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Better Breathing Programme Collaborative. Clinical Leads: Sarah Candy & Fiona Horwood Team: Jen Mepham, Charulata Kulkarni, Prof Harry Rea, Fiona Smyth, Samuel Menia, Barbara Lambert, Meg Goodman, Rose Ikimau, Michelle Mills , Ta-Mera Rolland, Richard Small, Sarah Mooney - PowerPoint PPT Presentation
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20,000 Days Campaign StoryboardLearning Session 3, 11-12 March 2013
Better Breathing Programme Collaborative
Clinical Leads: Sarah Candy & Fiona Horwood
Team: Jen Mepham, Charulata Kulkarni, Prof Harry Rea, Fiona Smyth, Samuel Menia, Barbara Lambert, Meg Goodman, Rose Ikimau, Michelle Mills, Ta-Mera Rolland, Richard Small, Sarah Mooney
Project Manager: Alison HowittImprovement Advisor: Prem KumarDecision Support: Penny Wilkings
Aim
• The aim of this project is to keep more people with chronic respiratory disease well in the community by increasing the number of participants enrolled into Better Breathing (community based pulmonary rehabilitation) from 60 to 250 per year.
This will result in;
a reduction of unplanned admissions, increased exercise tolerance and improved health related quality of life.
Driver Diagram
- Include Collaborative Driver Diagram
Change Packages
2O Drivers(Theory of change)
Change Ideas Tested
(describe process)
Evidence of Improvement
Access & Community
Community Location and Venue
Transport options
Attendance & Feedback
Access & Community
Patient Engagement
GP support and involvement
Supporting attendance for Maori and Pacific patients
Attendance & Feedback
Identifying patients
Referrals
Assessments
Waiting List, drop outs & starting programme
Change Packages
2oDrivers(Theory of change)
Change Ideas Tested
(describe process)
Evidence of Improvement
Programme Programme Content
Sessions and format
Equipment
Speakers
Clinical outcome assessments
Based on current research, modifications based on testing, user feedback.
Combined Programme
Healthy Hearts – Heart Failure Patients
Initial set up phase.
Most Successful PDSA Cycles?
- Include PDSA Tree diagram
Most Successful PDSA?
Act Plan
Study Do
• Additional pulmonary rehabilitation programme into the community
• Otara• Pukekohe
• Programmes need to be design to suit the community they serve and each community is different.
• Having the flexibility to provide programmes tailored to the patient demographics is essential for best outcomes
• Identify & secure venues• Supply equipment• Design programme• Engage Community• Identify patients• Arrange staffing &
speakers• Start programme
• Continue to refine and measure the programmes.
• Offer as a Franchise model with flexibility to suit patient demographice
Measures Summary
• Outcome Measures– The number of patients enrolled in each community Better
Breathing programme– The number of unplanned hospital admissions
• Process Measures– The number of referrals to Better Breathing– The number of participants who start Better Breathing – The number of participants completing the programme– The change in distance walked on 6 minute walk test– The change in health related quality of life questionnaire
scores
Implementation
Implementation Areas
Changes to Support Implementation
PDSA cycles
Standardisation Developing Process Map
Programme Guidelines
Developed Otara, To some extent tested in Pukekohe
Documentation Plan to create a franchise “options” document giving examples as case studies
Training Developing training materials Testing on new staff
Measurement Produce and monitor guideline measures, covering clinical outcomes, patient drop out and completions targets.
Resourcing Information on ideal venue, staffing and equipment in Franchise document.
Adapted from “The Improvement Guide. A Practical Approach to Enhancing Organizational Performance” Gerald Langley et al., 2009, p180.
