Rehabilitative Care Alliancerehabcarealliance.ca/uploads/File/Mandate_II_Presentations/... · 8 Priority Area of Focus RCA Solution Definitions •Development of common terminology,

Rehabilitative Care Alliance Provincial Stakeholder Webinar

December 11, 2015

Overview of Webinar

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The teleconference is being recorded for posting with the slides to the RCA website.

Please enter your questions into the chat function in the webinar

We will attempt to answer as many questions as possible, time permitting

All questions entered into the chat function will be used to inform a follow up Q&A document

www.rehabcarealliance.ca

Presenters

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Dr. Peter Nord – Co-Chair, RCA

Charissa Levy, Executive Director

Sue Balogh, Project Manager

Emmi Perkins, Project Manager

Mark Unwin, Project Coordinator


Meeting Objectives

Provide an Overview of the Development/Structure of the Rehabilitative Care Alliance

Provide an Overview of Mandate I Deliverables

Describe the Progress of Mandate II Initiatives

4 www.rehabcarealliance.ca

Development/Structure of the Rehabilitative Care Alliance

The Rehabilitative Care Alliance (RCA) is a provincial collaborative that was established by Ontario’s 14 LHINs in April 2013 with a two-year mandate to effect positive changes in rehabilitative care that focus on supporting

improved patient experiences and clinical outcomes and enhancing the adoption and effectiveness of clinical and

fiscal priorities.


Alignment With Other System Priorities

Identification of RCA priorities is informed by

evidence and data, as available, and by extensive

provincial stakeholder engagement and input into

the final deliverables.

The work of the RCA aligns with and builds upon

Ministry of Health and Long-Term Care priorities

and directions and other province-wide initiatives.


First Mandate Deliverables

The RCA’s first mandate was from April 2013 - March 2015

Leadership of the RCA Secretariat brought together

representatives from all LHINs, MOHLTC, HSPs from

hospital and community sectors, patients and caregivers.

Full & summary reports provide an overview of the

recommendations and tools developed for LHINs and

HSPs based on the RCA’s five priority areas of focus.

http://www.rehabcarealliance.ca/news?news_id=94




Overview of RCA Mandate I

www.rehabcarealliance.ca 8

Priority Area of Focus RCA Solution

Definitions

•Development of common terminology, clear definitions, patient characteristics and resources across all levels of rehabilitative care

•Provides clarity for patients, families and referring professionals and the structure to establish a baseline assessment of current services and inform gap analysis.

• Definitions Framework for Bedded Levels of Rehabilitative Care

• Definitions Framework for Community Based Levels of Rehabilitative Care

• Referral Decision Tree for Rehabilitative Care

Capacity Planning and System Evaluation

• Support monitoring and evaluation of rehabilitative care services, programs and system performance through development of a standard rehabilitative care capacity planning and evaluation toolkit.

• Rehabilitative Care Capacity Planning Framework

• Rehabilitative Care System Evaluation Framework



Frail Senior / Medically

Complex

Develop a rehabilitative care approach for frail senior/medically complex populations to support operationalization of priority elements of the "Assess and Restore Framework to Support Aging in Place."

• Standardized ‘Direct Admission Priority Process’ (DAPP) to Bedded Levels of Rehabilitative Care from Community/ED

• DAPP Toolkit • Assessment Urgency Algorithm as

Standardized Provincial Screening Tool • Process and Outcome Indicators • Compendium of Rehabilitative Care

Best Practices

Overview of RCA Mandate I (cont’d)

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1Living Longer, Living well. Highlights and Key Recommendations from the Report Submitted to the Minister of Health and Long-Term Care and the Minister Responsible for Seniors on recommendations to inform a Seniors Strategy for Ontario

(December, 2012)

Assess and Restore Framework to Support Aging in Place1




Outpatient / Ambulatory

Inform evaluation/ planning at the provincial, regional, organizational & program levels through development of a comprehensive and standardized MDS for OP/AMB rehabilitation.

