Integrating AMI Care Across a Healthcare Service System

Safer Healthcare NowNational WebEx

October 19th, 2009Diane Shanks and Leila Lavorato

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Regionalization

• Occurred in 1995• Influenced “systems” approach to care delivery

– Identified gaps– Provided opportunities to address gaps through

collaborative approach and processes

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Program Management

• Regional administrative and quality oversight– Facilitated the standardization of policies, protocols, and

equipment– Facilitated a regional approach to data collection/management

and analysis• Provided clinical expertise• Provided a strong collaborative network of clinical experts to

support a health “system” approach to care

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Multidisciplinary Committee

• Membership included key departments/services/individuals influencing care delivery to the AMI patient population

• Representation from across the continuum from pre-admission to community care

• Regional representation

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Strategies

• Clinical Pathway• Standardized physician order sets/forms• Staff education and training• Indicator collection and analysis

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Performance/Quality Indicators

• Challenges of data collection– Multiple sources/care environments/sites– Resource limitations– Timeliness

• Variety of indicators required– Utilization– Quality– Performance

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Approach and Heart Alert

• Electronic databases for the collection of clinical data of acute coronary syndrome patients admitted to a healthcare facility for coronary care and procedures

• Established in Alberta, but has expanded across Canada

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Approach and Heart Alert

• Provided the opportunity:

to capture data in one system

to contribute to Provincial/National database

to improve the continuity and timely exchange of vital patient information between referral regions

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Implementation

• Developed processes for data collection and entry in a timely manner

• Implemented region wide• Implemented within current resources• Developed (with the support of Approach resources)

administrative reports for our own organizational purposes

Implemented October 1, 2007

BUILDING HEALTHY LIFESTYLES CARDIAC REHAB PROGRAM

Our Patient’s Journey

Presented October 19, 2009Leila Lavorato

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• Referral

– Automatic - ACS pathway

– Health Care provider

– Self / Family

• Initial Intervention

– Inpatient visit / introduction

– Education Package

– Intervention screening

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• Education Series– Heart CHEC

• “What Now?”• “What Next?”

– BHL Class Calendar – free, no referral needed• Generic• Disease specific topics

• Assessment– Program Nurse– Coaching model / Motivational interviewing– Set SMART goals / Develop action plans– Consult programs / services

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• Exercise testing/screening

– BHL program referral / Pre Requisite / Physician approval

– Pre Testing / Screening

• 6 Minute Walk Test

• Timed Up and Go

• Body Composition

– Establish Exercise Level I, II, III

– Identify activity tolerance / physical limitations

– Determine Site or Home based

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• Exercise programming

– COMMUNITY SITE • Emergency procedures • Levels I, II, III• Mixed groups• Led by RN, RT, EP• 2 / week for 3 months + home exercise• Structured, monitored moving to self managed activity• Aerobic, Muscle Strength, Stretching exercises

- HOME BASED • Fit and Functional Class / Lifestyle Journal• Regular check- ins• Same follow up and testing

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• Follow up – 3, 6, 12 months– Exercise Testing– Cardiac Rehab specific Group Visit

FOR MORE INFORMATION

BUILDING HEALTHY LIFESTYLES CARDIAC REHAB PROGRAM CALL TOLL FREE 1 866 506 6654 or direct 1 403 388 6329

BUILDING HEALTHY LIFESTYLESPROGRAM MODEL

Patient/Family Health Care Provider Physician

Building Healthy LifestylesReferral to home base - NAVIGATED

Secondary / Tertiary PreventionPrimary Prevention

Disease Specific Programs - Assessments – Education - Management

Building HealthyLifestyle

Group Classes

DISEASESPECIFICPROGRAM

OUTCOMES

THERAPEUTIC EXERCISE REFERRAL

PRE REQUISITION COMPLETIONPHYSICIAN APPROVAL

EXERCISE TESTING

FIT & FUNCTIONAL

HOME EXERCISE Levels I, II or III - Endurance - Muscle Strength - Flexibility

Level I

Level II

Level III

- Incident Report

- Progress Report

3 month POST PROGRAM OUTCOMES

COMMUNITY/HOME6 Month & 12 MonthTesting & Follow Up

Diabetes

Heart FunctionClinic / Network

Clinical Nutrition

Acute CoronarySyndrome - Cardiac

ChronicRespiratory

Risk Factor MxWeight Loss