An Introduction to:InterProfessional Common Assessment InterProfessional Common Assessment

Tools in Stroke CareTools in Stroke CareWithin the Central East Stroke Network

Donelda Moscrip, MSc, S-LP(c), Reg CASLPORegional Stroke Rehabilitation Coordinator

Central East Stroke Networkmoscripd@rvh.on.ca

705-728-9090 ext 46312

Objectives for TodayObjectives for Today

1. Share project purpose & approach

2. Highlight stroke best practices in use of common assessment tools

3. Share next steps in moving forward

Central East Stroke NetworkCentral East Stroke Network

Project PurposeProject Purpose

• Collaboratively identify and implement common assessment tools across the continuum of care for stroke survivors in Central East Stroke Network.

Collaborative Change ApproachCollaborative Change Approach

• Emergent change adaptation

• Appreciative inquiry– Best possible end state– Focus on the possibilities

• Hearing the voices in the system

Gathering Gathering What IsWhat Is

Gathering What Is Best PracticeGathering What Is Best Practice

• Varied use of measures

• Measures frequently used only at admission and not at discharge

• Not necessarily using measures tested for responsiveness

• Using measures with weak psychometric properties

(Korner-Bitensky et al, 2006)

Canadian Best Practices in Stroke Canadian Best Practices in Stroke Rehabilitation Outcomes: Rehabilitation Outcomes: Report of the Expert PanelReport of the Expert Panel

• Prioritized a set of outcome measures that could be used to evaluate the outcomes of stroke rehabilitation in Canada.

• Used the International Classification of Functioning to identify measures for the domains of body structure and function, activity and participation.

• Recommended measures for clinical use based on reliability, validity, responsiveness, proven application with stroke and ease of use.

Gathering What Is Best PracticeGathering What Is Best Practice

• A Best Practice for Stroke Care– Consensus Panel on the Stroke

Rehabilitation System Report (2007)Standard 5 – “Stroke related impairments and functional status will be evaluated by rehabilitation professionals trained in stroke rehabilitation using standardized, valid assessments.”

– Canadian Best Practice Recommendations for Stroke Care (2008, p E53, Table 8)5.1(iii) – “Clinicians should use standardized, valid assessment tools to evaluate the patient’s stroke-related impairments and functional status.”

Recommended Outcome Tools Recommended Outcome Tools for Stroke Rehabilitationfor Stroke Rehabilitation

Criteria for inclusion:• Cross-continuum• Interprofessional

administration• Can be administered in a

reasonable amount of time at beginning and end of rehabilitation

• Minimize cost of training• Ideally available in

English and French• …

Gathering What is Current PracticeGathering What is Current Practice

• Which of the recommended outcome measures are being used in CESN?

http://www.surveymonkey.com/s/CAT-OM

Discovering Discovering What Could What Could

BeBe

Results from Pilot Project: Results from Pilot Project: Based on your reality what is the best possible state Based on your reality what is the best possible state in your setting (that this project could impact upon)?in your setting (that this project could impact upon)?

• More consistent identification of need for follow-up in the community.

• More seamless transitions.

• Better allocation of resources.

• Trust of assessment results in transfer of information.

• Reduce duplication and increase treatment time.

• Use of a dynamic process to adopt emerging best evidence.

• Opportunity for tailoring approaches (goals, referral, re-entry, …) based on needs of client.

Identifying Identifying What Is What Is NeededNeeded

Results from Pilot Project:Results from Pilot Project:What do you think will help people to What do you think will help people to

consistently use the core set of tools?consistently use the core set of tools?

Physician support

Leadership support

Education about when each tool is beneficial

Practical education about how to use the tools

Endorsement from others (other hospitals, PPL)

Access to tools, including copies of tools & funding

Taking part in a pilot project so they can try out the tools and experience the pros and cons

Education about the benefits and problems associated with inconsistency

Show the evidence that demonstrates that consistent use of outcome measures increases efficiency, communication between care providers and patient outcomes.

Results of Pilot Project:Results of Pilot Project:What other enablers are you aware of?What other enablers are you aware of?

• Forced-use – required use (on transition documentation, forms, etc)

• Standards of care on EMR (times and pop-up)

• Literature support

• Clinician comfort with tools

• Free or no cost assessment tools

• Tools that can be used with other populations

Moving Moving ForwardForward

A Collaborative ForumA Collaborative Forum

• Learn more about best practice use of common assessment tools for rehabilitation of stroke survivors

• Review results of survey• Collaborate to decide

upon a list of 4-5 core tools for implementation across the district.

A Collaborative ForumA Collaborative Forum

• Collaborate to generate a list of needs.• Establish willingness to take the key

messages to teams / organizations.• Establish readiness to adopt a core set

of tools across the care continuum.• Identify next steps

Next Steps for ProjectNext Steps for Project

Next Steps for ProjectNext Steps for Project

• Complete the survey with your team (We are hoping for 1 collaborative response from each organization or from each area of the continuum from an organization.)

http://www.surveymonkey.com/s/CAT-OM

• Currently planning the forums– Watch for registration information coming soon.– Are you interested in helping out with the forum? (contact

Donelda)

• Support implementation across CESN

A Collaborative ForumA Collaborative Forum

SAVE THE DATE!SAVE THE DATE!

York DistrictSept 14, 2010

Durham & HKPR DistrictsSept 22, 2010

ReferencesReferences• Canadian Stroke Network, Heart & Stroke Foundation of Canada

(2008). Canadian Best Practice Recommendations for Stroke Care. CMAJ, 179(12)

• Ontario Stroke System, Heart & Stroke Foundation of Ontario (2007). Consensus Panel on Stroke Rehabilitation System “Time is Function”.

• Bayley, Mark (January 7, 2009) – Presentation entitled “Measuring the Outcomes of Stroke Rehabilitation: Results of a Canadian Stroke Strategy / Heart and Stroke Foundation National Consensus Panel” Archived on OTN

• Korner-Bitensky, Nicol (2006) – Presentation entitled “The Canadian National Survey on Rehabilitation Practices for Stroke”

www.cesnstroke.ca

Thank You for Listening!Thank You for Listening!

moscripd@rvh.on.ca