1. Strategic Clinical Networks & Clinical Care Pathways: Creating & Managing Quality in Alberta Health Services CEO Forum Feb 6, 2013 Montreal
Dr Tom Noseworthy

2. Alberta Health Services
One health care delivery system for an entire Province
The ‘third way’ in Canada
Largest health care system in Canada- 3.7 million people
Budget $12B, 100,000 employees, 7500 doctors
Formed in 2008, 5 Zones added in 2010, Networks in 2012
Nine clinical networks launched to date
Up to six more planned
We aspire to being the best in Canada

3. How will the Provincial Clinical Mandate of AHS be Accomplished?
Strategic Clinical Networks
Clinically-led change
Performance measurement, research & best evidence drive practice
Clinical care pathways
Clinical variance management & peer review

4. Goals of Clinical Networks?
Achieve the best outcomes
Practice the highest quality of clinical care
Seek the greatest value from resources used
Engage clinicians in all aspects of this work

5. Why Clinical Networks?
Networks are positive ways for all partners along a broad continuum to be involved in planning & improving care & service delivery
Networks have been shown to be an effective mechanism to ensure collaboration, joint decision-making and shared learning
Networks are a proven model to promote the use/uptake of clinical experience, knowledge and evidence-based clinical pathways to reduce clinical variation & improve care

6. What are Strategic Clinical Networks (SCNs)?
Collaborative clinical teams with a provincial strategic mandate to improve quality & outcomes
Led by clinicians, driven by clinical needs, focused on outcomes & based on best evidence
Comprised of an all-inclusive membership, with 25 core members (community & specialty clinicians, patients, policy-makers, researchers) & leadership (0.5 Senior Medical Director, 0.5 Strategy Vice-President & 0.3 Scientific Director)

7. Scope encompasses entire continuum of care
How do SCNs Work?
Broad mandate:
Specific populations: seniors, women's health, children
High impact: cardiovascular disease & stroke
High burden: diabetes, obesity & nutrition, amh
Scope encompasses entire continuum of care
From population health & prevention to primary care to acute care to chronic disease management to palliation
Projects & activities aligned with AH & AHS, priority-setting integrated with & into organizational decision-making
Resourced & supported to improve clinical outcomes

8. Planned Support & Resources for Each SCN
Dedicated Business Intelligence Unit
Project management, clinical analytics, case costing, quality improvement, pathway development, patient safety, knowledge management, health technology assessment
Embedded research capability and expertise
Education & skills development for leaders
Funding including:
Seed money for innovation, initiatives, and research
Remuneration of core members
Opportunities to retain savings that are realized

9. First Six SCNs (June 12/12) Addiction and Mental Health
Bone and Joint Health
Cancer Care
Cardiovascular Health and Stroke
Obesity, Diabetes and Nutrition
Seniors’ Health

10. Next Six SCNs (Fiscal 2013) Population Health and Health Promotion
Primary Care & Chronic Disease Management
Maternal Health
Newborn, Child, and Youth Health
Neurological Disease, ENT, and Vision
Complex Medicine (GI, Kidney & Respiratory)

11. Operational Clinical Networks
Similar to SCNs
Provincial, clinically led teams
Similar infrastructure & resources
Differ from SCNs
Responsible across populations
Operationally focused
Social determinants/ EOL agenda not required in projects

12. Three Operational Clinical Networks (Jan13)
Critical Care
Emergency Services
Surgical Services

13. Obesity, Diabetes & Nutrition Addiction & Mental Health
Snapshot of all 12 SCN ( & 3 OCN Projects) ** 9/15 new projects are ready to initiate by January 31, 2013
Cardiovascular Health and Stroke
SCN
Obesity, Diabetes & Nutrition
SCN
Seniors’ Health
SCN
Bone & Joint
SCN
Cancer
SCN
Addiction & Mental Health
SCN
Surgery
OCN
Emergency
OCN
Critical Care OCN
Insulin Pump criteria**
Fragility & Stability -
Hip Fracture Rx and Prevention**
ART
E-referral**
Depression Pathway
aCATS**
TBD
TBD
Vascular Risk Reduction
C-CHANGE**
Inappropriate use of antipsychotics**
Rural Stroke Program**
Enhancing recovery after surgery**
Elder Friendly Care**
Hip & Knee 5 year Plan
Lung Cancer
Safe Surgery Checklist**
3 avoid risks for AHS
4 equally high value
4 with some external funding
1 aligned with IHHP concept
3 Placeholders for SCN/OCN Equity
2 Mature Tier 1: in flight

15. CV&S: Rural Stroke Action Plan
Project Scope:
Create standards and clear definition of rural stroke unit care
Implement early supported discharge (ESD) & enhanced stroke unit care in 5 small stroke centres
Implement enhancements to stroke unit care for 10 rural primary stroke centres
Project Financials:
Q4 (12/13): $ 141,964
13/14: $1,745,950
TOTAL Project: $2,873,594
Benefits to be Realized:
Short term – Jan 31/ 13 – Mar 31 /14
ESD implemented in 5 small centres serving100 patients
26% reduction in length of stay; 3 persons avoid nursing home care; 1 life saved
Long term– year window
214 new patients per year receive ESD and over 1000 new patients per year receiving full stroke unit services; 23 lives saved/year; 17 patients avoid nursing homes after stroke/year
Reduction in length of stay of over 20%
System Impact:
Acute care
Transition management
Long term care

16. CV&S: Vascular Risk Reduction
Project Scope:
Opportunity to lead country in OHS screening for vulnerable populations & impact lifestyle changes in patients with vascular risk through:
Screening & early management to increase early diagnosis & treatment of disease – done in community pharmacies across Alberta & 1 designated worksite (TBD)
Reduction in morbidity & mortality by:
C-CHANGE adoption in primary care, community pharmacies and worksite (s) TBD
Target vulnerable populations
Integrate & enhance risk reduction clinics across system
Project Financials:
Q4 -12/13: $ ,557
13/14: $1,182,228
TOTAL AHS COST: $1,226,228
Partner contributions (TBD):
Alberta Health – C-CHANGE roll out (see next slide) * budget TBD for TOPS
Pharmacies / worksite – provide program delivery & budget to support operations within their setting (TBD)
Benefits to be Realized:
Short term – Jan 31/ 13 – Mar 31 /14
% increase in screening rates in 2000 physician practices across Alberta
>6000 screened in community pharmacies & worksite (>20% in areas of high vulnerability)
Long term – year window
10% reduction in smoking rate
80% who are screened meet target for BP, LDL-C
System Impact :
Prevention – primary and secondary
Ambulatory care, primary care, community, industry
Integrated approach
Pan SCN initiative ODN, AMH, Cancer