Best Practice Recommendations for Inpatient Stroke Care: Rationale and Evidence for Integrated Stroke Units in North Simcoe Muskoka LHIN
|
|
- Linda Ball
- 8 years ago
- Views:
Transcription
1 Best Practice Recommendations for Inpatient Stroke Care: Rationale and Evidence for Integrated Stroke Units in North Simcoe Muskoka LHIN Physician Education Session May 24, 2013 Dr. Mark Bayley,, Cheryl Moher,, Matthew Meyer
2 Objectives By the end of this session you will be able to: name key best practices for stroke care, in particular acute and rehabilitation stroke unit care discuss how HSFR and QBP for stroke can be aligned with LHIN planning identify the principles of the proposed system change for cross-continuum stroke care in NSM LHIN discuss the benefits of implementing Integrated Stroke Units to enhance stroke care in view of the geography of NSM LHIN
3 Impact of Stroke Stroke is the third leading cause of death and long term disability in Canada. 50,000 Canadians experience a stroke each year; and over 14,000 Canadians die as a result. 20,000 in Ontario 682 in North Simcoe Muskoka (based on average admissions per yr over 5 yrs) 300,000 living with the effects of stroke 25% recover with a minor impairment 40% are left with a moderate to severe disability (Heart and Stroke Foundation of Ontario 2010). 22% of residents in LTC age 65 or older have had a stroke (Heart and Stroke Foundation of Ontario, 2000) and stroke is the third most common diagnosis in long-term care (Price Waterhouse Cooper 2001).
4 Objective Understand the evidence and rationale for the Ontario Stroke Reference Panel recommendations for Specialized Stroke Units Early admission to rehabilitation Intensity of therapy Access for Severe stroke Outpatient Rehabilitation
5 Models of Stroke Care General Medical Ward Acute Stroke Units Combined acute and subacute stroke units (also known as Integrated Stroke Units) Subacute Stroke Rehab units Roving/Mobile Stroke Teams
6 Pooled Analysis for Death and Dependency Model of Care OR (95% CI) Acute stroke care 0.70 (0.56, 0.86) Combined acute 0.56 ( ) and subacute Subacute Rehab 0.63 ( ) Mobile stroke team 1.00 ( ) Overall 0.68 ( )
7 Specialized Stroke Units in Ontario More likely to provide best practice stroke care: increased access to acute thrombolysis admission to stroke units discharge to inpatient rehabilitation, and access to secondary prevention clinics higher rates of appropriate medications at discharge, and lower 90 day rates of stroke recurrence Ontario Stroke Evaluation Report 2012
8 Why Consolidate Stroke Care? Is there a relationship between Volumes and outcomes?
9 Methodology Data Sources and Patient Sample The Canadian Institute for Health Information Discharge Abstract Database (DAD) was used to identify all adult ischemic stroke separations (> 18 years old) at 128 acute hospitals in the province of Ontario between April 1, 2005 to March 31, We excluded hospitals with <15 ischemic stroke discharges per year, in-hospital strokes and elective admissions. Ischemic stroke patients were identified if the most responsible diagnosis code was either ICD-10-CA I63 (excluding I63.6), I64 or H34.1. We took the first ischemic stroke event for each individual in each fiscal year. N = 70,895
10 Methodology Statistical Analyses Hospital Volume: Hospital annual ischemic stroke discharge volume was assigned as the mean (+/- SD) at each hospital over 7 years (April 1, 2005 to March 31, 2012). Spline plots were used to evaluate if there was a linear relationship between hospital ischemic stroke volume and 30-day all-cause mortality. Small, medium and high volume-based categories used to describe the association between hospital ischemic stroke volume and 30-day allcause mortality. Risk-adjusted Mortality: We used a modified version of the Canadian Institute for Health Information stroke 30-day mortality risk adjustment model 7 and included year. Multivariate logistic regression with the generalized estimating equations approach to account for within hospital patient clustering.
11 Ontario Results 30 day Mortality Adjusted OR 95% CI Small volume hospital ( annual volume) Medium volume hospital ( annual volume) High volume hospital ( annual volume)
12 Findings As with other medical conditions ischemic stroke volume and 30-day all-cause mortality is non-linear and becomes attenuated at greater volumes ( >= 165, the volume-mortality curve begins to flatten). After taking into account case-mix across hospitals, hospitals that have average annual stroke volumes greater than 15 but less than 130 per year have 30-day risk-adjusted all-cause mortality rates 38% higher than high volume hospitals that see on average 300 ischemic stroke patients per year.
13 Goal. Earlier Onset of Rehabilitation
14 Benefit of Early Therapy in Animals Methods: Biernaskie et al. (2004) subjected rats to rehab x 5 weeks beginning at 5, 14 and 30 days post small strokes Control animals social housing
15 Benefit of Early Therapy in Animals- Results: All received 5 weeks of enriched environment Day 5 admission marked improvement Day 14 moderate improvement Day 30 no improvement vs. controls Corresponding cortical reorganization in brain around stroke
16 % D/C SRU GMU Weeks
17 * OT PT SRU GMW Mean hrs/pt
18 PSROP (Post-Stroke Rehabilitation Outcomes Project) Study of 7 stroke rehab centers (6 in United States, n=1161; 1 in New Zealand, n=130) Comprehensive study of stroke rehabilitation examining the black box PSROP study, Archives of PM&R Dec 2005 suppl
19 What did the more efficient Stroke centers do? Admitted to specialized inter-disciplinary stroke rehab units Admitted earlier and more disabled More intensive therapy (incl. W/E) Less time in assessments Move to high level tasks early Well developed outpatient services
20 Therapy Intensity
21 Reality Check: Therapy is Cheap; Length of Stay is Not Therapists are not replaced when sick or absent Laissez-faire attitude towards rehab therapies even though it is what we are supposed to be doing At least 60% of stroke rehab budget costs are nursing (versus <20% of core therapies) Stroke rehab patient gets an average of a little over one hour of therapy per day Need to ensure standards for daily therapy
