SlideShare a Scribd company logo
1 of 40
Download to read offline
Dealing with Complexity:
The Bridgepoint Health Hospital Experience




Renee Lyons, Ph.D.
Chair in Complex Chronic Disease Research and
Scientific Director, Bridgepoint Collaboratory for Research and Innovation
Professor - Dalla Lana School of Public Health, University of Toronto
Dale Min, Kerry Kuluski and Alexis Schaink

Quality of Care for People with Multiple Chronic Diseases: New Opportunities and
Challenges Forum
Granada, Spain
Tuesday, June 1, 2010
                                                                                   1
Overview

• Third Frontier (Multi-morbidity, Complex Chronic
Disease, and the Deficit Crisis)
• Bridgepoint Health and the Collaboratory
• Research initiatives
• Opportunities for Collaboration




                                                     2
The Third Frontier:
Complex Chronic Disease
What is it?
• More than one chronic disease
• Complex care (individualized, patient-focused but systematic)
• Coordinated, linked up care over time
• Data and metrics that reflect complexity
• High prevalence of mental health problems
• High prevalence of social, economic, and/or cultural issues
• High risk for additional health problems and hospitalization
• Self management and family support are challenges
• Patient flow an issue
• Health system re-design needed!


                                                             3
CCD Intersects with Many Factors

                        Culture




         Mental
                                          Family
         Health




                                       Socioeconomic
       Environment
                                           Status




                     Quality of Life



                                                       4
In Contrast to the Health System
Focus
• Acute care – designed for short-term episodic care
• Reactive models
• Treat and street
• Ineffective for prevention and treatment
• Patient and family experience usually unsatisfactory
• Inadequate attention to prevention (tipping points)




                                                         5
Global Burden of
Chronic Disease

• The main cause of death and disability worldwide
– 60% of all deaths (Abegunde et al., 2007)
• In 2030, predicted to cause 75% of deaths
worldwide (WHO, 2008)
• In the UK, 80% of GP consultations CD; 80% of
people living with long-term conditions needed
support for self care (DH, 2004)



                                                  6
Health Care Expenditures
in Canada

• $39 billion or 42% of health care expenditures related to
chronic disease (Mirolla, 2004)
• Total economic burden of 7 most prevalent chronic diseases
(medical plus productivity losses) exceeded $93 billion
(CDAC, 2004)
• 60% of the health care budget spent on chronic disease in
Nova Scotia (Colman, 2002)
• Cost of CD varies by region by diagnosis (Manitoba Centre
for Health Policy, 2010)



                                                              7
Complex Chronic Disease
• Heaviest users (Reid, 2003)
• 36% of diabetes health care expenditures associated with
co-morbidity (Simpson et al., 2003)
• In Manitoba, 30.5% of all people with chronic disease
have co-morbidities – 2 to 3 times as costly depending on
the combination (MCHP, 2010)
• Co-morbidity management – acute model does not work.
Increased symptom burden at high risk for developing
additional health problems (Williams et al., 2007)




                                                             8
Disparity/Economic Costs

• Low-income Canadians are:
   – 50% more likely to report having a
     chronic disease
   – 3 times more likely to report having 2
     or more chronic conditions.
    (2007 Report on Ontario’s Health System; Ontario Health
    Quality Council, 2007)




                                                              9
10
11
Statistical Challenges in CCD
• Massive variability in prevalence, impact and
distribution across populations/geography.
• Substantive variability in the unit of analysis and
measures.
• Lack of common definition of CCD and valid index
to measure complexity and capture burden
• Co-morbidity does not explain critical elements of
prevention or management.
• Cost and use predictions not dependable.
                                                    12
Taking Action
Prevention/Population Health:
• Fifty percent of premature deaths and 70% of chronic
disease in US is preventable. Up to 80% of premature deaths
from CVD, stroke and diabetes could be averted by
intervention (WHO, 2005)
• Attention to the social determinants
Care:
Patients in acute hospital medical wards are mostly older and
have multiple co-morbid conditions that require complex and
holistic care that the systems of case mix, diagnosis related
groups and management systems do little to promote.
(Williams, 2010, p.65)

                                                          13
Bridgepoint Health




                     14
Toronto, Ontario, Canada   15
16
17
18
The Strategy Process

                                                       2006      Implementation!
                                                      Six Year
                                                      Business
                                       2004 to 2006     Plan
                                        Canada’s
                                         Leader                    We are
                            2004        Strategy                   here!
                          New vision
                             and
            2001 - 2004    mission
                An
            integrated
1995-2000   network of
             services

 Survival




                                                                          19
Four Key Outcomes of Strategy
• Reduce the burden of
complex chronic disease
• Improve the quality of life
and improve wellness for
individuals living with
chronic disease
• Create, share and
disseminate new
knowledge
• Drive societal and health
system change

                                20
21
Bridgepoint Hospital
• Publicly funded
• In-patient care
• Ambulatory and day services – 20,000 visits
• 479 beds: 367 complex & 112 rehabilitation
• 1,200 employees
• 400 volunteers
• Ethnically diverse
• Health disparities




                                                22
In-Patient: Complex
Rehabilitation
                 • Moderate to severe acquired
                 brain injury
                 • Major surgery with
                 complications
                 • Stroke with moderate
                 functional impairment
                 • Elderly patients with hip
                 fractures
                 • Multiple severe
                 fractures/trauma
                 • Elective surgery, hip and
                 knee replacement

                                               23
In-Patient: Complex Care
Multiple chronic conditions
• Stroke with major functional   • Post-surgical complications
impairment
                                 • Advanced diabetes
• Advanced progressive
                                 • Advanced HIV/AIDS
neuro-muscular disease
                                 • End stage disease
• Moderate or severe acquired
brain injury
• Cardiovascular and
respiratory complications
• Severe wounds




                                                             24
Ambulatory Care: Day
Treatment
• Physiotherapy               • Physiatry
• Occupational therapy        • Spasticity Clinic
• Speech language pathology   • Cognitive group
• Social Work                 • Tai Chi group
• Nursing                     • Acupuncture
• Vocational rehabilitation   • Pool therapy
counseling
                              • Pain management
                              • LEGSS (Lower Extremity
                              Gait Support Services)



