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  • Data to Decisions eBulletin #56: Patient Priorities Questionnaire – We hear you.

    Some members have found the patient priorities survey long and complex and not something everyone (or ANYONE!) would want to do. All the same, some patients still want to do it. We are pleased that nearly 70 have already completed it. This data will refresh the way the Quality Roll-Up score is calculated so we can learn even more about how AFHTO members deliver high-quality, patient-centered care that is linked to lower healthcare system costs. This matters to patients. That is why they helped create this survey. It is also why they are sharing it with others so they can decide for themselves if they want to help in this important work. They invite you to do the same. To help in that regard, we have summarized and addressed some of the questions coming from members. Get moving on getting your patients moving: Check out the information from last month’s Get Moving! event. It’s full of ideas about how to use physical activity to improve all kinds of outcomes, from mental health to healthy aging in seniors, chronic disease management, and general well-being. Measuring beyond the “body parts:” With D2D, AFHTO members are measuring quality in a way that reflects what matters to patients as well as to providers. LHIN physician leads from across the province have just had a taste of it and now they’ve got an appetite to hear more – from you! Reach out to the primary care and quality physician leads in your region (ask us if you need help identifying them) and keep the conversation going. Check out the “cheat sheet” for talking points. Help all Ontarians receive the best possible care! HQO is looking for health care professionals to join the new Ontario Quality Standards Committee. This is a unique opportunity to share with others what we are learning together about patient-centered measurement. Read more or sign up here. What do you think about QIPs? Speak your mind! AFHTO will be working with HQO to make the QIP process better for next year. Tell us what works and what would make it better: More clarity? More guidance? Format changes? Our voices are stronger together, so even if you’ve already given feedback directly, please share it with us and increase our collective impact. We’re hiring: See our Careers section for more details.

    Help spread the word about D2D – invite others to sign up for the eBulletin.

  • AFHTO 2017 Conference: help available for abstract submission

    Interested in submitting a poster or concurrent session abstract for the AFHTO 2017 Conference but not sure how to proceed? Help is available!

    Over the years, with feedback from our conference working groups and attendees, we’ve learned what makes an abstract stand out from the crowd. Below is a list of resources to help you, including our 2016 “What Attendees Really Want” webinar, which explains exactly how submissions are evaluated and guides you through the submission process. All are welcome. Please pass this along to your peers, colleagues and network including those from other healthcare sectors, non-profits, and the academic and research communities. The deadline to submit abstracts for concurrent sessions and posters is May 8, 2017 at 9:00 am (EST). Helpful links for building your abstract:

    Still not sure if your work is a good fit? Feel free to ask us! Email info@afhto.ca or call 647-234-8605x 200. We’d be happy to help. Reduced registration fee for concurrent session presenters: For each approved concurrent session, up to 2 presenters will each be granted a $50 discount off the conference registration fee. Additional discounts apply for patients presenting at the conference. (Discount doesn’t apply for poster displays.)

    Conference key dates

    • April 6, 2017                          Applications for concurrent session and poster abstracts open
    • May 8, 2017                            Deadline to submit concurrent session and poster abstract
    • Late June 2017                      Conference registration opens
    • October 25 & 26, 2017        AFHTO 2017 Conference

  • SGFP Email, Strategic Plan, Compensation Update, Patients First, Regional Governance & Leadership Workshops and Membership Survey

    The email below was sent to AFHTO member EDs, Lead MDs & NPs and Board Chairs.

    Email from the SGFP

    We realize that the email correspondence sent out on Sunday, April 9th by the OMA Section on General and Family Practice (SGFP) is raising a number of questions and concerns and we are trying to clarify the data sharing issues with the SGFP. We are not aware of any requirements for FHTs to report to LHINs, nor has any data reporting requirements to the Ministry changed. We are, however, working collaboratively with the OMA on a data sharing agreement template which we hope to share with the members soon.

    AFHTO Strategic Plan

    Thank you to everyone that participated in the webinars last week – Setting the course for our new direction: Draft AFHTO Strategic Plan 2017 to 2020. This is an interesting time in health care and as we move from transition to transformation, we want to make sure that AFHTO is well set up with its priorities to support its membership. If you did not participate in the webinars and would like to hear more about what is being proposed, click here to see the video or the slides. We want to also make sure you have a chance to provide feedback so if you have any thoughts as you read through the vision, mission and strategic priorities, please send them to info@afhto.ca by April 21st.

