Strategic Clinical Networks & Clinical
Care Pathways: Creating & Managing
Quality in Alberta Health Services
CEO Forum Feb 6, 2013
Montreal
Dr Tom Noseworthy
1
Alberta Health Services
•
•
•
•
•
•
•
•
One health care delivery system for an entire Province
The ‘third way’ in Canada
Largest health care system in Canada- 3.7 million people
Budget $12B, 100,000 employees, 7500 doctors
Formed in 2008, 5 Zones added in 2010, Networks in 2012
Nine clinical networks launched to date
Up to six more planned
We aspire to being the best in Canada
2
How will the Provincial Clinical Mandate of
AHS be Accomplished?
• Strategic Clinical Networks
• Clinically-led change
• Performance measurement, research & best
evidence drive practice
• Clinical care pathways
• Clinical variance management & peer review
3
Goals of Clinical Networks?
•
•
•
•
Achieve the best outcomes
Practice the highest quality of clinical care
Seek the greatest value from resources used
Engage clinicians in all aspects of this work
4
Why Clinical Networks?
• Networks are positive ways for all partners
along a broad continuum to be involved in
planning & improving care & service delivery
• Networks have been shown to be an effective
mechanism to ensure collaboration, joint
decision-making and shared learning
• Networks are a proven model to promote the
use/uptake of clinical experience, knowledge
and evidence-based clinical pathways to
reduce clinical variation & improve care
5
What are Strategic Clinical Networks (SCNs)?
• Collaborative clinical teams with a provincial
strategic mandate to improve quality & outcomes
• Led by clinicians, driven by clinical needs,
focused on outcomes & based on best evidence
• Comprised of an all-inclusive membership, with
25 core members (community & specialty
clinicians, patients, policy-makers, researchers)
& leadership (0.5 Senior Medical Director, 0.5
Strategy Vice-President & 0.3 Scientific Director)
6
How do SCNs Work?
• Broad mandate:
– Specific populations: seniors, women's health, children
– High impact: cardiovascular disease & stroke
– High burden: diabetes, obesity & nutrition, amh
• Scope encompasses entire continuum of care
– From population health & prevention to primary care to
acute care to chronic disease management to palliation
• Projects & activities aligned with AH & AHS, prioritysetting integrated with & into organizational decision-making
• Resourced & supported to improve clinical outcomes
7
Planned Support & Resources for Each SCN
• Dedicated Business Intelligence Unit
– Project management, clinical analytics, case costing, quality
improvement, pathway development, patient safety,
knowledge management, health technology assessment
• Embedded research capability and expertise
• Education & skills development for leaders
• Funding including:
– Seed money for innovation, initiatives, and research
– Remuneration of core members
– Opportunities to retain savings that are realized
8
First Six SCNs (June 12/12)
•
•
•
•
•
•
Addiction and Mental Health
Bone and Joint Health
Cancer Care
Cardiovascular Health and Stroke
Obesity, Diabetes and Nutrition
Seniors’ Health
9
Next Six SCNs (Fiscal 2013)
•
•
•
•
•
•
Population Health and Health Promotion
Primary Care & Chronic Disease Management
Maternal Health
Newborn, Child, and Youth Health
Neurological Disease, ENT, and Vision
Complex Medicine (GI, Kidney & Respiratory)
10
Operational Clinical Networks
Similar to SCNs
i. Provincial, clinically led teams
ii. Similar infrastructure & resources
Differ from SCNs
i. Responsible across populations
ii. Operationally focused
iii. Social determinants/ EOL agenda not
required in projects
11
Three Operational Clinical Networks (Jan13)
• Critical Care
• Emergency Services
• Surgical Services
12
Snapshot of all 12 SCN ( & 3 OCN Projects)
** 9/15 new projects are ready to initiate by January 31, 2013
Cardiovascular
Health and Stroke
SCN
Vascular Risk
Reduction
C-CHANGE**
Rural Stroke
Program**
Obesity, Diabetes
& Nutrition
SCN
Insulin
Pump
criteria**
Seniors’ Health
SCN
Bone & Joint
SCN
Inappropriate
use of
antipsychotics**
Enhancing
recovery after
surgery**
3 avoid risks for AHS
Elder
Friendly
Care**
Fragility &
Stability Hip Fracture
Rx and
Prevention**
Hip & Knee
5 year Plan
Cancer
SCN
Addiction &
Mental Health
SCN
Surgery
OCN
ART
E-referral**
Depression
Pathway
aCATS**
Lung
Cancer
4 equally high value
1 aligned with IHHP concept
Emergency
OCN
Critical Care
OCN
TBD
TBD
Safe Surgery
Checklist**
4 with some external funding
3 Placeholders for SCN/OCN Equity
2 Mature Tier 1: in flight
13
30-Day In-Hospital Mortality Following Stroke - 2010/11
25
20.93
20
18.23
Risk-Adjusted Rate (per 100)
17.87
15
13.41
11.71
11.71
10
5
0
South Zone
Calgary Zone
Central Zone
Edmonton Zone
North Zone
Best Large RHA/Zone
(Calgary Zone, AB)
14
Source = CIHI CHRP
CV&S: Rural Stroke Action Plan
Project Scope:
• Create standards and clear definition of rural stroke unit care
• Implement early supported discharge (ESD) & enhanced stroke
unit care in 5 small stroke centres
• Implement enhancements to stroke unit care for 10 rural
primary stroke centres
Project Financials:
• Q4 (12/13):
• 13/14:
• TOTAL Project:
Benefits to be Realized:
System Impact:
Short term – Jan 31/ 13 – Mar 31 /14
• Acute care
•
•
• Transition management
ESD implemented in 5 small centres serving100 patients
26% reduction in length of stay; 3 persons avoid nursing home
care; 1 life saved
$ 141,964
$1,745,950
$2,873,594
• Long term care
Long term– 1- 3 year window
• 214 new patients per year receive ESD and over 1000 new
patients per year receiving full stroke unit services; 23 lives
saved/year; 17 patients avoid nursing homes after stroke/year
• Reduction in length of stay of over 20%
15
0
