Reports
Alternate Level of Care (ALC)
Beyond Acute Care: Next Steps in Understanding ALC Days (March 2008)
This report extends the picture of Alternate Level of Care (ALC) beyond acute care and into rehabilitation hospitals with new 2008 survey data.
GTA Rehab Network ALC Survey 2006: Mapping the way to targeted solutions (November 2006)
The report provides information on the ALC survey conducted in February 2006, including: the approach used; the conclusions drawn from the data analysis; and the targeted solutions and implementation strategies that have been developed to reduce ALC days.
GTA Rehab Network ALC Subgroup Final Report: Development of Inpatient Referral Guidelines (July 2005)
The development of the Inpatient Rehab Referral Guidelines has resulted in the standardization of best practices for the inpatient rehab referral process to improve patient flow through the system. This is one of a number of initiatives led by the Network that contributes to smooth and efficient patient transitions from acute care to rehab.
Further to the recommendations set out in the GTA Rehab Network report, Analysis of Alternate Level of Care (ALC) Snapshots: Patients Awaiting Rehabilitation in ALC and Inpatient Rehabilitation Capacity (May 2004), a subcommittee of the ALC Task Group convened in the fall of 2004 to develop a set of guidelines for the inpatient rehabilitation referral process for use by both acute care and rehabilitation hospitals. This report summarizes the work of the ALC Subgroup and provides a detailed account of the approach used to develop the Inpatient Rehab Referral Guidelines, the results of the process evaluation and the recommendations submitted to the ALC Task Group.
Analysis of Alternate Level of Care (ALC) Snapshots: Patients Awaiting Rehabilitation in ALC and Inpatient Rehabilitation Capacity (May 2004)
Some patients in need of rehab following acute care face delays in accessing appropriate services. To better identify the types of patients affected and the factors contributing to these delays, the Network conducted five “snapshot” surveys of the patient populations in ALC beds awaiting rehab. The surveys were conducted throughout the GTA between April and September 2003. This report provides a detailed analysis of the snapshot data by individual regions of the GTA, aggregate information across the GTA, and organization type. The report concludes with a summary of the implications of these findings and recommendations to address the identified issues.
Geriatric Rehabilitation
Clarifying the Complexities of Inpatient Geriatric Rehab (February 2007)
Many elderly patients do not receive the rehabilitation they need. One of the reasons is a lack of consistent services and referral criteria among programs providing geriatric rehab. This report addresses this issue by providing standardized definitions for inpatient and outpatient geriatric rehabilitation that describe geriatric rehab services provided in various types of units and programs; delineating differential criteria for each type of service; and identifying key activities and the nature of the services provided.
Musculoskeletal (MSK)
MSK Flow Task Group Initiative: Primary, Elective, Unilateral Total Joint Replacement (June 2011)
In 2010 the MSK Flow Task Group of the GTA Rehab Network, together with representatives from the Joint Health and Disease Management Committee was convened to lead an initiative at the request of the Toronto Central LHIN to identify factors to enhance system-wide performance for primary, elective unilateral hip and knee total joint replacement (TJR). The MSK Flow initiative involved two phases. The first phase of the initiative (Fall 2010) focused on gathering and analyzing information obtained through (1) key informant interviews; (2) an on-line survey of orthopaedic surgeons pertaining to post-surgical referral practices; and (3) data extracted by the Toronto Central LHIN from the Discharge Abstract Database and National Rehabilitation Reporting System. The second phase (winter/spring 2011) focused on identifying the processes and resources required to achieve provincial targets and analysis of the impact on rehabilitation resources
Exploring the Applicability of the RNAO Best Practice Guidelines for Pain Assessment and Management in Hip Fracture Patients (November 2008)
The GTA Rehab Network, in collaboration with the Regional Geriatric Program of Toronto and researchers across the province, conducted a study designed to help clinicians evaluate and implement the RNAO Best Practice Guideline for Pain Assessment and Management through an innovative approach to knowledge translation. Funded by the Canadian Nurses Foundation (Nursing Care Partnership program made possible by a grant from the Canadian Health Services Research Foundation), the study focused on pain management in elderly hip fracture patients in the last 24 hours of acute care and the first 24 hours of inpatient rehabilitation.