    Compensation Update

    And a huge thank you to everyone that has participated in the Compensation Campaign Phase 2: Getting to the 2012 Rates. As a reminder, AFHTO, along with AOHC and NPAO, continues to call on the Ontario government to support primary health care interprofessional teams by investing an additional $130 million annually to bring our team members to the 2012 recommended wage rates. Our members took up the call to action and as at the end of March 2017, over 900 e-letters, 1800 petition signatures, 45 letters from Boards of Directors, 450 tweets and 14 mentions of the petition in Hansard have been reported. Meetings have also occurred with the Premier’s Office, Minister’s Office, Minister of Finance’s Office, Treasury Board Secretariat, the opposition health critics…not to mention the number of meetings our members have had with their own MPPs! We are eagerly waiting for the Ontario budget announcement (hopefully later this month) to see what impact our campaign has had and to set the path towards Phase 3.  Keep the conversations going with your elected officials to ensure this issue stays top of mind.

    Patients First Update

    Four weeks to the First Planned CCAC to LHIN Transfer – to stay up to date with the Patients First Act and to learn more about when the transfers will be completed in your LHIN, click here.

    There continues to be questions pertaining to the Patients First legislation and FHTs/NPLCs; AFHTO is working with the Ministry and the LHINs to ensure consistent messaging:

    • Base funding for FHTs & NPLCs will continue to flow through the Primary Health Care Branch, Ministry of Health and Long Term Care (MoHLTC).
    • FHT-MoHLTC contracts and NPLC-MoHLTC contracts will also remain with the Ministry.
    • FHTs & NPLCs are now health service providers (HSPs). The Local Health System Integration Act, 2006 now lists FHTs & NPLCs as HSPs. See section 2(2)11. That section is “in force”.
    • However, LHSIA only applies to the agencies who are actually receiving funding from LHINs (there is nothing that a FHT/NPLC has to do under LHSIA if it is not receiving funding from the LHIN).
    • The legislation enables LHINs to fund FHTs & NPLCs directly for certain projects, programs, and/or initiatives – the legislation applies IF AND WHEN the LHIN starts funding FHTs & NPLCs for projects, programs and/or initiatives.
    • IF funding is received directly from the LHIN for projects, programs and/or initiatives, the LHIN and the FHT/NPLC shall enter into a service accountability agreement (section 2.0).
    • If you have not connected with your LHIN, you are highly encouraged to do so to learn more about your LHIN’s process of entering into HSP contracts. Let us know if you have any questions at info@afhto.ca.

    Regional Governance & Leadership Workshops

    AFHTO has conducted Governance & Leadership workshops in 13 of the 14 LHIN regions to support FHT & NPLC leadership in asking the question: “what can we be doing now to prepare for the future state?” Implementing strengthened governance practices, understanding the current primary care landscape and encouraging generative conversations at the board level can help us collectively prepare for the known – and unknown – changes occurring in our primary care system. For a summary of what we heard across the province, click here.

    Membership Survey

    As part of the membership renewal this year, we have asked our members to fill in a membership survey to give AFHTO a better picture of its members. We apologize for the lengthiness of the survey but as we go through health system reform, we are seeing an increase of interest in FHTs & NPLCs and the great work that is being done in primary care.

    To better represent the interests of our members and to advocate on your behalf, it always helps to have data. For example, with those who have filled out the survey already – 100% indicate that they provide home visits, 87% indicate that they are a skills based Board and 85% indicate that AFHTO needs to continue its leadership in measurement through participation in D2D. But we need everyone’s participation so please make it a priority to fill this in over the next few months. If you would rather just share your AOPs (we do not have access to them), please send to info@afhto.ca.

  • Navigating Change Through Strengthened Leadership: Regional Governance Workshops

    Primary Care is in a period of transition, and FHT/NPLC leaders across the province are asking what we can we be doing now to prepare for the future.

    To address this question, AFHTO facilitated Governance & Leadership workshops in 13 of the 14 LHIN regions. These focused on strengthening governance practices, understanding the current primary care landscape, and encouraging generative conversations within boards to help us collectively prepare for change in our primary care system.

    In these sessions, we observed was that there are many primary care leaders who are motivated to help in the transformation of the health system and ensure that it remains grounded in primary care, as is the intent of the Patients First legislation. While there is a tremendous amount of great work occurring across the province, there also remains plenty of opportunity for improvement.

