Glenrose Rehabilitation Hospital

Service Redesign

Key Drivers • Access to services needs to be clear,

transparent, timely and appropriate to meet the needs of children and families.

• The continuum of care is difficult to understand from the perspectives of families and referral sources.

• Current services have developed over time following trends and opportunities; how the services fit together is unclear.

• Technological advances have provided new opportunities in healthcare delivery.

Key Drivers • Increasing birthrates

• (42% increase over last 10 years for Edmonton)

• Increasing prematurity rates (increase health risk) • “Alberta has the highest rate of

premature birth in Canada, at 8.7 percent. The costs associated with preterm births in Canada are tens of billions a year.”

• Childhood Disability Prevalence = 4%

Key Drivers Population growth-

“By 2041, Alberta’s total population is projected to expand by over 2 million people to reach almost 6 million…”

”…future population growth is mainly driven by international migration (net migration is projected to account for 65%, or 1.4 million people)”

http://www.finance.alberta.ca/aboutalberta/population_reports/2012-2041-alberta-population-projections.pdf

Autism Incidence and Prevalence

• American prevalence (CDC) of Autism in 8-year-old children is 1 in 88; this is a 70% increase between 2000 and 2008.

• There is no indication that rates are falling; prevalence rates in recent years have either held steady or increased.

• We presume this prevalence is similar in Canada (e.g., NEDSAC study suggested 1 in 77 in SE Ontario).

• Our data suggest this prevalence is similar in northern Alberta.

• Severity data is not readily available, though about 40% of children with Autism have an IQ below 70 (Intellectual Disability cutoff).

GRH Autism Clinic Patients

• As of July 2013, we have 2270 patients in the Glenrose Autism Clinic.

• Approximately 900 of these have a high level of severity, judging solely by IQ (not including those with higher IQ and major behaviour problems).

• The modal (most common) age of children in the Autism Clinic is 6, though the median is 11.

GRH Autism Clinic Admissions

• Based on these prevalence data, within the Glenrose Autism Clinic catchment area, there should be approximately 290 new referrals/year.

• In the last two fiscal years, we have admitted 328 and 302 new patients in the Autism Clinic, a rate roughly in keeping with CDC/NEDSAC rates.

• Assuming projected increases in Alberta population of 1.54% per year, even if Autism prevalence just holds steady (a conservative estimate), this would yield a total of 1518 new referrals from 2013-2017.

• This compares to 563 children within the Autism Clinic who would turn 18 in that time.

Guiding Principles• Accessibility and responsiveness

(“Any door is the right door”) • Patient and family centred care • Collaborative care• Service coordination• Evidence-based practice• Continuity of care• Standardized practice• Fiscally responsible within the context

of quality and sustainability (Resource Stewardship)

Steps to improve• To identify a service delivery model &

design to allow the alignment of services toward common purposes and outcomes

• To review the scope and purpose of services

• To identify frameworks and practices to guide needed processes

• To establish redesign teams for planning and implementation

• Establish metrics to measure quality and outcomes

• Evaluation

Current landscape

• Alberta Health Services- Provincial structures; concept of Health Equity (in particular access and quality)

• Alberta Education- Regional Collaborative Services Delivery Framework (universal design for learning)

• Human Services- Information Sharing Strategy; Social Policy Framework

Chronic Care Model“Patient & Family Centred Care”

- Provincial PFCC- Child Health Interest Group- Glenrose Family Advisory Network (GFAN)-

integration into structures and functions of Peds Rehab

- Simulation Project – GFAN/GRH/GRHF- Recreation planning project- GFAN/YMCA/GRH - Transition to Adulthood Project- GFAN/GRH/Community- Family to Family Support Program- GFAN/GRH

- Service Delivery Design- developed upon principles according to Appreciative Inquiry

Chronic Care Model“Informed, Activated Patient and

“Prepared Practice Teams”

– Chronic Care Model video 23:15-26:24– E:\LINKS\Clipped Chronic Care.wmv– Social Policy Framework

» Building Adult Capabilities to Improve Child Outcomes: A Theory of Change

» E:\LINKS\Building Adult Capabilities.wmv» E:\LINKS\Building Adult Capabilities.mp4

http://www.youtube.com/watch?v=urU-a_FsS5Y

Chronic Care Model“Service Delivery”

Child

Parents

Child Parents

CURRENT STATE

FUTURE STATE

Specific Actions- “Informed & Activated”

- Parent/caregiver Education, Resources & Support Centre (under development)- to build confidence and competence in the ability to raise a child with a disability or developmental needs

- e.g.,- In Your Dreams- Food for Thought- Positive Behavior Support Training- Transitions- New Beginnings- Family to Family Support

Specific Actions“Prepared for Practice”

- Learning and Development Centre (launched in 2013)- to enable GRH to provide education and support to our staff and other service providers

- E.g., Autism 101 for EEG Tech’s and day surgery staff at Stollery; training in pharmacy, medical students and dentistry

- Best practice and knowledge mobilization program (under development)- to enable our staff to provide the best care according to evidence available and to enable them to address their clinical questions in a systematic way

- e.g., diagnosis of autism project

Chronic Care Model“Service Delivery”

Specific Actions“Service Delivery”

• E.g.,- Participation in the Autism Treatment Network- to

advance practice to ensure the best medical care for children and youth with autism and their families ( main focus areas right now are Sleep and partnership with primary care providers)

- Adults with Autism Project- Sinneave/GRH/Community

- Service review and redesign for pediatric developmental populations (on deck)

- Service review for “outreach” activities (on deck)

1. Communication Plan2. Evaluation plan 3. Continuous Quality Improvement 4. Monitoring results 5. Performance feedback