This document outlines a plan to improve cardiovascular disease care across the South East Local Health Integration Network region. It identifies 8 priority initiatives: 1. Expanding a bypass protocol to increase rapid access to heart attack treatment within 60 minutes for more of the region. 2. Improving processes for transferring patients between hospitals for specialist procedures to increase access and efficiency. 3. Establishing a regional forum with primary care providers to improve prevention and management according to guidelines. 4. Developing standardized discharge information and communication tools to streamline care transitions. 5. Creating a regional heart health and disease management network for rehabilitation services. 6. Improving outpatient access to diagnostic services and specialist assessments in

1. South East Regional Cardiovascular Disease Clinical Roadmap Plan DirectionsPresentation & DiscussionSouthEast CHCs EDs Group March 2, 2011 Presented by: Chris Simpson, CVD Roadmap Clinical Lead; Julie Caffin, Operational Lead; Cynthia Johnston, Clinical Implementation Specialist; & Vic Sahai, LHIN Lead

2. Goals for today We share with you Brief recap – Clinical Services Roadmap (CSR) goals & mandate of CVD Roadmap Work Team Why CVD ? - Key characteristics of SE LHIN population & region relevant to CVD care delivery challenge CVD Draft Roadmap – eight priority improvement initiatives You share with us From the CHC perspective - What have we gotten right? What is missing? Advice, insights, what do we need to know? Who will work with us – on one initiative or several

3. LHIN Intent with the Clinical Services Roadmap Develop a blueprint to “renovate” parts of the current healthcare system Address principles of patient centredness, accessibility, quality of services Ensure efficiency and sustainability A “zero sum game” In summary, Are we – collectively - doing the best that we can do? Honestly?

4. Clinical Services Roadmap Work Teams Mandate/Process Seven priority areas of opportunity identified by LHIN (cardiovascular disease, ED wait times, healthcare acquired infection, mental health & addiction, high risk maternal & newborn care, restorative care, surgery) Established 7 Work Teams – each with Clinical & Operational Leads Mandate to achieve a regional, integrated system of healthcare Describe desired future state for each area (i.e., CVD) Identify gap - current vsdesired Prepare implementation plan over 1-3 years Result is draft CVD Continuum Roadmap illustrated by the logic map Eight priority initiatives / areas for improvement identified

6. Builds on and strengthens the existing regional relationships & roles

9. SE LHIN has highest proportion of CVD risk factors in Ontario

10. SE LHIN has the highest proportion of citizens 65+

11. Significant acute care utilization for heart disease related issues

13. Leading Cause of Death Belleville Area 2001-4 Source: LHIN Recap SubLHIN Planning Area Summary 2008

14. Leading Cause of Death Smiths Falls, Perth, Lanark Area 2001-4

15. An Aging Population – Increased CVD

16. South East LHIN Region presents challenges for patients to access services& for healthcare providers to provide services

18. More CVD Facts Heart & Stroke Foundation (HSFO), Canadian Cardiology Society,… guidelines for suggested better, proven ways to organize & provide care Canadian Heart Health Strategy & Action Plan - a national strategy framework for CVD planning MOHLTC has asked Cardiac Care Network, HSFO and Ontario Stroke Network to consider a provincial strategy for the treatment of CVD Emphasis on the continuum of care is needed Emphasis on standardization in treatment and management that is grounded in a culture of safety, quality, and best practices – patient-centred care

19. Vision for CVD Care Continuum An integrated, leading practice continuum of cardiovascular disease prevention, treatment and management services accessible across the South East LHIN Region Based on partnership, collaboration, a culture of quality improvement & patient centred disease prevention & management principles

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22. Additional quality life years Favourable environments Healthybehaviours Lower population risk Fewer acute events Less chronic disease Information and Monitoring Access to Services Research Health Human Resources SE LHIN Cardiovascular Vision and Action Plan The Vision HEALTH PROMOTION PRIMARY SECONDARY Interventions Required TREATMENT Policy and environmental change Behaviour change strategies Prevention, detection & management of risk factors Timely access to quality (acute) care Timely access to quality chronic disease manage-ment/rehab PREVENTION Timely access to end oflife care OUTCOMES Reduced burden of CVD Sustainable health system Added quality life years Reduced inequities Healthier population

24. 1. Rapid Access to STEMI Treatment – Bypass Protocol Expansion Will increase area of region of by-pass for ST elevated myocardial infarction (STEMI) – direct to vascular catheter lab at KGH for PCI Work with EMS/hospitals/Regional Paramedic Program to phased-in approach to expansion – 60 minutes window facilitate necessary agreements – data capture Regional CVD process for ongoing coordination, evaluation, quality assurance structure/process

25. South East Local Health Integration Network Map Ideal* STEMI Protocol Expansion

26. 2. Inpatient access to tertiary specialists - improve inter-centre transfer processes 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 Volume increased and new/various circumstances & pathways evolved – challenges to timeliness & efficiency; Initiative will refresh standards & processes / collaborative pathways; Improve pre-transfer assessments to ensure tertiary treatment is indicated; i.e., remote consults - OTN as appropriate; access to tests results remotely; Confirm/establish processes for direct discharge from KGH rather than return to home hospital for discharge.

28. KGH

29. HDH

30. Campbellford

32. Brockville General

34. KGH

37. For example - QHC – Belleville General857 Separations Select CVD Primary Diagnosis 2008/9

38. 4. Improved Discharge Information and Communication Tools Comprehensive and timely (what and when agreements)for patients and primary care providers To streamline the transitions / handoff points in care Share best practice & Develop standardized packages & processes Discharge instructions, summary templates Medication reconciliation & processes for timely follow-up with patients & primary care providers Share best practice information sources – link to HF and CVD Rehab services

39. 5 & 6 Regional Heart Health & Disease Management Network - Heart Failure and Cardiac Rehab Services In partnership with primary care, hospitals, specialists across the region Based on a regional best practice standards framework & guidelines (CHFN, CRNO) CV rehab & heart failure services and settings across the region – linked to multidisciplinary CDPM Develop business case (for funding approval) Phased-in implementation across the region

40. 7. Improved outpatient access to CVD diagnostic services and specialist assessment Coordinated/consolidated in “one stop” model(s) Based on best practice standards framework - available across the LHIN Appropriate service locations/models determined locally - (as appropriate) e.g., at Belleville, Brockville, Smiths Falls/Perth Pilot/initial implementation at Hotel Dieu Hospital

42. Plan of care developed with the patientECG and Blood work Admit to KGH Outpatient angio F/U PCP F/U Cardiology Clinic No F/U required History and physical – Nurse Practitioner

43. 8. CVD Information Access & Communications Solutions Will establish a CVD IA & C Solutions Group Develop a standards framework – what functionality is required for optimum CVD care? Complete a gap analysis – what needs to be improved? Prepare initial draft of regional strategy plan re: opportunities/future approaches to establishing 2-way shared information solutions Early win - a standardized data sharing agreement among all hospitals to enable / remove the administrative barriers to information sharing

44. Discussion What are we missing – what have we gotten right? Advice, insights, what do we need to know? Who will work with us – on one initiative or several?