Ultimate Blogging Championship

Author: sitesuper

  • Patients First Act: Opportunity to strengthen primary care

    Government has taken a key step to move forward with its proposal for health care – the Patients First Act has been tabled in the legislature today. This legislation brings together all of the key health system players at a local level to focus on the unique health needs of people in communities across the province. Local Health Integration Networks (LHINs), working with primary care, home and community care, public health and hospitals, will be better able to strengthen communication within the “circle of care” for patients. They’ll also be better positioned to distribute resources and monitor health system performance to ensure people get the appropriate care and support they need where and when they need it. AFHTO sees the potential enabled by this legislation. It creates the opportunity for much closer ties between primary care, home care and community services – a serious gap highlighted in a recent report from Health Quality Ontario. To really work, Patients First will have to go further to expand comprehensive team-based primary care. Evidence is increasingly showing that these primary care teams can provide the highest quality of care and reduce overall health system costs. Yet only 25% of Ontarians have access to these enhanced teams. This is not fair nor is it equitable. There is much work ahead to ensure implementation achieves optimal outcomes for Ontarians – patients, the underserved, and health providers. This work will also reinforce the need – and potentially reveal mechanisms – for investment to expand team-based primary care. For more information:

  • Government tables Patients First Act in legislature

    Government has taken a key step to move forward with its proposal for health care – the Patients First Act has been tabled in the legislature today.

    If passed into legislation, the Act would:

    • Add FHTs, NPLCs and AHACs (excluding physician component) to the list of health service providers (HSPs) that LHINs are allowed to fund and have accountability relationships
    • Require LHINs to establish sub-regions
    • Wind down CCACs
    • Give Ministry authority to set standards for LHINs and HSPs, and to issue directives, investigate or supervise LHINs
    • Give LHINs authority to issue directives, investigate or supervise HSPs (with some limitations for hospitals and long-term care)

    There is more:

    Implementation details

    AFHTO participated in briefings with the Minister’s Office and with the Deputy Minister and other senior staff. Here’s what we understand so far:

    Timing

    Expect LHINs to get going right away to establish subLHINs and build relationship with primary care. They don’t need legislative change to move ahead with this.

    Legislative process is anticipated to be completed in late fall, aiming for structural items to be in place by April 1, 2017. It will take 3-5 years for implementation.

    FHT/NPLC/AHAC funding and accountability

    The legislation enables LHIN funding – which will make it much easier for primary care teams to receive Health Link funding directly, and likewise for other local LHIN-funded initiatives.

    AFHTO has emphasized that, before LHINs are allowed to take any greater role in funding and accountability of primary care, the Ministry must assess and ensure each LHIN’s capacity to understand and fulfill their role. AFHTO has compared this to the “readiness assessment process” each FHT has been required to complete successfully in order to be given greater authority over their budgets. Ministry understands this need.

    Ministry will be working with AFHTO (and other stakeholders where appropriate) to put in place new FHT contract templates by April 1, 2017. These contracts will be with the Ministry; the legislation would allow the Ministry to transfer the contracts to LHINs at some future point in time.

    No change to board governance

    Health care organizations remain intact. An expanded LHIN board (3 extra people) will govern; no new governance layer is to be added for subLHINs. LHIN staff would be assigned to convene providers in each subLHIN. Expect subLHINs to have populations sizes ranging from under 50k to close to 500K, with most being between 100k – 200k.

    Physicians/clinicians

    Physician funding and contract negotiations remain with Ministry. Legislation would give LHINs ability to act on behalf of the Minister to monitor and manage (but not negotiate) contracts with physicians. It would also require LHIN planning to include physician resources, and to this end, require physicians to notify LHINs of upcoming practice changes.

    The Act would also set up an “Integrated Clinical Council” under Health Quality Ontario to develop standards. AFHTO has cautioned about the limitations of a “disease and body part approach”, stating that standards set for primary care will need to be relevant to “whole people”.