                                                         25
Bridgepoint: Family
Health Team
• Opened March 2008
• Primary care services:
    • Nurse Practitioner
    • Social Worker
    • Dietitian
    • Pharmacist
    • Registered Nurses
    • Physicians
• Research/Data Development
• LiveWell! program

                              26
The Bridgepoint Collaboratory
for Research and Innovation in
   Complex Chronic Disease




    Leading edge research that advances
understanding of and action on CCD prevention
                   and care                27
Left to Right: Dale Min, Kerry Kuluski, Alexis Schaink and Renee Lyons   28
The Collaboratory

                            Researchers/Advisors
Alex Jadad                   Ross Upshur                   Chandrakant Shah
Canada Research Chair        Associate Scientist           Professor Emeritus
Global eHealth               ICES and Sunnybrook           Dalla Lana School of
                                                           Public Health


Harvey Skinner               Louise-Lemieux Charles        Rick Glazier
Dean of Faculty of Health    Chair, Department of Health   Scientist
York University              Policy                        ICES and Li Ka Shing
                             University of Toronto         Knowledge Institute


Andreas Laupacis             Susan Jaglal                  Blake Poland
Executive Director           Vice-Chair of Research        Associate Professor,
Li Ka Shing Knowledge        Rehabiliation research        Dalla Lana School of
Institute                                                  Public Health

                                                                                  29
Build from Strengths at Bridgepoint:




Dr. Bob Bernstein                                 Jane Merkley
Data Development                                    Skill Mix


                           Dr. Heather MacNeill
                               COIL Project                      30
Build from Strengths at Bridgepoint:




Kate Wilkinson
Quality and Safety
                                           Susan Himel
                                       LiveWell! Prevention
                                             Project




                                                              31
18 Month Objective

  5 Themes            5 Research Teams




                  5
 5 Researchers/          5 Grants
   Post-Docs
                                     32
Emerging Themes

1) Data development and CCD
2) Quality and Safety Innovation
3) A CCD Training Platform – Collaborative
   Online Interprofessional Learning (C.O.I.L.)
4) Primary care
5) Facility design



                                              33
Grants


1) International Post-Doctoral Cluster in
   Complex Chronic Disease
2) Partnerships for Health Systems
   Improvement




                                            34
35
The Bridgepoint Study


• Define the Patient Population – The What?
• Patient and Family Need Assessments
• Asset Mapping
• Literature Review (of CCD populations and
models)




                                              36
The Bridgepoint Study


“How do we respond?” – The How?
  • Determine the components of CCD models
  that are most relevant to Bridgepoint.
  • “Think Tank” to develop a model based on
  evidence collected.



                                               37
The Health Care Funding Crisis
Opportunities for Collaboration:
Efficiency and Effectiveness?
• Quality Patient and Family Experience
• Skill Mix
• Patient Flow
• Safety
• Prevention
• Blending Health – Social Development
• End of Life
• Mental Health
                                          38
Opportunities for Collaboration

• Conceptual Development
• Data Development: Measures and Indicators
• Clinical and Health Services Intervention
• Population-based Health Systems Intervention
• Linked-up Services – Coordination
• Person-centered: Self Management Strategies
• Training/Decision Platforms
• Health Policy

                                                 39
Thank You!
Contact Information
Websites:
http://www.bridgepointhealth.ca
http://www.lifechanges.ca

Email:
RLyons@bridgepointhealth.ca



                                  40

More Related Content

What's hot

The 2nd Diabetes Attitudes, Wishes & Needs (DAWN2) study: objectives and meth...
The 2nd Diabetes Attitudes, Wishes & Needs (DAWN2) study: objectives and meth...The 2nd Diabetes Attitudes, Wishes & Needs (DAWN2) study: objectives and meth...
The 2nd Diabetes Attitudes, Wishes & Needs (DAWN2) study: objectives and meth...Primary Care Diabetes Europe
 
Hospice Basics and Benefits | VITAS Healthcare
Hospice Basics and Benefits | VITAS HealthcareHospice Basics and Benefits | VITAS Healthcare
Hospice Basics and Benefits | VITAS HealthcareVITAS Healthcare
 
The opportunity and waste of human potential: Managing the mental health of t...
The opportunity and waste of human potential: Managing the mental health of t...The opportunity and waste of human potential: Managing the mental health of t...
The opportunity and waste of human potential: Managing the mental health of t...Studiosity.com
 
Dementia Near the End of Life
Dementia Near the End of LifeDementia Near the End of Life
Dementia Near the End of LifeVITAS Healthcare
 
Lowitja institute
Lowitja instituteLowitja institute
Lowitja instituteBiteTheDust
 
A Change in Behavior: A Pragmatic Clinical Guide to Delirium, Terminal Restle...
A Change in Behavior: A Pragmatic Clinical Guide to Delirium, Terminal Restle...A Change in Behavior: A Pragmatic Clinical Guide to Delirium, Terminal Restle...
A Change in Behavior: A Pragmatic Clinical Guide to Delirium, Terminal Restle...VITAS Healthcare
 
Sepsis and Post-Sepsis Syndrome
Sepsis and Post-Sepsis SyndromeSepsis and Post-Sepsis Syndrome
Sepsis and Post-Sepsis SyndromeVITAS Healthcare
 
Trends in the Primary Care Management and Health Service Use of the Dementia ...
Trends in the Primary Care Management and Health Service Use of the Dementia ...Trends in the Primary Care Management and Health Service Use of the Dementia ...
Trends in the Primary Care Management and Health Service Use of the Dementia ...DataNB
 
Managing a Dual Eligible Population
Managing a Dual Eligible PopulationManaging a Dual Eligible Population
Managing a Dual Eligible PopulationVITAS Healthcare
 
Assessment of Physical Activity Level in Adults with Intellectual Disabilitie...
Assessment of Physical Activity Level in Adults with Intellectual Disabilitie...Assessment of Physical Activity Level in Adults with Intellectual Disabilitie...
Assessment of Physical Activity Level in Adults with Intellectual Disabilitie...Remedypublications1
 
When Decision-Making Is Imperative: Advance Care Planning in the ED
When Decision-Making Is Imperative: Advance Care Planning in the EDWhen Decision-Making Is Imperative: Advance Care Planning in the ED
When Decision-Making Is Imperative: Advance Care Planning in the EDVITAS Healthcare
 
