Advancing High Quality and High Value Palliative Care

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1 Advancing High Quality and High Value Palliative Care OCTOBER 2014 Hspice Palliative Care Prvincial Steering Cmmittee Update 7 HOSPICE PALLIATIVE CARE PROVINCIAL STEERING COMMITTEE MEETINGS HIGHLIGHTS (9/16/2014) At the last Steering Cmmittee meeting in September, members apprved the fllwing six pririty indicatrs t measure Palliative Care in the prvince: 1. Hme supprt fr discharged palliative care patients 2. ER visits in the last 2 weeks f life 3. % f palliative care patients discharged frm hspital that were seen in the ER within 30 days 4. CCAC hme care wait times 5. Outpatient palliative care wait times- Reginal Cancer Centres 6. Hspital readmissin within 30 days fr palliative care patients The technical specificatin and target setting guidelines are currently being refined. It is anticipated that these indicatrs will be shared fr LHIN endrsement in upcming Service Accuntability Agreements (cmmencing 2015/2016. These indicatrs, alng with thse currently under further develpment, will supprt LHINs in achieving the strategic gal f a 10% reductin in the ttal number f hspital days that are attributed t palliative care.

2 2 Update frm Cmmunicatin and Awareness Wrking Grup Cmmunicatins and Public Awareness is a key issues identified in the Declaratin f Partnership and Cmmitment t Actin (the Declaratin). The wrk undertaken in includes: Under Build Public Awareness and Engage in Public Dialgue Prmted Advance Care Planning Day (April 16, 2014) Thrugh Hspice Palliative Care Ontari s (HPCO) Advance Care Planning-Health Care Cnsent Cmmunity f Practice, recrded fur educatinal sessins n Advance Care Planning (ACP) fr health service prviders; the general public, and a train- the-trainer wrkshp fr health prfessinals. Psted vides nline at HPCO alng with wrkshp PwerPint presentatins and facilitatr guides Distributed t each LHIN and Hspice Palliative Care/End Of Life Netwrk a cpy f the vides n CD and hard cpies f the ACP Ontari Wrkbk. Initiated cnversatins with specific calitin partners (OHA and OMA) t prmte adptin f Speak Up Ontari ACP materials. Wrk with ther calitin partners t prmte Speak Up Ontari Under Imprve Access t Infrmatin Thrugh a Central Hub fr Infrmatin and Supprt. Initiated an inventry f knwn HPC related websites, database, and infrmatin surces Validated/updated the links frm the inventry Develping a categrizatin system fr site cntent Initiated a dialgue with thehealthline.ca Infrmatin Netwrk abut using thehealthline.ca as the back end fr the Central Hub Presenting cncepts t jint LHIN/PEOLCN table fr discussin and feedback (Oct/14) Submit recmmendatin t HPC SC n implementatin f the Central Hub Update frm Clinical Cuncil Selected frm a large pl f phenmenal palliative care leaders thrughut Ontari, Dr. Denise Marshall was selected as the clinical leadership fr the Steering Cmmittee and Clinical Cuncil, taking n the rles f Chair - Clinical Cuncil (Chair) & LHIN Prvincial Lead fr Hspice Palliative Care t lead

3 3 significant and crdinated enhancements in palliative care prvince-wide and further the recmmendatins utlined in the Declaratin f Partnership fr advancing high quality, high value palliative care in Ontari Fllwing an inspiring respnse t the call fr applicatins t the Clinical Cuncil a small membership was drawn frm the strng leadership fund within Ontari s palliative care cmmunity - representing a variety f care specialties and regins thrughut the prvince Leadership fr the Clinical Cuncil was further strengthened by the installatin f the Vice Chair psitin, Dr. Jeff Myers t wrk alngside the LHIN Prvincial Lead fr Hspice Palliative Care & Chair in leading the Clinical Cuncil in prviding advice t the Steering Cmmittee frm a clinical and implementatin perspective n the actin cmmitments utlined in the Declaratin. The Vice Chair will als wrk with the Chair in ensuring that hspice palliative care is planned and delivered, under the gvernance structure established as part f the Prvincial Hspice Palliative Care Steering Cmmittee The Clinical Cuncil was installed and held its inaugural meeting n June 27th, during which it aimed t develp a cmmn visin fr the Cuncil, a shared understanding f its mandate, and a critical path fr its future wrk The Cmmunity Care Access Centres in Ontari are cmmitted t imprving palliative care service delivery. Twards this gal, the CCACs have implemented a ppulatin fcused mdel f care which includes specialized prgrams fr palliative patients. The 14 CCACs als implemented the Hspice Palliative Care Nurse Practitiner prgram t supprt end f life care and earlier identificatin f palliative patients with advanced chrnic illness. In additin, six CCACs have been pineers in testing integrated care mdels fr palliative patients thrugh the Integrated Client Care Prgram (ICCP). With an interest in advancing palliative care acrss the CCAC sectr the CCACs are embarking n an initiative this Fall t review CCAC palliative prgram best practices and t identify practices fr prvincial spread. The gal is t ensure patients in every part f Ontari have access t high quality palliative care services thrugh the CCACs. Ontari Cmmunity Care Access Centres

