An Introduction to: InterProfessional Common Assessment Tools in Stroke Care Within the Central East Stroke Network

1. An Introduction to:InterProfessional Common Assessment Tools in Stroke CareWithin the Central East Stroke Network Donelda Moscrip, MSc, S-LP(c), Reg CASLPO Regional Stroke Rehabilitation Coordinator Central East Stroke Network moscripd@rvh.on.ca 705-728-9090 ext 46312

2. Objectives for Today • Share project purpose & approach • Highlight stroke best practices in use of common assessment tools • Share next steps in moving forward

3. Central East Stroke Network

4. Project Purpose • Collaborativelyidentify and implement common assessment tools across the continuum of care for stroke survivors in Central East Stroke Network.

5. Collaborative Change Approach • Emergent change  adaptation • Appreciative inquiry • Best possible end state • Focus on the possibilities • Hearing the voices in the system

6. Gathering What Is

7. Gathering What Is Best Practice • Varied use of measures • Measures frequently used only at admission and not at discharge • Not necessarily using measures tested for responsiveness • Using measures with weak psychometric properties (Korner-Bitensky et al, 2006)

8. Canadian Best Practices in Stroke Rehabilitation Outcomes: Report of the Expert Panel • Prioritized a set of outcome measures that could be used to evaluate the outcomes of stroke rehabilitation in Canada. • Used the International Classification of Functioning to identify measures for the domains of body structure and function, activity and participation. • Recommended measures for clinical use based on reliability, validity, responsiveness, proven application with stroke and ease of use.

9. Gathering What Is Best Practice • A Best Practice for Stroke Care • Consensus Panel on the Stroke Rehabilitation System Report (2007)Standard 5 – “Stroke related impairments and functional status will be evaluated by rehabilitation professionals trained in stroke rehabilitation using standardized, valid assessments.” • Canadian Best Practice Recommendations for Stroke Care (2008, p E53, Table 8)5.1(iii) – “Clinicians should use standardized, valid assessment tools to evaluate the patient’s stroke-related impairments and functional status.”

10. Recommended Outcome Tools for Stroke Rehabilitation Criteria for inclusion: • Cross-continuum • Interprofessional administration • Can be administered in a reasonable amount of time at beginning and end of rehabilitation • Minimize cost of training • Ideally available in English and French • …

11. Gathering What is Current Practice • Which of the recommended outcome measures are being used in CESN? http://www.surveymonkey.com/s/CAT-OM

12. Discovering What Could Be

13. Results from Pilot Project: Based on your reality what is the best possible state in your setting (that this project could impact upon)? • More consistent identification of need for follow-up in the community. • More seamless transitions. • Better allocation of resources. • Trust of assessment results in transfer of information. • Reduce duplication and increase treatment time. • Use of a dynamic process to adopt emerging best evidence. • Opportunity for tailoring approaches (goals, referral, re-entry, …) based on needs of client.

14. Identifying What Is Needed

15. Results from Pilot Project:What do you think will help people to consistently use the core set of tools? Physician support Leadership support Education about when each tool is beneficial Practical education about how to use the tools Endorsement from others (other hospitals, PPL) Access to tools, including copies of tools & funding Taking part in a pilot project so they can try out the tools and experience the pros and cons Education about the benefits and problems associated with inconsistency Show the evidence that demonstrates that consistent use of outcome measures increases efficiency, communication between care providers and patient outcomes.

16. Results of Pilot Project:What other enablers are you aware of? • Forced-use – required use (on transition documentation, forms, etc) • Standards of care on EMR (times and pop-up) • Literature support • Clinician comfort with tools • Free or no cost assessment tools • Tools that can be used with other populations

17. Moving Forward

18. A Collaborative Forum • Learn more about best practice use of common assessment tools for rehabilitation of stroke survivors • Review results of survey • Collaborate to decide upon a list of 4-5 core tools for implementation across the district.

19. A Collaborative Forum • Collaborate to generate a list of needs. • Establish willingness to take the key messages to teams / organizations. • Establish readiness to adopt a core set of tools across the care continuum. • Identify next steps

20. Next Steps for Project

21. Next Steps for Project • Complete the survey with your team (We are hoping for 1 collaborative response from each organization or from each area of the continuum from an organization.)http://www.surveymonkey.com/s/CAT-OM • Currently planning the forums • Watch for registration information coming soon. • Are you interested in helping out with the forum? (contact Donelda) • Support implementation across CESN

22. A Collaborative Forum SAVE THE DATE! Durham & HKPR DistrictsSept 22, 2010 York DistrictSept 14, 2010

23. References • Canadian Stroke Network, Heart & Stroke Foundation of Canada (2008). Canadian Best Practice Recommendations for Stroke Care. CMAJ, 179(12) • Ontario Stroke System, Heart & Stroke Foundation of Ontario (2007). Consensus Panel on Stroke Rehabilitation System “Time is Function”. • Bayley, Mark (January 7, 2009) – Presentation entitled “Measuring the Outcomes of Stroke Rehabilitation: Results of a Canadian Stroke Strategy / Heart and Stroke Foundation National Consensus Panel” Archived on OTN • Korner-Bitensky, Nicol (2006) – Presentation entitled “The Canadian National Survey on Rehabilitation Practices for Stroke” www.cesnstroke.ca

24. Thank You for Listening! moscripd@rvh.on.ca