Foro calidad OPIMEC Renée Lyons

Dealing with Complexity: The Bridgepoint Health Hospital Experience Renee Lyons, Ph.D. Chair in Complex Chronic Disease Research and Scientific Director, Bridgepoint Collaboratory for Research and Innovation Professor - Dalla Lana School of Public Health, University of Toronto Dale Min, Kerry Kuluski and Alexis Schaink Quality of Care for People with Multiple Chronic Diseases: New Opportunities and Challenges Forum Granada, Spain Tuesday, June 1, 2010 1

Overview • Third Frontier (Multi-morbidity, Complex Chronic Disease, and the Deficit Crisis) • Bridgepoint Health and the Collaboratory • Research initiatives • Opportunities for Collaboration 2

The Third Frontier: Complex Chronic Disease What 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! 3

CCD Intersects with Many Factors Culture Mental Family Health Socioeconomic Environment Status Quality of Life 4

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) 5

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) 6

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) 7

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) 8

Disparity/Economic Costs • 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) 9

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. 12

Taking Action Prevention/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) 13

Bridgepoint Health 14

Toronto, Ontario, Canada 15

The Strategy Process 2006 Implementation! Six Year Business 2004 to 2006 Plan Canada’s Leader We are 2004 Strategy here! New vision and 2001 - 2004 mission An integrated 1995-2000 network of services Survival 19

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 20

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 22

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 23

In-Patient: Complex Care Multiple chronic conditions • Stroke with major functional • Post-surgical complications impairment • Advanced diabetes • Advanced progressive • Advanced HIV/AIDS neuro-muscular disease • End stage disease • Moderate or severe acquired brain injury • Cardiovascular and respiratory complications • Severe wounds 24

Ambulatory Care: Day Treatment • Physiotherapy • Physiatry • Occupational therapy • Spasticity Clinic • Speech language pathology • Cognitive group • Social Work • Tai Chi group • Nursing • Acupuncture • Vocational rehabilitation • Pool therapy counseling • Pain management • LEGSS (Lower Extremity Gait Support Services) 25

Bridgepoint: Family Health Team • Opened March 2008 • Primary care services: • Nurse Practitioner • Social Worker • Dietitian • Pharmacist • Registered Nurses • Physicians • Research/Data Development • LiveWell! program 26

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 27

Left to Right: Dale Min, Kerry Kuluski, Alexis Schaink and Renee Lyons 28

The Collaboratory Researchers/Advisors Alex Jadad Ross Upshur Chandrakant Shah Canada Research Chair Associate Scientist Professor Emeritus Global eHealth ICES and Sunnybrook Dalla Lana School of Public Health Harvey Skinner Louise-Lemieux Charles Rick Glazier Dean of Faculty of Health Chair, Department of Health Scientist York University Policy ICES and Li Ka Shing University of Toronto Knowledge Institute Andreas Laupacis Susan Jaglal Blake Poland Executive Director Vice-Chair of Research Associate Professor, Li Ka Shing Knowledge Rehabiliation research Dalla Lana School of Institute Public Health 29

Build from Strengths at Bridgepoint: Dr. Bob Bernstein Jane Merkley Data Development Skill Mix Dr. Heather MacNeill COIL Project 30

Build from Strengths at Bridgepoint: Kate Wilkinson Quality and Safety Susan Himel LiveWell! Prevention Project 31

18 Month Objective 5 Themes 5 Research Teams 5 5 Researchers/ 5 Grants Post-Docs 32

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 33

Grants 1) International Post-Doctoral Cluster in Complex Chronic Disease 2) Partnerships for Health Systems Improvement 34

The Bridgepoint Study • Define the Patient Population – The What? • Patient and Family Need Assessments • Asset Mapping • Literature Review (of CCD populations and models) 36

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. 37

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 38

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 39

Thank You! Contact Information Websites: http://www.bridgepointhealth.ca http://www.lifechanges.ca Email: RLyons@bridgepointhealth.ca 40

Foro calidad OPIMEC Renée Lyons

by Observatorio de Prácticas Innovadoras en el Manejo de Enfermedades Crónicas Complejas (OPIMEC) on Jun 14, 2010

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