Vaughan/Richmond Hill, ON – Motivated by a deep desire to better understand its most complex patients, Mackenzie Health undertook an in-depth study of its patient population in early 2013. The resulting information is now being used to make informed decisions for the future and help Mackenzie Health move toward its vision of creating a world-class health experience for patients.
The study focused on the top 10 per cent of Mackenzie Health’s high-acuity patients, with a deep-dive analysis on the top one per cent. The study was intended to help the organization improve transitions between care providers, access to services, quality and coordination of care, all in the pursuit of improving the patients’ experience and health outcomes. The results of the study were not only surprising, but also counter-intuitive, and the resulting information has helped staff and physicians develop new strategies to better meet the needs of these patients.
Debunking Myths and Creating Evidence-based Care
Prior to the study, some of the common assumptions among clinicians were that high-acuity patients were almost always older seniors who had three or more chronic conditions. It was also assumed that most of these patients visited the Emergency Department six or more times each year. These assumptions indirectly influenced the hospital’s efforts to care for the patients who require the most assistance.
What the Study Revealed
Imagine the surprise among staff and physicians when the results of the study showed that less than half of the high-acuity patients are over 75 and that less than a third have three or more chronic illnesses. And while cancer was not initially considered a prevalent factor in the top 10 per cent patients, finding out that this patient population is three times more likely to have cancer than the average patients prompted another “Aha!” moment. An additional surprise came with respect to Emergency Department visits. The study found no significant difference between high-acuity and regular Emergency patients, with an average of only two visits a year.
How the Study Will Make a Difference
While at times counter-intuitive, the study results provided valuable, timely information which challenges Mackenzie Health staff and physicians to think differently in order to respond to the needs of its patient population.
Mackenzie Health’s immediate focus will be on creating and implementing additional strategies to improve the outcomes of high-acuity patients through new nurse navigator roles and clinics, through enhanced care processes, and by advancing broader system collaboration. For example, the clinical team in cardiology is developing a patient passport for individuals with Congestive Heart Failure. This passport will assist patients to track their symptoms, interventions and doctor visits. The result will be improved communication between patients and their healthcare team and increased effectiveness of treatment.
The improved understanding and management of high-acuity patients may also help reduce the costs to the healthcare system, as the top 10 per cent of high-acuity patients account for the majority of the hospital’s direct acute care costs. In the 2011/12 fiscal year, Mackenzie Health’s top 10 per cent most complex patients (approximately 1380 patients) accounted for 62 per cent of the organization’s resources and the top one per cent of these (138 patients) accounted for 49 per cent of the costs.
The information gathered will not only inform the planning and design of the organization as a whole, but will also have a significant impact on the development of the new Mackenzie Vaughan Hospital, scheduled for completion in 2019.
Mackenzie Health will be looking at sharing its innovative approach with other hospitals in the province and across the country through publications, conferences and other channels.
Quotes
“There will always be people who need a significantly higher amount of care in terms of lengths of stay in the hospital, the number and type of interventions and treatments, and the need for critical care than the average population. For this reason, it is essential to better understand these patients with complex needs and develop targeted strategies to help improve their care outcomes and, in turn, help reduce the costs to the system.”
- Kristine Jarvi, Executive Director, Transformation, Mackenzie Health
“Specific to the Emergency Department, the information revealed by the study is extremely valuable to Mackenzie Health as it helps us understand that, despite the general pre-study assumptions, most high-acuity patients are not frequent Emergency Department patients. The findings offer a fresh perspective and allow us to make informed decisions going forward.”
- Julie Simard, Interim Operations Director, Emergency, Medicine, Intensive Care Unit, District Stroke and Flow, Mackenzie Health.
“Mackenzie Health’s evaluation is a step in the right direction as it will allow us to make better use of our resources, plan according to our patients’ needs and ultimately improve care to create healthier communities.”
- David Stolte, Vice President, Strategy and Redevelopment, Mackenzie Health
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