Foundation-funded Hirdes' project illuminates home and community care challenges - adds evidence to ALC strategy & boosts understanding of chronic disease management in frail elderly

There is a tendency to label an individual as needing to go to a nursing home irrespective of need when they're in the hospital...If we took the approach to exhaust all options for care in the community, we may be able to have these people live independent and happy lives back in the community. (Dr. John Hirdes, Scientific Director of the Homewood Research Institute & Professor at the Department of Health Studies and Gerontology, University of Waterloo. The Change Foundation podcast, January 15, 2009)

Who are Ontario's Alternate-Level-of-Care (ALC) patients and what do we need to ensure smoother transitions for patients moving from hospital to home to community care? How do we better support and care for people who are at home managing their own complex chronic diseases like congestive heart failure? These are just some of the systemic, timely and inter-related big picture questions to be pursued in a two-year quality improvement research collaboration between The Change Foundation and Ontario Home Care Research Chair John Hirdes.

The study's first focus is on the clinical and social needs of ALC patients waiting in acute hospitals for long-term care (LTC). Analysis of ALC discharge to LTC indicates that the classification of 'ALC patient waiting for LTC' is not always driven by clinical need. The percentage of ALC patients in acute care beds has doubled since 2004, reaching 20 per cent. Early evidence from Dr. Hirdes' Foundation-funded work mining a rich database (1 million long-stay HC client records and 60,000 records for clients in acute care hospitals awaiting LTC placement) using the International Resident Assessment Instrument for Home Care (interRAI-HC) data has already been put to good use. Dr. Hirdes has presented these findings as part of Dr. Alan Hudson's ER=ALC strategy tour to LHIN leaders, CCAC directors and other decision-makers across the province who are seeking solutions to this system-wide problem.

Dr. Hudson, the MOHLTC Lead in the Access to Services and Wait Time Strategy, appreciates this timely partnership, saying: "Dr. Hirdes' ALC research has played an important role in reframing the analysis of Ontario's complicated ALC population. The data and analysis we received helps us get a more precise picture of the population and their varying needs to better understand the interconnected sources of the problem and what must be done to change the system to help move patients more safely and quickly back into their own homes and communities. We commend The Change Foundation for supporting this work, and look forward to seeing further and final findings to help accelerate much-needed policy solutions."

Hear why Dr. Hirdes has chosen to study chronic disease through the lens of congestive heart failure (CHF) in the following video podcast. Managing heart failure at home and empowering elderly patients to take action about their own care are important strategies to reduce health-care costs and adverse events and to promote effective chronic disease management. In the second year, the study will also examine and compare the needs of the backbone of our system - informal caregivers.

The study aligns well with the Foundation's goal to improve the quality of home and community care and will provide new data and analysis to support the province's Aging at Home initiative.

Hear directly form Dr. Hirdes on this joint study and its significance in the following podcast. Read his bio and related research summary. Read related fact sheets by the Change Foundation on Home Care in Ontario and The Human Cost of Informal Care.

CPRN & The Change Foundation host roundtable to discuss latest research & distill advice for Ontario policy makers on how to improve integrated care for seniors

How can Ontario improve the coordination and continuity of care for seniors, many of whom have chronic conditions, as they move between hospital, primary and community care and interact with an array of health services and providers? Research tells us that certain models of care keep seniors healthier without adding costs. What are those models? What can Ontario learn from other jurisdictions and what does it do well already? These are just some of the big picture questions to be debated during a Feb. 25th roundtable co-hosted by The Change Foundation and Canadian Policy Research Networks (CPRN).

Chaired by Foundation board member and respected health consultant Neil Stuart, the roundtable brings together some of the best, most forward-looking minds on geriatric health policy from across the country with a special focus on initiatives in British Columbia and Quebec. The diverse gathering will draw senior policy decision-makers in Ontario, drawn from the Cabinet and Premier's Office, health sector associations, LHINs, CCACs and provincial ministries across Canada.

