Successfully reported this slideshow.
South East Regional Cardiovascular Disease Clinical Roadmap Plan DirectionsPresentation & DiscussionSouthEast CHCs EDs Gro...
Goals for today<br />We share with you<br />Brief recap – Clinical Services Roadmap (CSR) <br />goals & mandate of CVD Roa...
LHIN Intent with the Clinical Services Roadmap<br />Develop a blueprint to “renovate” parts of the current healthcare syst...
Clinical Services Roadmap Work Teams  Mandate/Process<br />Seven priority areas of opportunity identified by LHIN<br />(ca...
Cardiovascular Disease (CVD) Clinical Services Roadmap<br />Guiding principles:<br />Regional integrated CVD system that s...
Builds on and strengthens the existing regional relationships & roles
New focus on management of chronic underlying disease (e.g.. CHF) and reduction of avoidable ER visits, admissions and rea...
Why Cardiovascular Disease? <br />“A ‘perfect storm’ of risk factors and demographic changes is brewing that will lead to ...
SE LHIN has highest proportion of CVD risk factors in Ontario
SE LHIN has the highest proportion of citizens 65+
Significant acute care utilization for heart disease related issues
High readmission rates - cost to the healthcare system & quality of life</li></li></ul><li>South East LHIN Deaths per Year...
Leading Cause of Death Belleville Area 2001-4<br />Source: LHIN Recap SubLHIN Planning Area Summary 2008<br />
Leading Cause of Death Smiths Falls, Perth, Lanark Area 2001-4<br />
An Aging Population – Increased CVD<br />
South East LHIN Region presents challenges for patients to access services& for healthcare providers to provide services<b...
Southeast Region ChallengeLarge Rural Area - Long Travel Distances<br />Population: 442,800<br /><ul><li>High rural distri...
More CVD Facts<br />Heart & Stroke Foundation (HSFO), Canadian Cardiology Society,… guidelines for suggested better, prove...
Vision for CVD Care Continuum<br />An integrated, leading practice continuum of cardiovascular disease prevention, treatme...
W<br />W<br />W<br />W<br />w<br />
W<br />W<br />W<br />W<br />w<br />
Additional quality life years<br />Favourable environments<br />Healthybehaviours<br />Lower population risk<br />Fewer ac...
1. Rapid Access to STEMI Treatment – Bypass Protocol Expansion<br />Will increase area of region of by-pass for ST elevate...
South East Local Health Integration Network Map<br />Ideal* STEMI Protocol Expansion<br />
2. Inpatient access to tertiary specialists -  improve inter-centre  transfer processes<br />Regional model agreement that...
Acute Hospitals where South East LHIN Residents Access Cardiovascular Related Care<br />Hastings County:<br /><ul><li> QHC...
KGH
HDH
Campbellford
Peterborough</li></ul>South Lanark, Leeds & Grenville Residents:<br /><ul><li>Perth & Smiths Falls sites
Upcoming SlideShare
Loading in …5
×

SE LHIN Cardiovascular Roadmap Information Presentation - CHC EDs March 2011

1,135 views

Published on

Community discussion presentation of proposed improvement initiatives to cardiovascular care continuum in one Local Health Integration Network in Ontario

