OACCAC May 28, 2015hssontario.ca/fr/Who/Conference/Documents/2015...How Does a Focus on Rehabilitative Care Support Health System Priorities? RCA Initiatives Addressing Auditor General

Rehabilitative Care Alliance OACCAC

May 28, 2015

Meeting Objectives

1. Provide an overview of rehabilitative care within the context of health system directions.

2. Provide an overview of the Development/Structure of the Rehabilitative Care Alliance

3. Describe Key RCA Deliverables with a Community Focus and the Status of their Implementation:

o ‘Framework for Community Levels of Rehabilitative Care’

o ‘Rehabilitative Care System Capacity Planning Framework’

o ‘Process to Support Frail Adults to Access Bedded Levels of Rehabilitative Care from the Community/Emergency Department’

o Outpatient/Ambulatory Care Minimum Data Set

2 www.rehabcarealliance.ca

What is “rehabilitative care”?

“Rehabilitative Care” is a broad range of interventions that result in the improved physical,

mental and social wellbeing of those suffering from injury, illness or chronic disease.”

CCC/Rehab Expert Panel – Definitions Working Group, 2011


Rehabilitative Care Alliance

The Rehabilitative Care Alliance (RCA) is a provincial collaborative that was established by Ontario’s 14 LHINs in April 2013 with an initial two-year mandate to effect

positive changes in rehabilitative care that focus on supporting improved patient experiences and clinical

outcomes and enhancing the adoption and effectiveness of clinical and fiscal priorities.


First Mandate Progress/Deliverables

LHIN CEOs established the Rehabilitative Care Alliance (RCA) in April 2013 for a two-year mandate

Leadership of the RCA Secretariat brought together representatives from all LHINs, MOHLTC, HSPs from hospital and community sectors, patients and caregivers.

Full & summary reports provide an overview of the recommendations developed for LHINs and HSPs based on the RCA’s five priority areas of focus.


First Mandate Progress/Deliverables

Mandate I Five Priority Areas of Focus:

Definitions

Frail Senior/Medically Complex

Capacity Planning and System Evaluation

Outpatient/Ambulatory

Planning Considerations for Re-Classification of Rehab/CCC beds


Alignment With Other System Priorities

The work of the RCA aligns with and builds upon Ministry of Health and Long-Term Care priorities and directions and other province-wide initiatives. Work on the five priorities was informed by evidence and data, as available, and by extensive provincial stakeholder engagement and input into the final deliverables.

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How Does a Focus on Rehabilitative Care Support Health System Priorities?

RCA Initiatives Addressing Auditor General Recommendations Cited by the AG and in the Ministry’s response as:

• Taking a system-wide view of rehabilitation in Ontario

• Developing recommendations that will help guide provincial standards for rehabilitative care programs across the continuum that are expected to help better track services and costs.

• Helping LHINs to develop a standardized rehabilitative care evaluation framework and indicators to evaluate rehabilitative care system performance.

• Identifying what information should be collected on outpatient services and how best to collect the data.

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How Does a Focus on Rehabilitative Care Support Health System Priorities?

RCA Initiatives to Support Capacity Planning and Reporting of Data Across the Outpatient Rehab Sector align with

recommendations in the March, 2015 Donner Report, Bringing Care Home:

The 14 LHINs must be responsible for a system capacity plan that considers the interrelationships between services along the full continuum of care regardless of where care is delivered. The LHINs should lead this planning exercise, which should identify and address gaps in care and services against provincial standards.

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How the Work of the RCA Supports the MOHLTC 10-Point Plan to

Strengthen Home & Community Care

• MOHLTC to create a Levels of Care Framework to ensure services and assessments are consistent across the province. Will be an easily accessible way for the public to understand the level of care they can expect. Represents a significant system-wide improvement, addressing service and information gaps.

• RCA’s Standardized Bedded & Community Definitions Framework for Levels of Rehabilitative Care:

• Establishes provincial standards for levels of rehabilitative care • Provides clarity for patients, families and referring

professionals on the focus and clinical components of rehabilitative care programs

• Standardized definitions for community-based rehabilitative care describe what should be provided to guide planning for home and community-based rehabilitative care services.

#2: Create a Levels of

Care Framework

10 Patients First: A Roadmap to Strengthen Home and Community Care, May 2015 http://www.health.gov.on.ca/en/public/programs/ccac/roadmap.pdf

http://www.health.gov.on.ca/en/public/programs/ccac/roadmap.pdf



• MOHLTC Bundled Care Approach: Where a group of providers will be given a single payment to cover all the care needs of an individual patient.

• Standardized dataset for outpatient rehab enables implementation of funding reform for Quality-Based Procedures by addressing the data gap within this part of the care continuum to help inform the OPR contribution to bundled care.

#4: Move Forward

with Bundled

Care





• RCA’s Levels of Care Framework provides a foundation to support capacity planning through a common understanding of rehabilitative care services.

• Implementation of the rehabilitative care capacity planning framework has the potential to generate system-wide cost savings through optimized use of community based rehabilitative care resources as an alternative to more costly inpatient rehab beds.

