Shorter lengths of stay. Reduced wait times. Fewer hospitalizations. Health care providers continually aim to improve client care while efficiently managing resources. In the Canadian inpatient rehabilitation sector, decisions that support these efforts are based on standardized data captured electronically at the point of care.

InsideCapture of Standardized Data 2Who Benefits, and How 6The Way Forward 8

Data Improves Rehabilitation Services in Canada

Informing Decisions:

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Capture of Standardized DataHospitals and specialty rehabilitation centres that deliver inpatient rehabilitation services

collect standardized client data electronically as part of routine care upon admission

to and discharge from rehabilitation programs. This point-of-care data includes

organizational information, client

identifiers, and socio-demographic

and administrative data. It also

includes clinical information

such as health characteristics

and measures of activity and

participation. Patient disability

is assessed using the FIM®

instrument,i an internationally

recognized and widely reported

assessment tool that measures

physical and cognitive function.

This data provides an invaluable portrait of inpatient rehabilitation services and

associated health outcomes at the organizational, regional, provincial and national

levels. It also helps clinicians create customized care plans for clients, leading to

better health outcomes and improved efficiencies in the form of shorter hospital stays,

reduced wait times and better access to care, as demonstrated in this brochure.

Since the collection of standardized

data is a component of the care

process, no additional data collection

efforts are needed as the data flows to

the National Rehabilitation Reporting

System (NRS) at the Canadian

Institute for Health Information

(CIHI). CIHI de-identifies the data,

conducts analyses and produces

aggregate-level reports for managers

and funders at organizational, regional

and provincial/territorial levels.

i. The FIM® instrument referenced herein is the property of Uniform Data System for Medical Rehabilitation, a division of UB Foundation Activities, Inc.

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About the National Rehabilitation Reporting SystemThe NRS was developed in 2000–2001 by CIHI to support policy and planning for rehabilitation services in Canada. It facilitates the collection of information on clients admitted to rehabilitation programs in hospitals and other rehabilitation facilities in nine provinces in Canada.

About the Canadian Institute for Health Information CIHI is an independent not-for-profit organization that provides essential information on Canada’s health system and the health of Canadians. Among other things, CIHI provides support for the collection, aggregation and use of inpatient rehabilitation data in Canada.

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Data helps shorten the length of stay

Reports based on NRS data suggested

that clients at the Brain and Spinal Cord

Rehabilitation Program at Toronto’s

University Health Network (UHN) had

positive post-treatment outcomes,

such as improved functional abilities

following rehabilitation. However, clients

were staying longer in the hospital to

achieve these improvements than those

in similar programs elsewhere.

To optimize the duration of hospital

stay without compromising client

outcomes, the UHN developed a Patient

Flow Initiativeii with a goal of aligning

the length of stay for clients in the

program with the national average for

such clients. Using a formula based on comparative national data, tentative discharge

dates were calculated at the time of admission to help reduce subjectivity and increase

transparency in decision-making. Uniform protocols and best practices were also

developed to support prompt client care.

As a result of this initiative, in just one year, the average duration of hospital stays for

clients in the program decreased by 15 days—from 86.2 to 71.5 days. The shorter

hospital stays permitted staff to provide care to 12% more clients. Importantly, this

increase in efficiency and access to care was coupled with an improvement in functional

outcomes. Clients and program staff alike are pleased with the benefits reaped by

promoting standardization in practice.

ii. Burns AS, Yee J, Flett HM, Guy K, Cournoyea N. Impact of benchmarking and clinical decision making tools on rehabilitation length of stay following spinal cord injury. Spinal Cord. In press.

“This successful initiative would not have been possible without data from the NRS. The NRS is an invaluable tool for benchmarking and program evaluation.”

— Dr. Anthony S. Burns, Staff Physiatrist, Brain and Spinal Cord Rehabilitation Program, University Health Network

ImprovedPatient inOntario

Flow

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Data helps reduce wait times for stroke clients

Long wait times for clients who have suffered a stroke prompted the Calgary

Stroke Program to work with partners to measure performance across its clinical

and support services. An analysis of data captured through the NRS showed

that more timely access to care

required a better alignment of client

needs with appropriate types of

rehabilitation services.

A new triage approach was

developed to evaluate client

disability and functional status

and to better match services with

client needs. In addition, an early

supported discharge program was

implemented to enable low-risk

clients to be discharged from the

hospital with appropriate home-

and community-based rehabilitation

support. This would free up beds for

those who needed them most. The goal of these changes was to increase access

and to ensure that home- and community-based rehabilitation services were

promoted for clients with non-acute care needs.

As a result of this initiative, the cost and average length of stay for stroke

rehabilitation clients decreased significantly. In fact, one inpatient rehabilitation

unit experienced an average decrease in length of stay from 72 to 42 days!