Ado hamza abdullahi
Ado hamza abdullahiAdo hamza abdullahi
Ado hamza abdullahiHamzaAdo
 
Bone Health, Falls Prevention and Falls Reduction Strategies - AIGNA Mastercl...
Bone Health, Falls Prevention and Falls Reduction Strategies - AIGNA Mastercl...Bone Health, Falls Prevention and Falls Reduction Strategies - AIGNA Mastercl...
Bone Health, Falls Prevention and Falls Reduction Strategies - AIGNA Mastercl...anne spencer
 

What's hot (20)

Pete Smith Pd Management April2007
Pete Smith Pd Management April2007Pete Smith Pd Management April2007
Pete Smith Pd Management April2007
 
The 2nd Diabetes Attitudes, Wishes & Needs (DAWN2) study: objectives and meth...
The 2nd Diabetes Attitudes, Wishes & Needs (DAWN2) study: objectives and meth...The 2nd Diabetes Attitudes, Wishes & Needs (DAWN2) study: objectives and meth...
The 2nd Diabetes Attitudes, Wishes & Needs (DAWN2) study: objectives and meth...
 
Hospice Basics and Benefits | VITAS Healthcare
Hospice Basics and Benefits | VITAS HealthcareHospice Basics and Benefits | VITAS Healthcare
Hospice Basics and Benefits | VITAS Healthcare
 
The opportunity and waste of human potential: Managing the mental health of t...
The opportunity and waste of human potential: Managing the mental health of t...The opportunity and waste of human potential: Managing the mental health of t...
The opportunity and waste of human potential: Managing the mental health of t...
 
Juan Carles Contel, Department of Health, Chronic Care Program, Catalonia
Juan Carles Contel, Department of Health, Chronic Care Program, CataloniaJuan Carles Contel, Department of Health, Chronic Care Program, Catalonia
Juan Carles Contel, Department of Health, Chronic Care Program, Catalonia
 
Dementia Near the End of Life
Dementia Near the End of LifeDementia Near the End of Life
Dementia Near the End of Life
 
Lowitja institute
Lowitja instituteLowitja institute
Lowitja institute
 
A Change in Behavior: A Pragmatic Clinical Guide to Delirium, Terminal Restle...
A Change in Behavior: A Pragmatic Clinical Guide to Delirium, Terminal Restle...A Change in Behavior: A Pragmatic Clinical Guide to Delirium, Terminal Restle...
A Change in Behavior: A Pragmatic Clinical Guide to Delirium, Terminal Restle...
 
Sepsis and Post-Sepsis Syndrome
Sepsis and Post-Sepsis SyndromeSepsis and Post-Sepsis Syndrome
Sepsis and Post-Sepsis Syndrome
 
Palliative care beyond cancer
Palliative care beyond cancerPalliative care beyond cancer
Palliative care beyond cancer
 
Trends in the Primary Care Management and Health Service Use of the Dementia ...
Trends in the Primary Care Management and Health Service Use of the Dementia ...Trends in the Primary Care Management and Health Service Use of the Dementia ...
Trends in the Primary Care Management and Health Service Use of the Dementia ...
 
Overview of HIV & Aging
Overview of HIV & AgingOverview of HIV & Aging
Overview of HIV & Aging
 
Geriatrics: Assessment in Older Adults Living with HIV
Geriatrics: Assessment in Older Adults Living with HIVGeriatrics: Assessment in Older Adults Living with HIV
Geriatrics: Assessment in Older Adults Living with HIV
 
Ph d proposal_seminar_apurva_pandya 21aug2010
Ph d proposal_seminar_apurva_pandya 21aug2010Ph d proposal_seminar_apurva_pandya 21aug2010
Ph d proposal_seminar_apurva_pandya 21aug2010
 
Managing a Dual Eligible Population
Managing a Dual Eligible PopulationManaging a Dual Eligible Population
Managing a Dual Eligible Population
 
Wound Care 101
Wound Care 101Wound Care 101
Wound Care 101
 
Assessment of Physical Activity Level in Adults with Intellectual Disabilitie...
Assessment of Physical Activity Level in Adults with Intellectual Disabilitie...Assessment of Physical Activity Level in Adults with Intellectual Disabilitie...
Assessment of Physical Activity Level in Adults with Intellectual Disabilitie...
 
When Decision-Making Is Imperative: Advance Care Planning in the ED
When Decision-Making Is Imperative: Advance Care Planning in the EDWhen Decision-Making Is Imperative: Advance Care Planning in the ED
When Decision-Making Is Imperative: Advance Care Planning in the ED
 
Ado hamza abdullahi
Ado hamza abdullahiAdo hamza abdullahi
Ado hamza abdullahi
 
Bone Health, Falls Prevention and Falls Reduction Strategies - AIGNA Mastercl...
Bone Health, Falls Prevention and Falls Reduction Strategies - AIGNA Mastercl...Bone Health, Falls Prevention and Falls Reduction Strategies - AIGNA Mastercl...
Bone Health, Falls Prevention and Falls Reduction Strategies - AIGNA Mastercl...
 

Viewers also liked

Break-Out sessie Factuurcongres 2009 van Peter Potgieser
Break-Out sessie Factuurcongres 2009 van Peter PotgieserBreak-Out sessie Factuurcongres 2009 van Peter Potgieser
Break-Out sessie Factuurcongres 2009 van Peter PotgieserFriso de Jong
 
PINsafe by SWIVEL
PINsafe by SWIVELPINsafe by SWIVEL
PINsafe by SWIVELajldr
 
A Specific Value Chain Framework for Mountain Products in a Globalised Market...
A Specific Value Chain Framework for Mountain Products in a Globalised Market...A Specific Value Chain Framework for Mountain Products in a Globalised Market...
A Specific Value Chain Framework for Mountain Products in a Globalised Market...University of the Highlands and Islands
 
Fr3 information spanish
Fr3 information spanishFr3 information spanish
Fr3 information spanishjtcool74
 
1.5.) DP application checklist
1.5.) DP application checklist1.5.) DP application checklist
1.5.) DP application checklistTom Schlodder
 
Linked data business models
Linked data business modelsLinked data business models
Linked data business modelsJesus Contreras
 
