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  • AFHTO 2016 Conference: Registration now live

    Registration now open for the AFHTO 2016 Conference! Leading primary care to strengthen a population-focuses health system October 17 & 18, 2016 – Westin Harbour Castle, Toronto, Ontario

    Ontario’s health system is on the cusp of a profound shift. Patients First has set a direction for primary care and organizing the health system to focus on local integration to meet the needs of people living in our communities. Primary care has the opportunity to become its strong foundation, delivering comprehensive care for all, over their lifetimes, by placing the health of populations in their local communities at the centre. Over 900 interprofessional primary care providers, patients and community partners will come together to explore how to set a course for primary care, drawing from the experience and views of leaders from all across the province. What will you learn from this 2016 AFHTO Conference to help you play your role in leading primary care to strengthen a population-focused health system?

    See the full Conference Schedule here. For general information you can visit our conference page. We look forward to seeing you at the AFHTO 2016 Conference!

  • 2016 Conference Themes

    Leading primary care to strengthen a population-focused health system

    The AFHTO 2016 Conference program will be built around 7 core themes.

    Concurrent Theme Descriptions

    Download a printable PDF of the theme descriptions here.

    1. Planning programs and fostering partnerships for healthier communities
    2. Optimizing access to interprofessional teams
    3. Strengthening collaboration within the interprofessional team
    4. Measuring performance to foster improvement in comprehensive care
    5. Coordinating care to create better transitions
    6. Leadership and governance in a changing environment
    7. Clinical innovations to address equity

    1. Planning programs and fostering partnerships for healthier communities

    Primary care teams are expanding their focus of care beyond rostered patient populations to the entire community. This requires new ways of planning programs and developing partnerships with the aim to care for their communities from a variety of perspectives – public health, health & social equity, LHIN & sub-LHIN regions, etc. – and identifying gaps/overlap in services with each. This stream will focus on how teams are planning for populations, improving health equity and reducing disparities, creating stronger partnerships with local health and community services, collaboration between LHIN and sub-LHIN regions and Health Links.

    2. Optimizing access to interprofessional teams

    Patients First calls to improve access to interprofessional teams for those who need it the most, focusing on equitable access across the province. Presently, only 25-30% of Ontarians can access interprofessional team-based primary care and only some other groups of physicians have access to certain IHPs for their patients. Primary care teams are trying to understand the needs in their community and their team’s capacity to adapt by asking tough questions:

    • Can the people who need care the most get it in their community?
    • How do primary care providers who don’t have access to interprofessional team resources get access for their patients?
    • How do we open the team to new patients and providers while still providing a team-based approach to care and without overwhelming existing resources?
    • What partnerships and agreements can be set up to open the door to these patients?

    This stream will focus on the steps taken so far to explore these questions and initiatives that have started to address this need.

    3. Strengthening collaboration within the interprofessional team

    Interprofessional primary care teams are designed to combine the expertise of a range of health professionals to provide comprehensive primary care. Creating a strong and high-functioning team dynamic is a challenge when teams are experiencing high turnover, new community partnerships/programs are introduced, and new team members are transitioning from solo to team practice. This stream focuses on how teams have overcome barriers to engage all team members in providing care, create a healthy team culture, manage conflict within the team, strengthen care coordination internally and in the community, and achieve optimal scope of practice for all team members.

    4. Measuring performance to foster improvement in comprehensive care

    Primary care teams have made significant progress to advance manageable and meaningful measurement for improved patient care. Early results from Data to Decisions (D2D) are showing that higher quality comprehensive, patient-centered care is related to lower healthcare costs. This stream will focus on the tools and processes teams are using to measure as well as how they are using the resulting information to improve quality.

    5. Coordinating care to create better transitions

    Primary care is an anchor for patients and families, providing comprehensive care throughout their lives and guiding them through the health system. Primary care providers offer patients and families a single point of contact to help them manage their own care and access programs and services. This stream highlights how primary care teams are managing care coordination for their patients whether through Health Links, supporting better integration through shared care models, implementing strategies for specific populations such as seniors or individuals who need access to mental health and addiction programs, or better management of chronic diseases.