22 Severe Strokes: Who should be Rehabilitated?
23 Rehab of Severe Strokes These are patients who are major contributor to ER/ALC issue Patients with severe strokes improve to a lesser degree and at slower rate Benefit of rehab more prevention of complications and improved discharge planning
24 Jorgensen et al. (2000) Comparative trial N = 1241 consecutive stroke patients Group 1 (n = 305) - general and neurological wards Group 2 (n = 936) - single stroke unit Patients similar in two groups 88% of all strokes admitted to hospital
25 Jorgensen et al. (2000) For severe strokes poor outcome reduced by 86%; relative risk of 1 and 5 year mortality reduced by 40% and 70% Authors attributed it to an interdisciplinary rehab approach
26 Outpatient Rehab Outpatient therapy improves short-term functional outcomes Hospital same as home-based Outpatient therapy is relatively inexpensive (1 PT/1 OT/0.5 SLP/0.5 SW = cost of 1 rehab inpt bed) 30% reduction in bad outcomes, including institutionalization and allows earlier discharge home Estimated savings is $2 for every $1 spent on outpatient therapies
27
28 Health System Reform and QBP Organizations will be paid on a per patient basis as long as they follow the evidence above Admission to stroke unit Rehab starts day 5 (ischemic) and Day 7 (hemorrhagic stroke) Rehab intensity of 3 hours per day Shorter lengths of stay Enhanced outpatient rehab (phase 2)
29
30
31 Reason for System Change in NSM There is an opportunity to develop a cost effective and integrated stroke care model that supports enhanced patient outcomes and is aligned with best practice.
32 Case for Change Four pillars: 1. interprofessional stroke units (acute and rehabilitation) 2. earlier access to rehabilitation 3. increased intensity of stroke rehabilitation, and 4. increased outpatient rehabilitation. founded in evidence-based practices for stroke care validated through consultation and collaboration
33 Integrated Stroke Model of Care The Case for Change recommended the preferred model for stroke system design for NSM LHIN as an integrated stroke model of care cross-continuum stroke care provided at appropriate centres across the LHIN beginning with Integrated Stroke Units (ISUs) Recommendations are: Stroke care clustered at 2 3 sites Hospitals with integrated stroke units provide acute and inpatient rehabilitation stroke care Stroke care will be supported by all health service providers across the LHIN
34 Guiding Principles for System Change Critical mass to develop and maintain interprofessional stroke expertise Patient centred care closer to home when possible Existing infrastructure
35 Considerations Cross-LHIN stroke service planning for the Parry Sound and Alliston populations and other NSM residents. Establish cross-continuum stroke services at each site including prevention clinics, outpatient rehabilitation, and potentially t-pa delivery. TIA (22% of current admissions) Regional bed registry Seasonal variations Impact on other programs (CCC slow stream rehab)
36 Service Provision: Community Phase Recommendations are for: Outpatient/ambulatory stroke rehabilitation programs associated with each ISU Satellite clinics in sub-lhin areas without ISU Ability for teams to provide therapy in the community when needed (mobile teams) Developed and validated with stakeholder input Interprofessional team care Stroke Care Expertise Appropriate therapy intensity (2 3 visits per week for each required discipline for a minimum of 8-12 weeks) Coordination with CCAC services (e.g. home safety assessments) System Navigation as a key component
37 Stroke Care in NSM: Opportunities for Improvement On average between 2007 and 2011: -153 TIA admissions annually (22%) ~$3,400 each, ~$518,000 total ALC bed days annually ~$600/day, ~$1.38M total
38 Stroke Care in NSM: Opportunities for Improvement On average between 2007 and 2011: Estimated Direct Cost of Stroke Care: $5,256,457 Cost of 10-day mean LOS $4,266,934 (-$989,523) Best-practice $2,788,900 (-$2,467,558)
39 Stroke Care in NSM: Opportunities for Improvement Estimated need for O/P or Community Rehab: 5729 OT and PT sessions (each) 2865 SLP Estimated Cost: Outpatient program: $1,361,086 Community program: $1,877,366
40 Stroke System Redesign: Anticipated Benefits Improved patient outcomes Improved quality of life, independence, ability to perform self care, return home, return to work,... Quality of Care Improved access to care Improved patient flow Reduced Length of Stay in hospital More people returning home after stroke Less people returning to hospital within 30 days of discharge Emerging evidence indicates that best practice stroke rehabilitation can help to minimize the economic burden of stroke on the healthcare system. Reduce length of stay Reduce ALC time
41 Questions? For those on live webcast questions for the presenters can be submitted to
42 Thank you.
The Key Elements of Stroke Rehabilitation: Mark Bayley MD FRCPC
The Key Elements of Stroke Rehabilitation: Mark Bayley MD FRCPC 1 Presenter Disclosure Information Presenter: Mark Bayley Associate Professor, University of Toronto and Medical Director, Neuro Rehabilitation,
More informationHow many RCTs in Stroke Rehab?
