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Healthcare Innovation
Unique collaborations involving the
public, private and non-profit sectors
Carole Madeley, RRT, CRE, MAppSc(RespSc)
Director, Respiratory Health Programs
Ontario Lung Association
Prince Edward Island COPD Project
A partnership was formed in 2011 between the:
 Harbourside Family Health Centre,
 the PEI Lung Association,
 Government of Prince Edward Island, and
 three Rx&D members: AstraZeneca,
GlaxoSmithKline and Pfizer.
 This Value Demonstrating Initiative (VDI) aimed
to improve quality of care, access, efficiency and
patient self-management with COPD patients in
Summerside, PEI.
Outcomes in PEI
After filtering out 40% of the original group who were
misdiagnosed with COPD, project results included:
 a 50% decrease in ER visits,
 a 30% reduction in return visits to ERs, and
 the average length of hospital stay reduced by 1
day per patient.
Given its success, the project was expanded across
PEI in 2012.
VDI on COPD in Ontario
Ontario Ministry of Health and Long-Term
Care (MOHLTC),
Canada’s Research Based Pharmaceutical
Companies (Rx&D)
&
Ontario Lung Association (OLA)
What is the Value Demonstrating Initiative
(VDI) on COPD?
A patient care pathway:
• Designed to improve care for people with COPD
through objective diagnosis and evidenced-based
care
• A coordinated systems approach to care focusing
on chronic disease management
• Targets patients at risk of acute exacerbation
• Incorporates quality improvement principles
VDI on COPD
• The VDI on COPD is an innovative
approach to improve care for people with
COPD by ensuring they have the evidenced
based care they require, which may include
smoking cessation, vaccinations, use of
medications, action plan, exercise,
education and access to support services.
Collaborations
• Started with discussions between MOHLTC and
Rx& D – decision to focus on COPD
• Ontario – 870,00 people living with COPD
Who to include:
• MOHLTC System Policy and Strategy Branch
• Ontario Lung Association - leader in ON for
COPD initiatives
Collaboration RX& D
• Opportunity to align with the government
priorities
• COPD first, then focus on other high end
users of our health-care system
• Interest in sustainability& replicability
• Investment is for tools/resources/evaluation
Collaboration Rx&D
• Rx&D noted that its primary interest remains
demonstrating the value and effectiveness of
medications as part of optimal care
• Formulary is deemed ‘out of scope’ for this
project
• Separate lobby efforts may be required, if the
evaluation shows medications were an effective
component of the care
Collaboration MOHLTC
• Huge in-kind support (no $$$ contribution)
• Established and co-chaired the expert panel
• Reached out to all of the LHINs to identify
the sites
• Role of Secretariat for all meetings
• Organized the monthly committee meetings
• Actively engaged in the process
Collaboration OLA
• 12+ years experience managing the Asthma Program with
MOHLTC
• Experience with delivering COPD programs
• BreathWorks COPD education series
• CREs on our toll-free Lung Health Information Line for
support
• Education workshops for health–care providers
• RespTrec training – Asthma, COPD & Spirometry
• Patient education and support groups
• OLA Project Sponsor – hired a VDI Project Manager
Innovation
• Strong evidence related to effective
interventions for people living with COPD
• Needed to learn more about the impact of
integration at the system level
• Not a clinical trial – a system change with
quality improvement as a focus
Communication
• Project Charter developed & signed by all partners
• Partners have representation on the Expert Panel,
Steering Committee, Clinical & Scientific
Committee & Governance Committee
• Leveraging each other’s strengths and
complimentary resources to achieve deliverables
that would not have been possible by each
organization alone.
VDI Project Focus
• Target Group: COPD patients who are at risk for acute exacerbations
(high health-care users)
• Care Coordination: Improve coordination of multidisciplinary COPD
care – amount, timeliness, effective transitions
• Right place for care: Shift from hospital to community care including
building community capacity in underserved areas, community-based
coordination, patient self-management
• Generalizable model: Create a model that integrates with other
chronic conditions.
• Sustainable: The model should be feasible, scalable, and sustainable
beyond the initial study period.
Expected Outcomes
• Improve patient level outcomes (clinical,
behavioural, quality of life)
• Reduce health-care utilization and costs (hospital
admission, 30-day re-admission, emergency visits,
mean annual cost, and cost per acute exacerbation)
• Increase # of patients reached with
multidisciplinary COPD care
• Increase patient adherence to, and healthcare
provider uptake of, evidence-based guidelines.
Out of Scope
•
•
•
•
Changes to the Ontario Drugs Benefit Formulary
Basic science research
New or additional government funding
Ongoing industry funding beyond initial study
period.
• Salaries for new staff at sites
The Expert Panel
• An expert panel provided evidence-based advice
on the design, implementation, and evaluation of
integrated multidisciplinary COPD care pathway
for patients
• The Expert Panel designed a patient care pathway
that is intended to:
• Improve patient level outcomes
• Reduce health-care utilization and costs
The Expert Panel
• The Expert Panel designed a patient care pathway
that is intended to:
• Increase the number of patients reached with
multidisciplinary COPD care
• Increase patient adherence to, and healthcare
provider uptake of, evidence based guidelines.
