Ultimate Blogging Championship

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  • D2D 3.0 Launch – Orientation Webinar

    D2D 3.0 Orientation Webinars were held on February 1, 2016

    AFHTO is pleased to announce the launch of D2D 3.0. Thank you to all teams who contributed to the report and are helping to advance manageable, meaningful, measurement in primary care. The purpose of these webinars is to familiarize members with the interactive display of the D2D 3.0 report, including how to access the report, reviewing your team’s data, comparing to different peer groups and key messages emerging from the data. Click here to see the D2D 3.0 interactive report.  

  • Bariatric Surgery #3: Advanced Bariatric Nutrition

    This is the third of a 3-part free webinar series presented in an unique collaboration between the Association of Family Health Teams (AFHTO) + Diabetes, Obesity and Cardiology (DOC) Network + FHT RD Network of Ontario + PHCAG. Jennifer Brown-Vowles, MSc, RD, of The Ottawa Hospital Weight Management Clinic and Bariatric Surgery Program will continue the webinar series with a focus on Advanced Bariatric Nutrition.

    Click here for the webinar slide deck. 

     

  • D2D 3.0: Progress in meaningful measurement for primary care

    Today’s release of Data to Decisions (D2D) 3.0 demonstrates significant progress by family health teams and nurse practitioner-led clinics to advance manageable and meaningful measurement for improved patient care.

    AFHTO members are guided by the Starfield Principles – focusing on the relationship with patients and the primary care team’s ability to deliver the care patients value. Its objective is to optimize quality, access and total health system cost of care for patients. D2D uses indicators from Health Quality Ontario’s Primary Care Performance Measurement Framework, with some modifications guided by input from front line providers.

    AFHTO members have made progress in:

    • Capturing EMR data to measure outcomes: The composite measure of diabetes is the first time a clinical outcome indicator based on EMR data has moved out of academic research into a performance report. It reflects how the entire interprofessional team contributes to care, and not just physician activity based on billing data. This data capture was made possible through standardized queries across multiple EMR platforms, developed by members but now available to any user of these EMRs within or beyond AFHTO.
    • Using EMR data to measure best practice rather than incentive payment: For the first time, percent of eligible children immunized is measured according to Public Health Agency of Canada (PHAC) guidelines. The results illustrate a difference in definition from that used for physician billing incentives related to Rotavirus immunization which is part of PHAC recommendations but not in the incentive definition.
    • Improving data quality: AFHTO members are measuring and improving the quality of their EMR data as a source of timely information for quality improvement. Measuring can also have a direct and immediate impact on patient care. In the process of measuring their EMR Data Quality for the first time, one team found a systemic issue affecting flow of information from a lab to their EMR. They fixed the problem, improved their ability to detect colorectal cancer, and in their words, “saved lives”!
    • Voluntarily increasing participation in D2D: Nearly two-thirds of AFHTO members submitted their data to D2D 3.0, continuing the growth from D2D 1.0 (27%) and 2.0 (54%). This gives insight into the care of nearly 2 million Ontarians.

    All three Starfield elements are now in place:

    1. Quality is reliably and comprehensively measured through a composite indicator. It reflects the experience of the entire patient, not just isolated body parts. It is calibrated according to what matters most to patients in their relationship with their provider. While refinements continue, it is now possible to compare quality over time and between settings in a more meaningful way than is possible by just examining physician billing data.
    2. Capacity of the entire clinical team is being measured for the first time. Forty-six teams contributed data to measure time spent delivering primary care relative to the number of patients served. This approach considers the contribution of the entire team and provides a mechanism for exploring the impact of patient complexity on the human resources required to deliver high quality care.
    3. Total cost of care is now in its third iteration of D2D. It has been refined in conjunction with the Institute for Clinical Evaluative Sciences to help teams explore aspects of costs that might be sensitive to change in primary care delivery. This measure captures more than 85% of the allocatable public spending per person in Ontario; it is adjusted to reflect age, sex, and complexity of patients to allow comparison over time and between primary care settings. This indicator is now identified as a priority by Health Quality Ontario for system measurement.

