, obesity & nutrition, amh

• Scope encompasses entire continuum of care– From population health & prevention to primary care to

acute care to chronic disease management to palliation

• Projects & activities aligned with AH & AHS, priority-setting integrated with & into organizational decision-making

• Resourced & supported to improve clinical outcomes

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Planned Support & Resources for Each SCN

• Dedicated Business Intelligence Unit– Project management, clinical analytics, case costing, quality

improvement, pathway development, patient safety, knowledge management, health technology assessment

• Embedded research capability and expertise• Education & skills development for leaders• Funding including:

– Seed money for innovation, initiatives, and research

– Remuneration of core members

– Opportunities to retain savings that are realized

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First Six SCNs (June 12/12)

• Addiction and Mental Health• Bone and Joint Health• Cancer Care• Cardiovascular Health and Stroke• Obesity, Diabetes and Nutrition• Seniors’ Health

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Next Six SCNs (Fiscal 2013)

• Population Health and Health Promotion• Primary Care & Chronic Disease Management• Maternal Health• Newborn, Child, and Youth Health• Neurological Disease, ENT, and Vision• Complex Medicine (GI, Kidney & Respiratory)

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Operational Clinical Networks

Similar to SCNs

i. Provincial, clinically led teams

ii. Similar infrastructure & resources

Differ from SCNs

i. Responsible across populations

ii. Operationally focused

iii. Social determinants/ EOL agenda not required in projects

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Three Operational Clinical Networks (Jan13)

• Critical Care• Emergency Services• Surgical Services

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Snapshot of all 12 SCN ( & 3 OCN Projects)** 9/15 new projects are ready to initiate by January 31, 2013

Obesity, Diabetes & Nutrition

SCN

Bone & JointSCN

Surgery OCN

Emergency OCN

Addiction & Mental Health

SCN

Cardiovascular Health and Stroke

SCN

Insulin Pump

criteria**

Rural Stroke Program**

Vascular Risk Reduction

C-CHANGE**

Enhancing recovery after

surgery**

ARTE-referral**

Fragility & Stability -

Hip Fracture Rx and

Prevention**

Inappropriate use of

antipsychotics**

Cancer SCN

Critical Care OCN

Seniors’ HealthSCN

Depression Pathway

Safe Surgery Checklist**

aCATS** TBDTBD

Hip & Knee 5 year Plan

Lung Cancer

Elder Friendly Care**

3 avoid risks for AHS

2 Mature Tier 1: in flight

4 with some external funding

1 aligned with IHHP concept 3 Placeholders for SCN/OCN Equity

4 equally high value

1414

17.87

11.71

20.93

13.41

18.23

11.71

0

5

10

15

20

25

South Zone Calgary Zone Central Zone Edmonton Zone North Zone Best Large RHA/Zone (Calgary Zone, AB)

Risk

-Adj

uste

d Ra

te (p

er 1

00)

Source = CIHI CHRP

30-Day In-Hospital Mortality Following Stroke - 2010/11

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Project Scope:•Create standards and clear definition of rural stroke unit care•Implement early supported discharge (ESD) & enhanced stroke unit care in 5 small stroke centres•Implement enhancements to stroke unit care for 10 rural primary stroke centres

System Impact:• Acute care• Transition management

• Long term care

Project Financials:•Q4 (12/13): $ 141,964•13/14: $1,745,950• TOTAL Project: $2,873,594

Benefits to be Realized:Short term – Jan 31/ 13 – Mar 31 /14• ESD implemented in 5 small centres serving100 patients • 26% reduction in length of stay; 3 persons avoid nursing home care; 1 life savedLong term– 1- 3 year window • 214 new patients per year receive ESD and over 1000 new patients per year receiving full stroke unit services; 23 lives saved/year; 17 patients avoid nursing homes after stroke/year•Reduction in length of stay of over 20%

CV&S: Rural Stroke Action Plan