Presentation on theme: "Canadian Health Outcomes for Better Information and Care"— Presentation transcript:
1Canadian Health Outcomes for Better Information and Care C - HOBICCanadian Health OutcomesforBetter Information and Care
2C-HOBIC Overview Project Background WRHA Implementation RAI outcome measuresChallenges and Lessons LearnedDiscussion.
3C-HOBICBackground:National Research Project in partnership with Canadian Nurses AssociationFunded by Canada Health InfowayProvinces involved: Manitoba, Ontario, Saskatchewan
4Project IntentProvide information to Health Care Professionals on clinical outcomes from information based on nurse sensitive indicatorsExplore how the outcome information is integrated into the work flowUtilization of the clinical data availableDescribe how managers and front-line health care professionals use the information to further evidence informed practice and care planning for the clients/patientsCreation of reportsIn Home Care, the nurse sensitive outcomes were broadened to include other disciplines as well, because the clinicians include not only nurses, but social workers and occupational therapists.
5Project DeliverablesDevelopment of 3 reports for use by clinicians and managersProvision of education on access to the reportsProvision of education on integration of the reports into care planning processProvision of follow-up support to clinicians and managersFacilitation of the evaluation of the Project in May 2009.
6Timeline Project Start - Oct 08. Report Requirements – Nov 08. Report Development – Complete Jan 2009.Staff Training – Jan 2009.Implementation – Feb to Mar 09.Follow-up Training & Support – Ongoing.
7Participants Six PCHs. Six Home Care Offices. Over 225 nurses. 60 Case Coordinators (professionals in a health related discipline)
8Participant Recruitment Provided information on the C-HOBIC project.Outlined commitment of regional staff to provide education.Outlined site responsibility to provide ongoing education.
9Education PlanGoal: to provide education about the use of reports in the care planning process including various RAI reports and the C-HOBIC report.Wanted to show the value of the previous work done by staff in the completion of the RAI. They could now get information which would help in the delivery of care.
10EducationLTC - The Education Plan included a central launch session and two site based sessions.HC - Staff were trained in small groups or individually.Two hour PowerPoint presentation with hands on access to CHOBIC report.Follow-up support.
11Educational Presentation Outline C-HOBIC project.Outcome data: why is it important.Review of care plan requirements.Discussion of interdisciplinary team approach to care planning.Report integration into the care planning processwhen, who, how.Report review and access.RAI outcome measure reports and C-HOBIC report.11
12Resident Assessment Instrument (RAI) A standardized assessment tool; different versions for home care (HC) and long term care (LTC)Completed on admission and quarterly in LTCCompleted on admission and annually in HCUsed to collect a minimum data set (MDS) with triggers for further assessmentCompleted electronically
13RAI Outcome MeasuresEach Measure evaluates a different aspect of the clinical status of the client.Each Outcome Measure is based upon carefully selected items in the RAI-HC and RAI-LTC assessment.Measures leads the clinician through an investigative process when reviewing the assessment, in creating the care plan and evaluating the care plan and client status.Evaluating the results of the care plan:Has the client’s status changed,If yes, ask yourself:What are the causal factors of the client’s change? E.g. new illness, change in informal or formal supports, etc.Is a change in care plan needed and are additional/different supports required?Is the client’s functional decline a factor of the aging process?Is the client’s functional improvement directly linked to the specific formal/informal supports provided? Eg. Stroke rehab clients; client/caregiver stress reduction service provision.If no, ask yourself:Is the care plan maintaining the client as expected? Often when there is no change in client function, we have attained our goal.
14RAI Outcome Measures IADL Difficulty (RAI-HC) IADL Involvement (RAI-HC)Cognitive Performance ScaleDepression Rating ScalePain ScaleIndex of Social Engagement (RAI-LTC)ADL Self-Performance Hierarchy ScaleCHESS Scale – Changes in Health, End-stage disease and Signs and SymptomsMAPLe Score – Method of Assigning Priority Levels (RAI-HC)
15RAI Outcome Measures IADL Difficulty (RAI-HC) Captures patterns of difficulty with the tasks of housework, meal preparation, and phone use.IADL Involvement (RAI-HC)Measures performance patterns of the tasks of housework, meal preparation, and phone use.Cognitive Performance ScaleMeasures cognitive status using daily decision-making skills, making self understood, short-term recall, and eating.