Evidence Based Stroke Rehabilitation: Maximizing Recovery and Improving Outcomes Robert Teasell MD FRCPC Professor and Chair Chief Physical Medicine & Rehabilitation St. Joseph s Health Care London University
More informationStroke Rehabilitation Triage Severe Strokes
The London Stroke Rehab Data Base Project Robert Teasell MD FRCPC Professor and Chair-Chief Department of Phys Med Rehab London Ontario Retrospective Data Bases In stroke rehab limited funding for clinical
More informationThe Impact of Moving to Stroke Rehabilitation Best Practices in Ontario
The Impact of Moving to Stroke Rehabilitation Best Practices in Ontario Matthew Meyer Project Coordinator, Stroke Rehabilitation Best Practices Ontario Stroke Network Overview Discuss: 1. Current State:
More informationStroke Rehabilitation
Stroke Rehabilitation Robert Teasell MD FRCPC Professor and Chair-Chief Dept Physical Medicine and Rehabilitation Schulich School of Medicine University of Western Ontario Lawson Health Research Institute
More informationEnhancing Community and LTC Rehabilitation Services for Stroke Survivors: Improving the System of Care
Enhancing Community and LTC Rehabilitation Services for Stroke Survivors: Improving the System of Care The Discharge Link A Cross - Continuum Partnership South East Ontario Population ~ 525,000 20,000
More informationTHE IMPACT OF MOVING TO STROKE REHABILITATION BEST PRACTICES IN ONTARIO FINAL REPORT
THE IMPACT OF MOVING TO STROKE REHABILITATION BEST PRACTICES IN ONTARIO FINAL REPORT Matthew Meyer, Christina O Callaghan, Linda Kelloway, Ruth Hall, Robert Teasell, Samantha Meyer, Laura Allen, Erik Leci;
More informationOntario Stroke System. Prepared by: Stroke Rehabilitation Evaluation Working Group Stroke Evaluation Advisory Committee May, 2007
Ontario Stroke System Stroke Rehabilitation Performance Measurement Manual Prepared by: Stroke Rehabilitation Evaluation Working Group Stroke Evaluation Advisory Committee May, 2007 Stroke Rehabilitation
More informationStroke Rehab Across the Continuum of Care in Quinte Region
Stroke Rehab Across the Continuum of Care in Quinte Region Adrienne Bell Smith Manager of Rehab Therapies QHC Karen Brown Manger Client Services, Hospital Access South East CCAC Disclosure of Potential
More informationTORONTO STROKE FLOW INITIATIVE - Inpatient Rehabilitation Best Practice Recommendations Guide (updated January 23, 2014)
TORONTO STROKE FLOW INITIATIVE - Inpatient Rehabilitation Best Practice Guide (updated January 23, 2014) Objective: To enhance system-wide performance and outcomes for persons with stroke in Toronto. Goals:
More informationCommuniqué 2: STROKE GUIDELINE IMPLEMENTATION. Toronto Central LHIN MSK/Stroke Implementation Group COMMUNIQUÉ 2: STROKE GUIDELINE IMPLEMENTATION 1
2 Communiqué 2: STROKE GUIDELINE IMPLEMENTATION Toronto Central LHIN MSK/Stroke Implementation Group COMMUNIQUÉ 2: STROKE GUIDELINE IMPLEMENTATION 1 IN DECEMBER 2012, THE TORONTO CENTRAL LHIN (TCLHIN)
More informationNorth East LHIN Stroke Care Review 2013. Draft Recommendations (as of April 22 nd, 2013)
North East LHIN Stroke Care Review 2013 Draft Recommendations (as of April 22 nd, 2013) Proposed Change 1: Consolidation of Inpatient Acute and Rehabilitation Stroke Care 1. Pre-Consolidation Allied Health
More informationMarina Richardson, M.Sc. Deb Willems, BSc.PT David Ure, OT Robert Teasell, MD FRCPC
Assessing the Impact of Southwestern Ontario s Community Stroke Rehabilitation Teams: An Economic Analysis Presenters: Laura Allen, M.Sc. (cand.) Matthew Meyer, Ph.D (cand.) Marina Richardson, M.Sc. Deb
More informationPatient Flow Pressures
Patient Flow Pressures Presentation to Board of Directors Hamilton Niagara Haldimand Brant Local Health Integration Network December 11, 2013 Patient Flow (in this context) Refers to the movement of individuals
More informationWhat do these stories illustrate about ER/ALC issue?
