Integrating AMI Care Across a Healthcare Service System Safer Healthcare Now National WebEx October 19 th, 2009 Diane Shanks and Leila Lavorato

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3 Regionalization Occurred in 1995 Influenced “systems” approach to care delivery –Identified gaps –Provided opportunities to address gaps through collaborative approach and processes

4 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

5 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

6 Strategies Clinical Pathway Standardized physician order sets/forms Staff education and training Indicator collection and analysis

11 Performance/Quality Indicators Challenges of data collection –Multiple sources/care environments/sites –Resource limitations –Timeliness Variety of indicators required –Utilization –Quality –Performance

12 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

13 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

14 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

BUILDING HEALTHY LIFESTYLES CARDIAC REHAB PROGRAM Our Patient’s Journey Presented October 19, 2009 Leila Lavorato

20 Referral – Automatic - ACS pathway – Health Care provider – Self / Family Initial Intervention – Inpatient visit / introduction – Education Package – Intervention screening

21 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

22 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

23 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

24 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 or direct

BUILDING HEALTHY LIFESTYLES PROGRAM MODEL Patient/FamilyHealth Care Provider Physician Building Healthy Lifestyles Referral to home base - NAVIGATED Secondary / Tertiary Prevention Primary Prevention Disease Specific Programs - Assessments – Education - Management Building Healthy Lifestyle Group Classes DISEASE SPECIFIC PROGRAM OUTCOMES THERAPEUTIC EXERCISE REFERRAL PRE REQUISITION COMPLETION PHYSICIAN 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/HOME 6 Month & 12 Month Testing & Follow Up Diabetes Heart Function Clinic / Network Clinical Nutrition Acute Coronary Syndrome - Cardiac Chronic Respiratory Risk Factor Mx Weight Loss