An Introduction to: InterProfessional Common Assessment Tools in Stroke Care Within the Central East Stroke Network

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An Introduction toInterProfessional Common
Assessment Tools in Stroke CareWithin the
Central East Stroke Network

• Donelda Moscrip, MSc, S-LP(c), Reg CASLPO
• Regional Stroke Rehabilitation Coordinator
• Central East Stroke Network
• moscripd_at_rvh.on.ca
• 705-728-9090 ext 46312

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Objectives 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

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Central East Stroke Network
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Project Purpose

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

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Collaborative Change Approach

• Emergent change ? adaptation
• Appreciative inquiry
• Best possible end state
• Focus on the possibilities
• Hearing the voices in the system

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Gathering What Is
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Gathering 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)

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Canadian Best Practices in Stroke Rehabilitation
Outcomes Report 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.

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Gathering 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 patients
  stroke-related impairments and functional status.

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Recommended Outcome Tools for 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

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Gathering What is Current Practice

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

http//www.surveymonkey.com/s/CAT-OM
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Discovering What Could Be
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Results from Pilot Project Based on your
reality what is the best possible state 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.

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Identifying What Is Needed
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Results from Pilot ProjectWhat do you think
will help people to 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.

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Results of Pilot ProjectWhat 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

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Moving Forward
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A 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.

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A 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

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Next Steps for Project
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Next 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.co
  m/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

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A Collaborative Forum

• SAVE THE DATE!

Durham HKPR DistrictsSept 22, 2010
York DistrictSept 14, 2010
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References

• 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

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Thank You for Listening!
moscripd_at_rvh.on.ca