    6. Leadership and governance in a changing environment

    Patients First describes the need for clinical leadership to deliver the system transformation expected in primary care in the coming months and years. The role of a “clinical leader” from a system standpoint denotes a clinician who looks up and out from their individual clinical setting to their wider community and the health system to effect change. Leaders, clinicians and governors in primary care teams will be challenged to fulfill this role. This stream will focus on sharing resources to strengthen individual leadership competencies, the role of clinical and administrative leaders in primary care teams, and the governance structures needed to foster change.

    7. Clinical innovations to address equity

    Primary care teams are resourced to care for patients with chronic and complex conditions by offering diverse professional expertise and access to the resources and skills required to manage the “whole patient”. This stream will focus on how teams are leveraging their resources and organizing care to address gaps, reach special populations and provide better access to care where and when its needed. Specific topics of interest include improving access and outcomes in mental health, palliative care, and diabetes.

  • Invitation to join focus groups to inform Ontario ehealth strategy

    Dear members,

    We are sharing the invitation below for clinicians and administrators in family health teams and nurse practitioner-led clinics to participate in focus groups to inform the next ehealth strategy for Ontario.

    This consultation is being led by MD+A Health Solutions, a technology consulting firm engaged by the Ministry of Health and Long Term Care.

    Members have clearly indicated in previous surveys related to Data to Decisions (D2D) that there are outstanding needs related to EMRs. You have also demonstrated tremendous capacity for getting value out of existing tools and thus are well-positioned to share your learnings and suggestions for systemic solutions.

    See the email and information sheet below to learn more about the consultation process, and to confirm your interest in participation.

    ________________________________________________________________________________________________

    Hello,

    The Ontario Ministry of Health and Long Term Care (the ministry) is currently refreshing their Clinician eHealth Strategy and is interested in gathering information on how Family Health Teams and Nurse Practitioner Led Clinics currently use Electronic Medical Records (EMRs) and other ehealth tools to support their practice. The ministry has engaged us, MD+A Health Solutions, a health information and technology consulting firm, to support this work.

    MD+A is currently in the process of reaching out to key stakeholders in the health sector to solicit input on a variety of topics related to the current and future state of clinician ehealth in Ontario. As part of this, MD+A is interested in holding three 60-minute focus group sessions with clinicians and administrators from FHTs and NPLCs to discuss:

    • Current use of EMRs and other digital health tools
    • Effectiveness of EMRs in supporting interdisciplinary care
    • Shared services and support models
    • Implementation and adoption supports and challenges

    MD+A would ask that you or a member of your FHT or NPLC participate in one of the focus groups. By participating, you will have an opportunity to inform the future of EMR use and health information technology in Ontario.

    MD+A anticipates holding sessions by webinar during the last week of June or first week of July. If you or someone in your organization is interested in participating in a session, please provide your availability as soon as possible but no later than Monday, June 27 at http://fluidsurveys.com/s/fhtfocusgroup/.  Focus groups will begin as early as June 28.

    More detailed information on the topics to be discussed and the dial-in information will be provided in advance of the session. In addition, a document that provides additional background on the project and FAQs has been attached to this email. If you have other questions or comments, feel free to email Lynsey Turchet at lynsey@mdahealth.ca.

    Thank you in advance for your participating in this process. Your feedback will be a key input in to the development of the clinician ehealth strategy.

    Sincerely,
    MD+A Health Solutions

    Relevant Link:

  • Learning Event – Improving Diabetes Care; Improving Diabetes Outcomes

    Registration is now open:

    Space is limited and will be available on a first come, first served basis. Participation is free, and meals and refreshments will be provided. Please share this learning opportunity with IHPs and QIDSS in your teams and encourage them to invite their patients.

    Learning & KTE Event Program

    Studies have shown that interprofessional care teams outperform other models in caring for patients with diabetes. Nevertheless, we still have a long way to go. AFHTO members have thus identified diabetes care as a priority for collectively advancing improvement in primary care. To support our members in this, AFHTO, in partnership with the Centre for Collaboration, Motivation, and Innovation(CCMI), and with the support of Ontario’s LHINs, is presenting a full-day learning event for QIDSS, IHPs, and patients with diabetes. Educators from the Ontario’s LHINs and CCMI will introduce attendees to self-management as a care tool and lead a discussion of how it can be used to address gaps in diabetes care. This will be followed the next day by a knowledge translation workshop for QIDS Specialists on creating concrete action plans for moving from measuring to improving diabetes (and other outcomes) in their own teams.