"An integrated system of health services and social supports is critical to meeting the health-care needs of Canada's growing ageing population," says CPRN President, Dr. Sharon Manson Singer. "We look forward to the discussions of the roundtable in identifying potential policy options and models to improve service delivery and contribute to an enhanced quality of life for older Canadians and their families."

Roundtable discussion will be based on a paper (final version to be released this Spring), Moving Toward Health Service Integration: Provincial Progress in System Change for Seniors (February 2009) prepared by CPRN Senior Research Fellow, Margaret MacAdam with funding from Ontario's Ministry of Health and Long-Term Care. The report includes a literature review and the results of a survey of provincial progress in implementing the features of integrated care systems (based on the respected Hollander Prince Framework for organizing continuing care services.) The framework's creator, Marcus Hollander, will discuss leading international examples of integrated care from other countries. MacAdam's work shows that while every province has made public commitments to providing integrated care, progress is uneven, and some features are not well developed by any jurisdiction.

The paper covers key areas for reform, including policy changes, administrative and clinical best practices, linkages with hospitals, primary care, and social and human services. Ontario is lauded for its $700 million Aging at Home strategy, a substantial three-year investment into integrated community support services, but it has yet to create a single entry point to the full range of CCAC and community support services, or provide a wide basket of community supports, expand assisted living support or accelerate the development of an Electronic Health Record (EHR).

The roundtable will feature both presentations and informal small group disussions. Two panels will discuss and profile integrated care solutions in Canada. Rejean Hebert, Dean of Medicine at University of Sherbrooke, will share Quebec's leading work on integrated information systems -- an element commonly endorsed by all provinces as key to progress -- and Katie Hill, Director of Home and Community Care, Ministry of Health Services in British Columbia will highlight that province's new initiatives to proactively prevent avoidable hospitalizations by seniors.

"We are proud to partner with CRPN to bring together some of Canada's finest and most experienced minds on ways to improve our system and keep our growing population of seniors independent and healthy for as long as possible. The resulting recommendations will help Ontario policy makers focus on practical priority next steps to improve the continuity of care and integration of services for the elderly -- a key goal of Ontario's Aging at Home strategy," says Change Foundation CEO Cathy Fooks.

Read the related CPRN report Frameworks of Integrated Care for the Elderly: A Systematic Review also by Margaret MacAdam.

Read the program and stay tuned this spring for a summary report from the round-table with policy recommendations for Ontario.

Community Engagement & The LHINs: Truth & Consequences
The Change Foundation to host symposium/workshop in partnership with LHINs

Community engagement (CE) is not just a legislated requirement for Local Health Integration Networks (LHINs) and health service providers, it is also an important lever to transform health care in communities across Ontario. And yet, research - and every-day experience - reveals that engaging the right people with a clear purpose and to an effective end can be as challenging as it is essential. That's why The Change Foundation is partnering with the LHINs to host an interactive, invitational symposium and workshop, Community Engagement & The LHINs: Truth & Consequences, on March 11th in Toronto.

Targeted to LHIN CEOs, Board Chairs, senior LHIN staff/CE Leads, the program will feature experts in CE research and practice such as Julia Abelson of McMaster University and Peter MacLeod from Mass LBP, as well as a panel of LHIN CEOs Gwen DuBois-Wing and Paul Huras. The symposium/workshop is designed to elicit strategic discussion about how to maximize the opportunity to engage the public in a way that enhances planning, services and health and to learn from LHIN CE experiences to date. It is being offered at an opportune time as the LHINs plan how to engage their publics in the development of Integrated Health Service Plans for 2010-2013.

The afternoon workshop will build on and expand participants' CE expertise, showcasing useful models, tools, tips, case studies, and applying past experience to current priorities and challenges. To reflect realities in the field, the day (which is being facilitated by engagement professionals from Ascentum Inc.) will incorporate the LHIN CE priorities and experiences identified in a pre-event survey.

"This Change Foundation has worked with the LHINs every step of the way - in particular with North Simcoe Muskoka, North West, and Mississauga Halton -- on this collaboration, which is shaping up to be a very focused and frank exchange of information, evidence, and experience on an issue critical to advancing health integration in Ontario. The importance of community engagement kept surfacing in our policy work, our research, and our outreach, and we trust this symposium and workshop will generate useful material for the array of health-care players engaged in engagement," said The Change Foundation CEO Cathy Fooks.

Said North West LHIN CEO Gwen DuBois-Wing: "We welcome this timely partnership with The Change Foundation to share community engagement successes and common challenges across LHINs. We look forward to learning from some of field's best thinkers and doers - and from each other -- as we finalize future plans to create a more responsive system better aligned with local needs and expectations and as we continue to build a trusting, two-way relationship with our communities."

Look for a report summarizing key learnings from Truth & Consequences on our website this Spring.

The Change Foundation releases its 2007/08 Annual Report, On Track

2007/2008 was a critical set-up year for The Change Foundation as we put our thinking to good use -- with good input, good will, and good wishes from Ontario's health-care community. We carved out research agendas to support health integration and quality improvement in home and community care, then got to work, attaching projects and people and products to them. We've made a solid start of many of those efforts, and we encourage you to find out more by scanning our annual report. It takes time and talent to deliver quality and excellence, but we think we're On Track to do just that. See where we've been, and read where we are headed.

CHQI: update
CHQI at The Change Foundation sponsors Ontario LHIN-learning at IHI's Triple Aim Conference

Earlier this month, CHQI at The Change Foundation provided support to two representatives from each of Ontario's 14 LHINs to attend the Institute for Health Care Improvement's (IHI) Triple Aim conference in Arizona. CHQI's Paula Blackstein Hirsch and the Foundation's Cathy Fooks also travelled with the 31 representatives including LHIN CEOs, Senior Directors and consultants to learn about a framework for improving quality at a LHIN level. The two-day seminar offered LHIN leaders an opportunity to learn from experts about the Triple Aim goals of improving population health, enhancing the patient experience, and reducing costs. IHI is an independent not-for-profit organization helping to lead the improvement of health care worldwide.

"We were keen to introduce Ontario LHIN leaders to the Triple Aim paradigm as this initiative is ideally suited to their mandate to improve population health and integration," says Blackstien-Hirsch. CHQI and The Change Foundation are planning a follow-up workshop for the LHINs this spring to explore how best to integrate this quality improvement learning into future planning and implementation.

Later this April (27-30), CHQI will subsidize tuition for executive teams from 10 health-care organizations to participate in the Institute for Healthcare Improvement's Executive Quality Academy (EQA) focused on development of quality as a core business strategy. The EQA is the first of four components in Leadership for Performance Excellence, a new program being launched by CHQI. The EQA is open to all executive teams comprised of CEOs, VPs, senior physicians and board members.

Acrostic challenge:
More cranium crunches with our latest acrostic puzzle

Our bodies may be more sedentary in winter, but our brains don't have to be. Continue to exercise your cranium by taking our February acrostic challenge. Once completed, the puzzle reveals a quote connected to our research collaboration with Dr. John Hirdes of the University of Waterloo and Homewood Research Institute on better understanding ALC patients and chronic disease management for seniors with Congestive Heart Failure.Hear his podcast here. To get started, download the acrostic software and fill out the puzzle.

The first person to send in completed puzzle will receive a $40 Chapters gift certificate.
Contact Anila Sunnak, asunnak@changefoundation.com

Look for the completed February crossword on our website on Monday March 9.

The Change Foundation, P.O. Box 42, 200 Front Street West, Suite 2501, Toronto, ON, M5V 3M1, Phone: 416.205.1353, Fax: 416.205.1440

Feedback appreciated. Please contact Anila Sunnak (asunnak@changefoundation.com).

View our privacy policy at (http://www.changefoundation.ca/privacy.html)