Expert Panel Members
Co–Chair: MOHLTC - Director, System Policy and Strategy
Branch
Co–Chair: Director, Research and Development, Pfizer
Canada
Secretariat MOHLTC
• Manager, Chronic Care and Aboriginal Health Unit,
Health Policy and Strategy Branch
• Team Lead
• Senior Policy Advisor
• Senior Policy Analyst
Expert Panel Clinical Experts
• A person living with COPD and on oxygen
24hr/day
• Clinical nurse specialist and researcher
• Physiotherapist and researcher
• Primary care physician at a FHT and a Board
Member of Ontario College of Family Physicians
• Respirologist and researcher with Institute for
Clinical Evaluative Sciences
Expert Panel Clinical Experts
• Pharmacist with significant government and industry
experience
• Primary care physician and the Chairperson, Family
Physician Airways Group of Canada
• Respirologist and a Principal investigator of COPD
primary care project, ESC LHIN
• Respiratory Therapist, OLA
• Respirologist and researcher on costs of COPD to health
care system
• Respirologist with a MSc in QI
VDI Pathway
Integrated, inter-professional community-based care
with:
• Patient needs assessment and self-management
plan
• Instructions on what to do with an exacerbation
• A written medication review and pre-written
prescriptions for exacerbations and vaccinations
Key features of VDI
• A Case Manager coordinates the care with
assessment, a self-management plan, education
and a referral plan
• The Case Manager follows the patient, providing
education sessions/referral to needed support
services
• The designated Case Managers are RNs, RRTs,
RPNs, or NPs
Key features of VDI
Access and referral to complementary services:
• Pulmonary rehabilitation/exercise maintenance
• Smoking cessation
• Social service providers (e.g., mental health)
• Home assessments
• Remote monitoring (Telehomecare and CCAC)
Implementation Support
• VDI Project Manager hired
• Workshops provided on site – Guidelines, Role
of Case Manager, COPD Action Plan, VDI
Pathway
• Case managers trained - COPD Trec and
Spirotrec
• Physicians and other HCPs workshop provided
on Spirometry Interpretation for Primary Care/
COPD Management
Implementation Support
• All sites have access to spirometry for objective
diagnosis
• All sites have access to smoking cessation
counselling
• Sites provided and trained on a new Clinical Data
Repository which also functions as a Clinical
Support Tool.
• Support for the Evaluation
Evaluation
• 2 part mixed-methods approach
Conduct a qualitative study to look at how well the
patient identification process, patient screening and
enrollment are working; the usefulness of it being
put into routine practice and its effectiveness on
patient care coordination;
• Evaluate the experiences of different
stakeholders regarding different parts of the
program
(Patients/Caregivers/HCPs/Administrators)
Evaluation
2nd part of this evaluation study
• Explore whether or not VDI on COPD
program improves quality of care, quality of
life and other patient outcomes after one
year of follow-up.
An independent evaluator has been selected to
work with the sites to analyze implementation
and outcomes.
Evaluation
• Evaluate the impact of the VDI on COPD on
patient outcomes (i.e. clinical, economic and
humanistic) after one year of follow-up.
• Determine what aspects of the multidisciplinary
program (ie, which combinations of services
utilized or which multidisciplinary service mix)
most contributed to the outcomes.
• Evaluate the cost-effectiveness of VDI on COPD
program.
VDI on COPD
The VDI on COPD is being implemented in three
regions in Ontario:
• Temiskaming Health Link ( North East ON, small
towns/ rural)
• Toronto Western Family Health Team (Toronto)
• Wise Elephant, Family Health Team
( Brampton)
Challenges with Implementation
• Concerns re staff capacity at each site
• Different EMRs and different stages of EMR
implementation at the three sites
• Ethics approvals required for the Evaluation
(delays)
• Data sharing agreements required
• Data dictionary needed to be defined
• Clinical Decision Support tool training
Challenges
• Need to train all Case Managers on COPD/
Spirometry/GOLD Guidelines (new approach)
• Reporting Links - hospital to Primary care site
needs to be established
• North has no local access to Pulmonary
Rehabilitation services
• Set up an improved referral to PR for the other
sites
Successes to Date
• Primary Care teams enthusiastic/engaged
• Coordinated a chronic disease management
approach to COPD
• Access to patient education materials/trainings/
workshops
• New data collection/clinical decision support
tool (ARGI)
• Part of an innovative care approach
Lessons Learned
• Importance of ‘selling’ change to the primary
care sector – not dictating it
• A great example of how Rx&D and its
members were able to align with the current
priorities of the MOHLC and how we can
successfully work together
• We collectively have a common goal, we work
out issues related to roles and responsibilities
• Need to meet needs of sites, work within their
requirements and at their speed
Steering Committee
Chair: Director, System Policy and Strategy Branch,
MOHLTC
Membership Rx&D and Funding organizations:
•
•
•
•
•
•
•
Director, Observational Research, AstraZeneca Canada
Senior Manager, Government Relations, AstraZeneca Canada
Director, Government Affairs-ON, Rx&D
VP, Private Markets and Government Relations, Rx&D
Healthcare Affairs Manager, Boehringer-Ingelheim
Representative, Novartis
Representative, Pfizer
Steering Committee
MOHLTC
• Director, Planning Research and Analysis Branch
• Manager, Chronic Disease Management and Prevention Unit
(CDMPU)
• Senior Policy Advisor, CDMPU
• Senior Manager, Drug Benefit Management, Drug Program Services
OLA
• Vice-President, Fund Development
• Director, Respiratory Health Programs
• Vice President, Provincial Programs
• Program Manager, VDI on COPD
VDI on COPD Implementation
• A Clinical and Scientific Leadership Panel
monitors the integrity, safety, and ethics of the
care pathway through implementation.
• Meets monthly: organized by MOHLTC
• Secretariat: MOHLTC
• Membership – Rx&D, OLA, MOHLTC,
Evaluation Team, Expert Panel Representatives,
Other physicians/researchers