• OP/AMB Evaluative Framework • Rehabilitative Care Minimum Data

Set (MDS) • Comprehensive Review of Existing

Functional Outcome Measures • Preliminary Measure of Patient

Experience • Outpatient/Ambulatory MDS

Implementation Toolkit

Planning Considerations

for Re-Classification of CCC/Rehab Beds

Identify current issues related to the reclassification of CCC to inpatient rehabilitation beds across the province.

Comprehensive toolkit that outlines considerations in a systemic and standardized manner to support the process of completing due diligence if a potential need to re-classify beds is identified.

Overview of RCA Mandate I (cont’d)

Second Mandate Goals/Objectives

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A briefing note describing the RCA’s first mandate deliverables and a proposed second mandate work plan was submitted to and approved/endorsed by the LHIN CEOs in February, 2015.

This approval/endorsement positions the RCA’s first mandate deliverables for full provincial implementation by LHINs by March 2017.

RCA playing a coordinating/supporting role as LHINs implement the deliverables.


LHIN CEOs MOHLTC

Rehabilitative Care Alliance Steering Committee

Co-Chairs – Donna Cripps and Peter Nord

ENABLERS

GTA Rehab Network Secretariat Support (Communication, Stakeholder Engagement, Coordination/Administration, Decision Support etc.)

Accountable to LHIN CEOs through

Alliance Co-Chairs

GTA Rehab Network

Secretariat

Contextual/Influencing Initiatives (Assess & Restore, Health System Funding Reform, Integrated

Funding Pilots, Coordinated Access, etc.)

QBP TJR Task & Advisory

Groups

Debra Carson Trillium Health

Partners

QBP Hip Fracture Task & Advisory

Groups

Roy Butler St. Joseph’s Health Care,

London

Outpatient / Ambulatory Task

& Advisory Groups

Marie Disotto-Monastero, Sunnybrook

Michael Gekas, Sinai Health System

Chris Sulway, TC LHIN

Definitions & CP Task & Advisory Groups

Dale Clement WW CCAC

Mark Edmonds CW LHIN

LHIN & HSP

Leads Advisory

Group

Mark Edmonds, CW LHIN & Andrea Lee,

Health Sciences North

FS/MC / A&R Task & Advisory

Groups

Dr. Jo-Anne Clarke,

North East SGS Carol Halt,

NE LHIN

Patient/Caregiver Advisory Group

Charissa Levy, RCA Executive Director

System Eval Task &

Advisory Groups

Imtiaz Daniel, OHA

Michelle Collins,

MH LHIN & Marilee Suter,

CE LHIN

Mandate II Governance

Second Mandate Goals/ Objectives

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5 Key Priority Initiatives in Mandate II

• Definitions & Capacity Planning

• Outpatient/Ambulatory

• System Evaluation

• Assess & Restore/Frail Senior Medically Complex

• QBP – Total Joint and Hip Fracture


Definitions & Capacity Planning

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RCA Definitions Framework

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The overall intent of developing the Definitions Frameworks is to:

Establish provincial standards for levels of rehabilitative care across the continuum

Provide consistency and clarity for patients, families & referring professionals on the focus & clinical components of rehabilitative care programs

Provide a foundation to support system and local capacity planning through a common understanding of rehabilitative care services

Definition Frameworks for Rehabilitative Care Support …

services provided in the community.


A S

har

ed U

nd

erst

and

ing

o

f

Restorative potential and who is eligible for rehabilitative care

The levels of rehabilitative care (both bedded and community-based) and for each level of care, the:

• Goals of care • Characteristics of patients/clients who would be served

within each level (including estimated average length of stay and discharge indicators)

• Medical and healthcare professional resources and intensity of therapy that would be available within each level of rehabilitative care*

*As the framework is not population-specific, the specialized tertiary services provided by some Health Service Provider organizations are beyond the resource thresholds outlined within the framework.