Cpl brochure company-overview_20111121
Cpl brochure company-overview_20111121Cpl brochure company-overview_20111121
Cpl brochure company-overview_20111121tommydm
 
Facultad de derecho universidad de antioquia curso metodología uno
Facultad de derecho universidad de antioquia   curso metodología unoFacultad de derecho universidad de antioquia   curso metodología uno
Facultad de derecho universidad de antioquia curso metodología unoWalter Augusto Zapata Jaramillo
 
Unicollaboration Organisation Launch
Unicollaboration Organisation LaunchUnicollaboration Organisation Launch
Unicollaboration Organisation LaunchRobert O'Dowd
 
Las sociedades internacionales y su incidencia en los políticos argentinos
Las sociedades internacionales y su incidencia en los políticos argentinosLas sociedades internacionales y su incidencia en los políticos argentinos
Las sociedades internacionales y su incidencia en los políticos argentinosRamón Copa
 
Titulo treinta y tres código penal subtítulo 4 cód
Titulo treinta y tres código penal subtítulo 4 códTitulo treinta y tres código penal subtítulo 4 cód
Titulo treinta y tres código penal subtítulo 4 códYadira Mangual
 

Viewers also liked (20)

FCommerce
FCommerceFCommerce
FCommerce
 
Break-Out sessie Factuurcongres 2009 van Peter Potgieser
Break-Out sessie Factuurcongres 2009 van Peter PotgieserBreak-Out sessie Factuurcongres 2009 van Peter Potgieser
Break-Out sessie Factuurcongres 2009 van Peter Potgieser
 
Ultimo
UltimoUltimo
Ultimo
 
PINsafe by SWIVEL
PINsafe by SWIVELPINsafe by SWIVEL
PINsafe by SWIVEL
 
A Specific Value Chain Framework for Mountain Products in a Globalised Market...
A Specific Value Chain Framework for Mountain Products in a Globalised Market...A Specific Value Chain Framework for Mountain Products in a Globalised Market...
A Specific Value Chain Framework for Mountain Products in a Globalised Market...
 
Fr3 information spanish
Fr3 information spanishFr3 information spanish
Fr3 information spanish
 
1.5.) DP application checklist
1.5.) DP application checklist1.5.) DP application checklist
1.5.) DP application checklist
 
Administración
AdministraciónAdministración
Administración
 
Aprendo haciendo danza
Aprendo haciendo danzaAprendo haciendo danza
Aprendo haciendo danza
 
Linked data business models
Linked data business modelsLinked data business models
Linked data business models
 
Cpl brochure company-overview_20111121
Cpl brochure company-overview_20111121Cpl brochure company-overview_20111121
Cpl brochure company-overview_20111121
 
Boletín XL noviembre 2016
Boletín XL noviembre 2016Boletín XL noviembre 2016
Boletín XL noviembre 2016
 
Facultad de derecho universidad de antioquia curso metodología uno
Facultad de derecho universidad de antioquia   curso metodología unoFacultad de derecho universidad de antioquia   curso metodología uno
Facultad de derecho universidad de antioquia curso metodología uno
 
Unicollaboration Organisation Launch
Unicollaboration Organisation LaunchUnicollaboration Organisation Launch
Unicollaboration Organisation Launch
 
CarlosArrieta15
CarlosArrieta15CarlosArrieta15
CarlosArrieta15
 
Las sociedades internacionales y su incidencia en los políticos argentinos
Las sociedades internacionales y su incidencia en los políticos argentinosLas sociedades internacionales y su incidencia en los políticos argentinos
Las sociedades internacionales y su incidencia en los políticos argentinos
 
Responsive Email
Responsive EmailResponsive Email
Responsive Email
 
Dosier currutacos
Dosier currutacosDosier currutacos
Dosier currutacos
 
Andrea UNRIZA
Andrea UNRIZAAndrea UNRIZA
Andrea UNRIZA
 
Titulo treinta y tres código penal subtítulo 4 cód
Titulo treinta y tres código penal subtítulo 4 códTitulo treinta y tres código penal subtítulo 4 cód
Titulo treinta y tres código penal subtítulo 4 cód
 

Similar to Foro calidad OPIMEC Renée Lyons

World Alzheimer Report 2016: Improving healthcare for people living with deme...
World Alzheimer Report 2016: Improving healthcare for people living with deme...World Alzheimer Report 2016: Improving healthcare for people living with deme...
World Alzheimer Report 2016: Improving healthcare for people living with deme...Adelina Comas-Herrera
 
iHT² Health IT Summit Atlanta 2014 - Case Study "Carilion Clinic’s Journey wi...
iHT² Health IT Summit Atlanta 2014 - Case Study "Carilion Clinic’s Journey wi...iHT² Health IT Summit Atlanta 2014 - Case Study "Carilion Clinic’s Journey wi...
iHT² Health IT Summit Atlanta 2014 - Case Study "Carilion Clinic’s Journey wi...Health IT Conference – iHT2
 
Population Health Planning for Chronic Disease
Population Health Planning for Chronic DiseasePopulation Health Planning for Chronic Disease
Population Health Planning for Chronic DiseaseSIMUL8 Corporation
 
C-TAC 2015 National Summit on Advanced Illness Care - Master Slide Deck
C-TAC 2015 National Summit on Advanced Illness Care - Master Slide DeckC-TAC 2015 National Summit on Advanced Illness Care - Master Slide Deck
C-TAC 2015 National Summit on Advanced Illness Care - Master Slide Deckzbarehmi
 
Stakeholder scoping 05 nov 14 insight version
Stakeholder scoping 05 nov 14 insight versionStakeholder scoping 05 nov 14 insight version
Stakeholder scoping 05 nov 14 insight versionCambridgeshireInsight
 
eHealth_Challenges_and_Opportunities.ppt
eHealth_Challenges_and_Opportunities.ppteHealth_Challenges_and_Opportunities.ppt
eHealth_Challenges_and_Opportunities.pptAlexandruGasnas1
 
Day 1_Session 1_Introduction to PC_Dr Sushma.pdf
Day 1_Session 1_Introduction to PC_Dr Sushma.pdfDay 1_Session 1_Introduction to PC_Dr Sushma.pdf
Day 1_Session 1_Introduction to PC_Dr Sushma.pdfRamchandra Solanki
 