What do these stories illustrate about ER/ALC issue? Maximizing the Impact of Rehab on Provincial Priority Issues Mark Bayley, MD, FRCPC Medical Director, Neuro Rehabilitation Program, Toronto Rehab and
More informationCommunity Stroke Rehabilitation Model May, 2013
Community Stroke Rehabilitation Model May, 2013 Community Stroke Rehabilitation Model May 2013 i Table of Contents EXECUTIVE SUMMARY... ii BACKGROUND...1 HNHB LHIN GEOGRAPHY AND POPULATION...1 STROKE AND
More informationWaterloo Wellington CCAC Community Stroke Program
Waterloo Wellington CCAC Community Stroke Program Stroke Collaborative 2014 October 27, 2014 Maria Fage, OT Reg. (Ont.) Manager, Client Services Map of Waterloo Wellington LHIN 2 Background Integration
More informationOntario Stroke Network. Regional Economic Overview South West LHIN
Ontario Stroke Network Regional Economic Overview South West LHIN Matthew Meyer, Andrew McClure, Christina O Callaghan, Linda Kelloway, Paula Gilmore, Deb Willems, Dr. Robert Teasell 9/19/2013 Table of
More informationNorth East LHIN Stroke Care Review - 2013. Northeastern Ontario Stroke Network Steering Committee
North East LHIN Stroke Care Review - 2013 Northeastern Ontario Stroke Network Steering Committee December 20 th, 2013 Table of Contents Item Page Executive Summary 1 A. Regional Stroke Review 2 B. Major
More informationSummary Report. Moving to Best Practice. Southwestern Ontario Stroke Rehabilitation Action Planning Day November 28, 2006
Southwestern Ontario Stroke Rehabilitation Action Planning Day November 28, 2006 Summary Report Moving to Best Practice Prepared by: Deborah Willems Southwestern Ontario Stroke Strategy January 29, 2007
More informationTORONTO STROKE FLOW INITIATIVE - Outpatient Rehabilitation Best Practice Recommendations Guide (updated July 26, 2013)
Objective: To enhance system-wide performance and outcomes for persons with stroke in Toronto. Goals: Timely access to geographically located acute stroke unit care with a dedicated interprofessional team
More informationDedicated Stroke Interprofessional Rehab Team. Mixed Rehab Unit. Dedicated Rehab Unit
Outpatient & Community I n p a t I e n t Stroke Rehab Definition Framework Institutional Setting Inpatient Rehab in Acute Care or Rehab Hospitals* Acute Care Integrated Specialized Units Transitional Care
More informationFall 2013. A progress report on improving rehabilitative care in Waterloo Wellington
Fall 2013 A progress report on improving rehabilitative care in Waterloo Wellington The Waterloo Wellington Rehabilitative Care Council Improving rehabilitative care in Waterloo Wellington, fall 2013,
More informationStroke Rehabilitation Intensity Frequently Asked Questions
Stroke Rehabilitation Intensity Frequently Asked Questions 1) What is the provincial definition of Rehabilitation Intensity? Rehabilitation Intensity 1 is: The amount of time the patient spends in individual,
More informationTransitioning to a System of Rehabilitative Care in Waterloo Wellington
Transitioning to a System of Rehabilitative Care in Waterloo Wellington Presented to the WWLHIN Board of Directors January 31, 2013 Item 20.0 Agenda Stroke and Rehabilitative Care System Initiatives..
More informationRehabilitation Services at Hospitals 3.08. Chapter 3 Section. Background DESCRIPTION OF REHABILITATION ELIGIBILITY FOR REHABILITATION
Chapter 3 Section 3.08 Ministry of Health and Long-Term Care Rehabilitation Services at Hospitals Background DESCRIPTION OF REHABILITATION Rehabilitation services in Ontario generally provide support to
More informationTransforming Patient Flow, Improving Patient Care
Transforming Patient Flow, Improving Patient Care Transformation by Design (TbyD) Dr. Peter Nord, VP, CMO, Chief of Staff Thelma Horwitz, Director, Quality and Process Improvement Heidi Hunter, Quality
More informationObjectives. Workshop Organization. Reality Check: Trends in Ontario. Ontario Stroke Rehab 2005/2006
Objectives Rehabilitation of Severe Strokes: Making the Tough Decisions Robert Teasell MD FRCPC Professor and Chair Chief Depart of Phys Med Rehab Parkwood Hospital Understand the impact of stroke severity
More informationPatient and Hospital Characteristics Associated with Assessment For Rehabilitation During Hospitalization for Acute Stroke
Patient and Hospital Characteristics Associated with Assessment For Rehabilitation During Hospitalization for Acute Stroke Lead Author: Janet Prvu Bettger, ScD, FAHA Duke University ; janet.bettger@duke.edu
More informationA STAR is born. Collaborative Strategy that works!
A STAR is born Collaborative Strategy that works! Objective Demonstrate the importance of developing and nurturing partnerships in achieving quality outcomes, providing the right care at the right place
More informationThe Sector Linkage Model for Improved Patient Flow. Dr. Peter Nord
The Sector Linkage Model for Improved Patient Flow Dr. Peter Nord Based on Premise that Better Quality Outcomes Result from Better Flow Healing Trajectories Current & Future Health Status Measures (FIM)
More informationAn Economic Model for Stroke Rehabilitation in Ontario: Mapping Resource Availability and Patient Needs
An Economic Model for Stroke Rehabilitation in Ontario: Mapping Resource Availability and Patient Needs Matthew J. Meyer, Shelialah Pereira, Andrew McClure, Norine Foley, Katherine Salter, Deborah Willems,
More informationHigh User Discussion Day. November 19 th, 2012 Nam Bains Health Analytics Branch, HSIMI
High User Discussion Day November 19 th, 2012 Nam Bains Health Analytics Branch, HSIMI Defining High Users: original analysis 2009/10 Acute inpatient care Day surgery Emergency rooms Inpatient rehabilitation
More informationThe following document was directed to the North East LHIN.
