IHI Triple Aim: Alberta Health Services - Edmonton Zone

The Challenge

In Canada and elsewhere, it is estimated that five percent of the population consumes 60 to 70 percent of all healthcare services. The urgency to improve care for these patients and their families is growing, as systems in the U.S. and Canada place more emphasis on care continuity, patient-centredness and reducing waste in cash-strapped systems.

The Triple Aim approach is a proven way of better meeting their needs, and simultaneously improving patient experience of care and population health while lowering per capita costs. These patients have complex, chronic or long-term health needs, often resulting in a mis-match between patient needs and traditional healthcare services offered.

To improve care for complex and high-cost patients, the Canadian Foundation for Healthcare Improvement worked with the U.S.-based Institute for Healthcare Improvement (IHI) to support Canadian teams’ participation in its Triple Aim Improvement Community (TAIC) and Better Health and Lower Costs for Patients with Complex Needs collaboratives. In Alberta, five percent of the population accounts for 66 percent of healthcare use and costs. The Eastwood community in Edmonton stands out as having a higher proportion of residents living with high health risks and poor health status.

The Improvement: Better care and better health at lower cost

Alberta Health Services (AHS)-Edmonton Zone has participated in IHI’s last three Triple Aim cohorts, beginning in 2012-13. The teams focused on people in the Eastwood community who are homeless, unstably housed or have a chronically high acute care utilization. More than half of this population in Eastwood have histories of trauma, mental illness or substance abuse.

AHS-Edmonton focused on designing, implementing and evaluating five improvement projects that would advance the Triple Aim for high-needs, high-costs patients in the Eastwood area.

  • Project 1 improves connection and engagement of persons who use substances or have mental health concerns with wrap around supports in the community. •
  • Project 2 addresses the reasons that home care clients in the Eastwood area experience frequent emergency department (ED) visits.
  • Project 3 better meets the health and social needs of women who use substances and may be pregnant or parenting in the community.
  • Project 4 provides primary care under one roof at East Edmonton Health Centre emphasizing prevention and screening. •
  • Project 5 reduces the need for ED visits by connecting clients with primary care services for wound care at Boyle McCauley Health Centre Wound Care.

The Results

By shifting 1,750 adults with addictions, mental health issues and chronic disease away from costly acute care and toward more affordable community care in three years (2012-2015), AHS-Edmonton Zone estimates it was able to reduce the average healthcare costs per individual in one project to less than $4,500 per month from $7,300 per month. The table shows the breakdown of the numbers of adults involved in all projects in 2013 and 2014.

Project Measures Early results - # of Clients
Project 1 (Reduce ED Visits for Mental Health & Addictions) Outcome Measures
  • Health Status (population health)
  • Frequency of ED visits (per capita cost)
Process Measures
  • Engagement with community-based providers (visits)
  • Quality of life
  • Social inclusion
2013 – 25 clients
2014 – 390 clients
Project 2 (Home Care Integration) Outcome Measures
  • Frequency of ED visits (per capita cost) Process Measures
Process Measures
  • Number of clients whose primary care physician notified of home care involvement
2013 – 5 clients
2014 – 25 clients
Project 3 (Women with Substance Abuse Problem) Outcome Measures
  • Frequency of ED visits (per capita cost)
  • Patient satisfaction (experience of care)
Process Measures
  • Quality of life
  • Access to care (next appointment)
  • Appropriate protocols, screening tools and clinical pathways for CDM
2013 – 7 clients
2014 – 126 clients
Project 4 (East Edmonton Health Centre) Outcome Measures
  • Health status of newborns (population health)
  • Experience with PC providers (experience of care)
Process Measures
  • Engagement with community-based providers (visits)
  • Increased engagement with primary-care providers (visits)
  • Sessions with mental health & addictions counsellors
  • Referrals to mental health providers
2013 – 120 clients
2014 – 175 clients
Project 5 (Boyle McCauley Health Centre Wound Care) Outcome Measures
  • Frequency of ED visits (per capita cost)
Process Measure
  • Number of clients attached to primary care providers
2013 – 118 clients
2014 – 590 clients

The Spread

Now entering their third year, these projects are driving change at Alberta Health Services. The number of clients served has scaled from five in January 2013 to more than 1,800 two years later without additional human resources. The team has consulted and shared their experiences using the Triple Aim with AHS teams in Grand Prairie and Calgary as well as Primary Care Networks throughout Edmonton Zone where these approaches are being adopted. The AHS-Edmonton Zone team also presented at conferences in Alberta, British Columbia and soon in Ontario in addition to sharing with Canadian, U.S. and Danish sites in the IHI collaboratives.

Team Leadership

  1. Home Living
    a. Colleen Berean, Program Manager (Project Team Lead)
  2. East Edmonton Health Centre
    a. Karen DeViller, Director (Project Team Lead)
  3. Addictions
    a. Cindy King, Program Manager (Project Team Lead)
    b. Jay Buhler, Care Manager (Project Team Lead)
  4. EMS (Complex Client Team) 
    a. Rob Sharman, Program Manager (Project Team Lead)
    b. Christine McGregor, Patient Navigator (Project Team Lead)
  5. Mental Health & Addictions (Reducing ED Presentations & Follow-Up Calls)
    a. Pamela Coulson, Director (Project Team Lead)
    b. Kim Poong, Care Manager (Project Team Lead)
  6. Boyle McCauley Health Centre (not part of AHS)
    a. Cecilia Blasetti, Executive Director (Project Team Lead)
    b. Karin Frederiksen, Clinical Manager (Project Team Lead)
  7. Secretariat
    a. Stephanie Donaldson, Directo, Primary Care & CDM (Portfolio Manager)
    b. Crispin Kontz, Manager, Primary Care & CDM (Coordinator)
    c. Eric Van Spronsen, Manager, Primary Care & CDM (Measurement Lead)
    d. Dawn Estey, Manager, Primary Care & CDM (Chronic Disease Team Planner) e. Wendy Boychuk, Project Coordinator

To learn more about CFHI’s initiatives to spread the Triple Aim framework in Canada, please visit: cfhi-fcass.ca/WhatWeDo/Collaborations/triple-aim
or email us at info@cfhi-fcass.ca