75th Anniversary & FY2019 Year-End Celebration Highlights Presentation
75th Anniversary & FY2019 Year-End Celebration Highlights Presentation75th Anniversary & FY2019 Year-End Celebration Highlights Presentation
75th Anniversary & FY2019 Year-End Celebration Highlights Presentationmskonhovd
 
Sanjeev Arora, MD, Director, Project Echo
Sanjeev Arora, MD, Director, Project EchoSanjeev Arora, MD, Director, Project Echo
Sanjeev Arora, MD, Director, Project EchoInvestnet
 
Elderly care practices in covid 19
Elderly care practices in covid 19Elderly care practices in covid 19
Elderly care practices in covid 19Jeyadeepa Ramaraj
 
International Health Policy and Practice: Comparing the U.S. and Canada on Ac...
International Health Policy and Practice: Comparing the U.S. and Canada on Ac...International Health Policy and Practice: Comparing the U.S. and Canada on Ac...
International Health Policy and Practice: Comparing the U.S. and Canada on Ac...The Commonwealth Fund
 
What does a palliative approach look like in residential care
What does a palliative approach look like in residential careWhat does a palliative approach look like in residential care
What does a palliative approach look like in residential careBCCPA
 
E Health Behaviour Change
E Health Behaviour ChangeE Health Behaviour Change
E Health Behaviour ChangeCameron Norman
 
Supporting medicines adherence developing the pharmacist contribution
Supporting medicines adherence   developing the pharmacist contributionSupporting medicines adherence   developing the pharmacist contribution
Supporting medicines adherence developing the pharmacist contributionPM Society
 
1362574283 economic burden dm sl
1362574283 economic burden dm sl1362574283 economic burden dm sl
1362574283 economic burden dm sldfsimedia
 

Similar to Foro calidad OPIMEC Renée Lyons (20)

World Alzheimer Report 2016: Improving healthcare for people living with deme...
World Alzheimer Report 2016: Improving healthcare for people living with deme...World Alzheimer Report 2016: Improving healthcare for people living with deme...
World Alzheimer Report 2016: Improving healthcare for people living with deme...
 
iHT² Health IT Summit Atlanta 2014 - Case Study "Carilion Clinic’s Journey wi...
iHT² Health IT Summit Atlanta 2014 - Case Study "Carilion Clinic’s Journey wi...iHT² Health IT Summit Atlanta 2014 - Case Study "Carilion Clinic’s Journey wi...
iHT² Health IT Summit Atlanta 2014 - Case Study "Carilion Clinic’s Journey wi...
 
Population Health Planning for Chronic Disease
Population Health Planning for Chronic DiseasePopulation Health Planning for Chronic Disease
Population Health Planning for Chronic Disease
 
Learning Health Care Systems
Learning Health Care SystemsLearning Health Care Systems
Learning Health Care Systems
 
C-TAC 2015 National Summit on Advanced Illness Care - Master Slide Deck
C-TAC 2015 National Summit on Advanced Illness Care - Master Slide DeckC-TAC 2015 National Summit on Advanced Illness Care - Master Slide Deck
C-TAC 2015 National Summit on Advanced Illness Care - Master Slide Deck
 
Stakeholder scoping 05 nov 14 insight version
Stakeholder scoping 05 nov 14 insight versionStakeholder scoping 05 nov 14 insight version
Stakeholder scoping 05 nov 14 insight version
 
eHealth_Challenges_and_Opportunities.ppt
eHealth_Challenges_and_Opportunities.ppteHealth_Challenges_and_Opportunities.ppt
eHealth_Challenges_and_Opportunities.ppt
 
Day 1_Session 1_Introduction to PC_Dr Sushma.pdf
Day 1_Session 1_Introduction to PC_Dr Sushma.pdfDay 1_Session 1_Introduction to PC_Dr Sushma.pdf
Day 1_Session 1_Introduction to PC_Dr Sushma.pdf
 
Levelling up and Health Inequalities 2022.pptx
 Levelling up and Health Inequalities 2022.pptx Levelling up and Health Inequalities 2022.pptx
Levelling up and Health Inequalities 2022.pptx
 
75th Anniversary & FY2019 Year-End Celebration Highlights Presentation
75th Anniversary & FY2019 Year-End Celebration Highlights Presentation75th Anniversary & FY2019 Year-End Celebration Highlights Presentation
75th Anniversary & FY2019 Year-End Celebration Highlights Presentation
 
Reconfiguring primary care for the era of chronic diseases
Reconfiguring primary care for the era of chronic diseasesReconfiguring primary care for the era of chronic diseases
Reconfiguring primary care for the era of chronic diseases
 
A Public Health Perspective
A Public Health PerspectiveA Public Health Perspective
A Public Health Perspective
 
Sanjeev Arora, MD, Director, Project Echo
Sanjeev Arora, MD, Director, Project EchoSanjeev Arora, MD, Director, Project Echo
Sanjeev Arora, MD, Director, Project Echo
 
The Five Million Lives Campaign
The Five Million Lives CampaignThe Five Million Lives Campaign
The Five Million Lives Campaign
 
Elderly care practices in covid 19
Elderly care practices in covid 19Elderly care practices in covid 19
Elderly care practices in covid 19
 
International Health Policy and Practice: Comparing the U.S. and Canada on Ac...
International Health Policy and Practice: Comparing the U.S. and Canada on Ac...International Health Policy and Practice: Comparing the U.S. and Canada on Ac...
International Health Policy and Practice: Comparing the U.S. and Canada on Ac...
 