DEFINITIONS FRAMEWORK FOR BEDDED LEVELS OF REHABILITATIVE CARE

Bedded Levels of Rehabilitative Care (i.e. Hospital-based designated inpatient rehab beds and complex continuing care beds as well as convalescent care/restorative care beds within LTCH)

Rehabilitation

(Low to high

intensity)

Activation/ Restoration

Short Term

Complex Medical

Management

Long Term Complex Medical

Management

Functional Trajectory Progression Progression Stabilization &

Progression Maintenance

Level of Care - Goal

Pa

tien

t

Ch

ara

cter

isti

cs Target Population

Functional

Characteristics

Estimated Average LOS

Discharge Indicator

Med

ica

l/A

llied

Hea

lth

Res

ou

rces

Medical Care

Nursing Care

Therapy Care

Intensity of Therapy

Reporting Tools

RCA Definitions Framework for Bedded Levels of Rehabilitative Care Available at http://rehabcarealliance.ca/definitions-1

http://rehabcarealliance.ca/definitions-1





RCA Definitions Framework for Community-Based Levels of Rehabilitative Care

(Available at http://rehabcarealliance.ca/definitions-1)






Deliverables of the Second Mandate


1. LHIN implementation* of the RCA Definitions Frameworks for Bedded & Community-Based Levels of Rehabilitative Care including:

LHIN-level adoption of new terminology, eligibility criteria and re-categorization of rehabilitative care resources according to the levels of rehabilitative care in the Definitions Frameworks

Identification of any challenges/barriers in achieving full alignment with the Definitions Frameworks by March 2017.

Development of an implementation plan* where full re-alignment has not been achieved by the end of this mandate.

* with support as required from the RCA www.rehabcarealliance.ca 20


Definitions & Capacity Planning 2. LHIN application of the RCA Capacity Planning Framework. It is recognized that LHINs may have different local needs/priorities and may be at different stages of rehabilitation capacity planning. As such, LHIN application of the RCA Capacity Planning Framework is expected to vary relative to each LHIN’s readiness to undertake a capacity planning exercise. RCA project management support will be provided accordingly.


RCA Capacity Planning Framework


Questions To Be

Answered by Capacity

Planning Process

Potential Measures/Considerations

Acute

Care

Bedded

Rehabilitative

Care

Community/

Ambulatory

Long Term

Complex

Medical Mgt

& LTC

Cu

rre

nt

Stat

e Population

Resources

Utilization

Access

Effectiveness

Complete Evaluation of Current State

Futu

re S

tate

Population

Resources

Utilization

Access

Effectiveness

Redesign

Work to date


Currently supporting LHINs as they work with health service providers to map existing community and bedded rehabilitative care programs relative to the Definitions Frameworks. Completion of the mapping tools is due to the RCA by Dec 21, 2015.

A Definitions & Capacity Planning Communications Toolkit was developed & disseminated to support LHINs in their communications to local stakeholders throughout the implementation of the RCA Definitions Frameworks.

The Secretariat has been providing support on the mapping exercise to the LHINs and HSPs through multiple group teleconferences (10 LHINs) as well as one-on-one support to individual HSPs and consultants involved with completing the mapping survey.


Next Steps


Provincial and LHIN-level analysis of the completed mapping

surveys to identify current state alignment with the

Definitions Frameworks for Rehabilitative Care.

Identify and use a LHIN Decision Support strategy to pull

select common data elements from the RCA’s Capacity

Planning Framework to support the LHINs’ regional

rehabilitative care capacity planning efforts. Other data

elements will be obtained from other sources including

OACCAC, MOHLTC, Access to Care.


