A novel made-in-Ontario solution using current health care system resources and health-care teams can prevent or improve patient stroke care, and save significant healthcare dollars
Toronto (May 24, 2011) - A White Paper released today by the Centre for Innovation in Complex Care (CICC) of the University Health Network (UHN) has identified significant care gaps of atrial fibrilation (AF) patients in Ontario, which contribute to debilitating strokes that could be prevented. As a result, the burden of AF-related stroke on patients, families and the healthcare system is significant.
The White Paper, entitled Reconnecting the Pieces to Optimize Care in Atrial Fibrillation, written by the CICC, provides a comprehensive review of the current gaps of AF care in Ontario, the challenges for patients and healthcare professionals, and the costs to the healthcare system.
It also provides suggestions on what improvements need to be made, such as using multidisciplinary teams and the resources already in the system, for e.g., primary care models, medication, homecare and information technology. Innovate AFIB, a pilot project described in the report, has been created to improve AF care and to serve as a model of care for other patients with complex, chronic illnesses, while simultaneously ensuring that healthcare costs do not spiral out of control. This work links together multiple groups to improve models of care, and has gained support from the Cardiac Care Network and Heart and Stroke Foundation.
"When it comes to atrial fibrillation and other chronic illnesses, we are facing the perfect storm in Ontario," says Dr. Dante Morra, Medical Director, CICC. "An aging population combined with a healthcare system that primarily supports episodic care, rather than the ongoing care required for chronic conditions such as AF, is creating unrelenting demand that our system cannot support."
"Despite these challenges, Ontario is in the fortunate position of having the right building blocks within our existing healthcare system because of the investments already made by our government," explains Dr. Morra. "Part of the solution will be to connect these blocks to bridge the gaps in AF care."
In Ontario, there are approximately 100,000 patients living with AF, a common and serious irregular heart beat. After age 55, the incidence of AF doubles with each decade of life and, if not managed properly, can lead to severe and debilitating strokes. In fact, people with AF are at least five times more at risk of having a stroke than those without AF, and twice as likely to die from one. For those who survive the stroke, the disabilities can be significant – paralysis, loss of speech, effects on memory and thought processes. AF is currently costing the Ontario health care system approximately $700 million annually.
The White Paper identifies several care gaps of AF patients in Ontario:
- A lack of standards in care across various healthcare providers an AF patient require (e.g., family physicians, heart specialists, pharmacists, emergency room physicians and other ER personnel, nurses, internal medicine specialists, neurologists, rehabilitation experts such as physiotherapists and speech pathologists, etc.).
- A lack of integration and information-sharing across the many healthcare providers.
- A lack of follow-up – even between emergency room personnel and an AF patient's family physician.
- A lack of support to primary care physicians.
"It is gaps such as these that contribute to the fact that only 10 per cent of AF patients in Ontario have their medications properly managed to protect them from stroke," says Dr. Frank Silver, Stroke Neurologist, Toronto Western Hospital. "We can, and must, do a better job of caring for patients with AF as the devastation from AF-related strokes is totally preventable."
Connecting for streamlined, sustainable care: working model within two years
The CICC is recommending restructuring the current Ontario system to develop a model of care for AF patients that is integrated and designed to meet all their needs – from detection of AF, to effective care in the community with patients' primary care providers, to consultation with cardiac specialists, to rehabilitation and long-term care (if needed). The end goals are the elimination of care gaps and the duplication of services and the creation of an integrated and streamlined treatment process.
"The Innovate AFIB project is a perfect example of how Ontario healthcare organizations are working together towards the common goal of improving patient care," says Tom Closson, President and CEO, Ontario Hospital Association (OHA). "It is this type of collaboration that can demonstrate how positive change can be made when connections are made across and within healthcare organizations."
In partnership with multidisciplinary Ontario health professionals who treat AF patients, and participants from government, the CICC developed a more streamlined and coordinated model of care. The approach suggests a provincial centre of excellence for AF care that sets standards and best practices, with regional AF hubs across the province. These hubs would work with family physicians in their regions to provide consultations, or be regional places of referral and ongoing support for AF patients.
"Providing coordinated care in Ontario is crucial to not only keeping AF patients as healthy as possible, and also to help ensure a high quality, sustainable health care system," says Kori Kingsbury, CEO, Cardiac Care Network of Ontario (CCN).
The CICC is now in the process of creating and testing this new approach within a number of AF centres in Ontario with the goal of having a working model that can be implemented and evaluated throughout the province in the coming year. Dr. Morra and his team are suggesting the success of this new model be determined by measuring it against what is referred to as a "value-based equation" – that more value will be gained by improving patient outcomes and reducing costs to the healthcare system. For instance, more value is created when healthcare professionals provide care earlier, shifting the focus to prevention rather than treatment. This leads to improved outcomes and decreased costs.
As Dr. Morra explains "The healthcare system can be sustainable if we change the way we care for patients in Ontario. There are many groups that believe we can improve care and reduce costs. New models of care such as the Virtual Ward, co-led through the CICC, demonstrate how sustainability can be achieved."
Reconnecting the Pieces to Optimize Care in Atrial Fibrillation is the first report by an inter-professional team of healthcare professionals involved in the Innovative A-Fib project at the CICC. Its findings are based on interviews with 75 healthcare thought leaders from across the province and from various disciplines, an in-depth literature review, and a comprehensive database review of Ontario AF patients. This project was possible with the support of Boehringer Ingelheim's commitment as a health solutions provider. CICC is now testing a working clinical model and hopes to have a second White Paper describing the results of the testing phase later this year.
The CICC White Paper is available online at www.thecicc.com.
About CICC
The Centre for Innovation in Complex Care (CICC) is dedicated to studying how to improve the entire process of care for patients with multiple problems. Its purpose is to engage our patients and clinicians to identify problems with current healthcare practices and develop solutions for addressing them. Innovative research and evaluation in a real clinical environment will allow our clinicians to use the latest technology to improve patient care. Key linkages with groups such as the Ministry of Health and the SIMS Partnership will ensure patients from across the city and the province will benefit from the innovative research conducted through the CICC.
About University Health Network
University Health Network is a major landmark in Canada's healthcare system, and a research hospital of the University of Toronto. Building on the strengths and reputation of each of our three hospitals, Toronto General Hospital, Toronto Western Hospital and Princess Margaret Hospital, UHN brings together the talent and resources needed to achieve global impact and provide exemplary patient care, research and education.
