Transcript Integrating AMI Care Across a Healthcare Service System

Integrating AMI Care Across a
Healthcare Service System
Safer Healthcare Now
National WebEx
October 19th, 2009
Diane 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 preadmission to community care
• Regional representation
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Strategies
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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
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BUILDING HEALTHY LIFESTYLES
CARDIAC REHAB PROGRAM
Our Patient’s Journey
Presented October 19, 2009
Leila Lavorato
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Referral
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Automatic - ACS pathway
Health Care provider
Self / Family
Initial Intervention
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Inpatient visit / introduction
Education Package
Intervention screening
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Education Series
– Heart CHEC
• “What Now?”
• “What Next?”
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BHL Class Calendar – free, no referral needed
• Generic
• Disease specific topics
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Assessment
– Program Nurse
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Coaching model / Motivational interviewing
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Set SMART goals / Develop action plans
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Consult programs / services
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Exercise testing/screening
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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
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BUILDING HEALTHY LIFESTYLES
PROGRAM MODEL
Patient/Family
Health Care Provider
Physician
Building Healthy Lifestyles
Referral to home base - NAVIGATED
Secondary / Tertiary Prevention
Primary Prevention
- Incident Report
Disease Specific Programs - Assessments – Education - Management
Diabetes
Acute Coronary
Heart Function
Syndrome - Cardiac
Clinic / Network
Clinical
Chronic
Risk Factor Mx
Nutrition
Respiratory
Weight Loss
Building Healthy
Lifestyle
Group Classes
- Progress Report
THERAPEUTIC EXERCISE REFERRAL
PRE REQUISITION COMPLETION
PHYSICIAN APPROVAL
DISEASE
SPECIFIC
PROGRAM
OUTCOMES
EXERCISE TESTING
FIT & FUNCTIONAL
Level I
HOME EXERCISE
Levels I, II or III
- Endurance
- Muscle Strength
- Flexibility
Level II
Level III
3 month POST PROGRAM OUTCOMES
COMMUNITY/HOME
6 Month & 12 Month
Testing & Follow Up