The following document was directed to the North East LHIN. If you require any further details into the information presented here please feel free to contact Jenn Fearn, Regional Rehabilitation Coordinator,
More informationRehabilitation Services Integration Initiative North York General Hospital and St. John s Rehab Hospital
Rehabilitation Services Integration Initiative North York General Hospital and St. John s Rehab Hospital Introduction Hospitals across Ontario have been experiencing a growing challenge in that many are
More informationCurrent State Review of Outpatient Rehabilitation Services in Ontario 2
Current State Review of Outpatient Rehabilitation Services Available at Ontario Acute and Rehabilitation Hospitals and Recommendations to Optimize the System October 2011 Contents Executive Summary...
More informationCardiovascular Health & Stroke SCN Project Overview
Cardiovascular Health & Stroke SCN Project Overview Background The Alberta Provincial Stroke Strategy (APSS) has been successful in enhancing rural and urban stroke care across the province with improved
More informationFaculty/Presenter Disclosure
The Long-Term Rehabilitation Management of Stroke Patients Robert Teasell MD FRCPC Professor, Dept PM&R Schulich School of Medicine University of Western Ontario CFPC CoI Templates: Slide 1 Faculty/Presenter
More informationMedicine, Complex Continuing Care, and Rehab. Community Forum Presentation
H Medicine, Complex Continuing Care, and Rehab Community Forum Presentation Complex Continuing Care Who are our Complex Continuing Care Patients Currently? Patients waiting for Long Term Care beds Patients
More informationAssess and Restore Funding Opportunity
Assess and Restore Funding Opportunity Central East LHIN Board Meeting, January 2014 James Meloche, Senior Director, SDI 1 Objective Inform the LHIN Board on the Ministry of Health and Long-Term Care Assess
More informationBEYOND ACUTE CARE: NEXT STEPS IN UNDERSTANDING ALC DAYS
BEYOND ACUTE CARE: NEXT STEPS IN UNDERSTANDING ALC DAYS MARCH 19, 2008 1.0 EXECUTIVE SUMMARY In its continued efforts to improve the delivery of and access to rehabilitation services, the GTA Rehab Network
More informationHow To Plan A Rehabilitation Program
Project Plan to Rehabilitation Service Connecting and Collaborating in the Continuity of Care in Rehabilitation Presented By: Arlene Whitehead, May 31, 2011 Rehabilitation Collaborative Overview OUTLINE
More informationALBERTA PROVINCIAL STROKE STRATEGY (APSS)
ALBERTA PROVINCIAL STROKE STRATEGY (APSS) Stroke Systems of Care Key Components APSS Pillar Recommendations March 28, 2007 1 The following is a summary of the key components and APSS Pillar recommendations
More informationComplex Care Planning in the Emergency Department: Demonstrating Rehabilitation Contributions
Complex Care Planning in the Emergency Department: Demonstrating Rehabilitation Contributions CAOT Conference 2016 Inspired for Higher Summits Banff, AB No conflict of interest Project Team all from Sunnybrook
More informationInpatient Rehab Referral Guidelines
Inpatient Rehab Referral Guidelines Table of Contents Introduction.. 3 Inpatient Rehab Referral Guidelines - Quick Reference Guide. 4 Inpatient Rehab Referral Guidelines: Determining if a patient is a
More informationPathways of Care for People With Stroke in Ontario
July 2012 Pathways of Care for People With Stroke in Ontario Health System Performance Overview Stroke represents a significant burden for patients, their families and the health care system. It is a leading
More informationItem 15.0 - Enhancing Care in the Community
BRIEFING NOTE MEETING DATE: October 30, 2014 ACTION: TOPIC: Decision Item 15.0 - Enhancing Care in the Community PURPOSE: To provide information regarding enhancements to care in the community and recommend
More informationImplementation of an Interprofessional Team Approach to Stroke Rehabilitation Among Stroke Survivors Using Home Care: Evaluation and Lessons Learned
Implementation of an Interprofessional Team Approach to Stroke Rehabilitation Among Stroke Survivors Using Home Care: Evaluation and Lessons Learned Maureen Markle-Reid, RN, MScN, PhD Associate Professor
More informationOutpatient/Ambulatory Rehab. Dedicated Trans-disciplinary Team (defined within Annotated References)
CARDIAC The delivery of Cardiac Rehab is unlike most other rehab populations. The vast majority of patients receive their rehab in outpatient or community settings and only a small subset requires an inpatient
More informationAccess to Care. Questions and Answers June 28, 2013
Access to Care Questions and Answers June 28, 2013 Access to Care 1. What is Access to Care and why is it important? Access to Care is an approach to care focused on supporting people, specifically seniors
More informationGoals of Presentations. The Rehab Team Do We Need a Recharge? Recharging the Rehab Team: Strategies to Improve Team Care and Patient Outcomes