• Reporting of standardized data across outpatient rehab programs will further inform LHINs how to best optimize use of community resources to improve and maintain the functional status of people in the community.

#10: Develop a Capacity

Plan



Second Mandate Goals/Objectives

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A proposed second mandate work plan was submitted to and approved/endorsed by the LHIN CEOs on February 19, 2015.

This approval/endorsement positions the RCA’s first mandate deliverables for full provincial implementation by LHINs by March 2017.

The RCA will play a coordinating/supporting role as LHINs implement the deliverables.

www.rehabcarealliance.ca

Second Mandate Goals/Objectives

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Deliverables of the Second RCA Mandate are Organized Around 3 Pillars:

I. Provide project

management support

to the LHINs to guide

their implementation

of the standardized

RCA tools, processes

and frameworks

developed through the

first mandate.

II. Continue to

support LHINs and the

MOHLTC with Assess

and Restore related

initiatives. Facilitate

knowledge exchange

related to

implementation of the

A&R Guideline &

associated funding.

III. Support

implementation of

existing QBPs through

identification of

standardized

rehabilitative care best

practices across QBP

handbooks (where not

already defined).


LHIN CEOs MOHLTC

Rehabilitative Care Alliance Steering Committee

Co-Chairs – Donna Cripps and Peter Nord

ENABLERS

GTA Rehab Network Secretariat Support (Communication, Stakeholder Engagement, Coordination/Administration, Decision Support etc.)

Accountable to LHIN CEOs through

Alliance Co-Chairs

GTA Rehab Network

Secretariat

Contextual/Influencing Initiatives (Assess & Restore, Health System Funding Reform, Integrated

Funding Pilots, Coordinated Access, etc.)

QBP TJR Task & Advisory

Groups

Debra Carson Trillium Health

Partners

QBP Hip Fracture Task & Advisory

Groups

Roy Butler St. Joseph’s Health Care,

London

Outpatient / Ambulatory Task

& Advisory Groups

Marie Disotto-Monastero, Sunnybrook

Michael Gekas, Sinai Health System

Chris Sulway, TC LHIN

Definitions & CP Task & Advisory Groups

Dale Clement WW CCAC

Mark Edmonds CW LHIN

LHIN & HSP

Leads Advisory

Group

Mark Edmonds, CW LHIN & Andrea Lee,

Health Sciences North

FS/MC / A&R Task & Advisory

Groups

Dr. Jo-Anne Clarke,

North East SGS Carol Halt,

NE LHIN

Patient/Caregiver Advisory Group

Charissa Levy, RCA Executive Director

System Eval Task &

Advisory Groups

Imtiaz Daniel, OHA

Michelle Collins,

MH LHIN & Marilee Suter,

CE LHIN

Mandate II Governance

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Key RCA Deliverables and the Status of Implementation

RCA Framework for Community Levels of Rehabilitative Care

Bedded and Community Definitions Frameworks developed to provide clarity for patients, families and referring professionals through the development of common terminology, clear definitions and standards of practice for all levels of rehabilitative care across the continuum

Defines two levels of rehabilitative care and for each, describes the goal, target population, medical and healthcare professional resources, and the overall focus and underlying principles of therapy services provided in the community.

A ‘Referral Decision Tree for Rehabilitative Care’ was also developed to assist referrers and provide consistency in determining the kind of rehabilitative care that is needed (e.g., bedded vs. community-based) and which level of care is most appropriate for patients/clients.



RCA Framework for Community Levels of Rehabilitative Care

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www.rehabcarealliance.ca 18


‘Rehabilitative Care System Capacity Planning Framework’


Questions To Be

Answered by Capacity

Planning Process

Potential Measures/Considerations

Acute Care

Bedded

Rehabilitative

Care

Community/

Ambulatory

Bedded or

Community

Long Stay

Cu

rre

nt

Stat

e Population

Resources

Utilization

Access

Effectiveness

Complete Evaluation of Current State

Futu

re S

tate

Population

Resources

Utilization

Access

Effectiveness

Redesign


Rehabilitative Care System Capacity Planning Framework

Can be used by LHINs to identify the existing rehabilitative care services/programs across the rehabilitative care continuum and to support planning activities.

May be used, in whole or in part, to develop a capacity plan for either a broad or specific rehabilitative care population depending on availability of information and specific local needs.

Levels of rehabilitative care included in the framework were developed to align with the levels described within the RCA Definitions Frameworks.

Using the Capacity Planning Framework will support:

o Development of a common language

o Foundational understanding of local and provincial rehabilitative care system resources

o Identification of system/service gaps

o Development of the required services locally or provincially



Process to Support Frail Adults to Access Bedded Levels of Rehabilitative Care from the Community/Emergency Department

A three-step ‘Direct Access Priority Process’ that includes: i. Early Identification/Screening

ii. Assessment to Determine Need for Bedded Rehabilitative Care

iii. Streamlined Referral

Implementation will require local contextualization of the standard process in consideration of available community resources.

