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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)
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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)
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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)
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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.
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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)
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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
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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
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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
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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
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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
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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
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
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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
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