Recharging the Rehab Team: Strategies to Improve Team Care and Patient Outcomes UDSMR Annual Conference - Thursday August 8, 2013 DALE STRASSER, MD ASSOC. PROFESSOR, REHABILITATION MEDICINE EMORY UNIVERSITY,
More informationImplementing a clustered acute stroke unit at a community hospital improves patient care
Implementing a clustered acute stroke unit at a community hospital improves patient care Linda Dykes, BScPT Manager, Sarnia Lambton District Stroke Centre Krista Steeves, BHScPT Physiotherapist, Bluewater
More informationStakeholder s Report. 2525 SW 75 th Ave Miami, Florida 33155 305.262.6800 www.westgablesrehabhospital.com
212 Stakeholder s Report 2525 SW 75 th Ave Miami, Florida 33155 35.262.68 www.westgablesrehabhospital.com PROFILE REPORT For more than 25 years, West Gables Rehabilitation Hospital has made a mission of
More informationComplex Outpatient. Injury. Rehab. Integrated, evidence-based rehab that supports a timely return to home, life, work or school
Complex Outpatient Injury Rehab Integrated, evidence-based rehab that supports a timely return to home, life, work or school Toronto Rehabilitation Institute At Toronto Rehab, our goal is to advance rehabilitation
More informationa message from the chair and executive director
a message from the chair and executive director a brain injury this year. For many, the injury will be life changing. And access to high quality services and support will be critical as they rebuild their
More informationMobile Rehabilitation Team St Vincent s Style. Dr Shari Parker Rehabilitation Physician
Mobile Rehabilitation Team St Vincent s Style Dr Shari Parker Rehabilitation Physician Drivers for Change 1. Pressure on beds, bed blocks 2. Evidence for Early Rehabilitation 3. The problem of Deconditioning
More informationCURRENT AND FUTURE TRENDS IN POST ACUTE CARE The Value and Role of Acute Inpatient Rehab
CURRENT AND FUTURE TRENDS IN POST ACUTE CARE The Value and Role of Acute Inpatient Rehab Robert S. Djergaian, M.D. Medical Director Banner Good Samaritan Rehabilitation Institute Stewardship Profitability
More informationRehabilitation. Care
Rehabilitation Care Bruyère Continuing Care is the champion of well-being for aging Canadians and those requiring Continuing Care, helping them to become and remain as healthy and independent as possible
More informationAlphaFIM Instrument Too ol1 Mild Stroke Project (Part II) Report
1 AlphaFIM Instrument Tool 1 Mild Stroke Project (Part II) Report Prepared by: Carmel Forrestal Regional Stroke Rehab Coordinator 1 The FIM instrument and AlphaFIM instrument referenced herein are the
More informationmeet us again for the first time: the new bridgepoint hospital and program overview
meet us again for the first time: the new bridgepoint hospital and program overview bridgepoint active healthcare Bridgepoint Active Healthcare manages, delivers, researches and teaches leading healthcare
More informationIntegrated Comprehensive Care Bundled Care
Integrated Comprehensive Care Bundled Care Health Council of Canada National Symposium on Integrated Care Oct 10, 2012 C. Gosse, K. Ciavarella St. Joseph s Health System SJHS is one of Canada s largest
More informationGet With The Guidelines - Stroke PMT Special Initiatives Tab for Ohio Coverdell Stroke Program CODING INSTRUCTIONS Effective 10-24-15
Get With The Guidelines - Stroke PMT Special Initiatives Tab for Ohio Coverdell Stroke Program CODING INSTRUCTIONS Effective 10-24-15 Date and time first seen by ED MD: The time entered should be the earliest
More informationImportance of Integrating Stroke Rehabilitation Across the Continuum of Care
Importance of Integrating Stroke Rehabilitation Across the Continuum of Care Dori Tooke, MHA, PT, CSCS Manager-Inpatient Rehab Program St. Luke s Medical Center Milwaukee, WI Disclosure Nothing to disclose
More informationHamilton Niagara Haldimand Brant LHIN Rehabilitation/Complex Continuing Care PAG. Service Delivery Model Review
Hamilton Niagara Haldimand Brant LHIN Rehabilitation/Complex Continuing PAG Service Delivery Model Review April, 2009 Service Delivery Model Review Introduction This document presents a summary of peer
More informationSystems Analysis of Health and Community Services for Acquired Brain Injury in Ontario
Systems Analysis of Health and Community Services for Acquired Brain Injury in Ontario July 2010 Report provided to the Ontario Neurotrauma Foundation by the Research Team: Dr. Susan Jaglal Principal Investigator
More informationValerie MacDonald RN BSN MSN ONC Janet McMullan, RN, BScN, MN Rhona McGlasson PT MBA
Valerie MacDonald RN BSN MSN ONC Janet McMullan, RN, BScN, MN Rhona McGlasson PT MBA Bone and Joint Decade: 2001 2010: 2010 2020 64 countries Key strategies: Raise awareness of growing burden of MSK disorders
More informationReview of Stroke Services in Tameside. Personal and Health Services Scrutiny Panel
Review of Stroke Services in Tameside Personal and Health Services Scrutiny Panel July 2012 Contents Paragraph Page No. Introduction by the Chair Summary 1 2 2 4 Membership of the Scrutiny Panel 3 4 Terms
