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The Design and Implementation of a Quality-Based, Bundled-Care Model for Schizophrenia in a Specialized Psychiatric Hospital: A Proof-of-Concept in Canada

Author:

Sarah Kipping

Ontario Shores Centre For Mental Health Sciences, Canada, CA
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Abstract

In Canada, the average costs to treat mental illness varies greatly depending upon the type of disorder. In 2012, the total direct cost of treating psychotic disorders to the Ministry of Health in Ontario, Canada was around 2.1 billion Canadian dollars. Psychiatric hospitalizations, followed by  long-term care needs, contributed to the high cost of care. As of 2017-2018 schizophrenia and psychotic disorders were costliest to treat, with an estimated average cost of 12,971 Canadian dollars per hospital stay (CIHI, 2019).  Bundled care models refer to a single payment for a full scope of care, are based on timely and highest quality of care, within an integrated care pathway provided to a patient during a defined episode of care. The results are a seamless transition experience and consistency in care for patients across providers and care settings. Bundled care models have been successfully created and implemented in other acute episodes of care, however within mental health and addictions and specifically within the specialized psychiatric setting are relatively new, as defining and articulating the episode of care across the chronicity of one’s lifetime has proven challenging. In this paper, we describe our experiences with designing a proof-of-concept bundled care model for patients with schizophrenia, implementing the model in the hospital setting, measuring adherence, and calculating the accompanying financial model. The comprehensive, evidenced based care elements that comprise optimal care for those with schizophrenia (in accordance with best practices and Health Quality Ontario’s Quality Standards) were mapped into a 61-day proof of concept pathway by taking into consideration - (a) daily nursing care activities (b) clinical care and treatment activities reflective of Quality Ontario’s governed quality standards for schizophrenia care (i.e. access to Family Intervention Therapy [FIT] and cognitive behavior therapy for psychosis [CBTp]) and (c) identification of exceptions to care. The financial model leveraged data retrieved from the electronic health record on a sample of 142 inpatients with a diagnosis of schizophrenia and reflective of the resources required to deliver the care elements and activities. Statistical analysis were conducted to identify areas of opportunity to standardize practice and align practices in quality improvement initiatives to increase adherence to the proof-of-concept model and pathway. Initial learnings included the identification of the variable risk factors that impact complexity and care. Next steps in this work include the definition and design of risk-adjusted, personalized pathways to further refine the model and reflect personalized care. By taking into consideration the complexity factors, both from a treatment perspective and population health focus with the social determinants of health, personalized pathways can be identified to ensure timely, quality, evidence-based and efficient care during the course of admission. Work is currently underway to develop formalized partnerships across care settings (acute care, specialized mental health care and community settings) to further broaden the model and support a seamless experience across care settings. Further learnings from this work have funding model implications and will inform mental health bundled care policies to support similar mental health clinical pathways.

How to Cite: Kipping S. The Design and Implementation of a Quality-Based, Bundled-Care Model for Schizophrenia in a Specialized Psychiatric Hospital: A Proof-of-Concept in Canada. International Journal of Integrated Care. 2022;22(S3):321. DOI: http://doi.org/10.5334/ijic.ICIC22162
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Published on 04 Nov 2022.

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