Health Outcomes for Better Information and Care

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This year marked a significant first for the Health Outcomes for Better Information and Care (HOBIC) project with the release of its first provincial report focusing on HOBIC measures in the acute care settings across Ontario. The HOBIC Acute Care Report adds value to examining health care performance through linking the HOBIC data with other databases, such as the Canadian Institute for Health Information – Discharge Abstract Database (CIHI-DAD), and by creating aggregate benchmarking across HOBIC sites in Ontario.

The report provides information about the coverage and completion rates of HOBIC measures.  Throughout the report effective strategies for improving assessment completeness, score changes and declines in Activities of Daily Living (ADL) are highlighted. With an aging population and an increased focus on length of stay, the ADL decline data provides organizations with valuable information to examine practice and implement strategies to prevent functional decline. Each HOBIC acute care site received an individual report for use in examining care within their organization and providing information on how they compare to other HOBIC sites.

The HOBIC project is funded by the Ontario Ministry of Health and Long-Term Care’s Information Management and Investment Division and managed by the Institute for Clinical Evaluative Sciences (ICES). HOBIC introduces the collection of standardized clinical information about functional status, symptoms (pain, fatigue, nausea, dyspnea) safety outcomes (falls, pressure ulcers) and readiness for discharge in acute care, complex continuing care, long-term care and home care settings across Ontario. On April 25, 2012, the HOBIC dataset received Tier 3 approval from the Ontario Health Informatics Standards Council, the authority for recommending health information standards in Ontario.

This information is collected by clinicians electronically at the point of care on admission and discharge (to acute and home care) or on admission and quarterly for other sectors. This information is abstracted along with patient demographic information to a real time database thereby providing clinicians with access to ‘real time’ information about individual patients to use in planning for and evaluating care. In addition, nurse managers and executives have access to a set of ‘real time’ reports at the unit level to use in examining the quality of care for patients on their unit.

HOBIC concepts are not new for clinicians—most clinicians assess patient’s functional status and other measures throughout the course of care delivery. What is new is that HOBIC introduces a standardized way of collecting this information that offers clinicians the opportunity to measure, quantify and demonstrate the impact of the care they provide on patient health.

Rhonda Ridgeway, Director of Patient Care at South Bruce Grey Health Centre-Chesley site, reports that they assess patients using the HOBIC questions every three days on their Restorative Care Unit to monitor patients’ progress in the program.  At Joseph Brant Hospital Marisa Vaglica, Professional Practice Chief Nursing and Special Projects, reports that they are “utilizing HOBIC data to influence Corporate Strategic Decision Making and Quality Resource Projects that support and foster making evidence-based decisions at the point of care.”  Some sites are printing the HOBIC discharge assessment and giving this to patients so that they can take this information with them when they follow-up with their primary care providers to support transitions of care

As part of the HOBIC project, researchers have access to a database of standardized aggregated HOBIC information. As of June 30, 2012 this database contained over 816,487 assessments. Recent studies provide examples of how HOBIC data is currently being used to understand how better information can improve health outcomes:

  • Dr. Walter Wodchis examined the relationship between HOBIC acute care discharge measures and the likelihood of acute care readmission within 3, 30, 60 and 90 days of discharge and found that early readmissions were related to nausea, while those occurring later were more strongly related to dyspnea. In addition, a higher patient score on the therapeutic self-care discharge assessment was negatively related to readmission for all time periods;
  • Dr. Linda McGillis Hall examined changes in clinical health outcomes between admission and discharge in acute care HOBIC sites and found significant improvements in all of the outcomes studied, with the exception of pressure ulcers. This suggests that nursing care interventions are having the desired effect on clinical outcomes, leading to an improvement in the outcomes by the time of discharge;
  • Dr. Lianne Jeffs examined the ability of this suite of standardized clinical information to predict the need for alternate level of care status and length of stay for patients that are admitted to acute care.

The HOBIC data are a unique source of standardized clinical information that can be used to answer important questions about health system and provider effectiveness, as well as clinical practice, in order to improve health outcomes for Ontarians.

The complete HOBIC Acute Care Report is available at: http://www.ices.on.ca/webpage.cfm?site_id=1&org_id=68&morg_id=0&gsec_id=0&item_id=7579&type=report

For more information about the HOBIC program please visit: http://www.ices.on.ca/webpage.cfm?site_id=1&org_id=26&morg_id=0&gsec_id=7129&item_id=7129