    Care coordination in primary care

    The legislation would allow the Ministry to begin the transfer of CCAC employees and assets to LHINs, and once completed, dissolve the CCACs. AFHTO, together with OPCC colleagues, continues to press the need for care coordinators to be embedded in primary care. We believe we will see a gradual change in their placement over time.

    As seen in yesterday’s report on care coordination from Health Quality Ontario, primary care providers in Ontario face the biggest challenges compared to other provinces and countries. AFHTO has just released a new case study – Effectively Embedding Care Coordinators within Primary Care – to help AFHTO members learn from colleagues who have already embedded CCAC care coordinators in their operations.

    Investment in primary care

    Team-based primary care is already making a HUGE contribution in moving toward the vision expressed in Patients First. AFHTO is continually pressing this case – our membership’s vision is that all Ontarians will have access to high-quality, comprehensive, interprofessional primary care.  We think the reforms introduced in the Patients First Act bring much greater attention to the role and importance of primary care, and with that, the potential for greater investment.

    Public health connection

    The legislation is a starting point that sets the expectation for LHINs and boards of health to do joint health services planning.  An expert panel on public health will be established to explore deeper partnerships between LHINs and Boards of Health.

    Indigenous health

    The Patients First discussion document acknowledged the need to identify changes to ensure health services address the unique needs of First Nations, Inuit and Métis peoples. While there is no change presented in the current legislation, government has announced a First Nations Health Action Plan. AFHTO’s Aboriginal and Inuit FHTs have been invited to join with AOHC’s AHACs and Aboriginal CHCs to examine options towards improving health for Indigenous peoples.

    AFHTO position on the Patients First Act

    We see the potential enabled by this legislation, and we see the work ahead to ensure implementation achieves optimal outcomes for Ontarians – patients, the underserved, and health providers. It also reinforces the need – and creates possible mechanisms – for investment to expand team-based primary care.

  • Data to Decisions eBulletin #35: Member input refines next D2D

    Member input on next D2D: Based on the HUGE turnout in the recent survey (more than 240 people from at least 75 teams), D2D 4.0 will feature one new indicator, expansion of two previous indicators, and 14 indicators which remain the same from previous versions. Click for details on follow-up after hospitalization and diabetes management indicators, and other updates for D2D 4.0. Watch for these in the D2D Data Dictionary coming out soon. Cheat sheet for tracking phone encounters: This tool has been created to help EDs  support their teams’ efforts to track phone encounters with patients. Not only does this provide better insight into the whole team’s contribution to care, it’s a crucial component to being able to report on “follow-up after hospitalization” in a way that better reflects how teams are doing this. Add your patients’ voice to the clinical trial of a patient-reported outcomes tool. Patient-reported outcomes are increasingly recognized as a major indicator of quality in health care. An Electronic Patient Reported Outcomes (ePRO) Tool is being developed and the research team is looking for you and your patients’ input in a pilot study. Join a webinar on June 2nd, at noon or contact improve@afhto.ca for more information. Team Level Primary Care Practice Report sent to EDs May 31: The new report contains refreshed data to May 2015. If you haven’t signed up for your team-level report, register by June 30th 2016, to get your data in time for D2D 4.0. Health Quality Ontario (HQO) wants to hear from you:

  • Case Study: Embedding Care Coordinators in your team

    AFHTO, in partnership with the Osborne Group, has prepared a case study for AFHTO members which looks at how five Family Health Teams (Mount Forest FHT, Sunnybrook Academic FHT, City of Lakes FHT, Guelph FHT,* and South East Toronto FHT) have effectively embedded the Care Coordinator role within primary care. Their advice to other primary care teams, and the lessons they have learned in the process, include the following:

    • Having a care coordinator as part of the team has a significant impact on quality and effectiveness of care.
    • Pay attention to the principles of change management as new models of service delivery are rolled out. Change may be difficult, and it may take some time to build relationships and trust.
    • With increased system coordination and collaboration there is a learning curve; it may take time but effective relationships are important to success.
    • Learn from other FHTs and primary care teams about their approaches so that you can build on their experience to build a collaborative model that fits the profile of your team and leverages your strengths.
    • Define the role broadly giving the Care Coordinator access to a broad array of providers and services.
    • Have a home base for the Care Coordinator at your site, or dedicated on-site time when inter-professional providers can see and talk to them. This improves efficiency and builds a sense of collaboration and teamwork.
    • Enable access to your EMR for the Care Coordinator.
    • A quality improvement perspective will contribute to a broad understanding of the role.