Outpatient/Ambulatory Initiative

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Outpatient/Ambulatory

Mandate II Deliverables

Provide leadership and direction to support a provincial pilot of the OP/AMB MDS and a reporting system

Report on results of provincial pilot including recommendations for a potential data collection system and high level implementation plan for provincial operationalization of the Minimum Dataset

Identify a patient classification system for the outpatient /ambulatory rehabilitative care setting.

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Identify and pilot measure(s) of functional change (PROM) for the outpatient/ambulatory rehabilitative care setting

Develop and pilot measure(s) of patient experience (PREM) for the outpatient/ambulatory rehabilitative care setting

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Work to Date


Proof of Concept (PoC), using NACRS Clinic Lite, approved by the MOHLTC in July, 2015

In collaboration with CIHI, RCA led the development of the core data elements and rehab patient classification codes within NACRS Clinic Lite

Currently working with potential pilot sites to support participation in the provincial PoC


Work to Date


A patient experience measure (PREM) for the OP/AMB rehabilitative care setting has been developed by Drs. J. McMurray and P. Stolee and will be piloted as part of the PoC

A measure of ‘Functional Impact’ (PROM and clinician measured) is being finalized

PoC to start in January 2016 with staggered entry as sites are ready to start


Work to Date


The NACRS Lite data collection system will capture the ‘Access & Transition’ and ‘Financial Performance’ quadrants of the RCA MDS.

The ‘Patient Experience’ and ‘Functional Impact’ quadrants will be collected manually.


System Evaluation

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Recent Progress

System Evaluation THINK TANK II

Subject-matter experts were invited to a ‘Think Tank’ meeting in September 2015 to develop a recommendation to the RCA System Evaluation Task Group regarding a methodology to be used to identify targets and benchmarks for indicators within the Rehabilitative Care System Evaluation Framework.


Think Tank II Recommendations to the System Evaluation Task Group

Recommendations:

1. Identify a 1-3 key indicators from within the RCA Rehabilitative Care System Evaluation framework for benchmarking that are a priority from a QI and data availability perspective

2. Identify a benchmarking methodology to be used for each priority indicator

NOTE: For all others report current performance, previous year performance, provincial median +/- average, top performers (TBD) and/or range to support regions to understand their own performance relative to peers.

3. Develop definitions for 1-3 key undefined indicators from within the RCA Rehabilitative Care System Evaluation framework

4. Develop reporting template and collect data

5. Report data to stakeholders (Fall 2016) www.rehabcarealliance.ca 33

Recent Progress

System Evaluation The Task Group completed an evaluation of the indicators

from within the RCA Rehabilitative Care System Evaluation Framework using the HSII Indicator Validation Tool via the ‘Expert Choice Tool’ with support CE LHIN

Weighted criteria were used: o Strategic Alignment: 40%

o Reliability: 15%

o Actionable (Attribution): 15%

o Timeliness: 15%

o Clarity/Understandability: 15%


Results of Prioritization Exercise

System Evaluation

Results of the prioritization exercise were recently shared with Task Group members. Five indicators were selected by the group for further exploration.

The RCA Patient Family Advisory Group was also consulted to inform top priority indicators from a patient/caregiver perspective.


Next Steps

System Evaluation

For short-listed priority indicators, benchmarking methodology will be established and data will be collected to support benchmark setting.

The group will complete a similar prioritization exercise to support identification of the undefined indicators from the RCA framework that should be prioritized to be defined.


Assess & Restore/Frail Senior Medically Complex

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Assess & Restore / Frail Senior Medically Complex


1. Implementation and evaluation of the standardized tools and indicators developed from the RCA’s first mandate that support the RCA’s ‘Direct Access Priority Process’ to access rehabilitative care from the community as piloted by LHINs with their A&R funding.

2. Revisions (as required) to the standardized tools and indicators developed from the RCA’s first mandate that support the RCA’s ‘Direct Access Priority Process’ to access rehabilitative care from the community as informed by the evaluations/findings from the LHIN funded A&R initiatives




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3. Continue to Support LHINs and the MOHLTC with Assess & Restore Related Initiatives:

Work with LHIN leads and Ministry to oversee implementation and support cross-LHIN coordination of Assess and Restore project objectives and learnings.