    • Thursday, June 16 – full day for IHPs, QIDS Specialists, and patients: How to use self-management techniques to move from measuring to improving care for patients with diabetes.
    • Friday, June 17 – half-day for QIDS Specialists: Developing collective action plans to improve diabetes (and other) outcomes.

    For more information, please consult the Program Agenda and FAQ or contact Carol Mulder.

    Location

    The workshop will be held in the Sala Caboto Ballroom of the Columbus Event Centre, located at 40 Playfair Avenue in Toronto.

    Accommodation / Hotel Discount

    The nearest hotel is the Holiday Inn Yorkdale, located at 3450 Dufferin Street. A special rate of $139.00/night is available on June 15 and 16. Register at this link or call 1-866-568-0046 and request the Association of Family Health Teams of Ontario group rate.  

  • C4 Because you care: Using your EMR data to save lives

    Theme 4. Measuring performance to foster improvement in comprehensive care

    Presentation Details

    • Date: 10/17/2016
    • Concurrent Session C
    • Time: 4:30pm – 5:15pm
    • Room: Metropolitan Ballroom Centre
    • Style: Presentation (information provided to audience, with opportunity for audience to ask question)
    • Focus: Practical (e.g. Presentation on how to implement programs and/or practices in the team environment)
    • Target Audience: Leadership (ED, clinical lead, board chair, board member, etc.), Clinical providers, Administrative staff

    Learning Objectives

    1. Describe what difference EMR data quality makes to patients: it saves lives
    2. Describe the ideal focus for improving EMR data quality: something that matters to you!
    3. Describe the ideal person to start improving EMR data quality: you, whoever you are!
    4. Describe the team characteristics needed to improve EMR data quality: any team, any time, any where”

    Summary/Abstract

    There is more in our EMRs than you might think!  We have each found key issues for our patient populations that relate directly to patient safety and health.  We worked to resolve them by strengthening our EMR data and processes.  We will be sharing our learnings about how we are protecting patient health through data clean up.  One important learning is that you can start with whatever matters most to you – and anyone can do it! You just need to look at your situation and your data with a critical eye. Another learning is that paying attention to the details matters. Having the right data in the right place at the right time in the right way can save lives! Conversely not having it causes risk to our patients.

    The data in our EMRs has incredible implications for individual patients as well as population health. We found out that it is not as hard as we might have thought to make a difference. Join us to hear how we are making patient’s lives better by improving data quality.

    Specifically, we will tell you about how participation in D2D 3.0 EMR data quality measure for preventative care helped us to identify and correct a serious issue in our colorectal cancer screening data.  We will also tell you about how the use of clinical and demographic data captured in EMR enhanced the rate of diabetes-related complication screening and immunization uptake in our Chinese and South Asian patient population.

    Presenters

    • Denis Tsang, Registered Dietitian, Carefirst Family Health Team
    • Anna Gibson-Olajos, Executive Director, Powassan & Area Family Health Team
    • Amy Choy, Registered Nurse, Carefirst Family Health Team
    • Meghan Peters, Quality Improvement Decision Support Specialist, City of Lakes Family Health Team

    Authors & Contributors

    • Myrtle Robichaud
    • Anuradha Srinivasan
    • Jennifer Mulligan, Administration, Powassan & Area FHT
    • Kerri Smith, Clinical Assistant, Powassan & Area FHT

  • Survey: How Primary Care Practice Attributes Can Support Performance

    Dear AFHTO member Executive Directors, Lead Clinicians and Board Chairs,

    We encourage you to participate in an important study to better understand what aspects of primary care practices in Ontario are associated with better quality of care. The information gained from this study may inform future investments in primary care, and will definitely inform AFHTO’s advocacy work.

    This study is led by the Bruyère Research Institute and supported by INSPIRE-PHC, a Primary Care Research Program funded by the Health System Research Fund of the Ontario Ministry of Health and Long Term Care are conducting a survey of primary health care practice organizations.

    Each team is asked to complete the survey once for each practice site. Please pass this survey along to the most appropriate contact for each site to fill in the survey.

    See the email and information sheets below for more information about the survey.