    AFHTO members are well-equipped to take the next steps to improve quality

    Results from D2D 3.0 suggest that there is solid and growing engagement with measuring performance. This can be leveraged as we turn our attention now to improving. The D2D interactive report allows teams to compare their own data over time and with their peers across the province. Clinical leadership within and among primary care teams is proving to be the key ingredient in getting people to participate in measurement, improve data capture and act on results.

    Measurement continues to become more meaningful: Follow up after hospitalization

    To be added to the next D2D, this indicator will use EMR data to capture all hospitalized patients receiving in-person OR phone contact with ANY clinician within 7 days of discharge from hospital. Unlike the current indicator based on physician billing data, this approach encourages more patient-centered and efficient follow-up (e.g. phone call by pharmacist to address mediation issues rather than forcing a patient to come in to see the doctor).

    Access to hospital discharge data is the crucial pre-requisite for this indicator – and for excellent quality primary care in general. AFHTO continues to encourage members and external partners such as OntarioMD, eHealthOntario and hospitals to expedite implementation of Hospital Report Manager in all regions.

    Ministry and LHINs are encouraged to support spread

    • Cost-effective, high-performing health systems are based on a strong foundation of comprehensive primary care; robust measurement is a key ingredient.
    • D2D provides a way forward. It is grounded in the Primary Care Performance Measurement Framework to ensure consistency and relevance for all Ontarians, and focussed on what is meaningful and manageable for primary care providers. The tools and processes developed by AFHTO are already being adopted beyond its membership.
    • Spread requires support – to further develop clinical leadership and deploy Quality Improvement Decision Support Specialists to enable more teams and other primary care providers participate in measuring and improving quality.

    Click here to see D2D 3.0 aggregate results.

    The Association of Family Health Teams of Ontario (AFHTO) is the advocate, network and resource centre for interprofessional comprehensive primary care teams.

  • Free Privacy Training Webinar for AFHTO Member Executive Directors

    For Privacy’s Sake…

    AFHTO is pleased to share that we have partnered with DDO Law to provide our members with FREE Privacy Training & Tools. The Office of the Information and Privacy Commissioner of Ontario (IPC/O) has provided further guidance as to their expectations for Health Information Custodians (and specifically with respect to physician practices and Family Health Teams). To assist our members in meeting and understanding the new privacy criteria, we have made available a 1hr Privacy Training Webinar for Executive Directors. https://youtu.be/VeTNYZ66qXE

    Resources from this webinar

    Other privacy resources for AFHTO members

    As a reminder, AFHTO has numerous related privacy resources currently available to members on the website, including:

    A similar webinar has been made available for Board Chairs.

