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Dealing with Complexity: The Bridgepoint Health Hospital Experience
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Dealing with Complexity:The Bridgepoint Health Hospital Experience
Renee Lyons, Ph.D.Chair in Complex Chronic Disease Research andScientific Director, Bridgepoint Collaboratory for Research and InnovationProfessor - Dalla Lana School of Public Health, University of TorontoDale Min, Kerry Kuluski and Alexis Schaink
Quality of Care for People with Multiple Chronic Diseases: New Opportunities and Challenges ForumGranada, SpainTuesday, June 1, 2010
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Overview
• Third Frontier (Multi-morbidity, Complex Chronic Disease, and the Deficit Crisis)
• Bridgepoint Health and the Collaboratory
• Research initiatives
• Opportunities for Collaboration
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The Third Frontier: Complex Chronic DiseaseWhat is it?• More than one chronic disease• Complex care (individualized, patient-focused but systematic)• Coordinated, linked up care over time• Data and metrics that reflect complexity• High prevalence of mental health problems• High prevalence of social, economic, and/or cultural issues• High risk for additional health problems and hospitalization• Self management and family support are challenges• Patient flow an issue• Health system re-design needed!
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CCD Intersects with Many Factors
Mental Health
Environment
Quality of Life
Socioeconomic Status
Family
Culture
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In Contrast to the Health System Focus• Acute care – designed for short-term episodic care• Reactive models• Treat and street• Ineffective for prevention and treatment• Patient and family experience usually unsatisfactory• Inadequate attention to prevention (tipping points)
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Global Burden of Chronic Disease
• The main cause of death and disability worldwide – 60% of all deaths (Abegunde et al., 2007)
• In 2030, predicted to cause 75% of deaths worldwide (WHO, 2008)
• In the UK, 80% of GP consultations CD; 80% of people living with long-term conditions needed support for self care (DH, 2004)
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Health Care Expenditures in Canada
• $39 billion or 42% of health care expenditures related to chronic disease (Mirolla, 2004)
• Total economic burden of 7 most prevalent chronic diseases (medical plus productivity losses) exceeded $93 billion (CDAC, 2004)
• 60% of the health care budget spent on chronic disease in Nova Scotia (Colman, 2002)
• Cost of CD varies by region by diagnosis (Manitoba Centre for Health Policy, 2010)
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Complex Chronic Disease
• Heaviest users (Reid, 2003)
• 36% of diabetes health care expenditures associated with co-morbidity (Simpson et al., 2003)
• In Manitoba, 30.5% of all people with chronic disease have co-morbidities – 2 to 3 times as costly depending on the combination (MCHP, 2010)
• Co-morbidity management – acute model does not work. Increased symptom burden at high risk for developing additional health problems (Williams et al., 2007)
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• Low-income Canadians are:– 50% more likely to report having a
chronic disease– 3 times more likely to report having 2
or more chronic conditions.(2007 Report on Ontario’s Health System; Ontario Health Quality Council, 2007)
Disparity/Economic Costs
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Statistical Challenges in CCD
• Massive variability in prevalence, impact and distribution across populations/geography.
• Substantive variability in the unit of analysis and measures.
• Lack of common definition of CCD and valid index to measure complexity and capture burden
• Co-morbidity does not explain critical elements of prevention or management.
• Cost and use predictions not dependable.
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Taking ActionPrevention/Population Health:
• Fifty percent of premature deaths and 70% of chronic disease in US is preventable. Up to 80% of premature deaths from CVD, stroke and diabetes could be averted by intervention (WHO, 2005)
• Attention to the social determinants
Care:
Patients in acute hospital medical wards are mostly older and have multiple co-morbid conditions that require complex and holistic care that the systems of case mix, diagnosis related groups and management systems do little to promote. (Williams, 2010, p.65)
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Bridgepoint Health
15Toronto, Ontario, Canada
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The Strategy Process
1995-2000
2004
2001 - 2004
Survival
An integrated network of services
New vision and
mission
2004 to 2006Canada’s
Leader Strategy
2006Six Year Business
Plan
Implementation!
We are here!
