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Developing a system Developing a system of careof care
Robert D. ReidRobert D. Reid
University of Ottawa Heart University of Ottawa Heart InstituteInstitute
[email protected]@ottawaheart.ca
A brief history…A brief history…
No. of Participants
0586 482 333 315 324 235 576 604 595 602 835
1600
6000
0
1000
2000
3000
4000
5000
6000
7000
'92 '93 '94 '95 '96 '97 '98 '99 '00 '01 '02 '03 '04 '05
Year
“Tickers”
Open OP ClinicAdd: 0.5 FTE
nurseIP program
New leader, 1.0 FTE nurse
Institutional approach
Regional network
What changed to allow What changed to allow for dramatic growth in for dramatic growth in
capacity?capacity?
Success comes from…Success comes from…
doing doing ordinaryordinary things things extraordinarilyextraordinarily well…well…
in a in a systematicsystematic way… way… at the at the right timeright time…… using using effectiveeffective interventions… interventions… with measured with measured outcomesoutcomes…… within a within a networknetwork of care… of care… and a and a cultureculture of prevention. of prevention.
InterventionIntervention Lives SavedLives Saved NNTNNT
Smoking CessationSmoking Cessation 328,400328,400 9 9
Lipid LoweringLipid Lowering 132,777132,777 34 34
BP ControlBP Control 63,282 63,282 31 31
ACE Inhibitors (CHF)ACE Inhibitors (CHF) 11,000 11,000 N/AN/A
ß Blockers (MI)ß Blockers (MI) 17,023 17,023 120120
ASA (MI)ASA (MI) 10,365 10,365 143143
Coumadin (A.Fib)Coumadin (A.Fib) 3,418 3,418 2,014 2,014
Projected Outcomes of Preventive Projected Outcomes of Preventive InterventionsInterventions
Doing ordinary things, Doing ordinary things, extraordinarily well…extraordinarily well…
IMPACT =IMPACT =
REACH *REACH *
EFFECTIVENESSEFFECTIVENESS
The Untapped National Potential
• 2,770,128 inpatient hospitalizations in Canada (02/03)
If 20% hospitalized pts. smokers
= 550,000 patients
““I rob banks because that’s I rob banks because that’s where the money is”where the money is”
Willie Sutton
In a systematic way…In a systematic way…
Documentation of smoking status of Documentation of smoking status of everyevery patient admitted to University patient admitted to University of Ottawa Heart Instituteof Ottawa Heart Institute
Intervention for Intervention for everyevery smoker smoker
The University of Ottawa The University of Ottawa Heart Institute In-Patient Heart Institute In-Patient
Smoking Cessation Smoking Cessation ProgramProgram
> 6500 admissions/year> 6500 admissions/year >1300 smokers identified (20%)>1300 smokers identified (20%) Cessation counseling provided to 90%Cessation counseling provided to 90% An absolute increase of 15% in long An absolute increase of 15% in long
term cessation ratesterm cessation rates 195 new quitters195 new quitters
Prev Med 2003; 36(6):710-20
At the right timeAt the right time
Readiness to change
59
33
810
30
60
0
10
20
30
40
50
60
70
PC C P
Stage of change
Per
cen
t o
f sa
mp
le
Population sample
Cardiac-In-hospital
Using effective Using effective interventions…interventions…
Brief or intensive counseling Brief or intensive counseling PharmacotherapyPharmacotherapy Self-help materialsSelf-help materials Follow-up contactsFollow-up contacts
Interactive voice response (IVR) Interactive voice response (IVR) technologytechnology
Linked to community Linked to community resources/programsresources/programs
AskAsk
AdviseAdvise
AssessAssess
AssistAssist
ArrangeArrange
““A health professional’s advice to stop smoking increases A health professional’s advice to stop smoking increases the rate of the rate of smokingsmoking cessation by approximately 30 percent.” cessation by approximately 30 percent.”
The Power of a Brief The Power of a Brief InterventionIntervention
Within a network of Within a network of care…care…
Hospitals
1o CareProviders
CommunityAgencies
Public Health
With measured With measured outcomes…outcomes…
To demonstrate value for moneyTo demonstrate value for money To provide feedback and motivationTo provide feedback and motivation To fine-tune your programTo fine-tune your program To benchmarkTo benchmark
…and great stories that bring your program to life
A Culture of PreventionA Culture of Prevention
Smoking CessationSmoking Cessation
… … single most powerful single most powerful preventionprevention
Intervention in clinical practiceIntervention in clinical practice
Social influencesSocial influences
ChampionsChampions Culture of preventionCulture of prevention Feedback on performanceFeedback on performance
Policy influencesPolicy influences
Smoking cessation as a quality indicatorSmoking cessation as a quality indicator Inclusion on care mapsInclusion on care maps Standard ordersStandard orders Allocation of human resourcesAllocation of human resources
Organizational Organizational influencesinfluences
Documentation of smoking status (a vital Documentation of smoking status (a vital sign)sign)
Staff trainingStaff training Availability of self-help materialsAvailability of self-help materials Availability of pharmacotherapyAvailability of pharmacotherapy Follow-upFollow-up Data trackingData tracking Links to community resourcesLinks to community resources
Provincial quit lineProvincial quit line Referral to tobacco cessation specialistsReferral to tobacco cessation specialists
ChecklistChecklist
PolicyPolicy Quality indicator?Quality indicator? Care map(s)?Care map(s)? Standard orders?Standard orders? Designated Designated
people?people?OrganizationOrganization Documentation?Documentation? Training?Training?
Self-help materials?Self-help materials? Pharmacotherapy?Pharmacotherapy? Follow-up?Follow-up? Data management?Data management? Links?Links?SocialSocial Champion?Champion? Culture of Culture of
prevention?prevention? Feedback?Feedback?
Success comes from…Success comes from…
doing doing ordinaryordinary things things extraordinarilyextraordinarily well…well…
in a in a systematicsystematic way… way… at the at the right timeright time…… using using effectiveeffective interventions… interventions… with measured with measured outcomesoutcomes…… within a within a networknetwork of care… of care… and a and a cultureculture of prevention. of prevention.