    *Please note: The case study on Guelph FHT, which was completed in 2016, no longer reflects the current state of care coordination in the Waterloo Wellington LHIN region. The LHIN has opted for a different approach and is not embedding care coordination in primary care. AFHTO asserts the role of primary care providers to lead care coordination. Primary care providers work to ensure access to interprofessional care for patients and identify a single point of contact to help patients and families navigate and access programs and services. The Ministry’s Patients First proposal speaks to deploying care coordinators in primary care. A number of teams have already done this and their experience can help other primary care teams as well.

    Learning from your peers: additional case studies

    AFHO has developed a series of case studies for our members to share the experience of colleagues on topics identified as being important to you:

     

  • Care coordination in primary care: new HQO report and AFHTO case study

    “Coordinating patient care is a fundamental role of primary care, which is the foundation of Ontario’s complex health system… However, patients do not always move through the system as smoothly as they could.”

    Health Quality Ontario’s (HQO) new report Connecting the Dots for Patients: Family Doctors’ Views on Coordinating Patient Care in Ontario’s Health System, released today, shows that family doctors are experiencing systemic barriers when coordinating care for their patients. The report highlights some of the experiences of family doctors including Dr. Thuy-Nga Pham, South East Toronto FHT (on pg. 13); Dr. Harry O’Halloran, Georgian Bay FHT (on pg. 28); and the CMHA Durham NPLC (p.15) in strengthening care coordination within their communities.

    This report adds to the growing body of evidence to support AFHTO and the Ontario Primary Care Council’s (OPCC) position statement on the role of primary care providers to lead care coordination. Care coordination in primary care has the potential to significantly:

    • Reduce the duplication and role conflict that currently exists in our health system;
    • Improve patient outcomes through much greater continuity and coordination of person-centred care.

    Click to read AFHTO’s position statement: Transitioning care coordination resources to primary care.

    Primary care providers work to ensure access to interprofessional care for patients and identify a single point of contact to help patients and families navigate and access programs and services. The Ministry’s Patients First proposal speaks to deploying care coordinators in primary care. A number of teams have already done this and their experience can help other primary care teams as well.

    NEW Case Study “Effectively Embedding Care Coordinators within Primary Care”* for AFHTO Members explores teams that currently have CCAC care coordinators embedded within their teams and the success factors and principles for establishing effective working relations. The case study explores lessons learned along the way and their advice to other teams. *Please note: The case study on Guelph FHT, which was completed in 2016, no longer reflects the current state of care coordination in the Waterloo Wellington LHIN region. The LHIN has opted for a different approach and is not embedding care coordination in primary care.

  • Primary care must lead care coordination

    We assert the role of primary care providers to lead care coordination.

    The Association of Family Health Teams of Ontario (AFHTO) endorses and embraces this position statement adopted with our colleagues in the Ontario Primary Care Council in November 2015.  Primary care providers work to ensure access to interprofessional care for patients and identify a single point of contact to help patients and families navigate and access programs and services. Furthermore, AFHTO implores the Ministry of Health and Long-Term Care to work with primary care teams and LHINs to bring greater efficiency and patient-centredness to care delivery, through steps to transition care coordination resources to primary care teams from community care access centres (CCACs). Primary care is an anchor for patients and families, providing comprehensive care throughout their lives. Primary care providers are the first contact or entry into the system for all new needs and problems, and they directly influence the responses of people to their health needs by listening to their concerns and preferences and providing clinical evidence-based assessment and treatment recommendations. Care coordination in primary care has the potential to significantly:

    • Reduce the duplication and role conflict that currently exists in our health system;
    • Improve patient outcomes through much greater continuity and coordination of person-centred care.