16RAI Outcome Measures Depression Rating Scale Pain Scale Score of 3 or more suggests possible depression; based on Section E, Questions 1a – g.Pain ScaleScore based on two questions: pain frequency and pain intensityIndex of Social Engagement (RAI-LTC)Measure of level of participation in social activitiesScore 0-6; higher score identifies increase in social activityADL Self-Performance HierarchyMeasures activities of daily living performance according to early, middle, and late stages of loss.Depression Questions: Section E.1a. client’s negative statements1b. persistent anger1c. expressions of unrealistic fears1d. repetitive health complaints1f. sad or worried expression1g. TearfulnessPainThere is a quality initiative looking into pain and how we identify it, and how to care plan around it.ADL Self-performance HierarchyEarly loss – personal hygieneMiddle loss – toilet use/locomotionLate loss – eating
17RAI Outcome Measures CHESS Changes in Health and End-Stage Signs and SymptomsMeasures medical complexity and health instability.Higher scores are associated with higher mortality, use of acute hospital services, pain, receipt of specialized treatments, and poor health outcomes.Score is based on:VomitingDehydrationLeaving uneaten foodWeight loss,SOBEdema,End-stage DiseaseDecline in cognitionADL
18RAI Outcome Measures MAPLe (RAI-HC) Method of Assigning Priority LevelsPredictive of facility admission, caregiver stress, or a feeling by family or client that the client would be better off elsewhere.Those clients in the Very High level are 10 times more likely to be admitted to a long term care facility within 3 months.Score is based upon:CognitionADL function and/orBehaviour disturbances including wandering.Show handout – MAPLe decision tree
19C-HOBIC Outcome Measures Included in the WRHA Project:ADL – Activities of Daily LivingBladder ContinencePainFallsPressure UlcersIADL – Instrumental Activities of Daily Living (Home Care)Not Included in the Project:Fatigue, Dyspnea, Nausea, Therapeutic Self-careThe data for the outcome measures was derived from the RAI-HC and RAI-LTC; those measures not included from the original project were those that could not be derived from the available assessment instruments presently utilized within the region.The Project focuses on more specific areas within the RAI-HC and the RAI-LTC assessment to give the clinician a more detailed analysis of the client’s/patient’s functional abilities in certain areas.
20C-HOBIC Individual Outcome Measure Report Provides a detailed analysis of each client’s/patient’s outcome data for the specified indicatorsMeasures are intended to lead the clinician through an investigative process when reviewing the assessment, in creating the care plan, and evaluating the results of the care plan and client status.
21LTC - Individual Report Show results for four quarters..most recent to remote (will be changing that)ADL…includes all of items in G section to show progress or decline over time as well as the ADL long form which is just a summary of a,b,e,g,h,i,jBladder continence, pain freq and intensity, falls, and skin ulcers is simply pulling forward values you entered in the last four quarters so you can easily compareRemember under skin ulcers MDS is asking for all types of wounds to be captured here (M1)..not just pressure ulcers ; have also included data from M2a…which was not indicated as required in the CHOBIC measures documentCan look to the quality indicator report to see how many pressure ulcersDEMO OF SOFTWARE AT THIS POINT IN PRESENTATION21
22HC - Individual Summary Report Provides a detailed analysis of the individual client’s functional status in the specific areas. The data is taken from the most recent four completed, locked RAI-HC assessments.22
23C-HOBIC Management Outcome Measure Report - Detailed Provides a detailed analysis of a specified caseload or office in Home Care or a specified unit within a facility or a facility in LTC with respect to the outcome data for the specified indicatorsI.e. These values identify the number of clients who have scored in each level of dependence in a particular quarter.
24Management Outcome Measure Report - Detailed The data are collected from the total number of assessments completed in each specific category from each yearly quarter (Q)Q1 = April, May, JuneQ2 = July, Aug, SeptQ3 = Oct, Nov, DecQ4 = Jan, Feb, Mar
25LTC - Management Detailed Report Indicates it is number of clients….actually number of assessments completed and signed off in the quarter25
26HC - Management Detailed Report Note: total number of clients may not equal the breakdown within each outcome measure, as there may have been 2 or more assessments done on the same client(s) during the one quarter.26
27C-HOBIC Management Outcome Measure Report - Summary Provides average values of the outcome data within the specific community area for Home Care and for the unit and facility for Long Term Care
29HC -Management Summary Report The report can be run by CC Caseload or Office29
30Lessons LearnedNeed to meet face to face with participants early on to ensure understanding of commitment and specific learning needs.Need to check and verify technology at each site before education begins.Investigate current technology solutions in use by clinical staff and define impact on the project.Not being able to access the reports directly from the RAI has been a significant issue for clinicians.30