Highlights and Lowlights
Highlights- Accessibility – patients report they are now able to attend a
programme- Patients feel safe and supported in a familiar environment
which is in the heart of their community- As a whole, the pulmonary rehabilitation service is able to offer
an increased number places on the programme (240 – 450)- Increased profile of pulmonary rehabilitation in South Auckland
Lowlights- Recruitment of staff - Practise nurse involvement in Otara- Pukekohe site size and availability
Achievements to date
Moving Pulmonary Rehabilitation to the community
Venues, equipment, programme, speakers, referrals, assessments, staff, speakers, advertising, patient information, cultural support
Starting the Better Breathing Programme in Otara (running for 7 months)
Starting the Better Breathing Programme in Pukekohe. (4 intakes)
Testing and refining everything while we are doing it.
Learning from the patients and the community
Co-ordinating all the various groups, departments, stakeholders and people.
Thank you to everybody that has been involved
20,000 Days Campaign StoryboardLearning Session 3, 11-12 March 2013
Better BreathingClinical Pathway
Clinical Leads: Fiona Horwood, Richard Hulme
Team: Katie Coulter, Nicola Corna, Diana Hart, Sue Beaumont-Orr, Michelle Mills, Ta-Mera Rolland, Richard Small
Project Manager: Alison HowittImprovement Advisor: Prem KumarDecision Support: Tanesha Patel
Aim
• The overall aim of the Better Breathing Collaborative is to work together with the Counties Manukau Community to help people with breathing problems to manage their condition well in the community.
• This will be accomplished by •Providing community based pulmonary rehabilitation, for 250 in Otara and Pukekohe.
• Introducing a COPD care bundle for patients with a primary diagnosis of COPD patients in Middlemore Hospital.
• Increasing the numbers of COPD patients, identified in primary care and by piloting the introduction of an “early diagnosis primary care bundle.”
Driver Diagram
- Include Collaborative Driver Diagram
Primary Care Change Packages
2o Drivers(Theory of change)
Change Ideas Tested Describe Process
Early Diagnosis
Primary Care Bundle The receptionist gives a CAT survey to a patient who is 40y+, is a smoker or ex-smoker & doesn’t have known asthma. The CAT survey has been incorporated into a decision support tool in the GP Patient Management System. GP act on the information provided by the patient
Clinical Pathway
Primary Care COPD Pathway CME
Roll out CME course developed by Clinical Pathway Group and ProCare. Focus on spirometry and WOF.
Primary and Secondary Change Ideas to be tested
2o Drivers(Theory of change)
Change Ideas
(describe process)
Evidence
Secondary care bundle has been developed and tested, using the “pink” form
Further evidence is required
Winter warrant of fitness for target patients
Options for spirometry in the community• Practices/Shared Group of Practices
• Locality Hub
• Alongside Better Breathing Programme
• Huff and Puff Bus
Most Successful PDSA Cycles?
Based on UK developed
Care BundleTested Resp
Ward
Order changed Y/N added
Tested Resp Ward
Further info added for non Resp wards
Tested on Gen Ward
Referral Check box, sign & date
added Tested Resp &
Gen Ward
Re-think and Simplify
Tested Resp Ward
One box removed, not
enough patients to test
Tested Resp Ward & Gen
Ward
Testing continues and we’ve
learn’t a lot
Measures Summary
- Measures related to Aim- Graphs of key measures
- Which of your run charts would you give to senior leadership to use?
- Include Collaborative Dashboard
Measures Summary
Outcome Measure • Unplanned admissions to Middlemore Hospital• Length of Stay in Middlemore• Readmission rate
Process Measures • Numbers of patients identified with COPD in primary care. • Numbers of patients receiving all or parts of early diagnosis primary
care bundle. • Numbers of patients offered, attending and completing community
based pulmonary. • Numbers of patients receiving discharge care bundle.• COPD patients by localities
Highlights and Lowlights- Highlights
- Working across primary and secondary care.
- Forming, what has become the COPD Team to work on the secondary care bundle.
- Having the opportunity to review best practices, adapting and testing them for our patients and community.
- Partnering with Auckland & Waitemata DHB’s for the COPD primary care pathway.
- Sharing ideas and learning’s with Northland DHB and Canterbury
- Lowlights
- The challenges of testing when there are no patients.
- Finding a meeting time that everybody can attend.