Consensus and Collaboration in the Care of Hip Fracture Patients: Towards a Plan for the System (November 2006)
A new initiative to improve hip fracture care is moving forward thanks to funding from the Ministry of Health and Long-Term Care. The project, led by the Total Joint Network and supported by the GTA Rehab Network, will implement a new model of care for GTA hip fracture patients who are admitted to hospital from their home or a community setting. The new model combines a shorter length of stay in acute care with an earlier transfer to an inpatient rehabilitation setting. Once transferred, patients will receive an interdisciplinary rehab assessment and participate in a comprehensive rehabilitation program focused on both physical and cognitive functioning. Based on their response to treatment, patients' rehabilitation may continue in that setting, or they may be discharged to complex continuing care, long-term care or home. The model and the consultations related to it are summarized in this recent report of the GTA Rehab Network hip fracture committee.
Current Status and Future Opportunities for Inpatient Musculoskeletal Rehabilitation: An Analysis of Supply Data and Provider Viewpoints on Future Needs (June 2006)
This report reflects the system changes resulting from the new model of joint replacement care being implemented across Toronto. As such, it complements the GTA Rehab Network's earlier report, which provided a baseline snapshot prior to those changes. This report combines and analyzes data from stakeholders in the acute and inpatient rehabilitation sectors and the GTA Rehab Network's Rehab Finder database; and makes recommendations related to: (a) enhanced services for the elderly hip fracture population, especially those with concomitant cognitive impairment; (b) improved access to low tolerance, long duration rehabilitation beds; (c) the need for consensus around the key characteristics of a complex MSK patient such that service needs and resources can be matched; and (d) standardized definitions and programs for MSK rehab patients.
Exploring the Hip Fracture and Joint Replacement Landscape in a Changing Context: Implications and Recommendations (March 2006)
This report provides a snapshot of the system prior to recent system changes in Total Joint Replacement Care. It also provides a cross continuum look at the available data on supply and demand for hip fracture and joint replacement patients. The full report is accompanied by an Executive Summary as a stand alone document and a quick reference document.
Best Practices Across the Continuum of Care for Total Joint Replacement (July 2005)
What is the evidence in joint replacement care? What do patients want to know? What are we currently giving patients for education material? This report provides a review of over 270 publications on joint replacement care across the continuum, a review of education resources currently offered to joint replacement patients, and the results of a qualitative study with patients to understand what their information needs are. The report was completed for the GTA Rehab Network by research associates Leslie Soever and Crystal MacKay. This research has been generously funded by a grant from The Change Foundation and the Government of Ontario. The views expressed here do not reflect those of The Change Foundation or the Government of Ontario.
Leading by Design: Standardizing and Tracking the Information Used to Make Decisions on Access to Rehab Services (May 2005)
This report summarizes the work of the GTA Rehab Network's Referral and Response Form Task Group. The Task Group developed, piloted and implemented a standardized rehab preadmission, referral and response form for musculoskeletal patients. The forms are intended to improve access, accountability and transparency through the referral process and provide the basis for the technological infrastructure needed for monitoring access, gaps, and waiting lists.
Stroke
High Tolerance Long Duration (LTLD) Stroke Demonstration Project: A Summary of Findings (July 2009)
The GTA Rehab Network conducted a stroke demonstration project from February to December 2007 to explore the feasibility of a High Tolerance Long Duration (HTLD) stroke rehab program. This report summarizes the approach and key findings of the project.
Low Tolerance Long Duration (LTLD) Stroke Demonstration Project Final Report (June 2006)
Final results from the Network’s Low Tolerance Long Duration (LTLD) Stroke Demonstration Project suggest the need for a review of the service delivery model and admission criteria for stroke rehab programs. This is one of several recommendations contained in the project’s final report. The project collected and analyzed data on patients admitted to LTLD stroke rehab programs at Bridgepoint Health, Castleview-Wychwood Towers, Lakeridge Health and Providence Healthcare between October 2004 and September 2005. The goal was to better understand the rehab needs and outcomes of survivors of severe stroke within the Toronto Central LHIN boundary in order to improve program planning.
