Making an Impact for Stroke Patients & their Families in Windsor-Essex

MAKING AN

I M PA C T for Stroke Patients & their Families in Windsor-Essex

Making an

I M PA C T Our patients depend on Hôtel-Dieu Grace Healthcare to provide the highest quality of care possible, their families depend on us to be there for them when they need that care, and our community depends on us to ensure that we are doing the right things, in the right way - and in the right places.

This is especially true for people who are experiencing a life changing health event like a stroke.

In a continuous effort to ensure best practice, HDGH set out to better meet the needs of stroke patients and their families living in Windsor-Essex by shifting existing resources to allow for intensive follow-up services supporting stroke patients after discharge from inpatient rehabilitation – right in their homes. This innovative, home-based rehabilitation program

Janice Kaffer President and CEO

has been operating since 2016 and is demonstrating some impressive results.

At HDGH, we are also committed to engaging in Research and Evaluation.

It is the only way we can find out new knowledge that could lead to changes in treatments, policies or care. This is what makes the development of new programs, new procedures and new tools possible.. It is how we find the most effective methods of care for our clients, and it is how we continually improve our programs and services.

This, our First Impact Report, is a great example of how we are bringing Research into Practice at HDGH. Not only did we base this new, innovative program on the best available evidence at the time, we measured our progress and our

outcomes to make sure that we were providing the right care, in the right way, and in the right place.

Most importantly, our evaluation of this program clearly demonstrates that the HDGH home based stroke rehabilitation program has contributed to a better system of stroke care in Windsor-Essex, and has resulted in significant improvements in patients’ functional activity level, reintegration into normal living, and quality of life .

Now that’s Making an Impact!

THINGS TO KNOW ABOUT STROKE REHABILITATION IN WINDSOR ESSEX In our region, the rate of acute hospitalizations due to stroke is among the highest in the province. In 2017, 538 stroke patients were admitted to hospital for an acute stroke/ transient ischemic attack (TIA, or mini stroke).

HDGH offers post-acute Inpatient Rehabilitation for approximately 35% of these stroke patients each year. The in-hospital rehabilitative program at HDGH provides the most intensive rehabilitation, including up to 3 hours of physical therapy, occupational therapy and speech therapy each day.

What’s Coming is Better than What’s Gone.

After completing in hospital rehabilitation, patients often participate in HDGH’s Outpatient Rehabilitation Program, which involves coming to HDGH a couple of times a week for approximately 12 weeks to continue their rehabilitation program.

In 2016, HDGH introduced a new approach to stroke rehabilitation - a home-based Community Stroke Rehabilitation Program, which provides equal access to rehab care for stroke survivors who are not able to participate in hospital-based outpatient services.

HDGH’s home-based, Community Stroke Rehabilitation Program provided at a patient’s home has emerged as an effective and viable alternative to traditional outpatient rehabilitation.

REHABILITATIVE CARE

ABOUT THE COMMUNITY STROKE OUTREACH PROGRAM DESCRIPTION: The Home-Based Community Stroke Rehabilition Program is a 12 week comprehensive and intensive rehabilitation program delivered safely in the home for adult stroke survivors in Windsor-Essex.

GOAL : The goal of the program is to enhance patients’ and families’ care experience and improve patients’ ability to resume their normal daily physical and social activities.

TEAM: The program team includes a variety of specialized care providers: a Physiotherapist, an Occupational Therapist, a Speech Language Pathologist, Certif ied Rehab Assistants, a Registered Nurse and a Social Worker.

FORMAT: The program consists of 3-4 home based rehab sessions per week, however, the number of sessions and type of therapy service is customized to meet individual needs and rehabilitation goals.

“Kingsville is a long way from Windsor.

After having his stroke even getting in and out of the car was a challenge. I couldn’t imagine having to travel into Windsor twice a week for rehabilitation during that time. As his primary caregiver, it was such a relief that he was getting the services he needed in the comfort of his home,” Carolyn said.

Mr. Stewart Wolfe (left) and wife Carolyn (right). Mr. Wolfe was one of the program’s first patients, traveling to his home in Kingsville, Ontario twice a week.

BEYOND HOSPITAL WALLS; STAFF SAY HOME-BASED REHAB A KEY TO RESTORING LIVES For more than 20 years, Maciej Jaglarz has been restoring people’s lives. He has worked in almost every area, unit and department as a Physiotherapist at Hôtel-Dieu Grace Healthcare (HDGH), and has 20 plus years of private community rehab experience.

He was also one of the orginal members the HDGH Community Rehabilitation Outreach Team at its inception in August of 2016.

“I thought I would be caring for a similar population that I had seen in the outpatient program. But this was not the case,” Jaglarz said. He continued to describe the holes that existed in the hospital rehabilitation program before the outreach team was implemented.

