1 / 22

Experience in Other Provinces: Ontario Stroke Analysis Quebec Stroke Summit October 7, 2008

Experience in Other Provinces: Ontario Stroke Analysis Quebec Stroke Summit October 7, 2008. Mary Lewis Director Government Relations and Health Partnerships, Heart and Stroke Foundation of Ontario. Mission : To continuously improve stroke prevention, care, recovery and re-integration.

Télécharger la présentation

Experience in Other Provinces: Ontario Stroke Analysis Quebec Stroke Summit October 7, 2008

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Experience in Other Provinces: Ontario Stroke Analysis Quebec Stroke Summit October 7, 2008 Mary Lewis Director Government Relations and Health Partnerships, Heart and Stroke Foundation of Ontario

  2. Mission: To continuously improve stroke prevention, care, recovery and re-integration.

  3. History • Guiding Principles: • Comprehensive • Integrated • Evidence-based • Province-wide

  4. OntarioStroke System Foundation of the Ontario Stroke System Communication Evaluation Monitoring, & CQI Research & Education Clinical, Process Standards Best Practice across the Continuum of Care Fewer strokes. Better Outcomes. Patient and Family Health care team Emergency Acute Prehospital Transition Stroke recognition Rehab Prevention Community & LTC Integration: System change

  5. Medical Director Regional Manager Education Coordinator Rehab Coordinator Community & LTC Coordinator Allied Health Outreach Admin support Funding Directed To: • 9 Regional Stroke Centres • 2 Enhanced District Stroke Centres = 11 Regional Teams • 16 District Stroke Centres • 24 Secondary Prevention Clinics • $1.4 Million for Research/Best Practices • $4.6 Million for Health Promotion CNS Behaviour Modification Admin/Coordinator

  6. OntarioStroke System Best Practice across the Continuum of Care Emergency Acute Prehospital Transition Stroke recognition Rehab Prevention Community & LTC • Regional acute stroke protocols – medical redirects for access to tPA • Telestroke • Organised emergency care • Acute Care pathways, early rehab • Acute stroke units • Dysphagia management • Rehab pilot projects • Triage to rehabilitation • Standards for rehab • Access to rehab • Telerehab • Enhanced community based rehabilitation • Community re-integration • Education in LTC • Public awareness • Links: public health, primary care • Healthy living – smoke-free living, physical activity, healthy eating • Blood pressure management • Risk factor management • TIA management • Secondary prevention clinics • Infrastructure • Research • Best practice guidelines • Clinical process standards • Education • Interprofessional care & expertise • Evaluation & CQI

  7. Enablers for Success • Broad engagement • Shared vision – finding common ground • Dedicated change agent/infrastructure • Champions • Networks and partnerships • Evidence based practice guidelines • Knowledge translation focus • Sharing of resources, tools, processes (care pathways, algorithms, agreements, protocols) • “Healthy” competition

  8. Lesson Learned in Achieving an Integrated Care System The process is just as important as the content • Engage all stakeholders from the beginning and keep it collaborative, multidisciplinary • You are implementing a system change that needs both champions and full-time “change managers” • Use evidence (best practice) to drive changes • You need to measure and monitor the impact of your system changes

  9. Lewis M, Trypuc J, Lindsay P, O’Callaghan C, Dishaw A.Healthcare Quarterly 9:50-59, 2006

  10. OSS Successes: Regional Stroke Centres Stroke registry of the CSN

  11. OSS Successes: Provincial Provincial CIHI DAD data

  12. Evaluation: Summary of Successes • Volumes • OSS diversion of patients to more specialized stroke centres • Volume of stroke admissions stable or decreased despite the projections of increased #’s of stroke with the aging population. • ED: increased access to tPA • Prevention • Improved wait times for CEA/CAS • Decreased one year re-visit rates for ON and for SEO • Decreasing mortality rates • Inpatient acute care • Reduction in complications • ALOS stable • In-hospital mortality rates decreasing

  13. Other Successes • Capacity building • Partnerships • Emergence of the Canadian Stroke Strategy • Cross Continuum Approach • New organisational design

  14. Evaluation: Summary of Areas to Improve • Greater number of younger people are experiencing stroke (19-65 year olds) • Wait times for CEA much higher for DSCs and community hospitals than RSCs. • Public awareness: 60% of pts at RSCs are not arriving in time to be eligible for tPA • Access to inpt rehab is limited for severe stroke and varies across the province • Limited and inequitable access to ambulatory and community based interprofessional rehab services • Limited public funding for help with pyschosocial issues

  15. OSS Rehab Challenges Provincial CIHI NRS data

  16. Recent Rehab Successes • Uptake from rehabilitation pilot projects • One region: Specialized stroke community rehab teams • Action plans for implementation of rehab consensus panel standards

  17. Making it Better • Provincial/Regional evaluation and performance improvement • Align research with system priorities • Align provincial and regional initiatives • Align initiatives with LHIN priorities – e.g. CDPM • Leverage e-health • Greater focus on rehabilitation and community re-integration

  18. Current Challenges • Finding the balance: provincial standards/ coordination vs regional implementation – will the provincial focus be lost? • Will LHINs ensure accountability for regional roles? – Lack of clarity re accountability. • How will inequities be addressed? • How do we balance disease specific issues with chronic disease approaches? • Mismatch/inequities in the evidence base

  19. Future Directions Fewer strokes. Better Outcomes. Patient and Family Health Care Team Emergency Acute Prehospital Transition Stroke recognition Rehab Prevention • 5 Provincial Strategic Directions • Credible Advisor to Improve Stroke Prevention & Care • Leadership and Coordination • Evaluation to Support Continuous Improvement • Innovation and Knowledge • Best Practices across the Care Continuum Community & LTC

  20. Thank you! For more info, visit: www.heartandstroke.ca/profed

More Related