Alternative Level of Care (ALC) in Canada

Patients who no longer require acute care but cannot be discharged to an appropriate setting immediately are often referred to as “bed blockers”, and designated ALC. The Ontario Ministry of Health and Long Term Care (MOHLTC) funding is based partially on average length of stay (ALOS), which is often quite long for ALC patients. Members of The Brondesbury Group have worked with groups focusing on this issue in community hospital and multi-site settings.If this is an issue in your hospital and you could use some coping strategies click here.

Moving Forward with Evidence-Based Care Management

Have you looked at how you are/could use evidence-based care management tools? Have you stopped at pathways? Have you checked your pathways lately? Here are some questions to guide those activities. LINK.

Looking at the Literature:

Here are some basic questions you should keep in mind as you search for published information. Sites to help you with this search are also listed.  LINK.

Common Issues in Organization-Wide Pathway Systems

Common issues in the development of organization wide pathway system include basic questions such as “what is this and can it fit comfortably into my practice” to more complex issues in dealing with expected variability in patient progress, while still tracking and managing unacceptable variability. LINK.


Presentations:

November 6, 2006: OHA - Utilization Management Session
->Dr. Edwin L. Weinstein.  Integration in Healthcare - A Canada-Wide Opinion Leader View

February 21-22, 2006: Clinical Pathways
->Judith Weinstein. Program Co-Chair & Speaker
->Presented by Insight Information
->The Old Mill, Toronto
->To find out more about the conference click here. 

April 30, 2004: Care Management Network
->Judith Weinstein. Review of "Pathways 101" ; "Assessment Tool for Pathways"
->The Scarborough Hospital, Toronto

Dec, 2003: Care Management Tools at a Small Hospital
->Judith Weinstein. Client Presentation.

Nov 4th, 2003: Care Management Network, Fall Session 2003
->Judith Weinstein. "Updated Assessment Tool for Pathways" and "Pathways 101"
->St. Michael’s Hospital, Toronto
->You can find the full presentations posted in the Clinical Pathways Web Forum supported by   the Grey Bruce Health Network at http://www.gbhnforum.on.ca
NOTE: November 2005 - Technical Problems - we will post notice here when resolved.
->Instructions for using the Clinical Pathways Web Forum found here.

June 2-4, 2003: Canadian Evaluation Society Conference
->In the Public's Best Interest: Evaluation, Accountability and Transparency
->Hyatt Regency Vancouver, British Columbia
->Judith Weinstein. Poster: Accountability for What?

October 15, 2002: Hamilton Regional Cancer Centre, Gynaecologic Oncology
->Sponsored by Ortho Biotech
->Judith Weinstein "Developing Pathways: Evidence-Based Clinical Management Tools"

October 4, 2002: The Spinal Cord Rehab Inter Program Exchange
->Hosted by Lyndhurst Centre part of Toronto Rehabilitation Institute
->Judith Weinstein "Pathways in Integrated Care Management Systems"

Handouts from our Most Frequently Requested Presentations:

The following presentations were delivered to conferences, clients, and in peer reviewed sessions. In some cases we provide links to information from the actual presentation. Although this gives an overview of the content, and we update this information periodically, we suggest that you contact us to discuss current needs of your organization.

Pathways 101: Evidence-Based Care Management Tools

The following presentation about basic steps in developing pathways has been presented a number of times. Following presentation at the Care Management Network a version is posted on the discussion forum kindly provided by the Grey Bruce Network. Here is a direct link to a recent handout from this presentation. LINK.

Path Appraisal, an Update

The following presentation was delivered at the Care Management Network at St Michaels Hospital Toronto in November 2003 and a version is posted on the discussion forum kindly provided by the Grey Bruce Network.

The original Tools for Path Appraisal were developed by J Weinstein, & J Hockley during 1999-2000, presented at a variety of conferences, and used by a number of organizations. The aim was to support both beginners and more experienced path teams to identify: where the organization is in the evolution of using paths; areas of success & achievement; opportunities for improvement; how to integrate paths with clinical practice, quality improvement, information management, decision support and evaluation system in order to use paths to their fullest potential.

The updated version of the path adds a “Smoke Detector Model” to the detailed checklist components of the original tool. LINK.

Accountability for What? Tracking Patient Activity

This presentation was accepted for the Conference of the Canadian Evaluation Society, In the Public's Best Interest: Evaluation, Accountability and Transparency, in Vancouver, June, 2003.  Health Care has many hidden barriers to sound evaluation processes, which pose problems even for those with many years of healthcare experience. One easy assumption is that stakeholder group discussions use terms and descriptors with a common meaning. In a decade of implementation of evidence-based care management tools, the author has found instead two common problems; terms may have different meanings, and descriptive phrases may lack precision.  Thus, facilitation processes must include accountability for expressing each professional’s perception of ordinary terms like ambulation.  Such preparatory work is necessary if data used in quality assurance processes and other cyclical or focused evaluation activities is to have the internal consistency to support reliable evaluation processes.

In this presentation, the author will use examples from various settings illustrating glossaries’ role in supporting an accountable evaluation process, by defining terms and activities, which support precisely stated outcome indicators. LINK.

Thinking about Evidence-Based Care Management and Decision Making

This presentation has been customized for client presentations at a number of regional organizations, including the teaching and community hospitals, and acute care through rehab and community care. Specific organizational system issues guide the planning of the session. Some organizations wish to focus on how care management tools can support their utilization management and decision support processes.  Other organizations need to consider integration with evidence-based decision making or knowledge organization activities and principles.  Here is a handout from one such presentation. LINK.

Pathways in Integrated Care Management Systems

What if regional players want to support patient care through a full episode, but the organization integration isn’t there yet? Here is a handout from a presentation proposing some key ways to go about it. LINK.