    AFHTO will continue to monitor each LHIN region as Patients First implementation gets underway and share successes and challenges so we can learn from each other and encourage a level of provincial consistency where needed.  The summary below provides key take-aways from the regional workshops and highlights potential areas of focus for FHT/NPLC leadership.

    Strengthening Governance Practices Engage in strategic and generative discussion at the board. Establish a culture of quality and patient safety. Bring the patient voice to the board!
    Engage with other teams and HSPs in LHIN sub-regions. Keep building relationships with the LHIN. Manageable, Meaningful Measurement Workshop Materials

    Strengthening Governance Practices

    Engage in strategic and generative discussion at the board

    • Consider implementing a ‘consent’ agenda – to allow more time for the board to engage in strategic and generative discussion
    • ‘Flip’ your agenda – start each meeting with a generative question to enhance the dialogue, and leave standard items and reports until the end.

    Establish a culture of quality and patient safety

    • Does your team have a culture of quality? Transparency? A just culture?
    • Assess your team culture with tools and surveys from Accreditation Canada or Imagine Canada; incorporate culture questions in staff surveys.
    • Consider having physicians sign off on the QIP to improve collective buy-in and encourage a team culture of quality.
    • Consider implementing monthly “Doing It Better” rounds to review “good catches” (a.k.a. “near misses”). This supports a commitment to transparency and establishing a just culture.

    Bring the patient voice to the board!

    Engage with other teams and HSPs in LHIN sub-regions

    • Consider establishing board-to-board relationships.
    • Adopt a “soft” approach, such as a jointly-held education day on privacy, Medical Assistance in Dying legislation (MAID), or collaborate on your QIPs.
    • Ask your LHIN about opportunities to bring boards together!

    Keep building relationships with the LHIN

    • Get involved to ensure the primary care voice is heard!
    • Encourage physician leaders to apply for the sub-region clinical lead positions.
    • Invite LHIN leaders to attend regional ED meetings. Possible areas of focus may include:
      • Supporting the sub-region clinical leads – finding ways to inform, consult, and collaborate with them to identify and promote a shared agenda.
      • Integrating care coordinators into primary care
      • Opportunities/education/training for clinical Leadership
      • Quality Improvement – leveraging D2D and QIDSS support
      • Capacity Assessment Framework – each LHIN is required to complete this framework – and we need to provide primary care input!

    Manageable, Meaningful Measurement

    • Align your QIP with your strategic plan or D2D
    • Think about participating in D2D if you haven’t already. This is our opportunity to lead primary care performance measurement.
      • Ask your board if they would be willing to remove the anonymity in D2D.
      • Please see (and share!) the handouts linked below for more information about D2D
        • What is D2D, and Why? This primer introduces D2D, summarizes the steps to participate, and gives links to some resources you may find helpful.
        • D2D 4.1 Results: A summary of the results from the last iteration of D2D – highlights on the front page, with more details on the reverse.
        • D2D 4.1: LHIN-Specific Summary: A breakdown of D2D 4.1 performance by LHIN region.
        • Quality/Cost Relationship: More information about the relationship between cost and quality, and about the Quality Roll Up indicator.

    Workshop Materials

       

  • Conversations at the LHIN Table: Key messages to share about measurement in primary care

    LHIN sub-region planning is underway across the province. You may or may not have been invited to participate yet. The good news is you don’t have to wait!  AFHTO has been reaching out to LHINs in various ways to increase their awareness and interest in the great work teams are doing. Now is the perfect time for you to jump in and lead the conversation. Get your team to get together with your sub-region peers and follow-up with your LHIN. This document outlines some key messages and resources to help you with this.

    Measurement

    AFHTO members are already measuring performance, with nearly two-thirds of members voluntarily contributing to D2D, now in its 5th iteration. We have learned a lot about what measures are important to patients and primary care providers, and what it takes to collect and report data for these measures.

    Quality improvement and decision support capacity

    AFHTO-member teams are well-equipped to lead. With our 35 QIDSS and nearly 20 QIDSS-like folks across the province, we’ve got a strong cohort of QI leaders. Through EMR communities of practice that include vendor representatives, our members have also developed strong networks of support for the major EMRs used in primary care.

