ARCHIVED - 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

(209 K) (524 K)

Presentation Outline

• Agenda
• The Arthroplasty Plan
• Components of TAP Model
• 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
• II UBCH - CSI Initiative
• OASIS - Gaps in Care
• OASIS - Goals
• OASIS Program
• OASIS Patient Journey
• OASIS - Multiple Stakeholders
• OASIS - Engagement Strategies
• Provincial Musculoskeletal Council

Agenda

1. The Arthroplasty Plan
2. UBC/CSI Initiative
3. OASIS
4. 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
• Integrate with regional and provincial initiatives
• 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
• 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
  • consults and surgeries
• 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