hospital continuum presentation (2)
TRANSCRIPT
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Continuum of Care inContinuum of Care in
Fall ManagementFall Management
Creating a Culture of Safety Paradigm in a localCreating a Culture of Safety Paradigm in a localcommunitycommunity
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Agenda
Introductions
Falls
Statistics
Etiology
Dizziness
Etiology of Dizziness
Systems Controlling
Balance
Traditional TherapyPrograms
Continuum Overview
Continuum Flow Chart
Center of ExcellenceModel
Assisted & IndependentLiving Communities
Discussion Action Plan
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Falls: Relevant StatisticsFalls: Relevant Statistics
Falls are not a normal part of agingFalls are not a normal part of aging
Balance related falls are the leading cause ofBalance related falls are the leading cause of
deaths in elderlydeaths in elderlyAnnual fall rates:Annual fall rates:
30% of those > 6530% of those > 65
50% of those > 8050% of those > 80
25% of patients > 50 who25% of patients > 50 who fxfx a hip die within 12a hip die within 12months, and 40% within 24 monthsmonths, and 40% within 24 months
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Etiology of FallsEtiology of Falls
Dizziness is the #1 reason for fallsDizziness is the #1 reason for falls
Loss of protective sensation is #2Loss of protective sensation is #2
50% of falls in elderly can be attributed to50% of falls in elderly can be attributed tovestibular dysfunctionvestibular dysfunction
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DizzinessDizziness
Lightheadedness: feeling faintLightheadedness: feeling faint
Vertigo: Perception of movement, either self orVertigo: Perception of movement, either self or
surroundingssurroundings OscillopsiaOscillopsia: Experience of objects that are: Experience of objects that are
known to stationary appear to be movingknown to stationary appear to be moving
Disequilibrium: Unsteadiness, imbalanceDisequilibrium: Unsteadiness, imbalance
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Etiology ofDizzinessEtiology ofDizziness
OtologicOtologic: 50% (vestibular): 50% (vestibular)
CNS: 22% (TBI, CVA, Migraine, etc)CNS: 22% (TBI, CVA, Migraine, etc)
Psychogenic: 15% anxiety, panic, depression)Psychogenic: 15% anxiety, panic, depression) Medication: 5%Medication: 5%
OtherOther
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Systems Controlling BalanceSystems Controlling Balance
VestibularVestibular
SomatosensorySomatosensory
VisualVisual MusculoMusculo--SkeletalSkeletal
CognitiveCognitive
70% of our balance is vestibular when our head and70% of our balance is vestibular when our head and
body are in motionbody are in motion
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Traditional Therapy ProgramsTraditional Therapy Programs
Historically reactive vs. proactiveHistorically reactive vs. proactive
Research shows traditional therapy programsResearch shows traditional therapy programs
have little to no effect on fall riskhave little to no effect on fall risk Strengthening and increasing functional enduranceStrengthening and increasing functional endurance
does not impact balance systemsdoes not impact balance systems
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Continuum Model
Screening of all Geriatric Patients
Physician Marketplace
Home Care Marketplace (as part of Oasis)
Community Screening Programs
Residents in Assisted Living and Independent LivingFacilities
Geriatric Patients prior to D/C from acute carefacilities
With a positive screen, patient enters continuum
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Hospital Is Ideal PlatformHospital Is Ideal Platform
Has a large discharge geriatric population who can be screenedHas a large discharge geriatric population who can be screened
by hospitalist prior to D/C for potential for fallsby hospitalist prior to D/C for potential for falls
Also may have home care agency who can screen all traditionalAlso may have home care agency who can screen all traditional
home care patients for fallshome care patients for falls Secondary opportunity for extended care marketplaceSecondary opportunity for extended care marketplace
If hospital has captured medical practices, then they can screenIf hospital has captured medical practices, then they can screen
all geriatric patients for fall risksall geriatric patients for fall risks
Secondary opportunity to develop a Center of ExcellenceSecondary opportunity to develop a Center of Excellence
All home care and outpatient therapists are trained in high levelAll home care and outpatient therapists are trained in high level
evaluative, treatment and education in fallsevaluative, treatment and education in falls
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Continuum Flow ChartContinuum Flow Chart
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Center ofExcellence In FallCenter ofExcellence In Fall
ManagementManagement Continuum of Care Philosophy:Continuum of Care Philosophy:
A screening, diagnostic and treatment center withA screening, diagnostic and treatment center withand without wallsand without walls
It has a physical location, however, is a true continuum.It has a physical location, however, is a true continuum.
