Informing. Decisions: Shorter lengths of stay. Reduced wait times. Fewer hospitalizations.

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1 Informing Decisions: Data Improves Rehabilitation Services in Canada Shorter lengths of stay. Reduced wait times. Fewer hospitalizations. Health care providers continually aim to improve client care while efficiently managing resources. In the Canadian inpatient rehabilitation sector, decisions that support these efforts are based on standardized data captured electronically at the point of care. Inside Capture of Standardized Data 2 Who Benefits, and How 6 The Way Forward 8

2 2 Capture of Standardized Data Hospitals and specialty rehabilitation centres that deliver inpatient rehabilitation services collect standardized client data electronically as part of routine care upon admission to and discharge from rehabilitation programs. This point-of-care data includes organizational information, client identifiers, and socio-demographic and administrative data. It also About the National includes clinical information Rehabilitation Reporting System such as health characteristics The NRS was developed in 2000 and measures of activity and 2001 by CIHI to support policy and participation. Patient disability planning for rehabilitation services in Canada. It facilitates the collection is assessed using the FIM of information on clients admitted to instrument, i an internationally rehabilitation programs in hospitals recognized and widely reported and other rehabilitation facilities in assessment tool that measures nine provinces in Canada. physical and cognitive function. This data provides an invaluable portrait of inpatient rehabilitation services and associated health outcomes at the organizational, regional, provincial and national levels. It also helps clinicians create customized care plans for clients, leading to better health outcomes and improved efficiencies in the form of shorter hospital stays, reduced wait times and better access to care, as demonstrated in this brochure. About the Canadian Institute for Health Information CIHI is an independent not-forprofit organization that provides essential information on Canada s health system and the health of Canadians. Among other things, CIHI provides support for the collection, aggregation and use of inpatient rehabilitation data in Canada. Since the collection of standardized data is a component of the care process, no additional data collection efforts are needed as the data flows to the National Rehabilitation Reporting System (NRS) at the Canadian Institute for Health Information (CIHI). CIHI de-identifies the data, conducts analyses and produces aggregate-level reports for managers and funders at organizational, regional and provincial/territorial levels. i. The FIM instrument referenced herein is the property of Uniform Data System for Medical Rehabilitation, a division of UB Foundation Activities, Inc.

3 3 Improved Patient in Ontario Flow Data helps shorten the length of stay Reports based on NRS data suggested that clients at the Brain and Spinal Cord Rehabilitation Program at Toronto s University Health Network (UHN) had positive post-treatment outcomes, such as improved functional abilities following rehabilitation. However, clients were staying longer in the hospital to achieve these improvements than those in similar programs elsewhere. This successful initiative would not have been possible without data from the NRS. The NRS is an invaluable tool for benchmarking and program evaluation. Dr. Anthony S. Burns, Staff Physiatrist, Brain and Spinal Cord Rehabilitation Program, University Health Network To optimize the duration of hospital stay without compromising client outcomes, the UHN developed a Patient Flow Initiative ii with a goal of aligning the length of stay for clients in the program with the national average for such clients. Using a formula based on comparative national data, tentative discharge dates were calculated at the time of admission to help reduce subjectivity and increase transparency in decision-making. Uniform protocols and best practices were also developed to support prompt client care. As a result of this initiative, in just one year, the average duration of hospital stays for clients in the program decreased by 15 days from 86.2 to 71.5 days. The shorter hospital stays permitted staff to provide care to 12% more clients. Importantly, this increase in efficiency and access to care was coupled with an improvement in functional outcomes. Clients and program staff alike are pleased with the benefits reaped by promoting standardization in practice. ii. Burns AS, Yee J, Flett HM, Guy K, Cournoyea N. Impact of benchmarking and clinical decision making tools on rehabilitation length of stay following spinal cord injury. Spinal Cord. In press.

4 4 Better Understanding of Client Needs in Alberta Data helps reduce wait times for stroke clients Long wait times for clients who have suffered a stroke prompted the Calgary Stroke Program to work with partners to measure performance across its clinical and support services. An analysis of data captured through the NRS showed that more timely access to care required a better alignment of client needs with appropriate types of rehabilitation services. Participation in CIHI NRS has provided us with access to inpatient rehabilitation data important in our quality management approach to improving client care. A new triage approach was developed to evaluate client disability and functional status and to better match services with client needs. In addition, an early supported discharge program was implemented to enable low-risk clients to be discharged from the hospital with appropriate homeand community-based rehabilitation support. This would free up beds for those who needed them most. The goal of these changes was to increase access and to ensure that home- and community-based rehabilitation services were promoted for clients with non-acute care needs. Luchie Swinton, Rehabilitation Facilitator, Calgary Stroke Program, Calgary, Alberta As a result of this initiative, the cost and average length of stay for stroke rehabilitation clients decreased significantly. In fact, one inpatient rehabilitation unit experienced an average decrease in length of stay from 72 to 42 days! By aligning client needs with the most appropriate rehabilitation service and discharging low-risk clients with community-based rehabilitation support, more clients had increased and timelier access to the acute stroke unit. Based on the success of the program, further streamlining of post-acute rehabilitation services in Calgary is planned, with a potential for roll-out to other regions in Alberta.

