Specialist Collaborative Models RGPs of Ontario Ottawa - PowerPoint PPT Presentation

Optimizing Outcomes For Frail High Risk Seniors Through Specialist-Specialist and Primary Care- Specialist Collaborative Models RGPs of Ontario

Ottawa Transcatheter Aortic Valve Insertion (TAVI) program (Presentation 1) Dr. Allen Huang The Ottawa Hospital RGPs of Ontario

 Since 2007, funding for 90 TAVIs/year  Weekly standing committee meetings  Members ◦ Interventional cardiology (4) ◦ Cardiac surgery (4) ◦ Radiology (TAVI – CT, Cardiac cath, echo) ◦ Geriatric riatric medi dicin cine (since ince 2014 14) ◦ Nurse program manager ◦ Nursing ◦ Cath lab manager ◦ OR manager ◦ Anesthesia

 43 meetings  163 cases presented  103 accepted (20 SAVR, 25 medical /palliative, 3 not severe AS, 7 deaths, 5 misc)  Average wait time 45-days  Mortality ◦ Waitlist 3 ◦ Procedure 2 ◦ 30-day 0 ◦ 1-year 8  Geriatrics consulted on 12 cases ◦ Pre-op (9) Recommended NO (4) 2 died within 3-months ◦ Post-op (3)

S W STR TRENGTHS THS WEAKN KNESS ESSES ES • Multiprofessional • Only cardiology/ • Multidisciplinary cardiac surgery fellows • Single program RN attend (ad hoc) • Great documentation Who Is Involved OP OPPOR PORTU TUNITI NITIES ES THRE TH REATS TS • Engage other residents • Single Geriatrician • Train other RNs • Single program nurse O T

S W STR TRENGTHS THS WEAKN KNESS ESSES ES • Clinical outcomes • funding cap – 90 excellent compared cases/year to Canadian peers • No surge capacity Funding Sustainability OP OPPOR PORTU TUNITI NITIES ES TH THRE REATS TS • Frailty assessment can • Changing indications improve targeting and • Changing technologies sharpen the model • Volume outstrips O T resources • New MOH funding model implications

S W STR TRENGTHS THS WEAKN KNESS ESSES ES • Heart Institute has a • lack of policy strong regional and • Service line response national recognition to funding pressures • Clinical and research programs Policy Support OP OPPOR PORTU TUNITI NITIES ES TH THRE REATS TS • opportunity for other • elder care is not part Canadian TAVI of the Heart Institute O T programs to learn strategic plan

S W STR TRENGTHS THS WEAKN KNESS ESSES ES • Heart Institute has a • Single organ thinking global reputation Setting OP OPPOR PORTU TUNITI NITIES ES THRE TH REATS TS • Integration of the • TAVI becomes a geriatric approach standard user-selectable • TAVI program can intervention O T inform other heart programs

S W STR TRENGTHS THS WEAKN KNESS ESSES ES • Intervention biases • Flexible consultations • Referral bias • Real-time shared • System bias for fixable problem-solving things Decision- Making OPPOR OP PORTU TUNITI NITIES ES THRE TH REATS TS • Share Canadian data • Unsustainable volume • Embed frailty • Pre-referral priming assessments O T

S W STR TRENGTHS THS WEAKN KNESS ESSES ES • Single geriatrician • Single geriatrician Geriatrician Selection OP OPPOR PORTU TUNITI NITIES ES TH THRE REATS TS • Recruit new • Single geriatrician geriatricians competing interests O T

S W STR TRENGTHS THS WEAKN KNESS ESSES ES • Society of Thoracic • Frailty is difficult to Surgeons (STS) risk easily define score is widely used • Missing components to STS risk score • Waitlist management Patient Selection OPPOR OP PORTU TUNITI NITIES ES TH THRE REATS TS • Results of McGill • Unrealistic expectations multi-center TAVI- & inappropriate referrals frailty study pending O T

S W STR TRENGTHS THS WEAKN KNESS ESSES ES • Single RN contact • Single RN • Co-ordinates • Education • Disseminates component limited to • Dedicated to program procedure & processes quality and education AGS Person-Centered Care OPPOR OP PORTU TUNITI NITIES ES THRE TH REATS TS • integrate patient • Funding driven only reported outcomes by volumes • Patient decision aid O T • Post-op delirium management

 Goal of heart teams is the provision of patient-centred care using a shared decision-making approach.  Outcomes - consistent provision of guideline-based decision making, better coordination of treatment plans, effective use of resources, and, for clinicians, greater knowledge and improved workplace satisfaction.  The success … depends largely on collaboration amongst multiple disciplines each of whom bring different areas of knowledge and expertise to the discussion.  Geriatric medicine brings a unique area of expertise that reaches beyond the standard decision-making parameters… creates the opportunity to consider a broader spectrum of treatment options for each patient… potential to assist with resource utilization and improve overall patient care.

 Consultative  collaborative transition  Geriatric medicine was invited to attend  Future directions: program refinement / screening / education / peri-procedure delirium management pathway  Inviting each specialty to present to the other is enabling (2-way learning)  Listen long enough to fully understand  Mastering ‘money - speak’

allenhuang@toh.ca