What does a palliative approach look like in residential care
What does a palliative approach look like in residential careWhat does a palliative approach look like in residential care
What does a palliative approach look like in residential care
 
E Health Behaviour Change
E Health Behaviour ChangeE Health Behaviour Change
E Health Behaviour Change
 
Supporting medicines adherence developing the pharmacist contribution
Supporting medicines adherence   developing the pharmacist contributionSupporting medicines adherence   developing the pharmacist contribution
Supporting medicines adherence developing the pharmacist contribution
 
1362574283 economic burden dm sl
1362574283 economic burden dm sl1362574283 economic burden dm sl
1362574283 economic burden dm sl
 

More from Observatorio de Prácticas Innovadoras en el Manejo de Enfermedades Crónicas Complejas (OPIMEC)

More from Observatorio de Prácticas Innovadoras en el Manejo de Enfermedades Crónicas Complejas (OPIMEC) (20)

Unidad 4: La Pluripatología. Tema 2: Manejo del Paciente Pluripatológico
Unidad 4: La Pluripatología. Tema 2: Manejo del Paciente PluripatológicoUnidad 4: La Pluripatología. Tema 2: Manejo del Paciente Pluripatológico
Unidad 4: La Pluripatología. Tema 2: Manejo del Paciente Pluripatológico
 
Unidad 4: La Pluripatología. Tema 1: Concepto de Paciente Pluripatológico
Unidad 4: La Pluripatología. Tema 1: Concepto de Paciente Pluripatológico Unidad 4: La Pluripatología. Tema 1: Concepto de Paciente Pluripatológico
Unidad 4: La Pluripatología. Tema 1: Concepto de Paciente Pluripatológico
 
Unidad 4: La Pluripatología. Tema 3: Herramientas pronósticas en el paciente ...
Unidad 4: La Pluripatología. Tema 3: Herramientas pronósticas en el paciente ...Unidad 4: La Pluripatología. Tema 3: Herramientas pronósticas en el paciente ...
Unidad 4: La Pluripatología. Tema 3: Herramientas pronósticas en el paciente ...
 
Unidad 4: La Pluripatología. Tema 3: Herramientas pronósticas en el paciente ...
Unidad 4: La Pluripatología. Tema 3: Herramientas pronósticas en el paciente ...Unidad 4: La Pluripatología. Tema 3: Herramientas pronósticas en el paciente ...
Unidad 4: La Pluripatología. Tema 3: Herramientas pronósticas en el paciente ...
 
Presentación de la sesión síncrona 1: Humanizar desde Atención Primaria: mito...
Presentación de la sesión síncrona 1: Humanizar desde Atención Primaria: mito...Presentación de la sesión síncrona 1: Humanizar desde Atención Primaria: mito...
Presentación de la sesión síncrona 1: Humanizar desde Atención Primaria: mito...
 
Unidad 5: La terapia farmacológica. Sistema de ayuda para la detección de int...
Unidad 5: La terapia farmacológica. Sistema de ayuda para la detección de int...Unidad 5: La terapia farmacológica. Sistema de ayuda para la detección de int...
Unidad 5: La terapia farmacológica. Sistema de ayuda para la detección de int...
 
Decálogo de la Humanización de la Asistencia Sanitaria
Decálogo de la Humanización de la Asistencia Sanitaria Decálogo de la Humanización de la Asistencia Sanitaria
Decálogo de la Humanización de la Asistencia Sanitaria
 
Humanización en la asistencia de las personas que cuidan
Humanización en la asistencia de las personas que cuidanHumanización en la asistencia de las personas que cuidan
Humanización en la asistencia de las personas que cuidan
 
Estrategias de acompañamiento y counselling
Estrategias de acompañamiento y counsellingEstrategias de acompañamiento y counselling
Estrategias de acompañamiento y counselling
 
Modelo de Humanización basado en las Competencias Personales
Modelo de Humanización basado en las Competencias PersonalesModelo de Humanización basado en las Competencias Personales
Modelo de Humanización basado en las Competencias Personales
 
Gestión emocional: profesionales humanizados/as
Gestión emocional: profesionales humanizados/asGestión emocional: profesionales humanizados/as
Gestión emocional: profesionales humanizados/as
 
Reflexión sobre la meditación guiada 'El final de tu vida'
Reflexión sobre la meditación guiada 'El final de tu vida'Reflexión sobre la meditación guiada 'El final de tu vida'
Reflexión sobre la meditación guiada 'El final de tu vida'
 
La mediación sociosanitaria intercultural, como herramienta de promoción de l...
La mediación sociosanitaria intercultural, como herramienta de promoción de l...La mediación sociosanitaria intercultural, como herramienta de promoción de l...
La mediación sociosanitaria intercultural, como herramienta de promoción de l...
 
Unidad 5: La terapia farmacológica. Sistema de ayuda para la detección de int...
Unidad 5: La terapia farmacológica. Sistema de ayuda para la detección de int...Unidad 5: La terapia farmacológica. Sistema de ayuda para la detección de int...
Unidad 5: La terapia farmacológica. Sistema de ayuda para la detección de int...
 
Presentación: "Componentes del PAP"
Presentación: "Componentes del PAP"Presentación: "Componentes del PAP"
Presentación: "Componentes del PAP"
 
Unidad 4: La Pluripatología. Tema 1: Concepto de Paciente Pluripatológico
Unidad 4: La Pluripatología. Tema 1: Concepto de Paciente PluripatológicoUnidad 4: La Pluripatología. Tema 1: Concepto de Paciente Pluripatológico
Unidad 4: La Pluripatología. Tema 1: Concepto de Paciente Pluripatológico
 
Presentación: "Componentes del PAP"
Presentación: "Componentes del PAP"Presentación: "Componentes del PAP"
Presentación: "Componentes del PAP"
 
Unidad 1: Cómo adecuar los objetivos y el Plan de Acción Personalizado al pro...
Unidad 1: Cómo adecuar los objetivos y el Plan de Acción Personalizado al pro...Unidad 1: Cómo adecuar los objetivos y el Plan de Acción Personalizado al pro...
Unidad 1: Cómo adecuar los objetivos y el Plan de Acción Personalizado al pro...
 
III Foro: "Calidad de la Atención a Personas con Enfermedades Crónicas: avanc...
III Foro: "Calidad de la Atención a Personas con Enfermedades Crónicas: avanc...III Foro: "Calidad de la Atención a Personas con Enfermedades Crónicas: avanc...
III Foro: "Calidad de la Atención a Personas con Enfermedades Crónicas: avanc...
 