Published in: Health & Medicine
  • Be the first to comment

  • Be the first to like this

SE LHIN Cardiovascular Roadmap Information Presentation - CHC EDs March 2011

  1. 1. South East Regional Cardiovascular Disease Clinical Roadmap Plan DirectionsPresentation & DiscussionSouthEast CHCs EDs Group March 2, 2011<br />Presented by: Chris Simpson, CVD Roadmap Clinical Lead; Julie Caffin, Operational Lead; Cynthia Johnston, Clinical Implementation Specialist; & Vic Sahai, LHIN Lead<br />
  2. 2. Goals for today<br />We share with you<br />Brief recap – Clinical Services Roadmap (CSR) <br />goals & mandate of CVD Roadmap Work Team<br />Why CVD ? - Key characteristics of SE LHIN population & region relevant to CVD care delivery challenge<br />CVD Draft Roadmap – eight priority improvement initiatives<br />You share with us<br />From the CHC perspective - What have we gotten right? What is missing?<br />Advice, insights, what do we need to know?<br />Who will work with us – on one initiative or several<br />
  3. 3. LHIN Intent with the Clinical Services Roadmap<br />Develop a blueprint to “renovate” parts of the current healthcare system<br />Address principles of patient centredness, accessibility, quality of services <br />Ensure efficiency and sustainability<br />A “zero sum game”<br />In summary, Are we – collectively - doing the best that we can do? Honestly?<br />
  4. 4. Clinical Services Roadmap Work Teams Mandate/Process<br />Seven priority areas of opportunity identified by LHIN<br />(cardiovascular disease, ED wait times, healthcare acquired infection, mental health & addiction, high risk maternal & newborn care, restorative care, surgery)<br />Established 7 Work Teams – each with Clinical & Operational Leads<br />Mandate to achieve a regional, integrated system of healthcare<br />Describe desired future state for each area (i.e., CVD)<br />Identify gap - current vsdesired <br />Prepare implementation plan over 1-3 years<br />Result is draft CVD Continuum Roadmap illustrated by the logic map<br />Eight priority initiatives / areas for improvement identified<br />
  5. 5. Cardiovascular Disease (CVD) Clinical Services Roadmap<br />Guiding principles:<br />Regional integrated CVD system that spans the continuum of services and care settings<br /><ul><li>For the residents of the SE LHIN
  6. 6. Builds on and strengthens the existing regional relationships & roles
  7. 7. New focus on management of chronic underlying disease (e.g.. CHF) and reduction of avoidable ER visits, admissions and readmission rates post cardiac events </li></li></ul><li>CVD Roadmap Process to Date<br />Feb. 2010 regional CVD forum – approx. 70 attendants – identified themes & general priorities for improvement (21)<br />CVD Clinical Work Team – 15 members– broadly representative <br />Over 8 mths - selected 8 priorities from 21 <br />Task teams – 8 small groups Lead by Clinical Work Team member(see the regional logic map)<br />input/representatives from region- developed high level plan for each priority <br />Draft high level operational plan submitted to SECHEF Feb. 16<br />Consultation phase now – discussions & online workbooks<br />Next phase – final operational plans to SECHEF by mid-May – approval by end of June for implementation<br />
  8. 8. Why Cardiovascular Disease? <br />“A ‘perfect storm’ of risk factors and demographic changes is brewing that will lead to the proliferation of cardiovascular disease among Canadians both young and old, creating an unprecedented burden on our healthcare system.” Heart and Stroke Foundation 2010<br /><ul><li>The leading cause of death and disability in Canada – highest cause of death SE LHIN
  9. 9. SE LHIN has highest proportion of CVD risk factors in Ontario
  10. 10. SE LHIN has the highest proportion of citizens 65+
  11. 11. Significant acute care utilization for heart disease related issues
  12. 12. High readmission rates - cost to the healthcare system & quality of life</li></li></ul><li>South East LHIN Deaths per Year by Cause 2001- 2004 > 30% each year attributable to Cardiovascular Diseases <br />Source: SE LHIN from Vital Statistics 2005<br />
