WOUND CARE
The wound client grouping is an excellent start to testing and implementing payment models based on defined otucomes. Focusing first on two wound types - diabetic foot ulcers and venous leg ulcers, and then expanding to others, the new model for wound clients is expected to have a significant impact on quality of care, improved health outcomes, increased use of innovations and more affordable health care delivery.
Highlights from the first outcome-based reimbursement trial
In August of 2011, Champlain CCAC and its partner provider, Carefor Health and Community Services, embarked on testing the ICCP “bundled payment” approach for a select grouping of wound care clients - the first opportunity to try ICCP’s outcome based reimbursement model in practice. The trial was completed in January of 2012, with the last client discharged on January 20th. The payment “bundle” included all service delivery costs (but not supplies and equipment costs) for 2 populations: clients with diabetic foot ulcers (DFUs) and clients with venous leg ulcers (VLUs). The expectation was that best practices and innovations would be applied to help the client achieve defined and agreed-upon health outcomes.
Key findings included the following:
· Relationships and integration with community resources (i.e. foot care clinics, compression fitters, potential community funding resources etc.) is imperative
· Timely initial assessments for wound categorization and treatment planning were critical for client positive health outcomes to be achieved
· Timely access to assistive equipment and supplies was found to be integral to the healing process
· A healing target of 84 days was reasonable for most clients
· Separate pricing for VLU and DFU bundles is recommended since this has the potential to further increase efficiency
The Champlain-Carefor test was limited to only 30 clients; further testing is currently underway in Central West CCAC and planning is underway to have other CCACs undertake proof of concept work.
Wound Care Library
Below you will find a selection of key materials informing the development and implementation of the wound care model design:
Wound Care Best Practices and Outcomes - Literature Review
Resources and Research Articles on Wound Care Evidence-Based Practice - References List
Information Session Presentation Slides (December 2, 2009)
Model Design and Site Selection Framework (December 2, 2009)
Wound Care Implementation (December 2, 2009)
Wound Care Impact Assessment
The impact assessment is concerned with evaluating effectiveness regarding clinical outcome improvement as well as a qualitative assessment of the implementation process. It will aim to provide key knowledge for spread and sustainability planning as well as inform future evaluations in any sector.
An interim evaluation report was submitted in August 2011 to the Executive Sponsors Committee by Impact Assessment Team Leads Drs. Katie Dainty and Merrick Zwarenstein. The report provides preliminary commentary on the Integrated Client Care Project’s (ICCP’s) original theory and implementation design and reflects on the significance of the project’s mandate and the work ahead. Recognizing the considerable effors of ICCP implementation sites and the inherent dedication of the home care sector to continuous quality improvement, the report also identifies progress and pertinent suggestions for improvements needed to achieve expected deliverables, providing a broader lens for viewing the areas for improvement and the barriers to success. The report is succinct and helpful in appropriately re-focusing the work of ICCP. Numerous measures have already been undertaken as a result of the observations of the evaluation team such as more explicit synchronicity with provincial initatives within the CCACs (e.g. Client Care Model) and the refinement of the original key design elements. It was affirming to see that our directions for outcome-based payment and establishing crucial infrastructures in technology and human resources as well as care planning across CCACs were supported. |