Conference Presentation
The following is a text version of the presentation given at the Conference on Timely Access To Health Care, held February 8-9, 2007 in Toronto, Ontario.
System Redesign for Improving the Continuum of Care for the Osteoarthritis Population
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Presentation Outline
Agenda
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The Arthroplasty Plan
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UBC/CSI Initiative
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OASIS
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Provincial Musculoskeletal Council
The Arthroplasty Plan (Richmond Hip & Knee Reconstruction Project)
Purpose
Implement and evaluate a high quality/volume low cost hip and knee reconstruction model
Objectives
- Maximize utilization of resources:
- Reduce average waiting time to 4-6 months
- Reduce ALOS to 4 days for hips 3 days for knees
- Improve OR efficiency by 20-25%
- Evaluate patient outcomes
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Integrate with regional and provincial initiatives
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TAP Model (Toolkit)
Components of TAP Model
- 650 cases/year
- process for running concurrent OR
- Prioritization scoring tools
- Waitlist Management
- Clinical Pathways
- Standardization of prostheses
- Evaluation (Project Database)
Completed Surgery Case Numbers
Waitlist Numbers for All Cases
Waitlist Numbers for Cases > 24 Weeks
Wait (Lead) Time for Hip & Knee Joint Replacement Surgery
Summary of TAP Project
- Objectives met
- Decreased wait list size and wait times
- Achieved 28% OR efficiency
- ALOS 4.1 Days for Hips
- ALOS 3.1 Days for Knees
- Operationalized TAP model
- Collaborative effort
- Shared knowledge
II UBCH - CSI Initiative
- Program announced February 2006
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Goals:
- decrease wait time for arthroplasty surgery by providing focused funding
- provide a model to explore and implement peri-operative efficiencies
- allow information transfer of successful approaches to all Health Authorities
- 1,600 additional arthroplasty cases per year
Results
- Cases completed 1,147
- Surgeon Participation 25/100
- Perioperative efficiencies
- Patient Satisfaction 4.7/5
- Information Transfer
OASIS - Gaps in Care
- Fragmentation of current services
- limited coordination between care providers
- Lack of coordinated capacity
- to respond to increasing demand for services
- Waitlist and wait time pressures
- Gaps in care for non-operative patients
- Lack of knowledge
- regarding available resources and supports
OASIS - Goals
- Limit the development and progression of OA
- Slow onset of complications that can cause severe disability
- Reduce avoidable declines in health
- Reduce variations in care
OASIS Program (osteoarthritis service integration system)
OASIS - Multiple Stakeholders
- Clients and caregivers
- Primary Care Physicians (PCPs)
- Allied Health Professionals
- Orthopedic Surgeons
- Rheumatologists
- Community Organizations
- Education Partners
OASIS - Engagement Strategies
- Participation in planning for system re-design & implementation processes
- Focus groups - testing ideas
- Leadership of Depts. of Orthopedics, Family Practice & Rheumatology
- Multiple vehicles for communications and engagement
- Beta-testing tools and processes
- Evaluate impacts on physician practice and gaps in care
- Soft launch and incremental up-take
Provincial Musculoskeletal Council
Initial Focus
- Facilitating use and engagement of UBCH / CSI throughout all health authorities
- Sharing of information regarding TAP and OASIS models
- Confirming the need for building Health Authority capacity to deal with projected demands for musculoskeletal care
PMC Subcommittees
- Prostheses Standardization
- Rehabilitation subcommittee
- Provincial collaborative
Future Roles
- Expand discussion into other areas of concern (e.g. foot and ankle, spine, fractured hip)
- Ensure a coordinated provincial approach
- Share lessons learned with other jurisdictions
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