Innovation in Health Care
ABJHI and its partners are changing the way bone and joint health care is provided. These exciting developments are occurring at a critical time. The need for efficient, high quality bone and joint health care is rising rapidly in Alberta, driven by population aging, population growth, increasing longevity, alarming rates of obesity and growing prevalence of chronic disease.
Find out more about the Alberta Bone and Joint Health Institute’s new health care model for Albertans.
A time of urgent need
The Institute’s bone and joint health care model has been developed at a time of urgent need for improvement in the public health system. Health care costs are escalating, services are being rationed, waiting times for surgery are excessive, quality is inconsistent, and treatments and medications are often inappropriate or unnecessary.
In response to these challenges, the Institute has built its model on the following patient-centered principles:
- Services at the levels of prevention, diagnosis and treatment of individual health conditions and diseases delivered according to “world’s best” benchmarks.
- Evidence-based approaches to prevention, diagnosis and treatment using a combination of the best available information and sound medical judgment.
- Access to and payment for evidence-based services guaranteed by the public system. (Publicly paid services not supported by evidence and sound medical judgment lose funding and funds redirected to evidence-based public health care.)
- Services and technologies not fully supported by evidence offered under predefined conditions and any financial gains reinvested to create additional value in the public health system.
- All services continually evaluated for access, quality and cost to ensure value being created.
- The ability of referring physicians and patients to choose their provider facilitated through published information, with public funds following the patient.
- Provider compensation continuum-based, linked to outcomes, and incentives provided for increasing value.
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Model tested on hip and knee replacements
The Institute’s work recognizes that changes are needed urgently to manage current and future needs for bone and joint health care. Alberta’s population is aging and the proportion of older people in the population is growing. In 25 years, there will be three seniors for every 10 working-age Albertans. Chronic diseases, such as osteoarthritis – the leading cause of hip and knee replacements – are increasing. Obesity, which increases the risk of osteoarthritis nine-fold, is escalating dramatically, especially among children and young adults.
Rapidly rising need for hip and knee replacements and lengthy waits have made faster access to these procedures one of the top priorities for health care systems across Canada. The Institute’s model was tested in this critical area with the launch of the Alberta Hip and Knee Replacement Pilot Project in April 2005. The 12-month pilot, which was conducted in the Capital, David Thompson and Calgary health regions, produced dramatic improvements in hip and knee replacement services.
- Wait to see a surgeon – dropped from an average 145 working days to 21 days
- Wait from consultation to surgery – fell from average of 290 working days to 37 days
- Stay in hospital down almost a day and a half – to 4.7 days from 6 days
- Patient outcomes improved – for example, 85% of patients were up and mobile the day of their surgery
- Patients were better able to function physically and had less pain following their surgery
- Patients and health care providers were more satisfied
Based on these outstanding results, the new Hip and Knee Replacement model is being rolled out as the standard of care across the three pilot health regions and will soon be expanded province-wide.
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Key elements of our new bone and joint health care model
Putting patients at the centre
- Evidence-based criteria and thresholds established to ensure best outcomes.
- Patient pre-operative, operative and post-operative services provided in focused facilities.
- Fully integrated and individualized patient care from initial consultation through to diagnostics, surgery, rehabilitation and lifestyle change.
- Each patient assigned a case manager to assemble and coordinate the required care team of physicians, nurses, therapists and educators.
- Patient choice of facility and surgeon, and access and availability to public services based on actual need.
- Patients and service providers sign contract specifying obligations of both parties to ensure best results are achieved.
- Predictability of health care services to be received.
- Standardized and comprehensive patient education to improve outcomes and expectations.
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Delivering health care in a multi-disciplinary team environment
- Bone and joint physicians work with other doctors, nurses, therapists and educators in multi-disciplinary care teams that leverage individual areas of expertise.
- Bone and joint multi-disciplinary care teams share care with primary care teams.
- By treating similar conditions repeatedly, teams uncover ways to be innovative, producing better results for patients and reducing costs.
- Bone and joint physicians and regional health authorities, supported by the Institute, work as one to advance and govern an evidence-based approach to treatment.
