Successful start to Bundled Care for hip and knee patients

Patient Navigator Larissa Teng with patient

Larissa Teng (right), Patient Navigator for the Hip and Knee ICC, helps ensure patients like Ann Maria (left) receive seamless care throughout their entire care journey.

In March, the provincial government announced they would be introducing new legislation to create Ontario Health, a new agency to oversee health care delivery and Ontario health teams, to manage care locally and integrate hospital and community care so that patients receive seamless care.

Prior to this announcement, North York General Hospital (NYGH) had already started implementing Bundled Care for hip and knee surgery, a model that reflects the concepts envisioned for Ontario health teams.

For the past year, the orthopedic program has undertaken a significant amount of work to create integrated care coordination for patients undergoing hip and knee surgery. NYGH receives a single payment from the Ministry of Health and Long-Term Care to provide patients with all of the care they need across multiple settings and providers. As a “bundle holder,” the hospital is accountable to ensure clinical services are delivered and providers are compensated along the patient's entire journey, from pre-operative visit to post hospital care such as outpatient rehab, inpatient rehab and community home care.

NYGH has established contracts with outpatient rehabilitation clinics provided by Lifemark, and homecare services provided by Bayshore. We are currently working on a contract with inpatient rehabilitation facilities (St. John's, Providence and Bridgepoint). These formal partnerships provide NYGH with access to information about how each patient is progressing and insight that is necessary in order to identify opportunities to improve their care by adjusting the services they require. In September 2018, in addition to our established knee class, NYGH has also implemented hip physiotherapy classes; 70% of our patients are now enrolled and receiving outpatient rehab at NYGH. 

Early data from the bundled care model shows that creating standardized care processes for patients after they are discharged from the hospital has been positive resulting in funds that have can be reinvested back into the hospital.

The benefits of this model include:

  • Deliver high quality, safe and accessible care: Care is integrated to create seamless transitions and ease a patients move from hospital to home
  • Connect care through partnerships:
    • Develop agreements to partner with community providers including outpatient rehab, inpatient rehab and home care
    • Break down silos between hospital and community by creating new lines of communication and sharing pertinent patient information
  • Transform: Leading a new health care delivery model to provide high-quality, seamless care to patients.
  • Outcome focused: Monitor and improve patient outcomes using patient-reported outcome measures (PROMS).

Moving forwards, the hip and knee bundled care model will expand to include bilateral hip and knee surgery and NYGH will expand the hip and knee rehab from three days to four days/week. As a bundle holder, we are responsible for collecting PROMS and will be implementing additional surveys to gather patient feedback (pre-operatively and post operatively (post discharge at three months and one year). 

Given the experience NYGH now has with implementing the bundled care and the success we've achieved to date, other surgical procedures are currently being considered for this type of model. NYGH is now sharing their experience through hosting site visits and poster presentation at conferences.

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