1 Annual Report 2005/2006
2 Vision for Rehabilitation in the GTA Rehabilitation is an integral and essential component of the continuum of health care, reinforcing positive health behaviours, rebuilding lives and reintegrating individuals into the community. Message from the Chair and the Executive Director 2005/2006 marked the first year of an ambitious new strategic plan for the GTA Rehab Network. The plan, Partners in Transformation, sets out a bold agenda to reshape rehabilitation in the GTA, guided by four strategic priorities: Align with and influence Ontario s Health Transformation Improve service delivery and access Inform planning and performance measurement Share best practices and enhance knowledge exchange The plan challenges the Network to build on the successes of its first five years and stake out a leadership role with government and a wide range of partners, both old and new. Tina Smith, Charissa Levy As reflected in the first strategic priority, all of our activity is informed by the changing healthcare environment, and in particular, the introduction of Local Health Integration Networks (LHINs). This past year, we began discussions with LHINs in the Greater Toronto Area to determine how we can support their mandate to create a locally-driven, integrated health care system. The Network has much to offer. We are experts in rehabilitation, with our members representing the full continuum of rehabilitation care across five LHIN boundaries. Our capacity to obtain, synthesize and interpret data allows us to support both policy-makers and clinicians in evidence-based decision making. Most importantly, we have a proven track record of developing tools and solutions to address systemwide issues. This report highlights some of those solutions, including initiatives to reduce length of stay in Alternate Level of Care (ALC) beds, improve access to Low Tolerance, Long Duration (LTLD) stroke rehabilitation, and provide education and best practice tools for the care of joint replacement patients. Mission The mission of the Greater Toronto Area Rehabilitation Network is to provide a forum for collaboration, communication and consensus-building that enables its members, the providers of rehabilitation services, to work toward the vision of an integrated rehabilitation system and coordinate service, promote equitable access, address gaps, reduce duplication, increase research and education, and measure overall performance. Strong partnerships will be critical as we continue to move our vision and strategic priorities forward. As the projects in this report demonstrate, collaborations with our own members and others across the continuum are already leading to positive change. Our vision is far-reaching, and it won t be achieved overnight. Meanwhile, we continue to deliver value to our members right now the tools, best practices and planning information they need to provide quality care to their patients. All of these efforts are made possible through the expertise and commitment of the many individuals who serve on Network committees and task groups, supported by the dedicated secretariat staff. We thank them all. They are our partners in transformation. Tina Smith, Chair Charissa Levy, Executive Director
3 Strategic Priority Improve Service Delivery and Access Promoting equitable access through improved coordination Reducing length of stay in Alternate Level of Care (ALC) For some patients requiring rehabilitation, the transition from an acute care hospital to a rehabilitation facility is anything but smooth. As recent work by the GTA Rehab Network demonstrated, inefficient processes and poor communication between providers often contribute to delays. This past year, the Network tackled these issues with the release of new inpatient rehab referral guidelines for use across the system. The guidelines establish clear criteria for determining medical stability and rehab readiness, as well as standards to guide the communication, timing and process for referrals. The Network also initiated a project with three acute care hospitals in order to better understand the rehab needs of more complex patients and the issues that prolong their stay in Alternate Level of Care (ALC) beds. In the coming year, the data will be analyzed and strategies created to improve transitions for these patients. Improving access to Low Tolerance, Long Duration (LTLD) stroke rehab Research shows that survivors of severe stroke are able to benefit from Low Tolerance, Long Duration (LTLD) stroke rehabilitation. However, the availability of this type of rehab is limited and there is considerable variation between programs. This past year, the Network led a demonstration project with four organizations to increase our understanding of stroke patients and their outcomes in LTLD rehab. The majority of patients experienced functional improvement. However, the data also suggested that some LTLD patients would receive more benefit from a standard high tolerance rehab program, but would require a longer length of stay than those programs currently accommodate. In the coming year, the Network will conduct a cost-benefit analysis of the various intensity and duration options to determine how to achieve the best patient outcomes in the most cost-effective manner. Streamlining the referral process Efficient patient referrals can only occur if frontline staff members have easy access to information on the rehab options available for their patients. This past year, the Network expanded Rehab Finder, its online, searchable database of rehab programs. It now includes single services, specialty services and information on rehab in complex continuing care (CCC). A comprehensive tool, Rehab Finder also provides clear information on admission criteria and wait list information to streamline the referral process.