By aligning client needs with the most appropriate rehabilitation service and

discharging low-risk clients with community-based rehabilitation support, more

clients had increased and timelier access to the acute stroke unit. Based on the

success of the program, further streamlining of post-acute rehabilitation services

in Calgary is planned, with a potential for roll-out to other regions in Alberta.

“Participation in CIHI–NRS has provided us with access to inpatient rehabilitation data important in our quality management approach to improving client care.”

— Luchie Swinton, Rehabilitation Facilitator, Calgary Stroke Program, Calgary, Alberta

Understandingin Alberta

Better

of Client Needs

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“Designing new services that meet the needs of the clients who use them is so much easier when there is data to support the decisions that need to be made. With the new ambulatory Pulmonary Rehabilitation Service, we have the confidence to launch a service that will be both responsive and accessible.”

— Jo-Ann Lapointe McKenzie, Former Program Director, Rehabilitation and Geriatric Program, Winnipeg Regional Health Authority, Manitoba

the NRS, the health authority proposed a new model of care to realign the delivery of

pulmonary rehabilitation. The proposed model enables clients to receive a prompt and

appropriate level of rehabilitation care for their condition in an outpatient, ambulatory

care setting. This eliminates hospitalization costs for these rehabilitation services and

allows the pulmonary rehabilitation beds in the hospital to be reallocated to high-need

and ventilator-dependent clients. The proposal received immediate approval and funding

from Manitoba Health to begin implementation.

The health authority is confident that the new model will result in better health

outcomes for its clients and more effective use of resources, while also providing

services to approximately three times as many clients.

Data used to reduce

hospitalizations for clients

In its quest to provide timely

rehabilitation services to its

clients, the Winnipeg Regional

Health Authority’s Rehabilitation

and Geriatrics Program decided

to redesign its inpatient

pulmonary rehabilitation

program. The key objective of

this initiative was to reduce

wait times and use resources

more efficiently. An advisory

group survey confirmed what

the planners were thinking:

many clients needed the

service but did not necessarily

require hospitalization.

Using data from sources including

TimelyManitoba’s

New Modelfor Care

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Who Benefits, and How Clients and Their Families• With standardized assessments, electronic transmission of

information can occur across care settings. This reduces the

burden for clients and families of providing basic information

to multiple providers.

• Data identifying how clients with similar conditions

typically recover following illness or injury can support

conversations with clients and family around developing

care plans and setting realistic expectations for outcomes

following rehabilitation.

• Data that supports improvements to client outcomes,

improved access, reduced wait times and shorter lengths

of stay directly benefits clients receiving health care services.

Clinicians and Other Caregivers• Access to information about impairment, services and

outcomes for clients with similar health conditions supports

clinicians and caregivers in devising the most appropriate

and highest-quality care plan to meet client needs.

• Interdisciplinary collaboration and continuity of care

is facilitated by the electronic capture and sharing of

standardized information. This information enhances

caregivers’ abilities to discuss the needs of clients and

their care plans in a common way across service settings.

System Managers and Funders • Comparative, standardized information helps system managers and funders plan for the future

by providing a better understanding of key issues—such as wait times, cost estimates and access

to the appropriate level of care—and by facilitating the design of services and programs that meet

the evolving needs of their populations.

• Summary information on client care and outcomes permits national comparisons for performance

measurement, program effectiveness monitoring and effective discharge planning.

• Administrative information linked to other data

sources provides a more in-depth view of continuity

of care and can help identify bottlenecks for client

flow through the health care system.

• Grouping methodologies (such as the Rehabilitation

Patient Group) help funders align resources with

population needs and appropriately allocate limited

funds across regions or provider organizations.

Rehabilitation Patient Group Helps identify populations by expected resource use for evidence-informed staffing and funding decisions.

The Way ForwardStandardized capture and use of data from clients in rehabilitation improves

health outcomes and enables evidence-based decision-making at all levels of

the health system. It supports the front-line delivery of quality care and drives

best practices in care delivery. At a system level, the use of information helps

identify efficiencies that can reduce costs and lengths of stay, improve wait times

and access, and ensure the highest quality of care.

A large number of hospitals and rehabilitation facilities across the country are

using the NRS to support their delivery of care. Opportunities now exist to

further leverage this comparative rehabilitation data to inform program, policy

and funding decisions for improved management and provision of rehabilitation

care in the overall health system.

The appropriate use of high-quality information on health needs, services and outcomes is critical to the future of Canada’s health system. Clinicians need information to support their care planning decisions. Health system managers need information for planning, quality monitoring and accountability. Policy-makers and senior decision-makers need information for system management and accountability. This product is one in a series designed to showcase the use and value of information at these various levels.

CIHI Communications

495 Richmond Road, Suite 600 Ottawa, Ontario K2A 4H6

Phone: 613-241-7860 (Ottawa) or 416-481-2002 (Toronto)

Email: communications@cihi.ca

Acknowledgements

The Canadian Institute for Health Information

(CIHI) would like to acknowledge and

express appreciation to the individuals and

organizations whose stories have been

showcased as part of this project.