It, therefore, can address the needs of patients who are:It, therefore, can address the needs of patients who are:
AmbulatoryAmbulatory
Home boundHome bound
Facility basedFacility based Assisted Living FacilitiesAssisted Living Facilities
Independent Living FacilitiesIndependent Living Facilities
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Center OfferingsCenter Offerings
Continuum of consultative services for PrimaryContinuum of consultative services for PrimaryPhysician to assess fall risk for their patients including aPhysician to assess fall risk for their patients including ascreening tool that can be implemented in the primarysscreening tool that can be implemented in the primarysofficeoffice
Full diagnostic testing including:Full diagnostic testing including: ENTENT
NeurologyNeurology
PodiatryPodiatry
Diagnostic services including VNG,Diagnostic services including VNG, PosturographyPosturography Specialized therapeutic evaluative and treatmentSpecialized therapeutic evaluative and treatment
services on an ambulatory, home care and extendedservices on an ambulatory, home care and extendedcare facility basiscare facility basis
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Center StructureCenter Structure
Center ofExcellence
ENT
Neurologist
Home CareTherapy
OutpatientTherapy
Podiatry
Other(Psychologist,
Physiatrist,Etc)
Assisted &Independent
LivingFacilities
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Potential Team MembersPotential Team Members
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Client PopulationsClient Populations
End Users
(Ambulatory)
End Users
(Home Bound)
Assisted &
Independent
Living
Facility
Primary
Physicians
Center of
Excellence
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Primary Physician Middle UserPrimary Physician Middle User
Program is marketed physician to physician as aProgram is marketed physician to physician as adiagnostic and treatment center that acts as andiagnostic and treatment center that acts as anextension of the primary physicianextension of the primary physician
Primary physician is given a screening tool to identifyPrimary physician is given a screening tool to identifypopulation of his patients who are at high risk of fallspopulation of his patients who are at high risk of falls
Advised of the specialized capabilities of, and prudencyAdvised of the specialized capabilities of, and prudencyof referring all home care patients because of screeningof referring all home care patients because of screening
process and specialized trainingprocess and specialized training Advised of specialized capabilities of part B therapyAdvised of specialized capabilities of part B therapy
provider vs. generic therapyprovider vs. generic therapy
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Assisted/Independent LivingAssisted/Independent Living
FacilitiesFacilities Primary concern is opening the front door andPrimary concern is opening the front door and
closing the back doorclosing the back door
Marketed via the proactive foundation ofMarketed via the proactive foundation ofprogram, and that it is activated by the DON,program, and that it is activated by the DON,not outside consultants who will have anot outside consultants who will have a
tendency to over utilize.tendency to over utilize.
Cross marketing (viral) of all services to theCross marketing (viral) of all services to thegeneral and professional communitygeneral and professional community
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Outpatient Part B Opportunity
There will be significant referrals to part A & B
outpatient therapy from the Center
Part B therapy centers can be developed inselected Assisted Living and Independent LivingFacilities which increases Hospitals outpatient
network and is a perceived benefit from the
perspective of the AL/IL
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ConclusionConclusion
Falls are an inevitable risk to aging populationsFalls are an inevitable risk to aging populations
Historic medical and therapeutic model areHistoric medical and therapeutic model are
reactive vs. proactivereactive vs. proactiveA seamless continuum of care model can beA seamless continuum of care model can be
successful instituted in any community whichsuccessful instituted in any community which
has a foundation of a Culture of Safety andhas a foundation of a Culture of Safety and
extends from the hospital to the ambulatoryextends from the hospital to the ambulatorymarketplace, home care marketplace andmarketplace, home care marketplace and
extended care marketplaceextended care marketplace