Other Reports
Outpatient Rehabilitation in the GTA: Understanding the Current State (June 2011)
The GTA Rehab Network Outpatient Rehabilitation Task Group led an analysis of the utlization of and access to outpatient rehabilitation programs. This report presents one of the first analyses of publicly-funded, hospital-based outpatient rehabilitation programs in the GTA that crosses multiple professions and populations. The goal of the project, which included a comprehensive survey and a series of key informant interviews, was to better understand and quantify the current and shifting state of outpatient rehabilitation services in the GTA during a time of fiscal restraint and perceived vulnerabilities. This analysis addresses a variety of issues, including populations served, availability of professions, length of stay, wait times and discharge criteria. In addition, the report explores the factors leading to changes in the sector and chronicles reported changes to this sector from 2007 to 2010. Findings from this project provide context about the current state of outpatient rehabilitation and will inform system planning and the development of a standardized data set for stroke and MSK outpatient rehabilitation services.
Summary of Fall Prevention Initiatives in the Greater Toronto Area (GTA) (October 2010) and Inventory of Fall Prevention Initiatives in the GTA (January 2010)
The GTA Rehab Network, along with its community and hospital partners, completed an inventory of fall prevention programs in the GTA as part of an initiative on community-based patient safety as it relates to falls. The Network also completed an accompanying summary report.
Enhancing Access and Patient Flow for Rehab and CCC to Support ER/ALC Priorities (April 2010)
In 2009, the Network entered into an agreement with the Toronto Central LHIN to further identify and address issues related to enhancing patient flow for rehab and CCC. Through its project charter, Enhancing Access and Patient Flow for Rehab and CCC to Support ER/ALC Priorities, the Network monitored and analyzed monthly reports from the electronic Resource Matching and Referral System (RM&R) from August 2009 to March 31, 2010. The final report summarizes the findings from the Network's analysis including operational system issues affecting patient flow.
Rehab Definitions Initiative: Final Report (March 2010)
Since 2006, the GTA Rehab Network has been leading a large-scale initiative to develop standardized rehabilitation program definitions for publicly-funded rehabilitation services across the care continuum. This initiative has translated evidence-based best practices into population-specific rehab frameworks to define the “gold standard” for what should occur as leading practices within rehab programs across the continuum. In the absence of evidence-based literature, definitions have been derived through consensus on optimal clinical practices. In addition, self-assessment tools have been developed to support organizations in the evaluation of their rehab programs against the definitions in each framework.
The LIFEspan Transition Model: A Process Evaluation (March 2010)
In 2010, the GTA Rehab Network completed a process evaluation of the LIFEspan (Living Independently and Fully Engaged) transition model on behalf of the Toronto Central LHIN. The LIFEspan model is a unique partnership between Holland Bloorview Kids Rehabilitation Hospital and Toronto Rehab that supports young adults transitioning from pediatric to adult healthcare services. The evaluation provided key considerations for expanding or replicating the model, as well as "lessons learned" to help future planning of youth to adult transition services.
The Feasibility and Impact of Implementing Bed Matching for Rehab and Complex Continuing Care in the Toronto Central LHIN (January 2010)
The GTA Rehab Network was asked by the Toronto Central LHIN to investigate the feasibility, impact, and resource requirements associated with adding bed matching into the existing electronic Resource Matching and Referral System (RM&R). As a result of its broad consultation with stakeholders locally and nationally, the Network has concluded that incorporating bed matching into Toronto Central LHIN's existing electronic referral system will be a complex task, given the multiple providers involved. The final report outlines in detail the multiple factors that require further consideration and steps that can be taken in the interim to support the move towards electronic bed matching.
