Prevention Planning: Beyond the Provincial Framework February 22, - PowerPoint PPT Presentation

Inter-LHIN Collaboration in Fall Prevention Planning: Beyond the Provincial Framework February 22, 2017

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Welcome & Introduction http://rgps.on.ca/files/IntegratedProvincialFallsPreventionFrameworkToolkit_July2011.pdf

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Fall Prevention in Ontario  There are currently a number of leading falls prevention interventions that have proven to decrease the rate and impact of falls in the elderly  Many health sectors and organizations are implementing fall prevention interventions, including: Local Health Integration Networks (LHINs), their Health Service Providers (HSPs) and Public Health Units (PHUs), some Community Health Centres (CHCs) and others

The Reality  Some great evidence-informed interventions, screening tools and frameworks  Fragmented system  Inconsistent approach to performance and measurement

The Intent A provincial and integrated fall prevention framework Reduction in the number and impact of falls on seniors and the health care system Increased quality of life for seniors

Project Working Group  An integrated, multi-sector working group co-chaired by the LHINs and Public Health convened in January 2011 to formulate the Integrated Provincial Falls Prevention Framework & Toolkit  Public Health is a key partner given its mandate and experience with respect to preventing falls across the lifespan

Partners St . John’s Rehab Hospital Dr. Mark Speechley Ontario Community Support Association Association of Local Public Health Agencies EOHU/BSEO Saint Elizabeth Health Care The Four Villages Community Health Centre Ontario Medical Association Ontario Seniors’ Secretariat Ontario Neurotrauma Foundation Centre for Addiction and Mental Health OMNI Health Care Ministry of Health and Long-Term Care Seniors Health Research Transfer Network (now, Seniors Health Regional Geriatric Programs of Ontario Knowledge Network) SMARTRISK (now, Parachute) Bruyère Continuing Care Registered Nurses’ Association of Ontario Accreditation Canada Community Outreach Programs in Ontario College of Family Physicians Addictions Ontario Agency of Health Protection and Dr. Vicky Scott Promotion (now, Public Health Ontario)

How to Achieve • Created an Integrated Provincial Falls Prevention Framework & Toolkit that will: • Guide the LHINs, PHUs and HSPs in effectively preventing falls and the impact of falls • Provide a provincial performance evaluation framework and key set of indicators to be measured consistently across the province • Collate current leading falls prevention practices and resources

Integrated Provincial Falls Prevention Framework Objective To improve the quality of life for Ontario seniors aged 65 years and over and lessen the burden of falls on the healthcare system by reducing the number and impact of falls on Ontario Seniors Approach Establishment of an Entity Establishment of an Effective LHIN-wide Falls Prevention Responsible for Collaboration and Program in Each LHIN Alignment at a Provincial and National Level Components Alignment and Comprehensive Inter-LHIN Collaboration and Evidence Standardized Effective Inclusive Local with Provincial Coordination Based Performance Governance Partnerships and Knowledge and National Assessment and Measurement Organizations & Exchange Intervention Initiatives

That was then, this is now • Provincial funding was not available • Exercise and fall prevention programs reform came about • Followed by Dr. Sinha’s report, Patients First, and many other initiatives such as Age Friendly Communities etc. • That didn’t stop a few LHINs and LHIN areas to take action and develop regional strategies on fall prevention and management • Here are three examples in Champlain, North East LHINs and South East LHIN area …

Champlain LHIN • LHIN funded part time project support in 2012 • Steering committee and governance structure established by early 2013. • Survey of primary and community care in early 2013 identified: ▫ Lack of a consistent approach ▫ Lack of Fall prevention knowledge ▫ Lack of useful resources ▫ Lack of an upstream approach

Champlain LHIN Since 2013, we: • Developed a set of Champlain Fall Prevention Tools • Screening using Staying Independent Checklist • Assessment and intervention algorithm (now embedded in an EMR) • Website www.stopfalls.ca • Exercise class navigation tool • Inter-professional communication tool • Ambulatory Care Fall prevention screening • PSW education module • CME for physicians • Next steps to build sustainability and embed use of Champlain Tools into practice e.g. Primary care, Emergency Departments