4 Strategic Priority Inform Planning and Performance Measurement Ensuring quality care by tracking and measuring outcomes Improving service delivery A new report released by the Network this past year provided a comprehensive picture of hip fracture and joint replacement rehab in the GTA and recommendations on how to improve it. Exploring the Hip Fracture and Joint Replacement Landscape in a Changing Context: Implications and Recommendations combines and analyzes data from local and national databases, and makes recommendations on how to improve the current service delivery model and the way in which outcomes are measured. While a new care model for joint replacements has already been implemented in the GTA, the report demonstrates the need for a standardized model of care for patients with hip fractures to create consistency in length of stay, resource use and patient outcomes. Hip fracture patients currently account for nearly 20 per cent of inpatient rehabilitation in the GTA. The Network has begun activity in this area, bringing together members from across the continuum to identify issues and begin work on a new model of care. Creating a foundation for outcome measurement Rehabilitation services are provided in a variety of settings acute care, inpatient rehab, outpatient clinics, in-home settings and more recently, long term care and complex continuing care environments. However, the scope of service varies, limiting the ability to measure and compare outcomes across settings, organizations and the rehabilitation system as a whole. This past year, the Network began a new project to define the key rehabilitation components provided for each care setting. This increased clarity and consistency will serve as the first step toward the creation of standards against which performance can be measured. FINANCIAL SUMMARY 2005/2006 Year ended March 31, 2006 Revenue Member contributions $ 396,280 Interest income 7,657 Total Revenue 403,937 Expenses Staffing and benefits 386,936 Project support (includes professional fees) 56,880* Other expenses 44,811 Total Expenses 488,627 Excess (deficiency) of revenue over expenses for the year (84,690) Carry forward from previous fiscal year 164,132 Closing balance $ 79,442** * Includes expenditure on 2005 strategic planning process. ** Additional cash in investments of $150,000 (Contingency Fund) Accounting services are provided by Toronto Rehabilitation Institute.
5 Strategic Priority Share Best Practices and Enhance Knowledge Exchange Improving patient outcomes through best practices Building a best practices community The Network s annual Best Practices Day adopted a broader provincial focus this past year by working with rehabilitation partners from Ottawa, Hamilton, London, Kingston and Sudbury. The symposium drew a record number of delegates and abstract submissions, providing clinicians, researchers, and policy and management professionals with a day of networking, learning and information exchange. In response to member requests, the Network also expanded its educational offerings this year with a day focused on best practices in the area of joint replacement. The event, which was presented in partnership with the Total Joint Network, drew more than 150 participants to learn about best practices and their application in a new model of care for joint replacement patients. This approach to providing clinicians with best practice evidence proved effective. In a survey of 40 clinicians who attended the day, 15 per cent indicated that they would be making changes to their practice as a result. Sharing knowledge with patients and professionals Best practices in joint replacement care also informed the development of myjointreplacement.ca, a public education website launched this past year for patients undergoing hip and knee replacement surgery. The site, created by the Network in partnership with The Arthritis Society and the Total Joint Network, reflects best practices as determined through an extensive literature review and consultations with patients, surgeons, physiatrists and allied health professionals. Honored with an award for best website by the Health Care Public Relations Association of Canada, the site averaged an impressive 1700 one-hour sessions of use each month. Providers were enthusiastic too 97 per cent of those responding to an online survey felt the website reflected best practice and indicated they would refer their patients to the site. The research evidence was also summarized into a quick reference guide to support clinicians in integrating best practices in hip and knee replacements into their clinical practice. Expanding opportunities for knowledge exchange This past year, the Network also worked with experts in the field of best practices and knowledge transfer to develop an infrastructure for expanding its knowledge exchange activities. Their input, together with a literature review and a survey conducted with 100 clinicians, researchers and administrators, will guide the Network in choosing clinical and operational areas of focus and the best formats for meeting member needs.