“I would see that many patients had rehab potential but when discharged from hospital, they were faced with external barriers to attending outpatient rehabilitation. Whether it was transportation or distance barriers, family circumstances or support issues, their rehab journey would be interrupted not because of their potential but because of circumstances beyond their control,” he said.

These holes were filled with the newly created rehab outreach team where upon discharge from inpatient rehab, patients would be assessed for barriers. The interdisciplinary team now provides care to assist with these identified barriers in the patients home.

“Now, I could have my patients practice lifting their leg on THEIR carpet, or getting up off of THEIR chair,”

said Jaglarz. “I could mimic situations in their real environment. This was huge.”

This one-on-one care model also meant that patients who had more challenges or risk could flourish.

This was not only important for the patient but also for their family member or caregiver. It meant stress would be reduced in knowing that these dedicated professionals were still there, still cared and ready to support their loved one.

“All in all it is a formula that works,” said Jaglarz smiling. “It is a valid model that compliments existing services.”

Progress is Impossible Without Change.

OUR PATIENTS

145

MAJORITY

SEVERE STROKE

SERVED BETWEEN AUGUST 2016 AND FEBRUARY 2018

43%

OF PROGRAM PATIENTS ARE SENIORS AGED 65+

57%

STROKE PATIENTS

PATIENTS WHO HAD EXPERIENCED A ACCOUNTED FOR

46%

Of individuals served by the program

OUR PROGRAM PHYSICAL THERAPIST REGISTERED NURSE OCCUPATIONAL THERAPIST SOCIAL WORKER SPEECH/LANGUAGE PATHOLOGIST CERTIFIED REHAB ASSISTANTS

3,800 26 HOME VISITS MADE BY TEAM APPROX.

OUR IMPACT EARLY FINDINGS INDICATE THAT SINCE THIS PROGRAM BEGAN, STROKE PATIENTS HAVE RETURNED HOME AN AVERAGE OF 7 DAYS EARLIER FROM OUR IN-PATIENT PROGRAM

7 DAY REDUCTION IN INPATIENT STAY

REHABILITATION

10

REHAB SPECIALISTS

SESSIONS PER PATIENT

REDUCTION IN MINUTES/DAY PATIENT NEEDS ASSISTANCE TO PERFORM DAILY ACTIVITIES SEVERE STROKE PATIENTS

IMPROVEMENT IN PATIENTS’ REPORTED QUALITY OF LIFE INCREASE IN THEIR ENGAGEMENT IN WORK, SOCIAL, AND RECREATIONAL ACTIVITIES

MILD/MODERATE STROKE PATIENTS

15

MINUTES PER DAY 24

Granger et al. Functional Assessment Scales: A Study of Persons After Stroke. Archives of Physical Medicine and Rehabilitation; 1993, 74: 133-138.

31

BY THE END OF THE PROGRAM, STROKE PATIENTS’ SIGNIFICANTLY IMPROVED IN THEIR ABILITY TO PERFORM DAILY PHYSICAL ACTIVITIES. PATIENTS REQUIRED, ON AVERAGE, 24 FEWER MINUTES OF HELP FROM ANOTHER PERSON ON A DAILY BASIS1

HDGH’S DEPARTMENT OF RESEARCH AND EVALUATION The Department of Research and Evaluation Services at Hôtel-Dieu Grace Healthcare (HDGH) promotes excellence in every care experience by integrating research, evaluation and evidence into practice. We do this by providing services to support our employees, physicians and researchers in conducting research, program evaluation and knowledge transfer and education (KTE) to benefit residents across the region. The Department of Research and Evaluation Services plays a fundamental role in supporting the overarching Corporate Strategy of developing Centres of Excellence in HDGH’s Mental Health and Addictions and Rehabilitative Care programs.

RESEARCH DISCOVER | Creating Knowledge Producing new knowledge that can be applied to a wider population and testing new, innovative practices.

EVALUATION ADVANCE | Demonstrating Impact Informing decisions, identifying improvements and providing information about the success of programs according to goals, objectives and anticipated patient outcomes.

KNOWLEDGE TRANSFER AND EDUCATION (KTE) INSPIRE | Stimulating Change Exchanging information and enabling evidence-based decisions in practice, planning and policymaking.

FAST FACTS – ABOUT RESEARCH AND EVALUATION AT HDGH - O ur team has advanced quantitative and qualitative research methodology skills.

- We conduct approximately 25+ research/evaluation projects each year.

- We are a member of weSpark – a partnership with the University of Windsor, St. Clair College and

Windsor Regional Hospital with a mission to enhance the health, well-being and care of people through transformative research and knowledge translation.

- We support dozens of students and volunteers each year.

LEARN MORE To learn more about HDGH’s Department of Research and Evaluation, visit: www.hdgh.org/research or send an email to research@hdgh.org