Measuring Rehabilitation Intensity in Ontario Beth Linkewich - - PowerPoint PPT Presentation

▶
measuring rehabilitation intensity in ontario
SMART_READER_LITE
LIVE PREVIEW

Measuring Rehabilitation Intensity in Ontario Beth Linkewich - - PowerPoint PPT Presentation

Jan 31, 2024 205 likes •480 views

Measuring Rehabilitation Intensity in Ontario Beth Linkewich (Beth.Linkewich@sunnybrook.ca) Toronto Stroke Networks, Sunnybrook Health Sciences Centre Ruth Hall (Ruth.Hall@ices.on.ca) Ontario Stroke Network, Institute for Clinical Evaluative

slide-1
SLIDE 1

Canadian Institute for Health Information cihi.ca @cihi_icis

Measuring Rehabilitation Intensity in Ontario

May 9, 2017 Presentation to Central South Rehabilitation Intensity Forum

Beth Linkewich (Beth.Linkewich@sunnybrook.ca)

Toronto Stroke Networks, Sunnybrook Health Sciences Centre

Ruth Hall (Ruth.Hall@ices.on.ca)

Ontario Stroke Network, Institute for Clinical Evaluative Sciences

Ryan Metcalfe (Rehab@cihi.ca)

slide-2
SLIDE 2

2

Rehab Intensity (RI) Following Stroke

  • Increased activity and environmental stimulation is important to neurological

recovery after stroke.

  • Stroke best practices recommend a minimum of 3 hours of therapy per-patient-

day in inpatient rehabilitation [1].

  • The Ontario Stroke Network (OSN) partnered with the Canadian Institute for

Health Information (CIHI) and Ontario’s MOHLTC to include mandatory collection

  • f RI data as part of the National Rehabilitation Reporting System (NRS) from April

2015 onward.

  • The OSN and regional stroke networks have worked with rehabilitation programs

to support implementation and quality assurance.

[1] Lindsay, M.P., Gubitz, G., Bayley, M. et al. (2010). Canadian Best Practice Recommendations for Stroke Care (Update 2010). On behalf of the Canadian Stroke Strategy Best Practices and Standards Writing Group. Ottawa, ON, Canadian Stroke Network. Retrieved from: www.strokebestpractices.ca

slide-3
SLIDE 3

Definition of Rehabilitation Intensity

  • Rehabilitation Intensity is defined as:
  • The amount of time that a patient is engaged in active, goal-directed, face to face

rehabilitation therapy, monitored or guided by a therapist, over a seven day/week period.

  • Physical, functional, cognitive, perceptual and social goals to maximize the

patient’s recovery * * Ontario Stroke Network, 2012. Measuring Rehabilitation Time in the National Rehabilitation Reporting System (NRS): # minutes of rehabilitation intensity (defined above) for OT, PT, S-LP, OTA, PTA, CDA

slide-4
SLIDE 4

Rehabilitation Intensity Requires a Cultural Shift

  • Shift in thinking from therapist time spent providing the

therapy to the patient time spent actively engaged in and receiving therapy.

  • “Bigger picture” experience
  • Setting up the environment for success

Volunteers Groups I am very busy all day long, but what are the stroke patients doing all day? How can we provide the most minutes of therapy AND maintain a complex stimulating environment?

slide-5
SLIDE 5

5

Rehabilitation Intensity Calculations

Rehab Time with an OT Rehab Time with a PT Rehab Time with an SLP Rehab Time with an OTA Rehab Time with a PTA + Rehab Time with a CDA _____________________ = Total Rehab Time Rehabilitation Intensity = Total Rehab Time (minutes) Active Rehab LOS (days)

At a facility or geographic level:

Average Rehab Intensity = Sum [Rehab Intensity per client] Number of clients (# Days from Admit to Date Ready for Discharge) – (Service Interruption Days) ______________________________________ = Active Rehab LOS

slide-6
SLIDE 6

6

Methodology & Data Quality

5,102 stroke discharges from Ontario facilities in 2015-2016 ~ 95% had valid, non-zero values coded in one or more of the rehab time fields – i.e., full or partial rehab time captured Top and bottom 1% (according to total number of minutes per day) were discarded from analysis 4,763 stroke rehab episodes

slide-7
SLIDE 7

7

Data Availability/Quality Issues

4.7% of records had only ‘0’, ‘999’, ‘9999’, or ‘99999’ coded and were excluded from analysis Large regional variation (0 - 25.5%) Q1 (12.6%) much worse than subsequent quarters (3.5% or less)

