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Opinion Innovative health-care programs exist – and work

One of the most frustrating traits of the Canadian health-care system is its failure to recognize and embrace success.

Believe it or not, there is a lot of innovation in health care.

Yet, it gets lost in the endless stream of complaints, ranging from the price of hospital parking to lack of pharmacare, and seemingly everything in between.

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But our not-quite-universal medicare system, for all its faults and failures, provides good care most of the time, despite the medical, technological, administrative, political and financial challenges that providing health care to an aging population of 36 million entails.

Practitioners are, by definition, problem solvers. Sometimes, policy makers and administrators latch onto those solutions, and scale and spread them so others can benefit.

Here's one modest example, with the fitting name INSPIRED – a sort-of acronym for "Implementing a Novel and Supportive Program of Individualized care for patients and families living with REspiratory Disease."

INSPIRED is designed to keep late-stage COPD (chronic obstructive pulmonary disease) patients out of hospital by providing support to them and their families in the community.

The program began back in 2010 at Queen Elizabeth II Health Sciences Centre in Halifax, an initiative of respirologist Dr. Graeme Rocker, respiratory therapist Joanne Michaud-Young and spiritual care practitioner Dr. Catherine Simpson.

The three were frustrated by the fact that care of COPD patients was largely reactive, insufficient and failing, leaving them lingering and suffering in hospital beds and placing tremendous stress on overwhelmed families when they were discharged.

The INSPIRED team created a treatment model that was more holistic, proactive, community-based, and which empowered patients and caregivers, and they were largely successful.

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"This program restores the dignity of the patient and family during late stages of COPD and through end-of-life care," Dr. Rocker says.

Like most good ideas, INSPIRED is quite straightforward, simple even. It identifies the neediest patients – those constantly in and out of hospital – and provides support, including:

  • A written action plan for managing COPD;
  • Routine follow-up phone calls after patients are discharged;
  • Education for caregivers that focuses on self-management;
  • Psychological support for patients and caregivers;
  • Advance care planning so there are no surprises at end of life.

Participants are even given a phone number to call if they have questions or problems – and someone actually answers that phone.

Dr. Rocker and his colleagues did something that's not done often enough in Canadian health care: They asked patients how their care could be improved, and then implemented the advice.

The team noticed that ER visits and hospitalizations fell dramatically among their patients. So they did a study and confirmed their observations.

It caught the eye of the Canadian Foundation for Healthcare Improvement (CFHI), which did something even more unusual – it scaled up a successful pilot project. With a modest $500,000, CFHI bankrolled the program at 10 other sites around the country, and conducted further in-depth research involving more than 2,000 COPD patients.

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Now the results are in: Emergency-room visits are down 52 per cent, and hospitalizations are down 64 per cent.

This is doubly noteworthy because COPD is common and deadly; it's the single most common cause of hospitalization and readmission among seniors with chronic health conditions. COPD patients, who suffer frequent exacerbations of their breathing problems, especially in late stages of the illness, are also frequent users of emergency departments.

The new research shows INSPIRED costs about $1,000 a patient. The cost savings are about $21,000 a patient.

When every $1 you spend saves $21, the next step should be a no-brainer – expand the program.

Refreshingly, that's what CFHI is doing: It's going to enroll another 2,300 patients at a variety of sites.

By 2021, the goal is to have 5,800 COPD patients in the program. An analysis conducted by RiskAnalytica estimates this will prevent 70,000 ER visits, result in 400,000 fewer days spent in hospital beds, and save $688-million in acute-care costs – not to mention provide better patient care.

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In the grand scheme of things – a $228-billion a year health system – this is a drop in the bucket.

But what if the approach – educating and empowering patients, and shifting care to the community – was applied systematically to chronic conditions?

Imagine if we took all our successful local innovations and pilot programs and actually implemented them on a larger scale. Imagine if we rejigged our current acute-care model to place the emphasis on chronic care so that it reflected the needs of our aging population and respected their wish for community-based care.

Now, that would be INSPIRED.

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