The Toronto Rehab NP Study: Improving access, continuity

1
The Toronto Rehab NP StudyImproving 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 Integration
• Nurse Practitioner, Complex Continuing Care -
  Toronto Rehabilitation Institute

2
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 NPs impact on the access,
  continuity and quality of primary health care

3
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

4
Outline

• Context Toronto Rehab Institute
• NP Role
• NP study
• Preliminary findings
• Next steps
• Discussion

5
MR
6
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.

7
Clinical Programs

• Cardiac Rehabilitation Secondary Prevention
• Complex Continuing Care Program
• Geriatric Rehabilitation Program
• Musculoskeletal Rehabilitation Program
• Neuro Rehabilitation Program
• Spinal Cord Rehabilitation Program
• Long Term Care Program

8
Toronto Rehabilitation Institute Patient Care
(Professional Practice) Pillars

Best Practice
Education
Professional Excellence
Spiritual Care
Ethics
Best Practice/Advanced Practice Leaders
Education Leaders Clinical Educators
Corporate Practice Leaders
Bioethicist
Chaplains

• 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)

• 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)

• B. Secker

• J. Huth
• P. Stevens
• S. Walters

• 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)

(Jan 5, 2005)
9
Collaborative Practice

• Clinical Programs
• Best Practice
• Education
• Professional Excellence
• Ethics Spiritual Care

10
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

11
Purpose of NP Study

• To describe the extent to which the NP role is
  implemented as designed in a CCC setting
• 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
• 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.

12
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

13
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

14
Study Design

• Mixed quantitative qualitative pre-post design
• Data collection from multiple sources
• 12-month NP implementation period
• One CCC unit

15
PRE-TEST
16
POST-TEST
17
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

18
Preliminary Findings contd

• NP contribution to improved
• 3. Access to PHC for residents in CCC
• Unit communication logs
• 4. 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)

19
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

20
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

21
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

22
For further Information

• Contact Karima Velji (PI)
• velji.Karima_at_torontorehab.on.ca
• Contact Souraya Sidani (PI)
• s.sidani_at_utoronto.ca
• Contact Linda Dacres, NP
• dacres.linda_at_torontorehab,on,ca