5 10 15 20 25 30 1 2 3 4 5 6 7 8 9 10 11 12 13 14

Records Excluded from Analysis (%) LHIN (Rank Ordered)

Proportion of Stroke Records Excluded

Source: National Rehabilitation Reporting System, 2015–2016, Canadian Institute for Health Information.

slide-8
SLIDE 8

8

What does the data tell us?

slide-9
SLIDE 9

9

Who is Providing Therapy?

  • PT and OT most

common

  • CDA least common
  • 12.4% of clients served

by all provider types

97% 95% 81% 78% 75% 18% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% PT OT PTA OTA SLP CDA

Proportion of Clients Treated (Ntotal = 4,763) Therapy/Provider Type

Prevalence of Each Therapy Type, 2015-2016

Source: National Rehabilitation Reporting System, 2015–2016, Canadian Institute for Health Information.

slide-10
SLIDE 10

10

How Much 1:1 Therapy Do Clients Receive?

  • Amount increased over

quarters: 63.1 (Q1) – 66.5 (Q4) min/day

  • Therapy assistants account

for 25% of therapy

  • Less than 1% of clients

meeting the therapy-per-day target

20.2 18.9 9.9 7.7 7.2 1.7 PT OT SLP OTA PTA CDA Total = 65.5 min/day

(Target = 180 min/day)

Average Minutes/Day by Therapy Type

Source: National Rehabilitation Reporting System, 2015–2016, Canadian Institute for Health Information.

slide-11
SLIDE 11

11

How Much 1:1 Therapy Do Clients Receive?

  • 61.5 min/day of 1:1 therapy

during the period of “active rehabilitation”

  • Amount increased over

quarters: 57.4 (Q1) – 63.6 (Q4) min/day

  • 180 min/day target is being

met by approx. 1% of clients

19.1 17.5 5.0 5.7 5.4

Median Therapy Minutes per Day by Therapy Type

PT OT SLP OTA PTA CDA

Total = 61.5

slide-12
SLIDE 12

12

How Much 1:1 Therapy Do Clients Receive?

Average amount of therapy is greater when you only look at those clients receiving that type of therapy e.g., People that received therapy from CDA received 9.7 min/day; all clients together received 1.7 min/day

20.2 18.9 9.9 7.7 7.2 1.7 20.9 19.8 13.1 9.9 8.8 9.7 5 10 15 20 25 PT (n=4608) OT (n=4542) SLP (n=3593) OTA (n=3718) PTA (n=3870) CDA (n=847)

Minutes per day (mean)

Therapy Type (n=Number of clients receiving that therapy type)

Average Rehab per Day by Therapy Type

Average calculated from all clients Average calculated from

  • nly those

clients receiving that particular therapy type

Source: National Rehabilitation Reporting System, 2015–2016, Canadian Institute for Health Information.

slide-13
SLIDE 13

13

Regional Variation in Rehab Intensity?

Much variability between regions (37.3 – 89.1 min/day)

10 20 30 40 50 60 70 80 90 100 1 2 3 4 5 6 7 8 9 10 11 12 13 14

Minutes per day (Mean) LHIN

Average Minutes/Day by LHIN

Provincial mean = 65.5 min/day

Source: National Rehabilitation Reporting System, 2015–2016, Canadian Institute for Health Information.

slide-14
SLIDE 14

14

Rehab Intensity by Resource Utilization Group

(loosely… “severity”)

Most therapy per day provided to “most severe” RPG; Least therapy per day provided to “least severe” RPG

14% 27% 24% 14% 8% 9% 4%

Discharges by Rehab Patient Group (RPG)

1100 1110 1120 1130 1140 1150 1160 71.9 61.9 68.7 68.4 63.6 59.9 53.9 10 20 30 40 50 60 70 80 1100 1110 1120 1130 1140 1150 1160 Rehab Time per Day (minutes) Rehab Patient Group (RPG)