6 Member Organizations of the GTA Rehab Network GTA REHAB NETWORK ANNUAL REPORT 2005/2006 Organization Key Organization Contact As of June 2006 Organized by cluster. One member from each cluster (indicated by bold type) acts as the representative on the Network s Coordinating Council. * Indicates former Council Member. ** Indicates former Key Contact. Chair Vice Chair Rehab Centres Bloorview Kids Rehab Bridgepoint Health Providence Healthcare St. John s Rehab Hospital Toronto Rehab West Park Healthcare Centre Toronto Acute Teaching Hospitals Mt. Sinai Hospital St. Michael s Hospital Sunnybrook Health Sciences Centre University Health Network Tina Smith, University of Toronto Mark Rochon, Toronto Rehab Institute Sheila Jarvis, President & CEO Marian Walsh, President & CEO Mary Beth Montcalm, President & CEO Malcolm Moffat, President & CEO Mark Rochon, President & CEO Anne-Marie Malek, President & CEO Diane Savage, Director, Social Work Lorraine Sunstrum-Mann, Program Director, Trauma/Neurosurgery and Mobility Programs Tish Belza, Program Director, Specialized Complex Care Program** Heather McPherson, Chair, Professional Advisory Committee Dr. Catherine Zahn, Vice President & COO Toronto Community Hospitals - Group 1 Baycrest Centre for Geriatric Care Clare Adie, Vice President, Professional and Community Services Humber River Regional Hospital David Keselman, Program Director, Medical Program North York General Hospital Georgina Veldhorst, Vice President, Patient Services & Chief Nursing Executive St. Joseph s Health Centre Mary Lynne McMaster, Administrative Director, Surgery and Oncology Program Betty Likwornik, Administrative Program Director, Medicine Program* ** Toronto Community Hospitals - Group 2 Rouge Valley Health System Heather Reid, Program General Manager, (Centenary site) Continuing Care and Rehabilitation The Scarborough Hospital Catherine Cotton, Patient Care Director, Orthopaedics and Rehabilitation Toronto East General Hospital Marla Fryers, Vice President, Programs and Chief Nursing Officer Milton O Brodovich, Vice President, Patient Services** Toronto CCACs East York Access Centre Etobicoke and York CCAC North York CCAC Scarborough CCAC Toronto CCAC GTA/905 CCACs Durham Access To Care CCAC of Halton CCAC of Peel CCAC of York Region Ex Officio Members Ontario Ministry of Health and Long-Term Care Regional Geriatric Program of Toronto Toronto Acquired Brain Injury Network University of Toronto Eileen Ryan, Interim Executive Director Cathy Szabo, Executive Director Linda Stark, Acting Executive Director Julie Foley, Executive Director Camille Orridge, Executive Director Janet Harris, Executive Director Sandra Henderson, Executive Director Ann Boucher, Executive Director Robert Morton, Executive Director * ** Bill Innes, Executive Director Marie DiSotto-Monastero, Hospital Consultant Christine Bérubé, Hospital Consultant ** Dr. Barbara Liu, Program Director Malcolm Moffat, Chair Dr. Gaetan Tardif, Director, Division of Physiatry GTA Rehab Network Task Groups and Committees As of June 2006 ALC Task Group Chair, Malcolm Moffat, St. John s Rehab Hospital Best Practices Day Task Group Chair, Dr. Gaetan Tardif, Toronto Rehab Change Foundation Grant Steering Chair, Dr. Nizar Mahomed, University Health Committee (myjointreplacement.ca) Network Community Re-engagement Chair, Nadia Hladin, West GTA Stroke Stroke Subgroup Network/Trillium Health Centre Hip Fracture Advocacy and Best Chair, Dr. Nizar Mahomed, University Practices Steering Committee Health Network Hip Fracture Models of Care Task Group Chair, Dr. John Flannery, Toronto Rehab LTLD Stroke Project Planning Subgroup Chair, Gaye Walsh, Bridgepoint Health Membership and Governance Task Force Chair, Tina Smith, University of Toronto MSK Best Practices Task Group Chair, Dr. Nizar Mahomed, University Health Network Rehab Definitions Task Group Chair, Dr. Mark Bayley, Toronto Rehab Stroke Rehabilitation Task Group Chair, Malcolm Moffat, St. John s Rehab Hospital GTA Rehab Network Staff As of June 2006 Halton-Peel Community Hospitals Credit Valley Hospital Halton Healthcare Services Trillium Health Centre William Osler Health Centre York Community Hospitals Markham Stouffville Hospital Southlake Regional Health Centre Toronto Grace Health Centre York Central Hospital Durham Community Hospitals Lakeridge Health Corporation Rouge Valley Health System (Ajax-Pickering site) Karyn Lumsden, Director, Rehab Services Denise Hardenne, Vice-President, Programs and Professional Practice Susan Bisaillon, Health System Director, Neurosciences/MSK Laurence Wolfson, Director, Mental Health and Long Term Care Janet Roberts, Vice President and Chief Nursing Executive Gary Ryan, Vice President, Human Resources, Medicine and Diagnostic Imaging Kathi Catton, Vice President, Patient Programs Carol Cober, Director, Continuing Care Program & Inpatient General Medicine Carol Anderson, Director, Complex Continuing Care, Geriatrics and Rehabilitation Services Heather Reid, Program General Manager, Continuing Care and Rehabilitation Charissa Levy Patty Aird Sue Balogh Linda Huestis Robert Jessop Linda Milan Judy Moir Tina Saryeddine * staff shared with Toronto ABI Network GTA Rehab Network 550 University Avenue Room 920 Toronto, ON M5G 2A2 Tel: Fax: Executive Director* Office Manager* Project Coordinator/Planner Communications Consultant Communications/Data Coordinator* Data Entry/Office Assistant Project Coordinator/Planner* Project Manager/Senior Planner