Previous Reports
Stroke
Low Tolerance Long Duration (LTLD) Stroke Demonstration Project Interim Report (October 2005)
In the fall of 2004, the GTA Rehab Network set out to conduct a Low Tolerance Long Duration (LTLD) stroke demonstration project to gain a better understanding of the characteristics, resource needs and factors influencing the outcomes of stroke patients in LTLD stroke rehab. This report summarizes the preliminary findings of an initial review of the data collected during the first six months of the project. A more detailed data analysis will be conducted at the end of the data collection period, the findings of which will be summarized in a final report in early 2006.
Community Re-engagement Stroke Subgroup Final Report ~ Stroke Information Card: Development of a New Resource for Family Physicians and Other Health Professionals (July 2005)
The Ontario Stroke Strategy has identified that improvements in transitions and re-engagement into the community are an integral part of the continuum of care for stroke survivors. This report summarizes the work of the Community Re-engagement Stroke Subgroup to develop the Stroke Information Card. As a new resource for family physicians and healthcare professionals, the Stroke Information Card provides information about community re-engagement and the community agencies that address the functional and psychosocial issues stroke survivors often face. In doing so, the Stroke Information Card enables health care professionals to develop the expertise and knowledge to ensure that community re-engagement is successful.
Stroke Information Card (May 2005)
An educational resource, the Stroke Information Card provides family physicians and other healthcare professionals with information about programs and resources to help them support successful community re-engagement by stroke survivors and their families. The card was developed based on a review of the literature and consultation with physicians, providers, stroke survivors and caregivers.
Low Tolerance Long Duration Stroke Rehabilitation Initiative Report (June 2004)
This report summarizes the work of the GTA Rehab Network's Stroke Rehab Task Group to develop a triage framework to determine when patients are appropriate for LTLD stroke rehab, and definitions of regular stream and LTLD stroke rehabilitation. The report also includes the results of a stakeholder session convened to obtain consensus from stroke rehab administrators and providers across the province regarding this work.
Inventory of Ambulatory and In Home Stroke Rehabilitation Services in the GTA (February 2003)
Implementing recommendations 17 and 18 of the document Needs Assessment and Plan for Integrated Stroke Rehabilitation in the GTA, this report provides an inventory of ambulatory and in home stroke rehabilitation programs and services in the Greater Toronto Area. It also provides tenets for a model of ambulatory and in home stroke rehabilitation and recommendations for next steps.
Needs Assessment and Plan for Integrated Stroke Rehabilitation in the GTA (February 2002)
This report details the needs assessment, findings and recommendations to work towards a system of coordinated stroke rehabilitation services in the GTA. Funding for this project was provided by the Ministry of Health and Long-Term Care as part of the Ontario Integrated Stroke Strategy 2000.
MSK
Measuring and Managing Supply and Demand: A Waiting List Information Management Proposal for Musculoskeletal Rehabilitation in the Greater Toronto Area (May 2003)
The goal of this proposal is to standardize communication to improve referrals in the GTA and work toward a real time system so that, at any given point in time, information on waiting lists can be collected and linked to capacity.
Other
Hospital Report 2005: Rehabilitation ~ Analysis of Performance Results for GTA Rehab Network Member Organizations (April 2006)
Hospital Report 2005: Rehabilitation gave Ontario hospitals that provide inpatient rehab services an opportunity to compare their performance to others in the province. To assist GTA Rehab Network members as they continue to act on those results, the Network secretariat has compared and analyzed the collective performance of Network members against the provincial average. This report identifies current Network initiatives that can assist members to improve performance in the quadrants and indicators used in the report; opportunities for improvement through joint initiatives with other Network members who share similar performance issues; and support the Network can offer to these approaches to performance improvement.
Clinical Committees' Survey Report: Current Status of Rehabilitation in the GTA (June 2001)
This report began the process of identifying and substantiating some of the rehabilitation issues GTA Rehab Network member organizations would like to address at the service delivery level. All public providers of rehabilitation participated in the survey and consensus on the priority areas noted in the report was obtained. | 