    LHIN-level and sub-region-level performance

    AFHTO members already have generated LHIN-level performance data.  Some members have taken the additional, proactive step of compiling their D2D data to generate sub-region performance reports. If your peers are interested in this, AFHTO staff can help you assemble these data so you don’t have to do it manually. In the next iteration, teams will have the option to identify their sub-regions so they can generate these summaries on their own, as they do for other peer-group summaries in D2D.

    Definition of Quality

    AFHTO members track quality in a way that reflects what matters to patients and providers. The D2D composite quality indicator describes quality in a more holistic way than is possible with individual “body part” measures such as blood sugar levels or cancer screening.

    Higher quality means lower cost

    AFHTO members have demonstrated that higher quality care is related to lower healthcare system cost, exactly as Barbara Starfield, pre-eminent primary care researcher, predicted based on her observations of the same phenomenon in international health system comparisons.

    Sub-region partnerships

    AFHTO members are already working in and learning from their experiences of partnerships, some of which mimic the sub-region areas. QIDSS partnerships are one example. Another example is Health Links – all of them include FHTs and/or NPLCs, and 22 of them (over 25%!) are led by AFHTO member teams.

    Governance and leadership

    AFHTO is committed to developing leaders and amplifying their voice. Through regional networks, peer mentorship, and sharing of locally-developed resources, our Executive Directors, clinical leads, and board directors are collectively strengthening their knowledge and skills and equipping themselves to be leaders in the field. We’re building on this foundation by providing tools and training to support best practices in governance and operations.

  • Mental health coaches, first of their kind in Canada, available to help rural & remote areas| Toronto Star

    Toronto Star article published April 7, 2017. Article in full pasted below.

    Isabel Teotonio, Toronto Star

    Each day, Antonio was slipping deeper into depression. His parents were ill, he feared being laid off from work and he was unhappy in his relationship, which he had moved to Toronto for. But when he started thinking about suicide — and at one point two years ago came “really, really close” to taking his own life — he knew he needed help. “I felt jailed, trapped,” says Antonio, who asked that his last name not be published. “I was in a very dark place.” He confided in his family doctor, who suggested he participate in the Partners Project run out of the Centre for Addiction and Mental Health (CAMH). It’s a three-year study looking at the effectiveness of a mental-health coach — the first role of its kind in Canada — who calls patients with depression, anxiety and at-risk drinking, the most common mental-health problems in primary care. Adam Whisler, one of the mental-health coaches, says patient response has been largely positive.
    “It’s been really awesome to talk to people who would otherwise be completely isolated or who are very nervous to go and speak with someone in person (about mental health),” he says. “By talking to them over the phone, it can help them drop their guard a bit and feel more comfortable.” The Partners Project, which started two years ago, is meant to bridge primary-care providers and the larger mental-heath services community. The way it works is a family physician, or nurse practitioner, refers a patient to the project. A treatment plan is designed by a psychiatrist, who supervises three specially trained mental-health coaches.
     
