Developing a system of care Robert D. Reid University of Ottawa Heart Institute breid@ottawaheart.ca

Institutional approach A brief history… Regional network Institutional approach “Tickers” Add: 0.5 FTE nurse IP program New leader, 1.0 FTE nurse Open OP Clinic

What changed to allow for dramatic growth in capacity?

Success comes from… doing ordinary things extraordinarily well… in a systematic way… at the right time… using effective interventions… with measured outcomes… within a network of care… and a culture of prevention.

Projected Outcomes of Preventive Interventions Intervention Lives Saved NNT Smoking Cessation 328,400 9 Lipid Lowering 132,777 34 BP Control 63,282 31 ACE Inhibitors (CHF) 11,000 N/A ß Blockers (MI) 17,023 120 ASA (MI) 10,365 143 Coumadin (A.Fib) 3,418 2,014

Doing ordinary things, extraordinarily well… IMPACT = REACH * EFFECTIVENESS

The Untapped National Potential 2,770,128 inpatient hospitalizations in Canada (02/03) If 20% hospitalized pts. smokers = 550,000 patients

“I rob banks because that’s where the money is” Willie Sutton

In a systematic way… Documentation of smoking status of every patient admitted to University of Ottawa Heart Institute Intervention for every smoker

The University of Ottawa Heart Institute In-Patient Smoking Cessation Program > 6500 admissions/year >1300 smokers identified (20%) Cessation counseling provided to 90% An absolute increase of 15% in long term cessation rates 195 new quitters

At the right time Prev Med 2003; 36(6):710-20

Using effective interventions… Brief or intensive counseling Pharmacotherapy Self-help materials Follow-up contacts Interactive voice response (IVR) technology Linked to community resources/programs

The Power of a Brief Intervention Ask Advise Assess Assist Arrange “A health professional’s advice to stop smoking increases the rate of smoking cessation by approximately 30 percent.”

Within a network of care…

“A thousand ways to make love but no lovers”

With measured outcomes… To demonstrate value for money To provide feedback and motivation To fine-tune your program To benchmark …and great stories that bring your program to life

A Culture of Prevention Smoking Cessation … single most powerful prevention Intervention in clinical practice

Types of influence for change

Social influences Champions Culture of prevention Feedback on performance

Policy influences Smoking cessation as a quality indicator Inclusion on care maps Standard orders Allocation of human resources

Organizational influences Documentation of smoking status (a vital sign) Staff training Availability of self-help materials Availability of pharmacotherapy Follow-up Data tracking Links to community resources Provincial quit line Referral to tobacco cessation specialists

Checklist Policy Quality indicator? Care map(s)? Standard orders? Designated people? Organization Documentation? Training? Self-help materials? Pharmacotherapy? Follow-up? Data management? Links? Social Champion? Culture of prevention? Feedback?

Success comes from… doing ordinary things extraordinarily well… in a systematic way… at the right time… using effective interventions… with measured outcomes… within a network of care… and a culture of prevention.