Inter-LHIN Collaboration in Fall Prevention Planning: Beyond the … Slide Decks... · 2017. 4....

Inter-LHIN Collaboration in Fall

Prevention Planning: Beyond the

Provincial Framework

February 22, 2017

1 Poll

Here

http://rgps.on.ca/files/IntegratedProvincialFallsPreventionFrameworkToolkit_July2011.pdf

Welcome & Introduction

1 Poll

Here

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

St. John’s Rehab Hospital

Ontario Community Support Association

EOHU/BSEO

The Four Villages Community Health

Centre

Ontario Neurotrauma Foundation

OMNI Health Care

Seniors Health Research Transfer

Network (now, Seniors Health

Knowledge Network)

Bruyère Continuing Care

Accreditation Canada

Ontario College of Family Physicians

Ontario Agency of Health Protection and

Promotion (now, Public Health Ontario)

Dr. Mark Speechley

Association of Local Public Health

Agencies

Saint Elizabeth Health Care

Ontario Medical Association Ontario

Seniors’ Secretariat

Centre for Addiction and Mental Health

Ministry of Health and Long-Term Care

Regional Geriatric Programs of Ontario

SMARTRISK (now, Parachute)

Registered Nurses’ Association of Ontario

Community Outreach Programs in

Addictions

Dr. Vicky Scott

Partners

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

Ob

jec

tive

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

Inclusive Local Partnerships

Comprehensive and Evidence

Based Assessment and

Intervention

Standardized Performance Measurement

Effective Governance

Establishment of an Effective LHIN-wide Falls Prevention

Program in Each LHIN

Co

mp

on

en

ts

Ap

pro

ac

h

Establishment of an Entity Responsible for Collaboration and

Alignment at a Provincial and National Level

Inter-LHIN Coordination

and Knowledge Exchange

Alignment and Collaboration with Provincial and National

Organizations & Initiatives

Integrated Provincial Falls Prevention Framework

• 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…

That was then, this is now

• 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

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

Strategic Framework 2013-15

Pillar 1

Public Awareness

Pillar 2

Detection, Diagnosis,

Intervention

Pillar 3

Best Practices for Health

Care Providers

Pillar 4

System Navigation

Pillar 5

Performance Management

Pillar 6

Advocacy

Well Seniors Seniors at Moderate to High Risk of Falls

Falls Prevention Services along the Continuum of Care

Available across sectors Community

Care & Public Health

Primary care

CCAC Hospital Tertiary

care

Long-term 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

visits to ED

66.8 65.9 12

Falls related

admissions

1400 1300 11

Falls related

admissions from

LTC

2456 2469 5

Champlain LHIN

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

“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.”

North East LHIN

www.nelhin.on.ca/stayonyourfeet

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)

NE LHIN Framework

Population-Based

Health Promotion:

5 pillars

www.nelhin.on.ca/stayonyourfeet

North East LHIN

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

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

History

2013-2015

• Regional collaboration with PHUs to support planning for publicly-funded exercise and fall prevention classes.

• Small stakeholder group convened to gauge interest in a regional strategy.

• Stakeholder forum to gauge interest & support planning and development of a regional fall prevention & management strategy.

• Environmental scan of existing programs and services available in the South East.

• Multi-sectoral strategic planning session to identify the purpose, scope, aims, objectives and activities of the strategy.

2016

• Draft strategy presented to stakeholders via webinar; validated direction & feedback provided through webinar & survey

• Consultation on strategy implementation planning

• Webinar and survey to inform & consult with regional stakeholders on strategy development

• Report to stakeholders including updated strategy & overview of progress to date.

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

South East LHIN

Next steps for 2017

PILLAR INITIATIVE

Public Education &

Awareness

Evaluation of Fall Prevention Month campaign to inform

direction of 2017 activities targeting consistent messaging on

the prevention, risk & impact of falls

Service Navigation &

System Integration

Full implementation of the fall prevention microsite – garnering

user feedback; promotion and sustainability planning

Provider Skill

Development &

Education

Further development of environmental scan & gap analysis of

education opportunities

Assessment &

Management

Exploration to identify key stakeholders & best practices

Engagement & Advocacy Development of engagement strategy for older adults

Engagement & communication with stakeholder groups to

validate & prioritize activities and operationalize the strategy

South East LHIN

Are there any clarification

questions for our presenters?

1. Type your questions into the chat box

2. Dial *7 on your telephone keypad to unmute

your line. Please dial *6 when you are finished

speaking to re-mute your line.

• Leveraging existing knowledge, skills, and

resources

• Greater impact on falls and falls-related injuries

in older adults in Ontario

• Older person first and system-wide thinking

made easier

• Going to scale: working together and learning

from each other province-wide

Value Proposition: Group Discussion

2 Polls

Here

• How could you be involved?

• Do you have other thoughts or suggestions?

Open Discussion

1. Type your questions into the chat box

2. Dial *7 on your telephone keypad to unmute your line.

Please dial *6 when you are finished speaking to re-

mute your line.

Important Contacts

Dr Paul Roumeliotis: • proumeliotis@eohu.ca Ontario Neurotrauma Foundation: Hélène Gagné, • helene@onf.org Champlain LHIN: Christine Bidmead & Dianne Rossy • cbidmead@toh.ca & drossy@toh.ca North East LHIN: Wendy Carew, • Wendy.Carew@LHINS.on.ca South East LHIN: Megan Jaquith & Rhonda Lovell • Megan.Jaquith@LHINS.on.ca & rhonda.lovell@kflapublichealth.ca Loop: www.fallsloop.com or www.chutesloop.com