Champlain LHIN Strategic Framework 2013-15 Pillar 2 Pillar 3 Pillar 4 Pillar 1 Pillar 5 Pillar 6 Best Practices Detection, Public System Performance Advocacy Diagnosis, for Health Navigation Awareness Management Care Intervention Providers Falls Prevention Services along the Continuum of Care Well Seniors Seniors at Moderate to High Risk of Falls Available across sectors Community Long- Primary Tertiary Care & Public CCAC Hospital term care care Health care 2016 adopted Stay on Your Feet model

Champlain LHIN Rates per 100,000 seniors over age 65 2014/15 2015/16 LHIN Rank 2015/16 Falls related 66.8 65.9 12 visits to ED Falls related 1400 1300 11 admissions Falls related 2456 2469 5 admissions from LTC

Champlain LHIN Lessons learned and next steps: • A new vision and framework for 2025; adopted Stay on Your Feet • A further gap analysis across the continuum shows that we need to build in sustainability • Champlain has 20% of Ontario Retirement home residents, need to plan accordingly • Standards that can be adopted for regional needs are key factors for: • Training and education • Screening and Assessment • Intervention/ program content and delivery • Need to prevent duplication of effort within and outside our LHIN

North East LHIN “For the last 5 years, the NE LHIN age -adjusted falls rate is consistently higher than the province.” www.nelhin.on.ca/stayonyourfeet

North East LHIN “For the last 5 years, a higher rate of NE LHIN seniors are being hospitalized for falls than in the province.” www.nelhin.on.ca/stayonyourfeet

North East LHIN • 2009, Aging at Home investment in two Public Health Units(PHUs) • 2013/14 – 5 PHUs agree to work with NE LHIN and adopt the best practice framework – Stay on Your Feet (SOYF) • 2014 – NE LHIN hires full time coordinator and a 3 year MOU is signed with the 5 PHUs • 2014 Regional SOYF Committee (all sectors and geography) formed to oversee strategy • Community Assessment Survey and draft 3 year plan prepared (2015 – 2018) www.nelhin.on.ca/stayonyourfeet

NE LHIN Framework

North East LHIN Population-Based Health Promotion: 5 pillars www.nelhin.on.ca/stayonyourfeet

North East LHIN Lessons learned • It takes a community…to prevent a fall • Change happens at the speed of trust – it takes time • Build on each partner’s strengths and share the workload • Engage older adults immediately • Integrate quality improvement processes - start small, apply test of change, learn and spread (PDSA) Next Steps • New Regional Strategic Committee – new mandate /membership; working provincially to reduce duplication • Year 3 priorities, sustainability and evaluation of SOYF www.nelhin.on.ca/stayonyourfeet

South East LHIN Impact of falls • In 2014/15, there were about 7,000 falls-related emergency department (ED) visits among those aged 65+ in the SELHIN ▫ Rate of 69 visits per 1,000 people aged 65+  2nd highest LHIN rate • About 22% of all falls-related ED visits for SELHIN residents had a previous visit within the last 12 months ▫ Similar to the provincial rate • In 2014/15, there were about 1,600 falls-related hospitalizations among those aged 65+ in the SELHIN ▫ Rate of 16 visits per 1,000 people aged 65+  9th highest LHIN rate

South East LHIN History 2013-2015 2016 • Regional collaboration with PHUs to • Draft strategy presented to support planning for publicly-funded stakeholders via webinar; validated exercise and fall prevention classes. direction & feedback provided through • Small stakeholder group convened to webinar & survey • Consultation on strategy gauge interest in a regional strategy. • Stakeholder forum to gauge interest & implementation planning • Webinar and survey to inform & support planning and development of a regional fall prevention & consult with regional stakeholders management strategy. on strategy development • Environmental scan of existing • Report to stakeholders including programs and services available in updated strategy & overview of the South East. progress to date. • Multi-sectoral strategic planning session to identify the purpose, scope, aims, objectives and activities of the strategy.

South East LHIN South East Regional Integrated Fall Prevention & Management Strategy

South East LHIN 6 Key Activities • Development and launch of fall prevention microsite on South East HealthLine • Fall Prevention Month (FPM) email campaign promoting the FPM online toolkit, launching the microsite & disseminating the report to stakeholders