Includes new tools to support operationalization of the provincial ‘Direct Access Priority Process’ including: o description of the target population

o definition of ‘restorative potential’

o checklist to rule out an acute cause of functional decline

o referral map

o proposed process timelines and a decision tree


Where Community ED

Who CCAC CSS Primary Care GEMS or Delegate

When • Referral for ADL/IADL support • A change in functional status • Part of 90 day re-Ax

• A change in functional status

• At time of check-up

• Upon presentation with functional impairment(s)

How Assessment Urgency Algorithm (AUA)/CLINICAL IMPRESSION

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Step #1 Early

Identification/ Screening

Step #3 Streamlined Referral

• If the screen identifies the patient as being ‘high risk’ ii, an urgent comprehensive assessment may be required if clinically appropriate and/or not recently completed.

• The assessment in Step #2 is to be completed collaboratively with Primary Care, SGS i & other involved community providers

Who CCAC Specialized Geriatric Services i Primary Care Provider(s)

What

Arrange for Completion of a Comprehensive Clinical Assessment by a Healthcare Provider(s) with Geriatric Expertise that Considers the Geriatric Syndromes and Baseline and Current Functional Status including: A. Confirmation that Patient is “High Risk” ii

Recent ADL/functional decline Risk of needing ED, hospital or LTC if nothing is done

B. Confirmation of Restorative Potential iii

C. Ruling Out an Acute Medical Cause of Functional Decline w Primary Care/ED Practitioner

Step #2 Assessment to

Determine Need for Bedded Rehabilitative

Care Note: Where already involved,

consider consulting members of the community allied ID team to

support assessment

* Denotes potential Lead Provider. LHINs may identify another organization/group to lead Steps #3 based on local resources i As per definition provided in “Specialized Geriatric Services - Review Template” (July 7, 2014). Ministry of Health and Long-Term Care (MOHLTC)

ii As per Rehabilitative Care Alliance definition of ‘High Risk’. An AUA Score of approximately 5 or 6 reflects “High Risk” iii As per Rehabilitative Care Alliance definition of Restorative Potential iv As per Rehabilitative Care Alliance Definitions Framework

Lead Provider* Centralized Intake Receiving Bedded Rehabilitative Care Provider

What

A. Confirm patient is eligible for bedded level of Rehabilitative Care iv

B. Determine most appropriate level of bedded Rehabilitative Care iv

NOTE: Expedited “priority” access may be considered for patients who present to ED or are anticipated to imminently require institutionalization

Complete Referral Form and Send to Most Appropriate “Lead Provider” (as identified in collaboration w LHIN partners) who will lead/navigate Step #3.


Outpatient/Ambulatory Care Minimum Data Set

A comprehensive and standardized minimum dataset for outpatient /

ambulatory rehabilitative care developed to inform evaluation and

planning at the provincial, regional, organizational and program levels

Enable standardized data collection and the development of

comparable performance metrics, evaluation and planning at the

provincial, regional, local and organizational levels, and to inform LHINs

and health service providers of the role of outpatient rehabilitative care

in supporting other aspects of hospital and community-based services



Outpatient/Ambulatory Care Evaluative Framework


A. Overarching Questions

1. What is the primary reason for which the patient is seeking treatment in the outpatient/ambulatory program?

2. What is the primary diagnosis for which the patient is seeking treatment in the outpatient/ambulatory program?

B. Patient/Caregiver

Experience C. Clinical Outcomes D. Access and Transition E. Financial Performance

B1. What is the

patient’s / caregiver’s

reported experience of

their outpatient

rehabilitative care?

C1. How much functional change

occurred in activity and/or

participation while attending an

outpatient/ambulatory program

whose primary function is to

restore/optimize function?

C2. Where the objective of


was maintenance, education,

self-management or

consultative/ assessment, was

that objective achieved?

C3. Did the


influence the caregivers’ level of

stress/burden associated with

caring for the patient?

D1. How many days did the patient

wait (once ready for rehab) for the first

treatment appointment date?

D2. Which type of organization

referred the patient to OP rehab?

(acute care, home care, inpatient rehab

etc.)

D3. Of the patients requesting

treatment, how many actually received

treatment?

D4. How many referrals were declined?

Reason for declined referral?

D5. How many patients were accepted

to be treated by the OP program but

the patient did not accept?

E1. Was the treatment plan completed? If not,

why?

E2. What is the average direct cost for an episode

of care to treat each discharged patient by patient

population?

a) How many discharged patients were treated

by the program per period?

b) What types of services did the patients

receive?

c) What was the average length of each episode

of care?

d) How many visits/attendances (average/

median) per health profession functional centre

and for all health profession functional centre

did each patient receive in the episode of care?

e) How much time is the program providing to

the patient per episode of care?

Assumptions – A patient grouping/classification tool will be identified and utilized to capture: •the patient’s functional need •the reason for referral/for accessing service •diagnostic code

Help Us Keep You Informed

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Announcements of new resources and tools supporting best practice in rehabilitative care

Opportunities to engage in and contribute to RCA projects and initiatives

Provincial EOI circulated May 13th for return June 5th


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Thank you

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