Rehab Intensity by RPG

Mean Median

Decreasing Resource Utilization (“Severity”)

Source: National Rehabilitation Reporting System, 2015–2016, Canadian Institute for Health Information.

slide-15
SLIDE 15

15

Next… We grouped clients based on Rehab Intensity (minutes of 1:1 therapy per day) into 4 groups (quartiles) and compared groups

slide-16
SLIDE 16

16

This is what the groups (RI Quartiles) look like

Group 4 receives more than twice the amount

  • f therapy of Group 2,

and approx. four times what Group 1 receives

28.2 51.9 72.5 103.2 27.2 51.7 72.9 110.1 20 40 60 80 100 120 1 2 3 4

Therapy Minutes Per Day

Group (RI Quartile)

RI min per day

Median Mean

Source: National Rehabilitation Reporting System, 2015–2016, Canadian Institute for Health Information.

slide-17
SLIDE 17

17

Age

Clients receiving more therapy per day are younger

77 74 73 71 74.6 72.2 71.3 69.4 64 66 68 70 72 74 76 78 27 min/day 52 min/day 73 min/day 110 min/day

Age (years) Group (RI Quartile)

Age by RI Quartile

Median Mean

Source: National Rehabilitation Reporting System, 2015–2016, Canadian Institute for Health Information.

slide-18
SLIDE 18

18

Total Function Change

Clients that receive the most therapy per day have the most function change over the course of their stay

19.1 23.0 25.9 28.6 5 10 15 20 25 30 35 27 min/day 52 min/day 73 min/day 110 min/day

Total Function Score Change (mean) Group (RI Quartile)

Average Total Function Change by RI Quartile

Source: National Rehabilitation Reporting System, 2015–2016, Canadian Institute for Health Information.

slide-19
SLIDE 19

19

So… more therapy per day results in more function change… right?

slide-20
SLIDE 20

20

Active Rehab LOS Efficiency

Clients receiving the most therapy per day are achieving a greater overall FIM/LOS efficiency than those receiving the least therapy per day, despite having longer rehab stays

0.83 0.94 1.00 1.03 1.01 1.10 1.16 1.19 0.00 0.20 0.40 0.60 0.80 1.00 1.20 1.40 27 min/day 52 min/day 73 min/day 110 min/day

Active Rehab LOS Efficiency Group (RI Quartile)

Active LOS Efficiency by RI Quartile

Median Mean

Source: National Rehabilitation Reporting System, 2015–2016, Canadian Institute for Health Information.

slide-21
SLIDE 21

21

Active Rehab LOS

Clients receiving most therapy per day are staying ~5 days longer than those receiving least therapy per day, on average So… these clients are receiving more therapy per day over more days i.e. (Rehab Intensity) x (Active LOS)

21 24 26 26 24.7 26.2 28.2 29.4 5 10 15 20 25 30 35 27 min/day 52 min/day 73 min/day 110 min/day

Active LOS (days) Group (RI Quartile)

Active LOS by RI Quartile

Median Mean

slide-22
SLIDE 22

22

Conclusions (data capture & therapy provided)

  • Mandating data collection with regional implementation collaboration has

resulted in strong uptake for RI data collection for stroke inpatient rehabilitation.

  • Coding of unknown values decreased over time and is anticipated to continue
  • decreasing. (Care should be taken to ensure that zeros are used when

associated service is not provided, regardless of the need or reason.)

  • Currently, persons with stroke in Ontario are receiving one-third the

recommended therapy-per-day in inpatient rehab.

  • Strategies to increase rehabilitation intensity are needed.
slide-23
SLIDE 23

23

Conclusions (quartile analysis)

  • Younger patients and patients with severe stroke receiving more therapy.
  • Patients receiving greater RI have more functional gains and LOS efficiencies,

despite a longer active LOS.

slide-24
SLIDE 24

24

What’s next?

  • Focus on clinical implementation of

rehabilitation intensity

  • Take advantage of the resources available to you

‒ Whiteboard ‒ Portal ‒ Pocket card to guide inclusion

  • Education resources under development to

support a sustainability

Common Opportunities Identified by Rehab Teams

slide-25
SLIDE 25

Beth.Linkewich@sunnybrook.ca Rehab@cihi.ca