  13. 13. Leading Cause of Death Belleville Area 2001-4<br />Source: LHIN Recap SubLHIN Planning Area Summary 2008<br />
  14. 14. Leading Cause of Death Smiths Falls, Perth, Lanark Area 2001-4<br />
  15. 15. An Aging Population – Increased CVD<br />
  16. 16. South East LHIN Region presents challenges for patients to access services& for healthcare providers to provide services<br />
  17. 17. Southeast Region ChallengeLarge Rural Area - Long Travel Distances<br />Population: 442,800<br /><ul><li>High rural distribution (44%)</li></ul>Hastings County 180 km. N to S<br /> 1 hour Bancroft to Peterborough<br /> 1 hour Smiths Falls to Ottawa or Kingston<br />1.5-2 hours Bancroft to Belleville<br />2.5 hours Bancroft to Kingston<br />1.5 - 2 hours Belleville to Brockville<br />204km. Brighton to Prescott<br />1 hour Picton to Kingston<br />Source map insert – http://www.southeastlhin.on.ca/en/docs/population_profile.pdf<br />
  18. 18. More CVD Facts<br />Heart & Stroke Foundation (HSFO), Canadian Cardiology Society,… guidelines for suggested better, proven ways to organize & provide care<br />Canadian Heart Health Strategy & Action Plan - a national strategy framework for CVD planning<br />MOHLTC has asked Cardiac Care Network, HSFO and Ontario Stroke Network to consider a provincial strategy for the treatment of CVD<br />Emphasis on the continuum of care is needed<br />Emphasis on standardization in treatment and management that is grounded in a culture of safety, quality, and best practices – patient-centred care<br />
  19. 19. Vision for CVD Care Continuum<br />An integrated, leading practice continuum of cardiovascular disease prevention, treatment and management services accessible across the South East LHIN Region<br />Based on partnership, collaboration, a culture of quality improvement <br />& patient centred disease prevention & management principles<br />
  20. 20. W<br />W<br />W<br />W<br />w<br />
  21. 21. W<br />W<br />W<br />W<br />w<br />
  22. 22. Additional quality life years<br />Favourable environments<br />Healthybehaviours<br />Lower population risk<br />Fewer acute events<br />Less chronic disease<br />Information and Monitoring<br />Access to Services<br />Research<br />Health Human Resources<br />SE LHIN Cardiovascular Vision and Action Plan<br />The Vision<br />HEALTH PROMOTION<br />PRIMARY<br />SECONDARY<br />Interventions Required<br />TREATMENT<br />Policy and environmental change<br />Behaviour change strategies<br />Prevention, detection & management of risk factors<br />Timely access to quality (acute) care<br />Timely access to quality chronic disease manage-ment/rehab<br />PREVENTION<br />Timely access to end oflife care<br /> OUTCOMES<br />Reduced burden of CVD<br />Sustainable health system<br />Added quality life years<br />Reduced inequities<br />Healthier population<br />
  23. 23.
  24. 24. 1. Rapid Access to STEMI Treatment – Bypass Protocol Expansion<br />Will increase area of region of by-pass for ST elevated myocardial infarction (STEMI) – direct to vascular catheter lab at KGH for PCI<br />Work with EMS/hospitals/Regional Paramedic Program to<br />phased-in approach to expansion – 60 minutes window<br />facilitate necessary agreements – data capture<br />Regional CVD process for ongoing coordination, evaluation, quality assurance structure/process<br />
  25. 25. South East Local Health Integration Network Map<br />Ideal* STEMI Protocol Expansion<br />
  26. 26. 2. Inpatient access to tertiary specialists - improve inter-centre transfer processes<br />Regional model agreement that tertiary specialty CVD procedures provided at KGH – e.g., angiogram, stent, pacemaker, CABG surgery, etc.-via inter-hospital transfer – often same day or next day return<br />Volume increased and new/various circumstances & pathways evolved – challenges to timeliness & efficiency;<br />Initiative will<br />refresh standards & processes / collaborative pathways;<br />Improve pre-transfer assessments to ensure tertiary treatment is indicated; i.e., remote consults - OTN as appropriate; access to tests results remotely; <br />Confirm/establish processes for direct discharge from KGH rather than return to home hospital for discharge.<br />