Facilitate knowledge exchange across LHINs, e.g., facilitation of forums/webinars/teleconferences with LHINs and relevant HSPs



Assess & Restore/Frail Senior Medically Complex Mandate II Deliverables

4. Summary analysis of the system impact of Assess and Restore funding and the RCA’s ‘Direct Access Priority Process’ (DAPP)

5. Development of an annual report describing:

Progress of coordinated LHIN efforts to implement the Assess and Restore Guideline

On-going evaluation of LHIN A&R funded initiatives and the RCA’s ‘Direct Access Priority Process’

Completed knowledge exchange events in support of A&R funded initiatives

Summary and analysis of progress across system and project indicators and lessons learned/successes across LHINs


Additional Task Group Directions


Promotion/education of a ‘Cross Continuum A&R Pathway’ that clarifies the 5 Essential Elements of A&R, the existing tools to support each element and alignment of these elements and tools with other system initiatives.


Provincial Webinar(s) Frailty e-modules – “5 Essential Elements of Assess and Restore”

Assess & Restore 5 Essential Elements Pathway (DRAFT)


1. Screening

• Clinical Judgment

• AUA • AUA Provincial

Implementation Toolkit (WWLHIN)

2. Assessment

• RCA Compendium

• RGP Definition of a CGA

• RGP CGA Core Elements & Competencies (CE/NE LHINs)

• QoL Measure(s)

3. Navigation & Placement

To Bedded & Community Levels of Rehabilitative Care

5. Transition To Home/

Community-Based Program(s)

4. Intervention

• RCA Compendium

• Emerging Practice

• BPGs • SFH Strategies • 2014/15 Assess

& Restore Initiatives Summary

•RCA Definitions Frameworks •RCA Referral Decision Tree •AUA Referral Pathways •RCA Rehab/A&R Definitions Cross-Walk

• RCA Definitions Frameworks

• RCA Referral Decision Tree

• HQO Adopting a Common Approach to Transitional Care Planning

• RCA Transition Checklist

Esse

nti

al E

lem

ents

o

f A

sses

s &

Res

tore

To

ols

an

d B

est/

Emer

gin

g P

ract

ices

Pro

mo

tio

nal

O

pp

ort

un

itie

s

Additional Task Group Directions


Identify the elements of and develop a tool to support “successful transitions” within the rehabilitative care system, as informed by: o Adopting a Common Approach to Transitional Care Planning

(HQO)

o RCA Hip Fracture QBP Transition Checklist

o Research literature & other information as available that describes the unique transitional care needs of frail seniors


Identification and Evaluation of

Existing Quality of Life Measure(s)


MOHLTC Evaluation of Assess & Restore Funded Initiatives


1. Ministry Mandatory Indicators

a) Mandatory System Indicator(s)

% of unplanned readmission to hospital within 30 days of discharge from hospital

% of unplanned, less-urgent ED visit within 30 days of discharge from hospital

% of primary care follow-up visit within 7 days of discharge from hospital

% of LTC placements where home care client could have stayed home/elsewhere in the

community

Annual ALC rate by: post-acute inpatient rehabilitative care services

discharge destination from acute care

a) Mandatory Output Indicator(s)

Number of incremental attendances/visits provided as a result of this funding, & Quality of Life (QoL) measure pre-post intervention

Number of frail seniors served as a result of this funding, & Quality of Life (QoL) measure pre-post intervention

Number of clinicians trained during this funding period

Quality Based Procedures Total Joint Replacement and Hip

Fracture

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Quality-Based Procedure Initiatives

Health Quality Ontario has developed Clinical Handbooks for a number of conditions “to serve as a compendium of the evidence-based rationale and clinical consensus driving the development of the policy framework and implementation approach for patients with specific conditions seen in hospitals1.”