    Click to read AFHTO’s position statement: Transitioning care coordination resources to primary care. Primary care teams want to coordinate care for their patients – this was clearly demonstrated by the 200+ leaders who participated in AFHTO’s October 2015 session on Leading Primary Care through the Next Stage. Through their work in Health Links, many primary care teams have demonstrated readiness to take on this role, and their success when they can mobilize the resources to fulfill this role. The transition of care coordination resources from CCACs to primary care teams is the logical next step.

    Resources for AFHTO members:

    Evidence and background on care coordination in Ontario:

  • Interested in serving on the AFHTO Board of Directors? Apply by July 5, 2016

    Dear AFHTO members: Primary care is evolving in our province; government’s Patients First proposal is pointing to significant change. It is a VERY interesting time to be serving on the AFHTO board of directors! To maintain balanced representation on the board, priority consideration will be given to candidates who are:

    • Physicians (Executive Directors and Interprofessional Health Providers are also welcome to apply)
    • From AFHTO members located in the eastern and northern regions of Ontario

    Four positions are to be elected for a 3-year term on the 14-member AFHTO board. The AFHTO by-laws call for balanced representation on the board to include the various forms of governance, the regions of the province, and the mix of the professions working within FHTs, NPLCs and other interprofessional models of primary care. The Governance Committee of AFHTO’s board invites anyone who works within an AFHTO member organization to apply by July 5th. Please share this call for nominations with all who work in your team. To apply:

    The Governance Committee of the AFHTO board will review all applications to assist the AFHTO board to determine the slate of candidates to recommend to the AFHTO membership for election at the AFHTO annual general meeting.

    • Nominees will be informed of their status by September 21.
    • Nominees who are not recommended for the slate will have until September 26 to determine whether they wish to proceed with having their name go forward on the election ballot.
    • The election will take place at the Annual General Meeting in conjunction with the AFHTO annual conference.  This year it will be held:

    Monday, October 17, 2016 8:30 AM – 9:30 AM The Westin Harbour Castle 1 Harbour Square Toronto, Ontario M5J 1A6

    Sincerely, Veronica Asgary-Eden Chair, Governance Committee AFHTO Board of Directors Clinical Psychologist, Family First Family Health Team

  • Governance For Quality Training

    The presentation slide decks for the Effective Governance for Quality in Primary Care Workshops, updated for 2016, are now available. To access them, see the links below (note: the workshop has 8 modules, each with a separate slide deck).

    What is Effective Governance for Quality in Primary Care?

    Effective Governance for Quality in Primary Care  is an evidence-based training program for FHT and NPLC Boards of Directors, Executive Directors and Medical Leads, . developed in partnership with the Canadian Patient Safety Institute (CPSI) and is delivered by peer leaders. To support the quality agenda in primary care, the Ministry of Health and Long Term Care (MOHLTC) partnered with CPSI, the Association of Family Health Teams of Ontario (AFHTO), the Association of Ontario Health Centres (AOHC), and the Nurse Practitioners Association of Ontario (NPAO) to customize CPSI’s Effective Governance for Quality and Patient Safety to Ontario’s primary care organizations. Effective Governance for Quality in Primary Care materials are updated regularly. Workshops are occasionally offered in Toronto and at various places around the province. Each workshop contains information to help Board members, Executive Directors and Medical Leads guide their organization in delivering quality primary care through good governance. Presentations from the session guide participants through exercises, case studies and best practices on how to lead, govern and improve organizations focused on quality. Please contact us to learn more.

