centralized collaborative complex care: care redesign using the triple aim
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C4 – Centralized Collaborative Complex Care Redesigning Care with the Institute for Healthcare
Improvement (IHI) Triple Aim Collaborative: Better Health and Lower Cost for Patients with Complex Needs
Dr. Tammie Dewan, Pediatrician, BC Children’s Complex Care Clinic Rita Janke, RN, Quality Leader, Sunny Hill Health Centre for Children
Kate Thomas-Peter, Project Manager, Children and Women’s Mental Health
Sunny Hill Health Centre for Children Behavioural Conditions
BC Children’s Hospital Neurology
BC Children’s Child and Youth Mental
Health
Breakout Session G7
Shaking the foundation of how we deliver complex care
Disclosure
Partial funding for year 1 of the collaborative received from the Canadian Foundation for Healthcare Improvement
No other disclosures
OUR BHLC SUB-POPULATION
Subpopulations of BHLC population (56-100 children/year)
Children with behaviourally/developmentally complex needs accessing BCCH Neurology, Child and Youth Mental Health (NeuroPsyc /Infant Psych) and SHHC BC Autism and Complex Development/Behaviour
Subpopulations of BHLC population
Children with behaviourally/developmentally complex needs accessing BCCH & SHHC
BHLC population: Patients at risk of high costs and poor health outcomes who would benefit from enhanced care
Children with Complex Needs accessing BCCH and SHHC
Triple Aim population: Everyone in your organization’s reach
All Children seen by BCCH & SHHC
Lucy’s Story Lucy is an 8 year old girl with Angelman’s
Syndrome diagnosed at age 3 after a 2 year history of her mother knowing “something wasn’t right”.
Lucy’s family lives 5 hours away from a major health center, so accessing specialized services requires waiting for outreach services or significant travel.
Lucy received community support until she turned 5 and started going to school. During this transition, Lucy “fell through the cracks” until her needs became unmanageable by the school.
Lucy’s physical and behavioral support needs have continued to increase resulting in several referrals for specialist assessments and services at age 6 and again at age 8.
There have been significant waits to be seen by these specialist clinics (6mos-1yr).
None of these services have been provided in a coordinated manner.
While she waits - both school and family life are being impacted
PATIENT
C4 Aim Statement
By July 2017 create an integrated care model to: Achieve the best health outcomes and experience for
children with behaviourally complex needs and their families.
Ensure that children have minimal wait times, a streamlined assessment process and an early diagnosis where possible.
Increase system-wide efficiencies
Ultimate goal is to enable children to access crucial early intervention and much needed support to maximize their overall development and participation within their family and community setting.
Moving from retrospective to
prospective patient identification
Identifying Candidates for Care Design
Identifying Lucy At diagnosis Presentation of key symptoms Crisis
PDSA 1 Review of
Triage Lists
PDSA 2 Joint
Physician Case
Review
PDSA 3 ID
Algorithm
PDSA 4 Refine
Algorithm
Develop an Enhanced Care Model to Fit Needs & Assets
BCCH Neurologist
Nurse Clinician Admin Support Mental Health
Psychiatrist Psychologist
Social Worker Occupational Therapist
Nurse Clinician Admin Support
SHHC Developmental Pediatrician
Social Worker Psychologist Intake Nurse
Occupational Therapist Psychologist Physical Therapist
Admin Support
Child Journey
Coordinator
Child in Need Services coordinated
“Seen by the right people at the
right time”
Possible Model to Test: Coordinated “Clinic Team”
Virtual or Physical Space Clinic
Community Team
Learning from 5 Patients – co-creating care plans to help design care.
Dimension Proposed Measure Data Source
Population Health
1. PedsQL 23 questions 2. Proxy self-rate health status: In general, how would you rate your child’s current
health (where health includes physical, behavioural, mental health? (Excellent, Very Good, Good, Fair, Poor)
3. Proxy Functional Status: In the last 30 days how many days of school did your child miss? (0-1, 2-5, 5-10, greater than 10 days) If in preschool or daycare – ask how many days the child is scheduled to attend a week)
4. Parental Burden of Care: During the past 30 days, how many days did your child’s condition keep you from your usual activities – work, social engagements, household activities? (0-5, 5-10, greater than 10 days)
5. Parent QL survey
• Family survey
Experience of Care
1. Family Experience of Coordination of Care standardized Tool (AHRQ) – select questions
2. How confident are you in managing your child’s physical/behavioural/mental health? (Very confident, Somewhat confident, Not at all confident).
3. How confident are you in managing the systems and services which support your child’s health (where health includes physical, behavioural, mental health) (Extremely confident, Very confident, Confident, Somewhat confident, Not at all confident).
4. Timeliness of care to: Wait time 1 (W1) – referral to 1st Clinically relevant appointment
• Survey •Pt Survey •Performance Measurement & reporting (PMR)
Per Capita Cost
1. Patient utilization cost of services within the integrated C4 clinic model over time and within a fiscal year.
2. Baseline cost data of historical utilization pattern (MIS costing methodology – CIHI 2011).
3. Utilization of Mental Health, Neurology & CDBC/BCAAN services over a fiscal year. • Costs of referrals • Cost of assessment
•Performance Measurement and Reporting
•Business Planning Financial Database •STAR Database – SHHC BCAAN/CDBC
Develop a
Learning System
Lessons Learned We are still learning…
IHI faculty support has been invaluable Learning together has been important
Start by understanding your broader populations and how you plan to segment
Understand who your partners are Listen to the patient voice, data and the care team Understand patient centred approach Scale-up approach to service design
Need the vision, commitment and time to support movement toward full scale
Importance of Senior Management/Clinical Support Culture Change
References
Pursuing the Triple Aim: The First 7 Years JOHN W. WHITTINGTON , KEVIN NOLAN , NINON LEWIS, and TRISSA TORRES
IHI White Paper
Care Coordination Model: Better Care at Lower Cost for People with Multiple Health and Social Needs Catherine Craig, MPA, LMSW: Faculty, IHI; Director of Health Integration, Community Solutions, Inc. Doug Eby, MD: Faculty, IHI John Whittington, MD: Faculty, IHI
IHI Triple Aim Collaborative – Better Health Care Lower Cost Webinar Series
Dr. Tammie Dewan, Pediatrician, BC Children’s Complex Care Clinic TDewan@cw.bc.ca Rita Janke, RN, Quality Leader, Sunny Hill Health Centre for Children rdjanke@cw.bc Kate Thomas-Peter, Project Manager, Children and Women’s Mental Health kthomaspeter@cw.bc.ca
Contacts
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