  27. 27. Acute Hospitals where South East LHIN Residents Access Cardiovascular Related Care<br />Hastings County:<br /><ul><li> QHC Belleville, Trenton, Bancroft, Picton
  28. 28. KGH
  29. 29. HDH
  30. 30. Campbellford
  31. 31. Peterborough</li></ul>South Lanark, Leeds & Grenville Residents:<br /><ul><li>Perth & Smiths Falls sites
  32. 32. Brockville General
  33. 33. Ottawa hospitals</li></ul>Lennox & Addington, Frontenac & Kingston Residents:<br /><ul><li>Lennox & Addington /Napanee
  34. 34. KGH
  35. 35. HDH</li></ul>Prince Edward County:<br /><ul><li> QHC – Picton</li></ul>Belleville & Trenton<br /><ul><li> KGH
  36. 36. HDH</li></li></ul><li>3. Partnership with Primary Care Providers<br />Will establish a regional forum with primary care providers <br />discuss & document current practice and gap analyses – re: CVD prevention & management guidelines achievement, challenges & opportunities – primary care & specialists<br />establish Partnership - structure/processes <br />agree on a plan to achieve guidelines for CVD P & M by …<br />This partnership is the key enabler for improved continuum of CVD care <br />Best practice evidence suggests up to 50% of hospital admissions for heart failure disease management could be managed in outpatient clinics and primary care settings (CHFN)<br />
  37. 37. For example - QHC – Belleville General857 Separations Select CVD Primary Diagnosis 2008/9<br />
  38. 38. 4. Improved Discharge Information and Communication Tools <br />Comprehensive and timely (what and when agreements)for patients and primary care providers<br />To streamline the transitions / handoff points in care<br />Share best practice & Develop standardized packages & processes <br />Discharge instructions, summary templates<br />Medication reconciliation & processes for timely follow-up with patients & primary care providers <br />Share best practice information sources – link to HF and CVD Rehab services <br />
  39. 39. 5 & 6 Regional Heart Health & Disease Management Network - Heart Failure and Cardiac Rehab Services<br />In partnership with primary care, hospitals, specialists across the region <br />Based on a regional best practice standards framework & guidelines (CHFN, CRNO)<br />CV rehab & heart failure services and settings across the region – linked to multidisciplinary CDPM<br />Develop business case (for funding approval)<br />Phased-in implementation across the region <br />
  40. 40. 7. Improved outpatient access to CVD diagnostic services and specialist assessment<br />Coordinated/consolidated in “one stop” model(s) <br />Based on best practice standards framework - available across the LHIN<br />Appropriate service locations/models determined locally - (as appropriate) e.g., at Belleville, Brockville, Smiths Falls/Perth <br />Pilot/initial implementation at Hotel Dieu Hospital <br />
  41. 41. Echo<br />Cardiac CT<br />Carotid Dopplers<br />Stress Echo<br />(DSE or ESE)<br />OR<br />Treadmill<br />Emergency/Urgent Care<br />Primary Care Provider<br />Cardiologist<br />Internist<br />Post-discharge<br />Patient at risk for cardiovascular disease<br />Draft Conceptual Model - HDHCARDIOVASCULAR <br />RISK MANAGEMENT UNIT<br />Cardiologist visit<br /><ul><li>All test results available
  42. 42. Plan of care developed with the patient</li></ul>ECG and<br />Blood work<br />Admit to KGH<br />Outpatient angio<br />F/U PCP<br />F/U Cardiology Clinic<br />No F/U required<br />History and physical – Nurse Practitioner<br />
  43. 43. 8. CVD Information Access & Communications Solutions<br />Will establish a CVD IA & C Solutions Group <br />Develop a standards framework – what functionality is required for optimum CVD care?<br />Complete a gap analysis – what needs to be improved?<br />Prepare initial draft of regional strategy plan re: opportunities/future approaches to establishing 2-way shared information solutions<br />Early win - a standardized data sharing agreement among all hospitals to enable / remove the administrative barriers to information sharing<br />
  44. 44. Discussion<br />What are we missing – what have we gotten right?<br />Advice, insights, what do we need to know?<br />Who will work with us – on one initiative or several?<br />

×