More informationRehabilitation Nurses: Champions for Optimizing Stroke Rehabilitation Across the Continuum of Care
Rehabilitation Nurses: Champions for Optimizing Stroke Rehabilitation Across the Continuum of Care Presenters Sandra Melchiorre RN, MN, ACNP, CNN (c) Regional Stroke Acute Care Advanced Practice Nurse,
More informationQuality-Based Procedures
Quality-Based Procedures Fiscal Year 2015/16 Volume Management Instructions and Operational Policies for Local Health Integration Networks Ministry of Health and Long-Term Care 1 Table of Contents 1.0
More informationEvolving New Practices in Hip & Knee Arthroplasty: It Takes A Team! CCHSE National Healthcare Leadership Conference June 11-12, 2007 Toronto
Evolving New Practices in Hip & Knee Arthroplasty: It Takes A Team! CCHSE National Healthcare Leadership Conference June 11-12, 2007 Toronto Focus of Presentation Toronto Central LHIN is developing a new
More informationHamilton Health Sciences Integrated Stroke Model of Care. Rhonda Whiteman, Stroke Best Practices Coordinator, Hamilton Health Sciences
Hamilton Health Sciences Integrated Stroke Model of Care Rhonda Whiteman, Stroke Best Practices Coordinator, Hamilton Health Sciences Integrated Stroke Model of Care Goals To provide a more comprehensive
More informationNational Stroke Association s Guide to Choosing Stroke Rehabilitation Services
National Stroke Association s Guide to Choosing Stroke Rehabilitation Services Rehabilitation, often referred to as rehab, is an important part of stroke recovery. Through rehab, you: Re-learn basic skills
More informationComplex Continuing Care Restorative Care (Combined Functional Enhancement and Restorative Care Programs)
Complex Continuing Care Restorative Care (Combined Functional Enhancement and Restorative Care Programs) Description: The Restorative Care program provides a moderate to low intensity goal-oriented rehabilitation
More information2016 International Stroke Conference Hot Topics Lori M. Massaro, MSN, CRNP Kari Moore, MSN, AGACNP-BC
2016 International Stroke Conference Hot Topics Lori M. Massaro, MSN, CRNP Kari Moore, MSN, AGACNP-BC Disclosures Lori M. Massaro, MSN,CRNP speakers bureau Genentech Kari Moore, MSN, AGACNP-BC -none 1
More informationHomeward Bound. Amanda Melvin, MSW Emily Hartman, BSN, RN Tiffany Curtis, BSN, RN, CRRN Cindy Regan, MSN, RN - BC
Homeward Bound Amanda Melvin, MSW Emily Hartman, BSN, RN Tiffany Curtis, BSN, RN, CRRN Cindy Regan, MSN, RN - BC Objectives Identify and differentiate the levels of stroke rehabilitation care. Identify
More informationACUTE CARE TO REHABILITATION
ACUTE CARE TO REHABILITATION JONATHAN P. QUEVEDO, M.D. JFK-JOHNSON REHABILITATION HOSPITAL PRESENTER DISCLOSURE INFORMATION JONATHAN P. QUEVEDO M.D. ACUTE CARE TO REHABILITATION FINANCIAL DISCLOSURE EMPLOYED
More informationISSUED BY: TITLE: ISSUED BY: TITLE: President
CLINICAL PRACTICE GUIDELINE PROFESSIONAL PRACTICE TITLE: Stroke Care Rehabilitation Unit DATE OF ISSUE: 2005, 05 PAGE 1 OF 7 NUMBER: CPG 20-3 SUPERCEDES: New ISSUED BY: TITLE: Chief of Medical Staff ISSUED
More informationLeicester Nuffield Research Unit Trends in disease and how they will impact on disability in the older population
Leicester Nuffield Research Unit Trends in disease and how they will impact on disability in the older population R. Matthews, C. Jagger & MRC CFAS Background Projections of future numbers with disability
More informationBrief, Evidence Based Review of Inpatient/Residential rehabilitation for adults with moderate to severe TBI
Brief, Evidence Based Review of Inpatient/Residential rehabilitation for adults with moderate to severe TBI Reviewer Peter Larking Date Report Completed 7 October 2011 Important Note: This brief report
More informationHigh Risk Profiling at points of transitions in care
High Risk Profiling at points of transitions in care Dr. John Puxty puxtyj@providencecare.ca Background 63% of all inpatient days in Ontario are accounted for by seniors 27.2% of inpatient days for seniors
More informationTiming it Right to Support Families as they Transition
Timing it Right to Support Families as they Transition Jill Cameron, PhD Canadian Institutes of Health Research New Investigator Assistant Professor Adjunct Scientist, Toronto Rehabilitation Institute
More informationTheme 3: Accessing ongoing post stroke care in the community
Break Out Session TSN Annual Forum Dec 03 2013 Theme 3: Accessing ongoing post stroke community a) Within your organizations, what are you doing well to collaborate and link your patients to ongoing -
More informationQuality Improvement Plan (QIP) Narrative for Health Care Organizations in Ontario 3/31/2015
Quality Improvement Plan (QIP) Narrative for Health Care Organizations in Ontario 3/31/2015 This document is intended to provide health care organizations in Ontario with guidance as to how they can develop
More informationWhat do ACO s and Hospitals want from SNF s and CCRC s