    It’s the coaches who regularly call the patients, usually weekly for about 20 to 30 minutes, to check in and provide support. The coaches then share the information from those calls with the overseeing psychiatrist, whose treatment suggestions may include medication, different dosages, blood work and referrals for formal therapy. Those recommendations are then given to the patient’s doctor so he or she can implement them. The program is meant to assist family doctors, who don’t always have the resources when dealing with mental health and addictions issues, and may have limited time for followup and support. It can also prove crucial for those in rural and remote areas, where there are limited mental-heath services. In Ontario, 1.3 million people suffer from co-existing physical and mental-health illness, and many aren’t getting the treatment they need because the health-care system isn’t designed to focus on both at the same time. That’s according to the Medical Psychiatry Alliance (MPA), which is supporting the study that’s being funded by Bell Let’s Talk. At first, Antonio was reluctant to participate because he didn’t want to share personal details on the phone with someone he had never met. But he couldn’t afford a therapist and was desperate. So he gave it a try. “After a few months, I was feeling better and doing better,” he says, noting the mental-health coach helped him set goals, monitored his symptoms and asked how he was responding to his anti-depressants. “There was continuous feedback between (the Partners team), my family doctor and me. And that was very important. I felt like I was taken care of.” This kind of integrated care was adopted from similar models in the United States and could become a widespread practice in Ontario. Those overseeing the project say results so far are encouraging. “Our hope is that this model can assist us in meeting the health-care gaps and increasing access for mental-health services for patients in the primary care context,” says Athina Perivolaris, a senior project manager for the MPA.
    “If we are able to do that, our hope then would be that we can take this model and have it widely adopted throughout the province.” The MPA was established in 2014 with funding from the province, an anonymous donor and four partners (CAMH, the Hospital for Sick Children, University of Toronto and Trillium Health Partners). It’s tasked with improving access to better-integrated mental and physical health care in Ontario. About 150 family doctors, mostly from the GTA, are working with the Partners Project, but researchers are trying to recruit more physicians in rural and remote areas. As part of the study, patients are placed in one of two groups: one that keeps getting usual care and another that receives usual care, plus the extra phone support from a mental-health coach. In some cases, the study’s researchers identified serious problems with patients, such as PTSD, drug use, mania and psychosis, which had been missed by family doctors. “Even when physicians detect some distress, they do not necessarily have the time to find out what the problem is,” says Perivolaris. Dr. Charles King of Village Family Health Team in Toronto welcomes the extra support and has referred about 35 patients to the project. “The idea is that you want to actively manage depression, anxiety and at-risk drinking. Typically a lot of people fall through the cracks with those problems.” Whisler has a bachelor’s degree in psychology and sociology, is a former youth worker and does mental-health research at CAMH. In order to participate in this project, he and the other coaches received special training that includes symptom-monitoring and how to speak with patients so they better understand their symptoms. For those with mild to moderate symptoms of depression and anxiety, regular chats with a mental-health coach may be sufficient, says Whisler. Coaches can help them with life skills and goals so their situation doesn’t worsen and require formal therapy. “From a system-level perspective, that makes a massive difference in reducing wait times for psychiatrists and psychologists and also reducing the cost to the overall health system.” For Antonio, regular phone sessions with a mental-health coach — a “comforting and reassuring” voice — made all the difference. “I’d probably be gone had I continued on that destructive path.” He’s now putting many of the skills he learned during their discussions to good use. For instance, he recently broke up with his partner — something he says would’ve pushed him over the edge a couple of years ago — but he’s managing. “I’m not exactly 100-per-cent OK . . . but I’m not where I was.” Click here to access the Toronto Star article. 

  • Let’s hear it from the patients – appelons les patients! Introducing AFHTO’s second patient priorities survey

    La version française suit l’anglaise.

    AFHTO is undertaking a second patient priorities survey to refine our definition of quality according to what matters to patients. It measures what’s important to them in their relationship with their doctor or nurse practitioner, and results will be used to inform D2D.

    The message below is being sent to patients across Canada:

    Hello!

     We want to hear from you.

     The Association of Family Health Teams of Ontario (AFHTO) wants to dig deeper into what matters most to patients when they think about their family doctor, nurse practitioner or primary heathcare team. What we learned from the first survey helped us find a better way to measure quality in primary care. It was such a success that we’ve decided to do it again. For the past few months we have been working with patient partners to develop and refine a second survey.

     By completing and sharing this survey you can highlight what matters most to patients. It will take about 20 minutes and participation is anonymous. We encourage you to participate and make your experience count!

     Participate in the survey

    We encourage you to complete the survey yourself, as a patient, and share it with your patients and peers.

    Thank you for your help.

     

    L’AFHTO entreprend un deuxième sondage sur les priorités des patients afin de peaufiner notre définition de la qualité selon ce qui importe aux patients. Il mesure ce qui est important pour eux dans leurs relations avec leur médecin ou leur infirmière praticienne spécialisée, et les résultats obtenus seront utilisés pour informer le processus de données à décisions.

    Le message ci-dessous est envoyé aux patients du Canada :

    Bonjour !

     Nous souhaitons connaître votre opinion.

     L’Association of Family Health Teams of Ontario (AFHTO) souhaite en savoir plus sur ce qui importe le plus aux patients lorsqu’ils pensent à leur médecin de famille, à leur infirmière praticienne spécialisée ou à leur équipe de soins de santé primaires. Les connaissances que nous avons tirées du premier sondage nous ont aidés à trouver une meilleure façon de mesurer la qualité des soins primaires. Cette initiative a connu tant de succès que nous avons décidé de renouveler l’expérience. Au cours des derniers mois, nous avons travaillé avec les partenaires des patients pour développer et peaufiner un deuxième sondage.