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Four Key Outcomes of Strategy
• Reduce the burden of complex chronic disease
• Improve the quality of life and improve wellness for individuals living with chronic disease
• Create, share and disseminate new knowledge
• Drive societal and health system change
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Bridgepoint Hospital• Publicly funded
• In-patient care
• Ambulatory and day services – 20,000 visits
• 479 beds: 367 complex & 112 rehabilitation
• 1,200 employees
• 400 volunteers
• Ethnically diverse
• Health disparities
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In-Patient: Complex Rehabilitation
• Moderate to severe acquired brain injury
• Major surgery with complications
• Stroke with moderate functional impairment
• Elderly patients with hip fractures
• Multiple severe fractures/trauma
• Elective surgery, hip and knee replacement
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In-Patient: Complex CareMultiple chronic conditions
• Stroke with major functional impairment
• Advanced progressive neuro-muscular disease
• Moderate or severe acquired brain injury
• Cardiovascular and respiratory complications
• Severe wounds
• Post-surgical complications
• Advanced diabetes
• Advanced HIV/AIDS
• End stage disease
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Ambulatory Care: Day Treatment• Physiotherapy
• Occupational therapy
• Speech language pathology
• Social Work
• Nursing
• Vocational rehabilitation counseling
• Physiatry
• Spasticity Clinic
• Cognitive group
• Tai Chi group
• Acupuncture
• Pool therapy
• Pain management
• LEGSS (Lower Extremity Gait Support Services)
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Bridgepoint: Family Health Team• Opened March 2008
• Primary care services:
• Nurse Practitioner
• Social Worker
• Dietitian
• Pharmacist
• Registered Nurses
• Physicians
• Research/Data Development
• LiveWell! program
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The Bridgepoint Collaboratory for Research and Innovation in
Complex Chronic Disease
Leading edge research that advances understanding of and action on CCD prevention
and care
28Left to Right: Dale Min, Kerry Kuluski, Alexis Schaink and Renee Lyons
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The Collaboratory
Researchers/AdvisorsAlex JadadCanada Research ChairGlobal eHealth
Ross Upshur Associate Scientist ICES and Sunnybrook
Chandrakant ShahProfessor Emeritus Dalla Lana School of Public Health
Harvey SkinnerDean of Faculty of Health York University
Louise-Lemieux CharlesChair, Department of Health PolicyUniversity of Toronto
Rick GlazierScientistICES and Li Ka Shing Knowledge Institute
Andreas LaupacisExecutive DirectorLi Ka Shing Knowledge Institute
Susan JaglalVice-Chair of ResearchRehabiliation research
Blake PolandAssociate Professor, Dalla Lana School of Public Health
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Build from Strengths at Bridgepoint:
Dr. Bob Bernstein Data Development
Dr. Heather MacNeill COIL Project
Jane Merkley Skill Mix
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Build from Strengths at Bridgepoint:
Kate Wilkinson Quality and Safety
Susan Himel LiveWell! Prevention
Project
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5 Themes
5 Researchers/
Post-Docs
5 Research Teams
5 Grants
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18 Month Objective
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Emerging Themes
1) Data development and CCD
2) Quality and Safety Innovation
3) A CCD Training Platform – Collaborative Online Interprofessional Learning (C.O.I.L.)
4) Primary care
5) Facility design
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Grants
1) International Post-Doctoral Cluster in Complex Chronic Disease
2) Partnerships for Health Systems Improvement
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The Bridgepoint Study
• Define the Patient Population – The What?
• Patient and Family Need Assessments
• Asset Mapping
• Literature Review (of CCD populations and models)
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The Bridgepoint Study
“How do we respond?” – The How?
• Determine the components of CCD models that are most relevant to Bridgepoint.
• “Think Tank” to develop a model based on evidence collected.
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The Health Care Funding Crisis Opportunities for Collaboration:Efficiency and Effectiveness?
• Quality Patient and Family Experience
• Skill Mix
• Patient Flow
• Safety
• Prevention
• Blending Health – Social Development
• End of Life
• Mental Health
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Opportunities for Collaboration
• Conceptual Development
• Data Development: Measures and Indicators
• Clinical and Health Services Intervention
• Population-based Health Systems Intervention
• Linked-up Services – Coordination
• Person-centered: Self Management Strategies
• Training/Decision Platforms
• Health Policy
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Thank You!Contact InformationWebsites:http://www.bridgepointhealth.cahttp://www.lifechanges.ca
Email: [email protected]