Hospital Continuum Presentation (2)

8/9/2019 Hospital Continuum Presentation (2)

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Continuum of Care inContinuum of Care in

Fall ManagementFall Management

Creating a Culture of Safety Paradigm in a localCreating a Culture of Safety Paradigm in a localcommunitycommunity


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Agenda

Introductions

Falls

Statistics

Etiology

Dizziness

Etiology of Dizziness

Systems Controlling

Balance

Traditional TherapyPrograms

Continuum Overview

Continuum Flow Chart

Center of ExcellenceModel

Assisted & IndependentLiving Communities

Discussion Action Plan


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Falls: Relevant StatisticsFalls: Relevant Statistics

Falls are not a normal part of agingFalls are not a normal part of aging

Balance related falls are the leading cause ofBalance related falls are the leading cause of

deaths in elderlydeaths in elderlyAnnual fall rates:Annual fall rates:

30% of those > 6530% of those > 65

50% of those > 8050% of those > 80

25% of patients > 50 who25% of patients > 50 who fxfx a hip die within 12a hip die within 12months, and 40% within 24 monthsmonths, and 40% within 24 months


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Etiology of FallsEtiology of Falls

Dizziness is the #1 reason for fallsDizziness is the #1 reason for falls

Loss of protective sensation is #2Loss of protective sensation is #2

50% of falls in elderly can be attributed to50% of falls in elderly can be attributed tovestibular dysfunctionvestibular dysfunction


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DizzinessDizziness

Lightheadedness: feeling faintLightheadedness: feeling faint

Vertigo: Perception of movement, either self orVertigo: Perception of movement, either self or

surroundingssurroundings OscillopsiaOscillopsia: Experience of objects that are: Experience of objects that are

known to stationary appear to be movingknown to stationary appear to be moving

Disequilibrium: Unsteadiness, imbalanceDisequilibrium: Unsteadiness, imbalance


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Etiology ofDizzinessEtiology ofDizziness

OtologicOtologic: 50% (vestibular): 50% (vestibular)

CNS: 22% (TBI, CVA, Migraine, etc)CNS: 22% (TBI, CVA, Migraine, etc)

Psychogenic: 15% anxiety, panic, depression)Psychogenic: 15% anxiety, panic, depression) Medication: 5%Medication: 5%

OtherOther


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Systems Controlling BalanceSystems Controlling Balance

VestibularVestibular

SomatosensorySomatosensory

VisualVisual MusculoMusculo--SkeletalSkeletal

CognitiveCognitive

70% of our balance is vestibular when our head and70% of our balance is vestibular when our head and

body are in motionbody are in motion


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Traditional Therapy ProgramsTraditional Therapy Programs

Historically reactive vs. proactiveHistorically reactive vs. proactive

Research shows traditional therapy programsResearch shows traditional therapy programs

have little to no effect on fall riskhave little to no effect on fall risk Strengthening and increasing functional enduranceStrengthening and increasing functional endurance

does not impact balance systemsdoes not impact balance systems


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Continuum Model

Screening of all Geriatric Patients

Physician Marketplace

Home Care Marketplace (as part of Oasis)

Community Screening Programs

Residents in Assisted Living and Independent LivingFacilities

Geriatric Patients prior to D/C from acute carefacilities

With a positive screen, patient enters continuum


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Hospital Is Ideal PlatformHospital Is Ideal Platform

Has a large discharge geriatric population who can be screenedHas a large discharge geriatric population who can be screened

by hospitalist prior to D/C for potential for fallsby hospitalist prior to D/C for potential for falls

Also may have home care agency who can screen all traditionalAlso may have home care agency who can screen all traditional

home care patients for fallshome care patients for falls Secondary opportunity for extended care marketplaceSecondary opportunity for extended care marketplace

If hospital has captured medical practices, then they can screenIf hospital has captured medical practices, then they can screen

all geriatric patients for fall risksall geriatric patients for fall risks

Secondary opportunity to develop a Center of ExcellenceSecondary opportunity to develop a Center of Excellence

All home care and outpatient therapists are trained in high levelAll home care and outpatient therapists are trained in high level

evaluative, treatment and education in fallsevaluative, treatment and education in falls


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Continuum Flow ChartContinuum Flow Chart


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Center ofExcellence In FallCenter ofExcellence In Fall

ManagementManagement Continuum of Care Philosophy:Continuum of Care Philosophy:

A screening, diagnostic and treatment center withA screening, diagnostic and treatment center withand without wallsand without walls

It has a physical location, however, is a true continuum.It has a physical location, however, is a true continuum.