Estilos de vida en la insuficiencia cardiaca
Estilos de vida en la insuficiencia cardiacaEstilos de vida en la insuficiencia cardiaca
Estilos de vida en la insuficiencia cardiaca
 

Recently uploaded

Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024EwoutSteyerberg1
 
Adenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosisAdenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosisSujoy Dasgupta
 
AUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functionsAUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functionsMedicoseAcademics
 
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptxDNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptxMAsifAhmad
 
Physiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxationPhysiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxationMedicoseAcademics
 
Male Infertility, Antioxidants and Beyond
Male Infertility, Antioxidants and BeyondMale Infertility, Antioxidants and Beyond
Male Infertility, Antioxidants and BeyondSujoy Dasgupta
 
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdfCONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdfDolisha Warbi
 
pA2 value, Schild plot and pD2 values- applications in pharmacology
pA2 value, Schild plot and pD2 values- applications in pharmacologypA2 value, Schild plot and pD2 values- applications in pharmacology
pA2 value, Schild plot and pD2 values- applications in pharmacologyDeepakDaniel9
 
How to cure cirrhosis and chronic hepatitis naturally
How to cure cirrhosis and chronic hepatitis naturallyHow to cure cirrhosis and chronic hepatitis naturally
How to cure cirrhosis and chronic hepatitis naturallyZurück zum Ursprung
 
Pharmacokinetic Models by Dr. Ram D. Bawankar.ppt
Pharmacokinetic Models by Dr. Ram D.  Bawankar.pptPharmacokinetic Models by Dr. Ram D.  Bawankar.ppt
Pharmacokinetic Models by Dr. Ram D. Bawankar.pptRamDBawankar1
 
Male Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaMale Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaSujoy Dasgupta
 
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.aarjukhadka22
 
Basic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptxBasic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptxkomalt2001
 
Neurological history taking (2024) .
Neurological  history  taking  (2024)  .Neurological  history  taking  (2024)  .
Neurological history taking (2024) .Mohamed Rizk Khodair
 
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdfSGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdfHongBiThi1
 
power point presentation of Clinical evaluation of strabismus
power point presentation of Clinical evaluation  of strabismuspower point presentation of Clinical evaluation  of strabismus
power point presentation of Clinical evaluation of strabismusChandrasekar Reddy
 
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...Shubhanshu Gaurav
 

Recently uploaded (20)

Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...
Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...
Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...
 
Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024
 
Adenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosisAdenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosis
 
AUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functionsAUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functions
 
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptxDNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
 
Physiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxationPhysiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxation
 
American College of physicians ACP high value care recommendations in rheumat...
American College of physicians ACP high value care recommendations in rheumat...American College of physicians ACP high value care recommendations in rheumat...
American College of physicians ACP high value care recommendations in rheumat...
 
Male Infertility, Antioxidants and Beyond
Male Infertility, Antioxidants and BeyondMale Infertility, Antioxidants and Beyond
Male Infertility, Antioxidants and Beyond
 
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdfCONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
 
pA2 value, Schild plot and pD2 values- applications in pharmacology
pA2 value, Schild plot and pD2 values- applications in pharmacologypA2 value, Schild plot and pD2 values- applications in pharmacology
pA2 value, Schild plot and pD2 values- applications in pharmacology
 
How to cure cirrhosis and chronic hepatitis naturally
How to cure cirrhosis and chronic hepatitis naturallyHow to cure cirrhosis and chronic hepatitis naturally
How to cure cirrhosis and chronic hepatitis naturally
 
Pharmacokinetic Models by Dr. Ram D. Bawankar.ppt
Pharmacokinetic Models by Dr. Ram D.  Bawankar.pptPharmacokinetic Models by Dr. Ram D.  Bawankar.ppt
Pharmacokinetic Models by Dr. Ram D. Bawankar.ppt
 
Male Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaMale Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy Dasgupta
 
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
 
Basic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptxBasic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptx
 
How to master Steroid (glucocorticoids) prescription, different scenarios, ca...
How to master Steroid (glucocorticoids) prescription, different scenarios, ca...How to master Steroid (glucocorticoids) prescription, different scenarios, ca...
How to master Steroid (glucocorticoids) prescription, different scenarios, ca...
 
Neurological history taking (2024) .
Neurological  history  taking  (2024)  .Neurological  history  taking  (2024)  .
Neurological history taking (2024) .
 
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdfSGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
 
power point presentation of Clinical evaluation of strabismus
power point presentation of Clinical evaluation  of strabismuspower point presentation of Clinical evaluation  of strabismus
power point presentation of Clinical evaluation of strabismus
 
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...
 

