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International Conference on

NEUROLOGY AND NEUROSCIENCE

MENTAL HEALTH AND PRIMARY CARE

October 16-18, 2017 | Toronto, Canada

J Neurol Neurorehabil Res 2017 | Volume 2 Issue 3

Developing a virtual shared care model for headache neurology in Toronto: A triple aim study

Jennifer Robblee

and

Shawna Kelly

University of Toronto, Canada

University Health Network, Canada

Introduction:

A “Triple Aim” study strives to improve the

patient experience, population health, and reduce per capita

costs within a target population. Migraine was identified to

be the 6th leading cause of global years lived with disability

in the Global Burden of Disease Study 2013. In Canada, the

2008 direct cost of migraine was over $300 million.

Methods:

A triple aim approach is being undertaken in

collaboration with a virtual interprofessional health team

called Seamless Care Optimizing the Patient Experience

(SCOPE) to improve migraine management. Primary care

physicians (PCPs) registered with SCOPE have access to

specialists including specialists like neurology, diagnostic

imaging, and community services through a virtual hub

with a nurse navigator. A SCOPE-related headache clinic has

been developed with a neurologist and nurse practitioner

interacting with the patients and PCPs in a shared care

model through use of a bi-directional care plan and

optimized communication. Patient & provider experience

will eventually be measured with surveys; developmental

iterations are currently based on qualitative feedback. Patient

health and function are measured with a standardized score

called the Headache Impact Test (HIT-6). To improve per

capita cost, opioid use and emergency department visits are

being tracked.

Outcomes:

This initiative, which started officially in February

2017, has been well received thus far by patients and

PCPs. There are currently 159 PCPs enrolled in SCOPE, and

101 SCOPE patients have been registered in the clinic. The

care plan is qualitatively reported as helpful, and in its fifth

iteration with plans for future electronic versions. Average

HIT-6 at consultation is 64/78 (very severe), and will be track

over time for reduction. Average weekly ED visits at the

University Health Network for headache patients rostered

with SCOPE PCPs are 5. On referral, 18% of patients were

previously on opioids. We have discontinued opioids in 75%

of those patients, and the remaining is being weaned.

Discussion:

This type program is a longterm effort, and in its

infancy. Significant changes are seen at the individual level,

and already in per capita costs for opioid use. Changes at the

population level for HIT-6 scores and per capita costs for ED

visits will require a long-term analysis. Patients and PCPs are

voicing approval of the shared care model. These changes

will be tracked objectively and qualitatively for objective

evidence of the promising patient stories thus far.

Conclusion:

Migraine is a debilitating condition with massive

cost to society. Management involves pharmacologic and

lifestyle treatments that require significant counselling

and co-management between the patient and healthcare

team. A model of shared care between the patient, PCP, and

neurology like SCOPE can improve patient experience. We

plan to show improvements in the health of the headache

population and decreased per capita costs as well as scale to

other groups..

Speaker Biography

Jennifer Robblee did her undergraduate degree at Dalhousie in Neuroscience, and

then came to Toronto for Medical School at the University of Toronto. She completed

her Residency in Neurology at the University of Toronto, and then started as a

General Neurologist at UHN. While in her first year, she completed the MSc of Quality

Improvement and Patient Safety (QIPS) and 2 years of the Veteran Affairs Quality

Scholars (VAQS) program. She runs the Toronto Western Hospital General Neurology

Clinic and the new KNC Headache Clinic. She is the Physician co-lead for the falls,

which is one of the 6 hospital acquired conditions (HACs) identified as part of the

Caring Safely initiative for UHN. She is also the SCOPE Neurologist. SCOPE is a program

focused on family practices with high patient users of healthcare resources.

Jennifer.Robblee@uhn.ca