    _______________________________________________________________________________________________

    Dear colleague,

    We would like to invite you to complete an online survey about your practice.

    Ontario practices vary not only in their remuneration and team structure, but also in other important organizational attributes such as technical resources, approach to care delivery, tools used to support care delivery, and services offered. Studying this variation can help us understand what structures contribute to better care, in what context and for which group of patients.

    The survey takes approximately 45-60 minutes to complete and can be completed by any member of the organization; although a Senior Clinical Staff member, Executive Director or Practice Manager is likely best-suited to answer the questions. A gift card is offered as a token of appreciation for your valuable contribution.  The survey will be available in English only as it has not been validated in French.

    The study information sheet is attached. The information sheet and online survey can also be accessed by clicking here: Primary Care Practice Organizational Survey.

    Relevant Links:

  • F7-b Outcome Measures for “Super Nova” COPD Program

    Theme 7. Clinical innovations to address equity

     

    Presentation Details

    • Date: 10/18/2016
    • Concurrent Session F
    • Time: 11:45am – 12:30pm
    • Room: Pier 2 & 3
    • Style: Presentation (information provided to audience, with opportunity for audience to ask question)
    • Focus: Balance between both (e.g. Presentation of a best-practice guideline that combines research evidence, policy issues and practical steps for implementation)
    • Target Audience: Leadership (ED, clinical lead, board chair, board member, etc.), Clinical providers, Representatives of stakeholder/partner organizations

    Learning Objectives

    Participants will identify and learn about the implementation of a tablet based program, how the FHT spread the initiative to identification of other chronic diseases, and learnings after one year of implementing an initiative that took off drastically.

    Summary/Abstract

    The results have been truly transformative; in just over four months, over 40 percent of patients (~3000) were screened for smoking and their status was updated in the EMR. Of those, 432 current smokers were identified, and the Canadian Lung Health Test (CLHT) was administered to 1300 patients, resulting in over 500 patients identified at risk for COPD. This compared to just 45 CLHTs completed in the previous year. The FHT also experienced a 33 percent increase in smoking cessation program referrals in the four months after launching the program. As an added benefit, patients updated an average of three demographic details in their patient record and email consent was collected from over 30 percent of the total patient population. On average, the screening process took just 4.5 minutes. Instead of spending this time unproductively in the waiting room, the patient was able to actively contribute to their patient visit and patient record. We are currently completing year one evaluation and are very pleased with the results and are looking forward to sharing the results with the AFHTO attendees.

    Presenters

    • Stephanie Kersta, Project Manager, Couchiching Family Health Team
    • TBD, CFHT
    • TBD, CFHT

  • F7-a Reducing Barriers to Primary Care for Older Adults Living in Supportive Housing

    Theme 7. Clinical innovations to address equity

     

    Presentation Details

    • Date: 10/18/2016
    • Concurrent Session F
    • Time: 11:45am – 12:30pm
    • Room: Pier 9
    • Style: Presentation (information provided to audience, with opportunity for audience to ask question)
    • Focus: Practical (e.g. Presentation on how to implement programs and/or practices in the team environment)
    • Target Audience: Clinical providers

    Learning Objectives

    Attendees will develop an understanding of the barriers faced by some older adults with serious mental illness and other chronic conditions. They will learn about the approach developed by John Gibson House (JGH) and Village FHT to improve health outcomes for this very difficult to serve and vulnerable population. Application of technology such as OTN and secure email will be discussed.

    Summary/Abstract

    This holistic and comprehensive approach has resulted in medication adjustments/decreases, new diagnoses and follow up treatments. Homebound patients, who  refused to see a family physician for years now receive in-house services. Daily OTN monitoring enables staff to intervene earlier.   The number of:

    1. ED visits has decreased from 10 visits to 6 visits
    2. Hospitalizations decreased from 29 visits to 14 visits, just over 50%.

    Secure email communication between JGH and VFHT supported rapid response to Flu Outbreak (2014/2015). The coordinated care enabled patients to receive prompt treatment, daily updates were easily facilitated and preventative measures (Tamiflu) were accessible to all patients.