    Workshop Slides:

     

    Workshop Handouts:

     

  • YOUR vote is in! Updates for the Data Dictionary for D2D 4.0

    Thank you to the more than 240 members from at least 75 teams who turned out for the survey about changes for D2D 4.0.

    As you overwhelmingly requested, most of the indicators ARE NOT CHANGING.

    See table below for the list of what is the same and what is new and improved!

    Data Source Indicator Status
    EMR Follow-up after hospitalization New
    EMR Diabetes Management Indicator Expanded (see below)
    EMR EMR Data Quality Expanded (see below)
    Patient Experience Survey Patient involved in decisions No change
    Patient Experience Survey Courtesy of office staff No change
    Patient Experience Survey Reasonable wait for appt. No change
    Patient Experience Survey Same/next day appointment No change
    HQO PCPR Cost No change
    HQO PCPR Patients rostered No change
    HQO PCPR SAMI No change
    HQO PCPR Readmissions to hospital No change
    HQO PCPR Regular primary care provider – individual No change
    HQO PCPR Regular primary care provider – team No change
    HQO PCPR Colorectal Cancer screening No change
    HQO PCPR Cervical Cancer screening No change
    EMR Childhood immunizations – all No change
    EMR Patients Served No change

    New and improved! Changes coming for D2D 4.0 are as follows:

    • Follow-up after hospitalization: a new indicator tracking follow up will be included: %  of patients for whom timely (within 48 hours) discharge notification was received (any condition) and had a follow up (by any mode, any clinician) within 7 days of discharge.
    • Diabetes management indicator: the current set of diabetes management measures (frequency and results of hba1c testing, blood pressure levels) is being expanded to include an indicator of cholesterol management: % of people with diabetes with a recent cholesterol (LDL) level of ≥ 2.0 mmol/L who are on statins.
    • EMR Data Quality: The current set of data quality measures (i.e. match between EMR and CCO rates for cervical and colorectal cancer and completeness of smoking status info) is being expanded to include a measure of clinical data consistency: % of patients with diabetes who have a diagnostic code for diabetes in the appropriate place in their record.
    • Time spent delivering primary care: More discussion is underway to improve data quality and relevance of this information for D2D 4.0. Stay tuned for more information.

    Further details for these and other indicators will be available in the D2D 4.0 Data Dictionary coming out at the end of June 2016.  The dictionary will be pre-released to QIDS Specialists for comment earlier in June for one last chance to include their advice for the final version.

    Reminder: Indicators based on administrative data will be available to all teams who have enrolled to receive the team level HQO Primary Care Practice Report (PCPR) at the end of May 2016.  This report will contain data current to March 2015. We suggest teams begin the review of their PCPR data and the data dictionary before summer to prepare for D2D 4.0, which will be released in late September 2016.

    If you have any questions regarding D2D or the Data Dictionary contact your local QIDS Specialist or the QIDS Program staff via Carol Mulder.

     

  • HQO Requesting Feedback on Quality Standards

    Health Quality Ontario would like your input on Quality Standards for Ontario. These are concise set of easy-to-understand statements outlining the best care possible for patients with selected conditions (see below for more details).

    As part of the HQO’s provincial Primary Care Quality Advisory committee, AFHTO has already sent feedback on the general question of Quality Standards in primary care.  One of AFHTO’s key messages is that primary care patients tend not to be “condition-specific.”  They frequently have multiple complex issues.  Quality Standards for primary care would ideally consider the complexity of questions associated with managing multiple morbidities and focus on building relationships with patients, in addition to helping manage individual body parts.

    HQO is looking for feedback from individuals as well as organizations on draft Quality Standards on schizophrenia, major depression and on the behavioural symptoms of people living with dementia. You can review these Quality Standards and send comments directly to HQO. Some questions you might want to consider are:

    • How helpful would these Quality Standards be in trying to manage YOUR patients?
    • How would information about your performance on these Quality Standards help you make sense of other data you are already tracking regarding your performance?
    • In general, how would Quality Standards help you focus your efforts to improve?