4 4 A Clinical Change Strategy dcument is being finalized in rder t make explicit a change strategy that will infrm the wrk f the Clinical Cuncil, and help the Cuncil arrive at specific, scalable and feasible clinical recmmendatins based n the fllwing clinical pririties utlined in the Declaratin: Palliative care needs t be accessible at the right time Family members r infrmal caregivers need t be well supprted Palliative care delivery needs t imprve fr all care settings Palliative care needs t be delivered acrss settings in mre integrated and seamless ways Individuals, teams, rganizatins and regins must share accuntability fr palliative care delivery Awareness and wnership fr excellence palliative care must be taken n by the public. Several recent Ontari evidence based initiatives have prduced key learnings that will be examined and where pssible, utilized by the Clinical Cuncil as it frmulates its clinical recmmendatins. The emphasis will be tw fld; t use the majr current, Ontari centric palliative care clinical initiatives, and t meaningfully discern and articulate unifying clinical recmmendatins fr Ontari, that have capacity fr bth standardizatin fr Ontari and reginal custmizatin. Time-limited Expert Panels ppulated by clleagues engaged in wrk related t the key activity r initiative and frm whm input n the clinical recmmendatin is critical will be struck t make specific recmmendatins based n their understanding f best practice recmmendatins and evidence. Specific bdies f wrk will be reviewed t extract key, pririty, scalable clinical recmmendatins. Synergy and verlapping recmmendatins frm the wrks (including the Auditr General s Reprt) will be highlighted, and the Clinical Cuncil thrugh the Chair and Vice Chair will present its recmmendatins t the Steering Cmmittee by the end f the calendar year With such a rich palliative care cmmunity in Ontari and varius leadership rles thrughut the prvince amng many rganizatins the membership f the Clinical Cuncil will be further strengthened by ensuring the alignment f the Cuncil s directin with these rles, ptentially adding members t the Cuncil.

5 5 Update frm Data and Perfrmance Subcmmittee The Prvincial Hspice Palliative Care Steering Cmmittee develped a data and perfrmance measurement strategy t drive imprvement in the delivery f palliative care in Ontari. This will help t advance the cmmitments utlined in the dcument Advancing High Quality, High Value Palliative Care in Ontari: Declaratin f Partnership and Cmmitment t Actin. As such, the Data and Perfrmance Measurement Subcmmittee was struck in 2013 and is cmprised f health care prviders, patient/family advisrs, health system administratrs, and academic experts in measurement and palliative care frm acrss Ontari. The main bjectives f the Subcmmittee are t develp and implement a data and perfrmance measurement strategy fr the delivery f palliative care in the prvince f Ontari. Specifically, t: 1) Develp a prvincial wrk plan that is aligned with the Declaratin and that supprts the 14 LHINs reginal plans; 2) Supprt the LHINs aim f develping an verarching system impact indicatr, as well as ther indicatrs t supprt that wrk; and Supprt the advancement f high quality and patient-centred palliative care in the prvince with a unified set f indicatrs and standardized apprach t data and perfrmance measurement. The wrk undertaken t date includes: leveraging Natinal Quality Fundatin (NQF) and Triple Aim elements t develp an Evaluatin Framewrk Develpment a Literature Scan & Snwball Sampling, which identified additinal indicatrs and inventry f measurement cncepts; where pssible indicatrs were assigned t an element f the evaluatin framewrk Mdified Delphi Cnsensus exercises: i. ROUND 1: Narrwing f indicatr list based n relevance, utcmefcused, directinality, actinability ii. ROUND 2: Assignment f indicatrs int 3 categries: accuntability, explanatry, develpmental iii. ROUND 3: Rank rdering f accuntability indicatrs by Subcmmittee via an nline survey reviewing VOICES Survey t capture Patient and Caregiver Experience n Palliative Care services acrss all settings in the prvince supprting varius LHIN-SAA tables regarding educatin f selected

6 6 indicatrs prgress and review f explanatry and develpmental indicatrs requiring further wrk thrugh validatin Update frm the Residential Hspices Wrking Grup The Residential Hspices Wrking Grup (RHWG) has held 10 meetings and has develped an interim draft reprt with advice n strengthening Ontari s end f life cntinuum and ptimizing the rle f residential hspices alng with ther partners invlved in the prvisin f high quality, high value care at the end f life. The RHWG has held fur successful Fcus Grups with the: Residential Hspices Executive Directrs, Palliative and End f Life Care Netwrk and LHIN leads, key research partners and with the Hspice Palliative Care Prvincial Steering Cmmittee and Clinical Cuncil. The gal f these engagement sessins is t generate imprtant input n key themes critical t imprving care at the end f life. The dialgue has generated insightful feedback that cntinues t shape the recmmendatins emerging frm the RHWG. Additinal fcus grups fr diverse grups and gegraphies, First Natins, Clients and Caregivers and Health Links are planned fr Octber The RHWG reprt is n track fr being finalized in Nvember QUESTIONS? Fr mre infrmatin n the Hspice Palliative Care Prvincial Steering Cmmittee, please cntact: Shehnaz Fakim Simne Falcner Senir Lead, Health System Perfrmance Senir Cnsultant Mississauga Haltn LHIN LHIN Cllabrative ext

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