It, therefore, can address the needs of patients who are:It, therefore, can address the needs of patients who are:

AmbulatoryAmbulatory

Home boundHome bound

Facility basedFacility based Assisted Living FacilitiesAssisted Living Facilities

Independent Living FacilitiesIndependent Living Facilities


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Center OfferingsCenter Offerings

Continuum of consultative services for PrimaryContinuum of consultative services for PrimaryPhysician to assess fall risk for their patients including aPhysician to assess fall risk for their patients including ascreening tool that can be implemented in the primarysscreening tool that can be implemented in the primarysofficeoffice

Full diagnostic testing including:Full diagnostic testing including: ENTENT

NeurologyNeurology

PodiatryPodiatry

Diagnostic services including VNG,Diagnostic services including VNG, PosturographyPosturography Specialized therapeutic evaluative and treatmentSpecialized therapeutic evaluative and treatment

services on an ambulatory, home care and extendedservices on an ambulatory, home care and extendedcare facility basiscare facility basis


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Center StructureCenter Structure

Center ofExcellence

ENT

Neurologist

Home CareTherapy

OutpatientTherapy

Podiatry

Other(Psychologist,

Physiatrist,Etc)

Assisted &Independent

LivingFacilities


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Potential Team MembersPotential Team Members


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Client PopulationsClient Populations

End Users

(Ambulatory)

End Users

(Home Bound)

Assisted &

Independent

Living

Facility

Primary

Physicians

Center of

Excellence


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Primary Physician Middle UserPrimary Physician Middle User

Program is marketed physician to physician as aProgram is marketed physician to physician as adiagnostic and treatment center that acts as andiagnostic and treatment center that acts as anextension of the primary physicianextension of the primary physician

Primary physician is given a screening tool to identifyPrimary physician is given a screening tool to identifypopulation of his patients who are at high risk of fallspopulation of his patients who are at high risk of falls

Advised of the specialized capabilities of, and prudencyAdvised of the specialized capabilities of, and prudencyof referring all home care patients because of screeningof referring all home care patients because of screening

process and specialized trainingprocess and specialized training Advised of specialized capabilities of part B therapyAdvised of specialized capabilities of part B therapy

provider vs. generic therapyprovider vs. generic therapy


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Assisted/Independent LivingAssisted/Independent Living

FacilitiesFacilities Primary concern is opening the front door andPrimary concern is opening the front door and

closing the back doorclosing the back door

Marketed via the proactive foundation ofMarketed via the proactive foundation ofprogram, and that it is activated by the DON,program, and that it is activated by the DON,not outside consultants who will have anot outside consultants who will have a

tendency to over utilize.tendency to over utilize.

Cross marketing (viral) of all services to theCross marketing (viral) of all services to thegeneral and professional communitygeneral and professional community


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Outpatient Part B Opportunity

There will be significant referrals to part A & B

outpatient therapy from the Center

Part B therapy centers can be developed inselected Assisted Living and Independent LivingFacilities which increases Hospitals outpatient

network and is a perceived benefit from the

perspective of the AL/IL


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ConclusionConclusion

Falls are an inevitable risk to aging populationsFalls are an inevitable risk to aging populations

Historic medical and therapeutic model areHistoric medical and therapeutic model are

reactive vs. proactivereactive vs. proactiveA seamless continuum of care model can beA seamless continuum of care model can be

successful instituted in any community whichsuccessful instituted in any community which

has a foundation of a Culture of Safety andhas a foundation of a Culture of Safety and

extends from the hospital to the ambulatoryextends from the hospital to the ambulatorymarketplace, home care marketplace andmarketplace, home care marketplace and

extended care marketplaceextended care marketplace

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Hospital Continuum Presentation (2)

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