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An advocate for hip- and knee-replacement patients, Dr. Nizar Mahomed recently won an award for leading the development of a new care model for these patients. The award was jointly presented by the Canadian Institute for Health Research and the Canadian Medical Association Journal.Dr. Mahomed, Medical Director, Musculoskeletal Health and Arthritis program, and Head of Orthopaedics, UHN Rehab Solutions, spoke with UHNews about the project.
What did the Total Joint Network project involve? There were two projects under the Total Joint Network. The first project was for hip- and knee-replacement patients and involved 25 health care organizations in Toronto. We developed a new, integrated model of care that decreased patients' length of stay in both acute care and rehabilitation hospitals by almost 40 percent. We did this while improving clinical outcomes, patient satisfaction and pain improvement. The project led to annual savings of $10 million to Ontario's healthcare system, and created extra capacity in inpatient rehabilitation because we managed the post-operative phase through community care access centres. Once we had the extra capacity, we put forward the second project, to develop an integrated care model for hip-fracture patients. We trained a cohort of health care providers, nurses and allied health professionals in dealing with frail elderly patients with dementia and delirium. This project involved 35 organizations and led to shorter lengths of stay in both acute care and rehabilitation. More importantly, it allowed us to rehabilitate over 80 percent of hip-fracture patients—who, historically, often ended up in long-term care facilities or nursing homes—back to their pre-injury status. The annual cost savings from the second project were $17 million.
Will hospitals in other parts of Ontario also use this care model? That's what the province would like—to move this beyond the GTA and into other areas in Ontario. The lessons learned from this project have helped to establish benchmarks that the province will use to evaluate the performance of different healthcare regions.
You mentioned that this new model of care has reduced wait times for hip- and knee-replacement patients. Describe how you measured that. The care model has reduced length of stay in hospital. Historically, when patients came in, their length of stay used to be seven to nine days in acute care, and two to three weeks in a rehab hospital. With this new model, we achieved five days in hospital for the majority of patients, and for those going to rehab, three days in hospital and seven days in rehab. In the first two years of the project, the volume of joint-replacement procedures in Toronto increased by 50 percent, but none of the hospitals or rehab centres had to add in-patient bed capacity because the efficiencies gained through the new care model allowed that throughput to happen without opening extra beds.
What were the results at UHN specifically?Had we continued with the old model, we would have had to increase our bed capacity by 50 percent. With the new model, we have increased our bed capacity by only 10 percent and we are doing 100 percent more cases now than in 2006-07.
What are the project's future goals? Hopefully the lessons learned from this project will allow us to make further improvements and efficiencies in the delivery of care, not only for hip and knee patients, but also in other patient populations.
How are you sharing this information with the rest of the province?All of our findings, care paths, models of care and learning tools are posted on our public website, totaljointnetwork.org, as well as on our patient education website.