Integrating AMI Care Across a Healthcare Service System
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Integrating AMI Care Across a Healthcare Service System
Safer Healthcare NowNational WebEx
October 19th, 2009Diane Shanks and Leila Lavorato
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Regionalization
• Occurred in 1995• Influenced “systems” approach to care delivery
– Identified gaps– Provided opportunities to address gaps through
collaborative approach and processes
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Program Management
• Regional administrative and quality oversight– Facilitated the standardization of policies, protocols, and
equipment– Facilitated a regional approach to data collection/management
and analysis• Provided clinical expertise• Provided a strong collaborative network of clinical experts to
support a health “system” approach to care
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Multidisciplinary Committee
• Membership included key departments/services/individuals influencing care delivery to the AMI patient population
• Representation from across the continuum from pre-admission to community care
• Regional representation
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Strategies
• Clinical Pathway• Standardized physician order sets/forms• Staff education and training• Indicator collection and analysis
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Performance/Quality Indicators
• Challenges of data collection– Multiple sources/care environments/sites– Resource limitations– Timeliness
• Variety of indicators required– Utilization– Quality– Performance
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Approach and Heart Alert
• Electronic databases for the collection of clinical data of acute coronary syndrome patients admitted to a healthcare facility for coronary care and procedures
• Established in Alberta, but has expanded across Canada
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Approach and Heart Alert
• Provided the opportunity:
to capture data in one system
to contribute to Provincial/National database
to improve the continuity and timely exchange of vital patient information between referral regions
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Implementation
• Developed processes for data collection and entry in a timely manner
• Implemented region wide• Implemented within current resources• Developed (with the support of Approach resources)
administrative reports for our own organizational purposes
Implemented October 1, 2007
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BUILDING HEALTHY LIFESTYLES CARDIAC REHAB PROGRAM
Our Patient’s Journey
Presented October 19, 2009Leila Lavorato
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• Referral
– Automatic - ACS pathway
– Health Care provider
– Self / Family
• Initial Intervention
– Inpatient visit / introduction
– Education Package
– Intervention screening
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• Education Series– Heart CHEC
• “What Now?”• “What Next?”
– BHL Class Calendar – free, no referral needed• Generic• Disease specific topics
• Assessment– Program Nurse– Coaching model / Motivational interviewing– Set SMART goals / Develop action plans– Consult programs / services
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• Exercise testing/screening
– BHL program referral / Pre Requisite / Physician approval
– Pre Testing / Screening
• 6 Minute Walk Test
• Timed Up and Go
• Body Composition
– Establish Exercise Level I, II, III
– Identify activity tolerance / physical limitations
– Determine Site or Home based
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• Exercise programming
– COMMUNITY SITE • Emergency procedures • Levels I, II, III• Mixed groups• Led by RN, RT, EP• 2 / week for 3 months + home exercise• Structured, monitored moving to self managed activity• Aerobic, Muscle Strength, Stretching exercises
- HOME BASED • Fit and Functional Class / Lifestyle Journal• Regular check- ins• Same follow up and testing
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• Follow up – 3, 6, 12 months– Exercise Testing– Cardiac Rehab specific Group Visit
FOR MORE INFORMATION
BUILDING HEALTHY LIFESTYLES CARDIAC REHAB PROGRAM CALL TOLL FREE 1 866 506 6654 or direct 1 403 388 6329
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BUILDING HEALTHY LIFESTYLESPROGRAM MODEL
Patient/Family Health Care Provider Physician
Building Healthy LifestylesReferral to home base - NAVIGATED
Secondary / Tertiary PreventionPrimary Prevention
Disease Specific Programs - Assessments – Education - Management
Building HealthyLifestyle
Group Classes
DISEASESPECIFICPROGRAM
OUTCOMES
THERAPEUTIC EXERCISE REFERRAL
PRE REQUISITION COMPLETIONPHYSICIAN APPROVAL
EXERCISE TESTING
FIT & FUNCTIONAL
HOME EXERCISE Levels I, II or III - Endurance - Muscle Strength - Flexibility
Level I
Level II
Level III
- Incident Report
- Progress Report
3 month POST PROGRAM OUTCOMES
COMMUNITY/HOME6 Month & 12 MonthTesting & Follow Up
Diabetes
Heart FunctionClinic / Network
Clinical Nutrition
Acute CoronarySyndrome - Cardiac
ChronicRespiratory
Risk Factor MxWeight Loss