    En remplissant et en communiquant ce sondage, vous pouvez mettre en relief ce qui importe le plus aux patients. Il faut compter environ 20 minutes pour répondre au sondage et la participation est anonyme. Nous vous invitons donc à participer et à faire en sorte que votre expérience compte!

    Participez au sondage

    Nous vous invitons à répondre vous-même au sondage, en tant que patient, et à le communiquer à vos patients et vos pairs.

    Nous vous remercions de votre aide.

  • Management of Chronic Non-Cancer Pain Tool

    One in five adults report chronic pain (pain experienced every day for 3 or more months). The Management of Chronic Non-Cancer Pain Tool is designed to help primary care providers manage adult patients with chronic non-cancer pain (CNCP). This tool was developed under the clinical leadership of Dr. Arun Radhakrishnan, and has been designed for day-to-day use in a typical office visit. It has been designed to guide primary care providers in developing and implementing a management plan for adult patients with chronic non-cancer pain in the primary care setting. Divided into five sections, the tool highlights the following:

    • Baseline and Ongoing Assessment
    • Non-Pharmacological Therapy
    • Non-Opioid Medications
    • Opioid Medications
    • Intervention Management and Referral

    The Knowledge Translation in Primary Care Initiative is aimed at developing and disseminating health information and clinical tools to support primary care providers.  Its purpose is to improve engagement and enhance communication with primary care providers across Ontario and is a collaboration of the Ontario College of Family Physicians (OCFP) and the Nurse Practitioners’ Association of Ontario (NPAO) and the Centre for Effective Practice (CEP). Relevant Links:

  • Implementing Choosing Wisely Canada Recommendations in Ontario to Improve Quality of Care: HQO Report

    Ontario clinicians deliver quality care by reducing unnecessary care: new report When it comes to medical tests and procedures, less can sometimes be better. According to a new report released this week, Ontario health care providers are successfully working to provide and improve quality care by reducing unnecessary care to patients across Ontario. Released by Health Quality Ontario and Choosing Wisely Canada, the report, Spotlight on Leaders of Change: Implementing Choosing Wisely Canada Recommendations in Ontario to Improve Quality of Care, includes examples of successful programs implemented by clinical leaders to address unnecessary care in hospitals, primary and long-term care settings, including AFHTO member North York FHT. There is growing recognition that unnecessary care is common in health systems around the world, including Canada. The American-based Institute of Medicine estimates that up to 30% of medical care may be classified as unnecessary, at times introducing preventable risks associated with that care. Unnecessary care is defined as care in which there is a lack of benefit or in which benefits are outweighed by the potential risks, including patient inconvenience, increased cost to the health care system, and even potential harm to patients. Choosing Wisely Canada launched a national, clinician-led campaign in 2014 to help patients and clinicians talk more openly about tests, treatments and procedures so that they, and their families, can make informed choices about the care they receive. Over the last two years, Ontario researchers have worked with Health Quality Ontario and Choosing Wisely Canada to measure how common unnecessary care is in Ontario. This work has shown, for example, that 30% of Ontarians received potentially unnecessary cardiac tests and blood work before low risk, non-cardiac surgery. And, according to the report, unnecessary tests are not confined to hospitals. The report also notes that in primary care, 21% of Ontarians had bone mineral density testing not covered by practice guidelines. Reducing unnecessary care also saves money. Savings from ordering tests and procedures only when they are needed can be redirected to other needed patient care. Many clinicians in Ontario have contributed to the national effort to develop the Choosing Wisely Canada recommendations. Efforts in Ontario will now focus on how recommendations can be adopted. To learn more about the Choosing Wisely Canada recommendations being implemented by Ontario’s clinical community, read the full report.

  • Setting the Course For Our New Strategic Priorities – Inviting Input from our Members!

    AFHTO is undergoing an important strategic planning process and we thank everyone who has filled in our survey or participated in our focus groups earlier this year. We’ve heard some great feedback about where AFHTO should be focusing its strategic priorities in the next three years but we want to make sure that the priorities resonate with our membership. Please register to join us for a webinar on Tuesday, April 4th from 4:00 p.m. to 5:00 p.m. or Friday, April 7th from 12:00 p.m. to 1:00 p.m. to learn more about where we’ll be focusing our attention in the next three years and provide feedback on those priorities and our strategic directions. We thank you in advance for your ongoing support of AFHTO and we look forward to collectively working with our members in ensuring we are improving primary care together. Relevant Materials: