Partnership funding: Supporting guidance for Outcome Measure 4
48/6 Care Model: A Novel Approach for Devising a Potential Outcome Measure
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48/6 Care Model: A Novel Approach for Devising a Potential Outcome Measure Quality Forum 2016 Sue Goulding MHS BN
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Transcript of 48/6 Care Model: A Novel Approach for Devising a Potential Outcome Measure
48/6 Care Model: A Novel Approach for
Devising a Potential Outcome Measure
Quality Forum 2016
Sue Goulding MHS BN
Disclosure Statement
I do not have any affiliations (financial or
otherwise) with a commercial organization.
Context
48/6 Model of Care
• assessment of 6 functional care areas through standard
screening questions
• initiation of an interdisciplinary care plan to support
maintenance of, or a return to, pre-hospital level of function
48/6 Elements
• Bowel & Bladder Management
• Cognitive Functioning
• Functional Mobility
• Medication Management
• Nutrition & Hydration Management
• Pain Management
• (Psychosocial)
Aim
Define a measure to demonstrate how the 48/6
Model of Care contributes to a better patient
outcome.
Challenges with Measures
How can we
measure success?
No known direct
outcome measures
Concurrent initiatives
No “pre” measurements
done
Need resources for
consistent auditing
Complexity
No validated tools
Brainstorming
Are there any measurement tools
already in use?
How can we work within our existing resources?
What do we really want to
focus on?
Assumption
The 48/6 Model of Care will support patients to
maintain functional independence or return to their
previous level of independence.
Dependency Scale
What if…
…..we plotted out the daily dependency scale
scores of patients from admission to discharge?
48/6 Goal: Patients will maintain or decrease their level
of dependence throughout their acute care stay.
Deeper Dive
What if …we compared the percentage of patients
who maintained or decreased their level of
dependence before and after 48/6 implementation?
48/6 Goal: More patients will maintain or decrease
their level of dependence post 48/6 implementation.
Results (Unit # 1) Level of
Dependency
Pre 48/6
(May/June 2014)
N= 70
Post 48/6
(March/April 2015)
N= 70
Increased 33% 20%
Same 48% 39%
Decreased 19% 41%
67% same level
dependency or
decreased
80% same level of
dependency or decreased
Results (Unit #2) Level of
Dependency
Pre 48/6
(May/June 2014)
N= 70
Post 48/6
(March/April 2015)
N= 70
Increased 33% 23%
Same 48% 41%
Decreased 19% 25%
67% same level
dependency or
decreased
66% same level of
dependency or
decreased
What We Learned
In General: • Ideally have outcome measure defined before project
implementation
• Determine baseline status using a validated tool for comparison
post-implementation
For 48/6: • Level of dependency IS a potential measure that
supports the goals of 48/6 and is worth exploring further
Brainstorming Part 2
We believe that reviewing scores daily
with the interdisciplinary team would:
• alert us to unexpected changes in dependency to
prevent functional decline
• help with personalized care planning toward
a “target” score
Ideas for Future
1. Incorporate target/ actual dependency score discussion in daily
interdisciplinary rounds
2. Write daily score and target score on bedside whiteboard
3. Focus on involving patients and families more in plan of care
4. Consider Clinical Frailty Scales and other validated tools
Summary
Sometimes we have to be creative and
devise a “seed”, and pilot it, so that one day
it becomes a “sprout”!
Questions for You
• Do you have a tool to measure dependency or are there
validated tools you might recommend as a similar
measure?
• If you were to use a similar tool and report on a unit
basis, what length of stay would you use? What
exclusion criteria?
• Have you considered comparing clinical frailty scales on
admission to scores at discharge?
Contact Information
Sue Goulding, MHS, BN
Vancouver Coastal Health
Patient Quality & Safety
604 880-8835