What do ACO s and Hospitals want from SNF s and CCRC s Presented to the Institute of Senior Living, April 11, 2013 A Division of Kindred Healthcare 1 Assessing the match: What hospitals and ACO s currently
More informationAttachment A Minnesota DHS Community Service/Community Services Development
Attachment A Minnesota DHS Community Service/Community Services Development Applicant Organization: First Plan of Minnesota Project Title: Implementing a Functional Daily Living Skills Assessment to Predict
More informationClinical Management of RUG selection
Clinical Management of RUG selection MATT SIVRET PT, CLT CHIEF CLINICAL OFFICER REHABCARE-DIVISION OF KINDREDHEALTHCARE Objectives Identify the Clinical Rationale for Rehab RUG intensity Understand the
More informationTOTAL JOINT REPLACEMENT GUIDELINE IMPLEMENTATION
1 Communique 1: TOTAL JOINT REPLACEMENT GUIDELINE IMPLEMENTATION Toronto Central LHIN MSK/Stroke Implementation Group COMMUNIQUE 1: TOTAL JOINT REPLACEMENT GUIDELINE IMPLEMENTATION 1 IN DECEMBER 2012,
More informationAppropriate level of care: a patient flow, system integration and capacity solution
Appropriate level of care: a patient flow, system integration and capacity solution Report by the expert panel on alternate level of care December 2006 TABLE OF CONTENTS 1.0 EXECUTIVE SUMMARY...3 2.0 OVERVIEW
More informationAppendix L: HQO Year 1 Implementation Priorities
Appendix L: HQO Year 1 Implementation Priorities Chronic Obstructive Pulmonary Disease (Source: COPD Chairs) Non-Invasive Positive Pressure Ventilation Early Ambulation If possible, seek patient preferences
More informationStatement of Purpose for the Strategic Plan
Contributors: Elena Espirtu, OTR/L Mary Gollinger, MS, CRRN, RN Renu Mahajan, MD Sriramjini Muthukrishnan, MD Keir Ringquist, PT, GCS David Miller Mamie Kutame, MSW William Kettlewell, RN Kimberly Zimmerman,
More informationPARTNERSHIP HEALTHPLAN OF CALIFORNIA POLICY / PROCEDURE:
PARTNERSHIP HEALTHPLAN OF CALIFORNIA POLICY/PROCEDURE Policy Number: MCUP3003 (previously UP100303) Reviewing Entities: Credentialing IQI P & T QUAC Approving Entities: BOARD CEO COMPLIANCE FINANCE PAC
More informationGENERAL ADMISSION CRITERIA INPATIENT REHABILITATION PROGRAMS
Originator: Case Management Original Date: 9/94 Review/Revision: 6/96, 2/98, 1/01, 4/02, 8/04, 3/06, 03/10, 3/11, 3/13 Stakeholders: Case Management, Medical Staff, Nursing, Inpatient Therapy GENERAL ADMISSION
More informationinterrai Suite as a Tool for Management of Health Services for the Elderly: An Integrated Screening and Assessment System
interrai Suite as a Tool for Management of Health Services for the Elderly: An Integrated Screening and Assessment System John P. Hirdes, Ph.D. Ontario Home Care Research and Knowledge Exchange Chair Professor,
More informationUse and Value of Data Analytics. Comparative Effectiveness Study Inpatient Rehab Hospital (IRH) vs. Skilled Nursing Facility (SNF)
Use and Value of Data Analytics Comparative Effectiveness Study Inpatient Rehab Hospital (IRH) vs. Skilled Nursing Facility (SNF) Ryan Wilson Vice President of Managed Care HealthSouth Corporation Gerry
More information20 Years in Stroke Rehabilitation: Trials, Tribulations and Tomorrow
20 Years in Stroke Rehabilitation: Trials, Tribulations and Tomorrow Julie Bernhardt Assoc Prof, Director AVERT Very Early Rehabilitation Program, National Stroke Research Institute and School of Physiotherapy,
More informationPREPARING THE PATIENT FOR TRANSFER TO AN INPATIENT REHABILITATON FACILITY (IRF) University Hospitals 8th Annual Neuroscience Nursing Symposium
PREPARING THE PATIENT FOR TRANSFER TO AN INPATIENT REHABILITATON FACILITY (IRF) University Hospitals 8th Annual Neuroscience Nursing Symposium May 31, 2013 2 DEFINITION: INPATIENT REHABILITATION FACILITY
More informationA SUMMARY. of the WLMH Operations and Role Review Report with Board Chair Comments relating to the New Hospital Building
A SUMMARY of the WLMH Operations and Role Review Report with Board Chair Comments relating to the New Hospital Building June 29, 2009 A Summary of the WLMH Operations and Role Review Report with Board
More informationDischarge Planning. Home Assess / Treat. inpatient CCC (active/ltld) rehab = ALC Designation LTC. Admit
DISCHARGE PLANNING GUIDELINES FOR INPATIENT REHABILITATION The Discharge Planning Guidelines for Inpatient Rehabilitation have been developed by the GTA Rehab Network s Patient Access and Flow Committee
More informationGood Samaritan Inpatient Rehabilitation Program
Good Samaritan Inpatient Rehabilitation Program Living at your full potential. Welcome When people are sick or injured, our goal is their maximum recovery. We help people live to their full potential.
More informationSt. Joseph s Health Centre, Toronto Central LHIN, Toronto, Ontario
St. Joseph s Health Centre, Toronto Central LHIN, Toronto, Ontario 350 Bed Acute Care Community Teaching Hospital serving SW Toronto 86,000 Emergency Visits, 12,000 Urgent Care Visits and 7,000 Just For
More information