5 5 Manitoba s New Model Timely Care for Data used to reduce hospitalizations for clients In its quest to provide timely rehabilitation services to its clients, the Winnipeg Regional Health Authority s Rehabilitation and Geriatrics Program decided to redesign its inpatient pulmonary rehabilitation program. The key objective of this initiative was to reduce wait times and use resources more efficiently. An advisory group survey confirmed what the planners were thinking: many clients needed the service but did not necessarily require hospitalization. Designing new services that meet the needs of the clients who use them is so much easier when there is data to support the decisions that need to be made. With the new ambulatory Pulmonary Rehabilitation Service, we have the confidence to launch a service that will be both responsive and accessible. Jo-Ann Lapointe McKenzie, Former Program Director, Rehabilitation and Geriatric Program, Winnipeg Regional Health Authority, Manitoba Using data from sources including the NRS, the health authority proposed a new model of care to realign the delivery of pulmonary rehabilitation. The proposed model enables clients to receive a prompt and appropriate level of rehabilitation care for their condition in an outpatient, ambulatory care setting. This eliminates hospitalization costs for these rehabilitation services and allows the pulmonary rehabilitation beds in the hospital to be reallocated to high-need and ventilator-dependent clients. The proposal received immediate approval and funding from Manitoba Health to begin implementation. The health authority is confident that the new model will result in better health outcomes for its clients and more effective use of resources, while also providing services to approximately three times as many clients.

6 6 Who Benefits, and How Clients and Their Families With standardized assessments, electronic transmission of information can occur across care settings. This reduces the burden for clients and families of providing basic information to multiple providers. Data identifying how clients with similar conditions typically recover following illness or injury can support conversations with clients and family around developing care plans and setting realistic expectations for outcomes following rehabilitation. Data that supports improvements to client outcomes, improved access, reduced wait times and shorter lengths of stay directly benefits clients receiving health care services. Clinicians and Other Caregivers Access to information about impairment, services and outcomes for clients with similar health conditions supports clinicians and caregivers in devising the most appropriate and highest-quality care plan to meet client needs. Interdisciplinary collaboration and continuity of care is facilitated by the electronic capture and sharing of standardized information. This information enhances caregivers abilities to discuss the needs of clients and their care plans in a common way across service settings.

7 System Managers and Funders Comparative, standardized information helps system managers and funders plan for the future by providing a better understanding of key issues such as wait times, cost estimates and access to the appropriate level of care and by facilitating the design of services and programs that meet the evolving needs of their populations. Summary information on client care and outcomes permits national comparisons for performance measurement, program effectiveness monitoring and effective discharge planning. Administrative information linked to other data sources provides a more in-depth view of continuity of care and can help identify bottlenecks for client flow through the health care system. Grouping methodologies (such as the Rehabilitation Patient Group) help funders align resources with population needs and appropriately allocate limited funds across regions or provider organizations. Rehabilitation Patient Group Helps identify populations by expected resource use for evidence-informed staffing and funding decisions.

8 The Way Forward Standardized capture and use of data from clients in rehabilitation improves health outcomes and enables evidence-based decision-making at all levels of the health system. It supports the front-line delivery of quality care and drives best practices in care delivery. At a system level, the use of information helps identify efficiencies that can reduce costs and lengths of stay, improve wait times and access, and ensure the highest quality of care. A large number of hospitals and rehabilitation facilities across the country are using the NRS to support their delivery of care. Opportunities now exist to further leverage this comparative rehabilitation data to inform program, policy and funding decisions for improved management and provision of rehabilitation care in the overall health system. The appropriate use of high-quality information on health needs, services and outcomes is critical to the future of Canada s health system. Clinicians need information to support their care planning decisions. Health system managers need information for planning, quality monitoring and accountability. Policy-makers and senior decision-makers need information for system management and accountability. This product is one in a series designed to showcase the use and value of information at these various levels. Acknowledgements The Canadian Institute for Health Information (CIHI) would like to acknowledge and express appreciation to the individuals and organizations whose stories have been showcased as part of this project. CIHI Communications 495 Richmond Road, Suite 600 Ottawa, Ontario K2A 4H6 Phone: (Ottawa) or (Toronto)

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