Foro calidad OPIMEC Renée Lyons

  • 1. Dealing with Complexity: The Bridgepoint Health Hospital Experience Renee Lyons, Ph.D. Chair in Complex Chronic Disease Research and Scientific Director, Bridgepoint Collaboratory for Research and Innovation Professor - Dalla Lana School of Public Health, University of Toronto Dale Min, Kerry Kuluski and Alexis Schaink Quality of Care for People with Multiple Chronic Diseases: New Opportunities and Challenges Forum Granada, Spain Tuesday, June 1, 2010 1
  • 2. Overview • Third Frontier (Multi-morbidity, Complex Chronic Disease, and the Deficit Crisis) • Bridgepoint Health and the Collaboratory • Research initiatives • Opportunities for Collaboration 2
  • 3. The Third Frontier: Complex Chronic Disease What is it? • More than one chronic disease • Complex care (individualized, patient-focused but systematic) • Coordinated, linked up care over time • Data and metrics that reflect complexity • High prevalence of mental health problems • High prevalence of social, economic, and/or cultural issues • High risk for additional health problems and hospitalization • Self management and family support are challenges • Patient flow an issue • Health system re-design needed! 3
  • 4. CCD Intersects with Many Factors Culture Mental Family Health Socioeconomic Environment Status Quality of Life 4
  • 5. In Contrast to the Health System Focus • Acute care – designed for short-term episodic care • Reactive models • Treat and street • Ineffective for prevention and treatment • Patient and family experience usually unsatisfactory • Inadequate attention to prevention (tipping points) 5
  • 6. Global Burden of Chronic Disease • The main cause of death and disability worldwide – 60% of all deaths (Abegunde et al., 2007) • In 2030, predicted to cause 75% of deaths worldwide (WHO, 2008) • In the UK, 80% of GP consultations CD; 80% of people living with long-term conditions needed support for self care (DH, 2004) 6
  • 7. Health Care Expenditures in Canada • $39 billion or 42% of health care expenditures related to chronic disease (Mirolla, 2004) • Total economic burden of 7 most prevalent chronic diseases (medical plus productivity losses) exceeded $93 billion (CDAC, 2004) • 60% of the health care budget spent on chronic disease in Nova Scotia (Colman, 2002) • Cost of CD varies by region by diagnosis (Manitoba Centre for Health Policy, 2010) 7
  • 8. Complex Chronic Disease • Heaviest users (Reid, 2003) • 36% of diabetes health care expenditures associated with co-morbidity (Simpson et al., 2003) • In Manitoba, 30.5% of all people with chronic disease have co-morbidities – 2 to 3 times as costly depending on the combination (MCHP, 2010) • Co-morbidity management – acute model does not work. Increased symptom burden at high risk for developing additional health problems (Williams et al., 2007) 8
  • 9. Disparity/Economic Costs • Low-income Canadians are: – 50% more likely to report having a chronic disease – 3 times more likely to report having 2 or more chronic conditions. (2007 Report on Ontario’s Health System; Ontario Health Quality Council, 2007) 9
  • 10. 10
  • 11. 11
  • 12. Statistical Challenges in CCD • Massive variability in prevalence, impact and distribution across populations/geography. • Substantive variability in the unit of analysis and measures. • Lack of common definition of CCD and valid index to measure complexity and capture burden • Co-morbidity does not explain critical elements of prevention or management. • Cost and use predictions not dependable. 12
  • 13. Taking Action Prevention/Population Health: • Fifty percent of premature deaths and 70% of chronic disease in US is preventable. Up to 80% of premature deaths from CVD, stroke and diabetes could be averted by intervention (WHO, 2005) • Attention to the social determinants Care: Patients in acute hospital medical wards are mostly older and have multiple co-morbid conditions that require complex and holistic care that the systems of case mix, diagnosis related groups and management systems do little to promote. (Williams, 2010, p.65) 13
  • 16. 16
  • 17. 17
  • 18. 18
  • 19. The Strategy Process 2006 Implementation! Six Year Business 2004 to 2006 Plan Canada’s Leader We are 2004 Strategy here! New vision and 2001 - 2004 mission An integrated 1995-2000 network of services Survival 19
  • 20. Four Key Outcomes of Strategy • Reduce the burden of complex chronic disease • Improve the quality of life and improve wellness for individuals living with chronic disease • Create, share and disseminate new knowledge • Drive societal and health system change 20
  • 21. 21
  • 22. Bridgepoint Hospital • Publicly funded • In-patient care • Ambulatory and day services – 20,000 visits • 479 beds: 367 complex & 112 rehabilitation • 1,200 employees • 400 volunteers • Ethnically diverse • Health disparities 22
  • 23. In-Patient: Complex Rehabilitation • Moderate to severe acquired brain injury • Major surgery with complications • Stroke with moderate functional impairment • Elderly patients with hip fractures • Multiple severe fractures/trauma • Elective surgery, hip and knee replacement 23
  • 24. In-Patient: Complex Care Multiple chronic conditions • Stroke with major functional • Post-surgical complications impairment • Advanced diabetes • Advanced progressive • Advanced HIV/AIDS neuro-muscular disease • End stage disease • Moderate or severe acquired brain injury • Cardiovascular and respiratory complications • Severe wounds 24
  • 25. Ambulatory Care: Day Treatment • Physiotherapy • Physiatry • Occupational therapy • Spasticity Clinic • Speech language pathology • Cognitive group • Social Work • Tai Chi group • Nursing • Acupuncture • Vocational rehabilitation • Pool therapy counseling • Pain management • LEGSS (Lower Extremity Gait Support Services) 25
  • 26. Bridgepoint: Family Health Team • Opened March 2008 • Primary care services: • Nurse Practitioner • Social Worker • Dietitian • Pharmacist • Registered Nurses • Physicians • Research/Data Development • LiveWell! program 26
  • 27. The Bridgepoint Collaboratory for Research and Innovation in Complex Chronic Disease Leading edge research that advances understanding of and action on CCD prevention and care 27
  • 28. Left to Right: Dale Min, Kerry Kuluski, Alexis Schaink and Renee Lyons 28
  • 29. The Collaboratory Researchers/Advisors Alex Jadad Ross Upshur Chandrakant Shah Canada Research Chair Associate Scientist Professor Emeritus Global eHealth ICES and Sunnybrook Dalla Lana School of Public Health Harvey Skinner Louise-Lemieux Charles Rick Glazier Dean of Faculty of Health Chair, Department of Health Scientist York University Policy ICES and Li Ka Shing University of Toronto Knowledge Institute Andreas Laupacis Susan Jaglal Blake Poland Executive Director Vice-Chair of Research Associate Professor, Li Ka Shing Knowledge Rehabiliation research Dalla Lana School of Institute Public Health 29
  • 30. Build from Strengths at Bridgepoint: Dr. Bob Bernstein Jane Merkley Data Development Skill Mix Dr. Heather MacNeill COIL Project 30
  • 31. Build from Strengths at Bridgepoint: Kate Wilkinson Quality and Safety Susan Himel LiveWell! Prevention Project 31
  • 32. 18 Month Objective 5 Themes 5 Research Teams 5 5 Researchers/ 5 Grants Post-Docs 32
  • 33. Emerging Themes 1) Data development and CCD 2) Quality and Safety Innovation 3) A CCD Training Platform – Collaborative Online Interprofessional Learning (C.O.I.L.) 4) Primary care 5) Facility design 33
  • 34. Grants 1) International Post-Doctoral Cluster in Complex Chronic Disease 2) Partnerships for Health Systems Improvement 34
  • 35. 35
  • 36. The Bridgepoint Study • Define the Patient Population – The What? • Patient and Family Need Assessments • Asset Mapping • Literature Review (of CCD populations and models) 36
  • 37. The Bridgepoint Study “How do we respond?” – The How? • Determine the components of CCD models that are most relevant to Bridgepoint. • “Think Tank” to develop a model based on evidence collected. 37
  • 38. The Health Care Funding Crisis Opportunities for Collaboration: Efficiency and Effectiveness? • Quality Patient and Family Experience • Skill Mix • Patient Flow • Safety • Prevention • Blending Health – Social Development • End of Life • Mental Health 38
  • 39. Opportunities for Collaboration • Conceptual Development • Data Development: Measures and Indicators • Clinical and Health Services Intervention • Population-based Health Systems Intervention • Linked-up Services – Coordination • Person-centered: Self Management Strategies • Training/Decision Platforms • Health Policy 39