AFIB Innovation Program

Why Did We Create the AFIB Innovation Program?

AFIB is the most frequently encountered arrhythmia, the incidence of which is increasing as the population ages. AFIB can increase the risk of stroke and heart failure, and leads to decreased quality of life.

Project Contact

Howard Abrams

Behind The Solution

The Approach

Hospitalizations and treatment for atrial fibrillation can be challenging, costly and resource intensive. The good news is that many AFIB related strokes and other complications are potentially avoidable with treatment. However, many patients aren’t receiving that treatment.

Improving this requires a multi-pronged approach, which incorporates an effective infrastructure and process management system in place for the delivery of care. The goal of the AFIB Innovation Program was to redesign the system and process of care for atrial fibrillation that not only reduces overall costs to the health care system itself, but more importantly improves patients’ quality of life and clinical outcomes, driving large scale improvement across the system.

The Design Solution

We tackled this problem through intervention at the acute, emergency management stage, through chronic management in primary care, via intervention directly with patients and their self-management and through a project aimed at identification of patients at high risk for AFIB development and subsequent stroke.

We designed and implemented an interdisciplinary rapid access transition clinic that was run by a collaborative team. The diverse team included Heart Rhythm Specialists, Neurologists, Internists, Family Doctors, Nurse Practitioners, Pharmacists, Researchers, Designers and Engineers that spanned across multiple healthcare organizations including the Centre for Innovation in Complex Care at University Health Network, St. Michael’s Hospital and the Taddle Creek Family Health Team. Evaluation and iterative design were embedded into the AFIB clinic.

Following the successful pilot of the AFIB Innovation Clinic, the innovation was sustained via the atrial fibrillation clinic at Women’s College Hospital.

A Fib about AFib

Video Transcript

We wanted to speak to you about the AFIB innovation program aninitiative designed to better deliver care to both people suffering from atrial fibrillation and support the people who care for them athan is the most common chronic heart rhythm problem whose incidence is growing as the population ages here's the fib about athan the current care system provides the best care for afib patients or is it so like many areas in healthcare we know that providers are doing their best but we also know that with some changes to the system we can still improve the experiences and outcomes of patients whether people with a thin feel symptoms or not it puts them at a greater risk of stroke which in many cases can leave them permanently disabled or even worse but it can also be prevented with the right treatment here at open lab we believe in applying a systems approach to solving healthcare problems we tackle this by looking at the patient and provider experience in 2009 we interviewed over 50 thought leaders from across the province from specialists to primary care and from doctors to administrators and everything in between this included engaging important stakeholders who endorsed our work in fact eighth they've made it onto the agenda for the vascular health blueprint for Ontario by mapping the journey of a patient through the current healthcare system we could see that it was confusing and disorganized and the patients were falling through the cracks however we could also see the opportunities for improvement and we ultimately identified four unique areas to work on screening patient self-management chronic management and primary care and management of the emergency eighth of patient currently there are no guidelines to help identify undiagnosed athan so we took point of care ECG technology to key community events to screen people with the goal of identifying the prevalence of afib we found undiagnosed athan in 1.5 percent of people 75 years and older in a city like Ottawa that's about 13,000 people unaware that they are at a higher risk of having a stroke many of which can be prevented this early work has stimulated cross-canada research into screening programs and evaluating the benefit of Earth identification and treatment to help patients already diagnosed with aphids self manage their condition we created know your colours a one page tool developed to encourage self-assessment and advocacy patients can see how well they are doing both from a hard perspective like is their heart racing are they having palpitations and also from a brain perspective are they on the best stroke prevention therapy for them the tool was tested with patients and their family doctors who found it both easy to use and effective and increasing 8th of awareness for clinicians in primary care we created the afib EMR toolkit which helps them estimate therisk of stroke and bleeding and decide when to refer patients for specialized care the EMR tool kit offers guideline based assessment with easy drop down menus and checklists that are converted into a chart mode perfect for documentation over ninety percent of family doctors that tested the tool said they would use it and recommend it to others and with such great reviews it's no surprise the heart and stroke foundation funded a trial to test the toolkit across the province through our mapping we also learned that some a fib patients don't get timely follow-up after leaving the hospital so we designed some tools for ED clinicians and we created a space where these patients can get the care they need this transitional care model we call the atrial fibrillation quality care program whoa-ho that's a mouthful let's call it a fq CP for short the program places a pharmacist and a nurse practitioner at the center of a care team supported by internal medicine cardiology and specialty care from an electrophysiologist patients get tailored education standardized assessment and guideline-based care and they end their primary care providers also have access to a clinician managed hotline for support early evaluations the program indicate a increase in appropriate use of stroke prevention therapies decrease in unnecessary ED visits and that the patient's quality of life improves the model was met with such enthusiasm that we created a website where anyone can access our tools or protocols the patient education material and information on how can implement this program in their own region it is already implemented across the entire midterm o West Healthlink and our model even received an accreditation can of the leading practice award the FIB used to be that the current system provided the optimal care for the eighth of patient but with the eighth of innovation program and all the impact we've already made we are well on our way to turning that fit into fact this work would not have been possible without the contribution of many patients and healthcare providers we really want to thank them from the bottom of our hearts pun intended for further information or if you have any questions please contact open lab at UHN CA and if you think this information would be helpful to others pass it on

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