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Glenrose Rehabilitation Hospital

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.

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Glenrose Rehabilitation Hospital

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  1. Glenrose Rehabilitation Hospital Service Redesign

  2. 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.

  3. 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%

  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

  5. 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).

  6. 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.

  7. 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.

  8. 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)

  9. 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

  10. 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

  11. 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

  12. 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

  13. Chronic Care Model“Service Delivery”

  14. 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

  15. 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

  16. Chronic Care Model“Service Delivery”

  17. 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)

  18. Communication Plan • Evaluation plan • Continuous Quality Improvement • Monitoring results • Performance feedback

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