1. Developing a system of care
Robert D. Reid
University of Ottawa Heart Institute

2. 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

3. What changed to allow for dramatic growth in capacity?

4. 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.

5. Projected Outcomes of Preventive Interventions
Intervention Lives Saved NNT
Smoking Cessation 328,
Lipid Lowering 132,
BP Control ,
ACE Inhibitors (CHF) 11,000 N/A
ß Blockers (MI) 17,
ASA (MI) ,
Coumadin (A.Fib) , ,014

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

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

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

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

10. 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

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

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

13. 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.”

14. Within a network of care…

15. “A thousand ways to make love but no lovers”

16. 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

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

18. Types of influence for change

19. Social influences Champions Culture of prevention
Feedback on performance

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

21. 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

22. 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?

23. 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.