    Presenters

    • Breanne John, John Gibson House, LOFT
    • Diana Noel, Executive Director, Village FHT
    • David Verrilli, Lead Physician, Village FHT

    Authors & Contributors

    • Laura Pye

  • F6 But I’m Only One Person: Supporting the Lead Physician Through an Interdisciplinary “Collaborative Care Group”

    Theme 6. Leadership and governance in a changing environment

     

    Presentation Details

    • Date: 10/18/2016
    • Concurrent Session F
    • Time: 11:45am – 12:30pm
    • Room: Pier 5
    • Style: Presentation (information provided to audience, with opportunity for audience to ask question)
    • Focus: Practical (e.g. Presentation on how to implement programs and/or practices in the team environment)
    • Target Audience: Leadership (ED, clinical lead, board chair, board member, etc.), Clinical providers

    Learning Objectives

    1. Understand the role and benefits of the Markham FHT’s “Collaborative Care Group (CCG)”
    2. Hear practical examples of how the CCG is integrated
    3. Recognize the benefits to the Lead Physician (LP) and Executive Director (ED) in sharing FHT clinical oversight through the CCG
    4. Learn how to implement a similar group at your FHT

    Summary/Abstract

    Approximately 15 program reviews are conducted annually, as well as 9 clinical role reviews on a biennial basis. Sharing the clinical leadership responsibility of the FHT among CCG members ensures the burden of this does not fall to the Lead Physician alone. The LP looks to group members to provide insight and guidance for all FHT clinical processes, while remaining accountable to the organization on deliverables.  The multi-disciplinary membership also ensures that the FHO/IHP group has representation in decision-making, and a venue for 2-way communication.

    Presenters

    • Lisa Ruddy, RN, Clinical Program Manager, Markham FHT
    • Allan Grill, MD, CCFP, MPH, FCFP, CCPE, Lead Physician, Markham FHT, Markham FHT
    • David Marriott, Executive Director, Markham FHT

  • F4 Measuring Quality in Primary Care: Beyond the Body Parts

    Theme 4. Measuring performance to foster improvement in comprehensive care

     

    Presentation Details

    • Date: 10/18/2016
    • Concurrent Session F
    • Time: 11:45am – 12:30pm
    • Room: Pier 7 & 8
    • Style: Panel Discussion (in addition to providing information, panelists interact with one another to explore/debate a topic)
    • Focus: Practical (e.g. Presentation on how to implement programs and/or practices in the team environment)
    • Target Audience: Leadership (ED, clinical lead, board chair, board member, etc.), Clinical providers

    Learning Objectives

    At the end of this session, attendees will be able to:

    • Drill down into the Quality roll-up indicator to make sense of it at the team level
    • Connect the “generalist” approach of primary care to the comprehensive approach to measuring quality with the composite Quality roll-up indicator
    • Continue advocating for comprehensive (vs body-part-focused) measurement of quality in LHIN-sub-region reporting in preparation for launch of Patients First

    Summary/Abstract

    The strength of primary care is  that it specializes in being generalized.  It focuses on the person, and is works from the strength of the relationship with that person to improve and sustain their health as a person.  Primary care providers don’t manage diabetes.  They manage patients with diabetes (and whatever else they came with).  Measurement of quality in primary care needs to be “generalist” as well, and have a comprehensive view, not a body-part-specific focus.  AFHTO’s response to this need is the Quality roll-up indicator.  The down side of a comprehensive measure like this is that it is hard for front line providers to make sense of and take action on.  This presentation outlines how teams can drill down into the composite measure to guide local responses to the their overall quality score as reflected in the composite Quality roll-up indicator.  This presentation also outlines how local teams can use the Quality roll-up indicators to demonstrate the contribution of teams to the quality of primary care in LHINs (and eventually LHIN sub-regions).  It models a way to discuss planning, measurement and reporting in the context of Patients First that leverages this “generalist” mindset to minimize the risk of defaulting to the easier but less meaningful path of body-part-focused measures of quality.

    Presenters

    • Ross Kirkconnell, Executive Director, Guelph FHT
    • Monique Hancock, Executive Director, STAR FHT
    • Carol Mulder, QIDS Provincial Lead, AFHTO

    Authors & Contributors

    • Ross Kirkconnell, Executive Director, Guelph FHT
    • Monique Hancock, Executive Director, STAR FHT
    • Alan Maclean, Lead Physician, Superior FHT
    • Carol Mulder, QIDS Provincial Lead, AFHTO