While the TJR and Hip Fracture handbooks may include recommendations for rehabilitation, the extent to which these handbooks provide detailed information on rehabilitative care best practices post surgery is limited and requires further development.


1Health Quality Ontario; Ministry of Health and Long-Term Care. Quality-based procedures: Clinical handbook for primary hip and knee replacement. Toronto: Health Quality Ontario; 2014 February. 95 p.

Hip Fracture & TJR QBP

Quality-Based Procedure Initiatives Mandate II Deliverables

1. Standardized rehabilitative care best practices for Hip Fracture & TJR

2. Standardized rehabilitative models of care (including identification of optimal locations, transitions and processes of care) across bedded and community-based levels of rehabilitative care for the Hip Fracture population

3. Identification of recommendations regarding indicators to support performance monitoring of QBP-related outcomes and system performance for inclusion in the RCA Rehabilitative Care System Evaluative Framework


Determining Appropriate Rehabilitative Care Destination


During the RCA’s first mandate, the “Definitions” working group developed the “RCA Decision Referral Tree” to help guide decisions on the most appropriate location for rehabilitative care for all patient populations.

The TJR and Hip Fracture Task Groups endorsed using the RCA’s Decision Referral Tree for hip fracture patients as a starting point for a model of care (second deliverable) while supporting alignment with provincial direction for rehabilitative care.

http://rehabcarealliance.ca/uploads/File/Toolbox/Definitions/Referral_Decision_Tree_for_Rehabilitative_Care_FINAL__Dec_11_2014_.pdf


Best Practice Framework


To support the first deliverable, a ‘Rehabilitative Care Best Practices Framework’ framework has been created.

The framework is based on existing pathways that identify best practice recommendations specific to the rehabilitative care location (Bedded Levels of Rehabilitation, Community-Based Rehabilitation, In-Home Rehabilitation, Long-Term Care).

The processes of care categories are based on the categories identified in the existing pathways.

Rehab Best Practice Framework for Hip Fracture Patients


Rehab Best Practice Framework for TJR Patients


Rehabilitative Care Best Practices for Primary Hip and Knee Replacement Patients

Processes of Care Pre-Operative Care Bedded Levels of

Rehabilitative Care

Community-Based

Rehabilitative Care

In-home

Rehabilitative Care

Screening

Assessments

Treatment/Interventions

• Individual & Group

Exercise Interventions

• Functional Training (e.g.

ADLs & Mobility)

Client & Family Education

Pain

Transition Care Planning

Clinical Outcome Measures


Next Steps


Nov –Dec: Identify standardized rehabilitative care best practices for Hip Fracture Patients across community levels of rehabilitative care.

Jan – Feb: Identify standardized rehabilitative care best practices for Hip Fracture Patients across in-Home Rehabilitative Care.

March: Identify standardized rehabilitative care best practices for Hip Fracture Patients across Long-Term Care. For TJR - Identification of process indicators to support performance monitoring of recommended QBP-related process/practices for TJR populations

Questions?

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Please enter your questions into the chat function in the webinar

We will attempt to answer as many questions as possible, time permitting

All questions entered into the chat function will be used to inform a follow up Q&A document

Still have questions? Get in touch with us: [email protected]


mailto:[email protected]

Help Us Keep You Informed

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Consider signing up to receive our quarterly newsletter and other news from the Alliance, to keep updated on:

Announcements of new resources and tools supporting best practice in rehabilitative care

Opportunities to engage in and contribute to RCA projects and initiatives


To sign up, visit http://rehabcarealliance.ca/subscribe You can choose to unsubscribe at any time.

Thank you

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Documents

Rehabilitative Care Alliancerehabcarealliance.ca/uploads/File/Mandate_II_Presentations/... · 8 Priority Area of Focus RCA Solution Definitions •Development of common terminology,