the toronto rehab np study: improving access, continuity & quality of primary health care for a...
TRANSCRIPT
The Toronto Rehab NP Study:
”Improving access, continuity & quality of
primary health care for a community of patients with
complex complex continuing care needs”
Presented at the ICN NP/APN Conference, South Africa, June 30, 2006
Linda Dacres, RN(EC), NP-PHC, BScN, MHSc (Family & Community Medicine), PhD (c)
Consultant, Primary Health Care and Ambulatory Innovations, NP Role IntegrationNurse Practitioner, Complex Continuing Care - Toronto Rehabilitation Institute
Introduction
The Primary Health Care Nurse Practitioner (NP) Study explores the extent to which the NP role is implemented at the Toronto Rehabilitation Institute in Complex Continuing Care
Evaluate the NP’s impact on the access, continuity and quality of primary health care
Principal Investigators
Principal Investigators Karima Velji Vice President, Patient Care & Chief Nursing
Executive - Toronto Rehabilitation Institute Dr. Souraya Sidani
Professor, Faculty of Nursing, University of Toronto
Funding: Health Canada Primary Health Care Transition Fund
Outline
Context: Toronto Rehab Institute NP Role NP study Preliminary findings Next steps Discussion
Toronto Rehab SitesOur Locations
MR
Mandate
Vision To advance rehabilitation and enhance quality of life.
Mission We partner with individuals, their families and supporting communities in innovative, effective adult rehabilitation and complex continuing care. In affiliation with the University of Toronto, we lead the integration of service, research and education, and the development of a coordinated rehabilitation system.
Clinical Programs
1. Cardiac Rehabilitation & Secondary Prevention
2. Complex Continuing Care Program
3. Geriatric Rehabilitation Program
4. Musculoskeletal Rehabilitation Program
5. Neuro Rehabilitation Program
6. Spinal Cord Rehabilitation Program
7. Long Term Care Program
• L. Inness (PT)
• L. Korkola (Nursing)
• D. Hebert (OT)
• C. Steele (SLP)
• L.Ruttan (Psychology)
• T. Dion (TR)
• N. Rave (Chiropody)
• J. Huth (Chaplaincy)
• J. Stretton (SW)
• E. Rolko (Pharmacy)
• D. Wildish (Dietitian).
• G. Tardif (Medicine)
Toronto Rehabilitation InstitutePatient Care (Professional Practice) Pillars
BestPractice
Education ProfessionalExcellence
Ethics Spiritual Care
Best Practice/Advanced Practice Leaders
Education LeadersClinical Educators
Corporate Practice Leaders
Bioethicist
• S. Solway (BP Leader)
• N. Foster (Cardiac)
• D. Driver (CCC)
• B. Trentham (CCC)
• N. Boaro (Neuro)
• L. Spanjevic (Geriatrics)
• M. McGlynn (MSK)
• J.Ibrahim (Emotional Care)
• Vacant (Pain)
• Heather Flett (Spinal)
• L. Sinclair (IPE -Leader)
• J. Kim (Nur - CCC)
• W. Kiersnowski (Nur- G)
• M. Gibson (Nur-S)
• L. Keats (Nur-S)
• T. John (Nur-M)
• S. Ram (Nur – N)
• K. Brunton (PT)
• J. Howe (PT)
• D. Hebert (OT)
• M. Lowe (OT)
• R. Mabrucco (SW)
• P. Gairy (Nur- CCC)
• B. Secker • J. Huth
• P. Stevens
• S. Walters
Patient Care
Research
Education
Mission
We partner with indivi-duals, their families and
supporting communities in innovative, effective adult
rehabilitation and complex continuing care. In affil-
liation with the University of Toronto, we lead the inte-
gration of service, research and education, and the
development of a co-ordinated rehabilitation
system.
ValuesWe are committed to:
CaringDiscovery
LearningCollaboration
AccountabilityAdvocacy
To advance Rehabilitation and
enhance quality of life
Vision
Chaplains
(Jan 5, 2005)
+
Collaborative Practice
Clinical Programs Best Practice Education Professional Excellence Ethics + Spiritual Care
Impetus for NP Study
Limited physician access Improve continuity of care, quality &
access to primary health care services Enhance communication –
interdisciplinary & families Increase response time - decrease
emergency transfers & costs incurred to health care system
Purpose of NP Study
1. To describe the extent to which the NP role is implemented as designed in a CCC setting
1. To identify the enablers and deterrents for a successful implementation of the NP role in CCC setting, including the collaboration between FP physician and NP
1. To evaluate the NP contribution to improved a) Access to PHC for residents in CCC b) Quality of technical and interpersonal aspects of care
provided to residents and families in CCC c) Communication and coordination of care among members of the interdisciplinary health care team.
Complex Continuing Care
224 beds – 6 clinical units Recent re-structuring Complex acute and
chronic medical and functional neurological needs
10 bed palliative care unit Multiple & demanding 24/7
health care requirements
NP Role
Utilizes full scope of RN(EC) practice Provision of PHC and specialized services to
residents &. Hub of interdisciplinary health care team Liaison and communications Counselling and health education Best-practice implementation Illness prevention End-of-life care
Study Design
Mixed quantitative & qualitative pre-post design
Data collection from multiple sources 12-month NP implementation period One CCC unit
PRE-TEST
Participants Targeted Recruited
Patients 25 17
Families and SDMs 50 32
Health Care Professionals 45 71
Total N=120
POST-TEST
Participants Targeted Recruited
Patients 25 15
Families and SDMs 50 19
Health Care Professionals 45 41
Total N=75
Preliminary Findings
1. Implementation of NP role (6) Self assessment and observation of
role components derived from the literature
2. Enablers and deterrents (25) Qualitative interviews
Preliminary Findings cont’d
NP contribution to improved: 3. Access to PHC for residents in CCC
Unit communication logs4. Quality of technical and interpersonal
aspects of care provided to residents and families in CCC MDS indicators Standardized encounter tool Individualized Care Index (van Servellen,1988
5. Communication and coordination of care Communication and coordination subscales
(Shortell et al., 1991)
Next Steps
Complete data analysis and report Dissemination of results Consultant, Primary Health Care &
Ambulatory Innovations, Nurse Practitioner Role Integration
Nurse Practitioner - Complex Continuing Care
NP role implementation in 4 clinical programs
Study Team
Karima Velji, Toronto Rehabilitation Institute (PI) Dr. Souraya Sidani, Faculty of Nursing, University of
Toronto (PI) Dr. James Edney, Toronto Rehabilitation Institute Dr. John Masgoret, Toronto Rehabilitation Institute Kathy McGilton,Toronto Rehabilitation Institute Dr. Gaetan Tardif, Toronto Rehabilitation Institute Marnie Bowser, Toronto Rehabilitation Institute Dr. Mary Van Soeren Moyra Vande Vooren
Acknowledgements
Primary Health Care Transition Fund
Program of the Ontario Ministry of Health and Long Term Care Demonstration Project # G03-05577
Toronto Rehabilitation Institute University of Toronto Alba DiCenso – McMaster University Michelle Clifford-Middel - Healthpositive
For further Information
Contact Karima Velji (PI)
Contact Souraya Sidani (PI)
Contact Linda Dacres, NP
dacres.linda@torontorehab,on,ca