Encouraging patient choice with innovative compensation models
- Bone and joint physicians, other service providers and regional health authorities paid on a case rate basis for publicly funded services.
- Case rates include professional and facility components for service providers; operative, inpatient, sub-acute and home care components for health regions.
- Case rate funds pooled provincially and funding follows the patient.
- Publicly available performance reports enable patients to make informed choices about facilities where they will spend public funds, creating an environment that promotes continuous improvement.
- Case rates and performance reports create incentive for aligned quality and efficiency gains.
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Aligning efforts across health regions
- A new Provincial Bone and Joint Advisory Committee aligns efforts, establishes priorities, and approves significant changes. Committee members: health authorities, provincial health ministry, physicians and the Institute.
- Independent regional boards oversee focused facilities and service delivery. Board members: health authorities, private citizens, physicians.
- Focused facilities linked by common electronic medical record and referral systems.
- Institute serves as catalyst for improved bone and joint health care, advancing innovative health care strategies, developing enhanced service delivery models, designing fully integrated continuums of care, evaluating health services, conducting research and driving continuous improvement.
Diverting services to single-purpose focused facilities from overcrowded hospitals
- Bone and joint health services diverted from overcrowded hospitals into focused facilities located in key urban centres.
- Focused facilities house physician offices, diagnostics, clinics, operating rooms, beds and rehabilitative services under one roof.
- Single-purpose facilities are more economical to build and operate than full-service hospitals.
- Focused facilities jointly owned and operated by physicians, regional health authorities and others in a not-for-profit structure.
- Focused facilities linked to satellite clinics and patients discharged to sub-acute care in rural hospitals.
- Bone and joint Info-Line launched to provide expert advice to primary care and to link hospital emergency physicians with specialists and expedite access to trauma services.
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Making all publicly funded health services evidence-based
- Public funding for all life and limb saving services.
- Public funding for all elective diagnostic and treatment services proven to be beneficial based on evidence and sound medical judgment.
- Unproven but promising services and devices offered under predetermined conditions.
- Institute analyzes existing and new services and devices, and provides recommendations to decision-makers at national, provincial and local levels.
Improving efficiency and asset utilization, and reducing demand on taxpayers
- Focused facilities built and expanded as needed to meet demand using full or partial private capital, reducing the demand on taxpayers to fund more capacity.
- Services continually redesigned to eliminate waste and add value.
- Thresholds established for access to publicly funded services to ensure that treatment is based on evidence and sound medical judgment.
- Focused facilities required to participate in training programs as part of their not-for-profit charter.
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Ensuring the public health care system is sustainable
- Prevention a major component of patient education to promote improved health and wellness and reduce future health care needs.
- Treatments are evidence-based to ensure patient safety and minimize costly waste, such as redundant use of resources.
- Services not fully supported by evidence available in focused facilities under predefined conditions and any financial gains reinvested to benefit the public health care system.
A satisfying journey through the health care system
The Institute’s health care model will make the patient’s journey through the public health care system satisfying and successful. Key steps along the way:
- Patient begins medical journey with visit to family physician.
- Family physician refers patient to a central assessment, diagnosis and treatment clinic specializing in bone and joint health care.
- Clinic determines required treatment such as physiotherapy, medication, surgery, lifestyle change or a combination of these.
- Patients requiring surgery given access to performance data – such as cases handled, post-operative length of stay, pain and function outcomes, device failures, health complications and readmissions – on all bone and joint focused facilities in Alberta. Patient compares performance against provincial standards and chooses focused facility.
- Clinic assigns case manager to patient. Case manager assembles required care team – physicians, nurses, therapists and educators – to deliver individualized care from initial consultation with specialist through to surgery, rehabilitation and, if necessary, lifestyle change.
- Patient and care team enter into contract specifying what each party must do to achieve optimal results. Example: Patient commits to stop smoking and commence monitored exercise program to increase strength prior to surgery. Care team commits to coaching patient toward goals, to surgery date and home care aid.
- Consultation, surgery, therapy, education, follow-up scheduled to meet or exceed provincial standards.
- Care team works as unit through entire patient journey to share case information and deliver optimal results.
- Case results entered into central database to track and report on focused facility performance against provincial standards.
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