Bundled Care

Supporting implementation of new models of care

Bundled care — a model for integrated care and funding — is expanding across Ontario following the provincial pilot for hip and knee replacements. The RCA is supporting this work in several ways:

Supporting ambulatory rehab data reporting

The RCA helped providers in the hip and knee pilot to use NACRS Clinic Lite to capture ambulatory rehab data. The RCA is continuing to provide this and other support to bundle service providers and the Ministry of Health as bundled care expands to other patient populations.

This work builds on the RCA's success in establishing a minimum data set for outpatient rehabilitative care and RCA pilots of several tools (NACRS Clinic Lite, WatLX™ Patient Experience Measure, Community Rehab Assessment outcome measure) to collect this data. For more information on the RCA pilots, the WatLX™ Patient Experience Measure, and the Community Rehab Assessment, please contact info@rehabcarealliance.ca.
Developing best practice recommendations for rehabilitative care

Hospitals participating in bundled care will be looking at care pathways to determine where care can be provided more efficiently. Working with Health Quality Ontario (HQO), the RCA has updated its Best Practices Framework for Patients with Hip & Knee Replacement to include recommendations for rehabilitative care following simultaneous bilateral knee and hip replacement. The RCA and HQO have also developed a guideline on best practices for rehabilitative care following shoulder arthroplasty. Both documents address current variations in practice across Ontario. Additional tools can be found on our Best Practice Guidelines and Tools page.

The RCA will be supporting quality improvement initiatives as health care providers work to align care with these best practices.
Supporting knowledge-sharing

The RCA is also supporting bundle holders and outpatient rehab providers as they implement bundled care by providing a forum for creating and sharing knowledge and experience on bundled care. This includes facilitating timely communication between the Ministry, HQO, CorHealth and rehab providers.

A more detailed list of activities for all RCA initiatives is found here.

NACRS Clinic Lite for Outpatient Rehab Data Collection
NACRS Clinic Lite Bundled Care Data Requirements 2022/23 (April 2022)	Reference tool to ensure the quality and comparability of outpatient/ambulatory rehabilitation data reported to CIHI's National Ambulatory Care Reporting System (NACRS). Provides information on how to complete the summary record, including detailed data element descriptions and collection instructions.
NACRS Clinic Lite Web Entry Tool — Visual Guide (April 2022)	This guide will help Ontario Bundled Care Project data submitters create client records in the NACRS Clinic Lite Web Entry Tool. Use this guide with the NACRS Clinic Lite Bundled Care Data Requirements Document which has more detailed information on creating records.
NACRS Clinic Lite Webinars: RCA provincial webinar on the OPR/MDS and the CRA Phase II pilot (January 10, 2018) presentation audio recording RCA provincial webinar on NACRS Clinic Lite data collection (May 1, 2018), and accompanying Q&A Summary of Service Duration definitions (August 2018)	Educational sessions and additional information on how to use NACRS Clinic Lite for the collection of outpatient/ambulatory rehab utilization data.
HQO Quorum site for bundled funding	Health Quality Ontario's Bundled Care Community of Practice (login required). A resource that provides support to enable successful implementation of bundled care and funding.
Supporting Bundled Care with Best Practices
Total Joint Replacement Framework (March 2017 / Rev November 2019 to include simultaneous bilateral) Addendum to the Rehabilitative Care Best Practice Framework in the Context of COVID-19 (October 2020)	Includes the framework, referral decision tree and process indicators to support performance monitoring of bundled care-related outcomes. Additional resources are available here. Additional evidence-based recommendations that align with current COVID-19 restrictions.
Guidance for post Shoulder Arthroplasty (November 2019)	Includes the guidance document and process indicators to support performance monitoring of bundled care-related outcomes.
Supplemental Information and Results of Minimum Data Set Pilots
Measuring Functional Outcomes in Outpatient/Ambulatory Rehabilitative Care using the interRAI Community Rehabilitation Assessment: Phase II Pilot Report (February 2020)	Final report on phase II pilot of the Community Rehab Assessment (CRA) clinical outcomes tool.
Overview of Data from the Provincial Phase II CRA Pilot of the interRAI Community Rehab Assessment (February 2020)	Supplementary data presentation to accompany the phase II pilot final report.
Outpatient Ambulatory Provincial Proof of Concept - Phase I Report (November 2018)	Final report detailing the methodology and results from the 2016 provincial proof of concept of the outpatient/ambulatory minimum dataset (NACRS Clinic Lite, Community Rehab Assessment and WatLX™).
Summary of Provincial Data of the Proof of Concept (March 2017)	Provincial overview of the data collected during the outpatient/ambulatory provincial proof of concept.
Overview of Key Findings: Provincial Validation Survey (March 2015)	Results of the survey to understand data collected by MOHLTC-funded outpatient/ambulatory rehab programs and implications of minimum data set.