  • Op-ed: Family Health Team poised to play larger role in primary care

    Guelph Mercury article published on January 27, 2016. Article in full pasted below. Ross Kirckconnell, Guelph Mercury A discussion paper released in December by the Ontario Ministry of Health and Long-Term Care proposes a significant overhaul of the primary care model to deliver “more effective integration of services and greater equity … timely access to primary care, and seamless links between primary care and other services.” The report proposes that each of the province’s 14 Local Health Integration Networks “bring the planning and monitoring of primary care closer to the communities where services are delivered.” This is an important community conversation that is overdue. The Guelph Family Health Team supports an improved model for providing primary care that better serves the health and lifestyle of patients while promoting efficiencies and savings across the system. We should be looking to the organizations that are already successful at doing more or less what the ministry has proposed. Our peers at the Guelph Community Health Centre are a solid example — they have been working on collaborative approaches to community health care for many years. Guelph FHT is another example. We are a non-profit corporation that brings family doctors and registered nurses together with other health-care specialists such as nurse practitioners, pharmacists, dietitians, mental-health counsellors and community agencies for a “wraparound” care team approach to patient wellness. Serving Guelph for 10 years, our work has included leading collaborative, community-led and team-based health-care solutions. The Guelph FHT is already attracting provincial attention as a best-practice model for collaborative and proactive primary care. Currently, the majority of family physicians and about 85 per cent of patients in Guelph participate in the Guelph FHT model. Guelph FHT is a logical choice to assume greater responsibility for co-ordinating primary care in our community. FHTs are well established in Canada, and especially in Guelph, where we are seen as a best-practice model with a proven track record of meeting community objectives. We are in a strong position to continue a leadership role in delivering the best health care to everyone in Guelph. The traditional approach of going to the doctor or emergency department when you need medical attention is evolving to that of a care team that offers patients medical and wellness support for every need in every stage of life, with the goal of keeping patients healthy so they are sick less often. In the FHT model, doctors are the quarterbacks of a full team they regularly interact with, rather than a sole practitioner providing medical care or referrals to external medical specialists or community supports. Guelph FHT patients can also access after-hours clinics and specialized programs such as Diabetes Care Guelph and Health Link, a program run in collaboration with more than a dozen community agencies to identify high-risk patients and create a care plan to address their specific needs in a proactive, personalized manner. The Guelph Health Link initiative, recently recognized as best-in-class with a provincial award from the Association of Family Health Teams of Ontario, is designed to improve complex and vulnerable patients’ well-being while reducing their impact on the health-care system. The effort is leading to faster response time for patients, who may not need to visit their doctor but can be helped by a Nurse Practitioner or other specialists such as a mental-health counsellor. In need of advice from a registered dietitian? There’s someone down the hall. Looking to ensure your pharmacist has a full understanding of your medical situation? No problem — they’re part of the team, too. Interested in some free workshops to learn how to improve your well-being? The Guelph FHT runs several. In addition to faster and more comprehensive access, the FHT model is demonstrating improved efficiencies across the system, and a proactive approach to patient care that is resulting in healthier people who are getting the right care at the right time, visiting the hospital emergency department less, and overall reduce the strain on a burdened health-care system. Careful and thoughtful planning, and significant stakeholder engagement, will be necessary before moving forward, it would be relatively easy to leverage the same person-centred approach to delivering a wider array of health-care services to the entire community. We look forward to participating, to delivering on a strong community imperative to do this right, and to the best possible primary care in Guelph. Ross Kirkconnell is the executive director of the Guelph Family Health Team. Click here to access the article on the Guelph Mercury website.

  • Starfield Principles: Valuing Comprehensive Primary Care

    There is a compelling association between comprehensive primary care and system efficiency and effectiveness. The lifelong work of the late Barbara Starfield observed that an investment in primary care was associated with improved system quality, equity and efficiency (reduced cost). In British Columbia this efficiency was quantified by Marcus Hollander. The total cost of care was measured for the sickest patients. Patients without close alignment to primary care had a system cost of $30,000 per patient per year. Patients with close alignment to primary care had a system cost of $12,000 per patient per year.

    The Starfield Model: A Performance-Oriented Approach to Measuring Primary Care

    Comprehensive primary care is the foundation of a sustainable, responsive health care system in Ontario. The goals of comprehensive primary care are to:

    • Optimize health outcomes for patients and populations
    • Meet patient and public expectations
    • Support a sustainable health care system

    The focus of the primary care team is therefore to:

    • Improve quality
    • Increase capacity to assure access for patients
    • Reduce the total cost of care

    To be able to optimize performance of primary care teams, the foundation must be set to:

    • Support the fundamental relationship between patients and their primary care team
    • Enable primary care teams to collect and report data efficiently
    • Encourage and reinforce excellence in team performance
    • Provide the feedback needed to promote stewardship of health system resources beyond the Primary Care Team

    The key components of this model are as follows:

    • Measurement is for teams providing comprehensive primary care to a defined patient population.
    • Measurement is focused on outcomes and processes, not activities and transactions.
    • Performance is measured in terms of quality, capacity and total system cost (depicted in the model above).
    • Assessing “quality” requires simultaneous measurement of multiple indicators. In order to track overall quality over all of these dimensions, a weighted score is developed. The weighting is informed through patient engagement. This is done across a sample of patients across the primary care teams to get their input on what they value in their care, and the results will inform the choice of indicators, their weightings, and thresholds.
    • Indicators are defined by a representative body that negotiates and refines the selection and weighting of the indicators, always referring back to the relative values that the population expressed. This establishes a uniform measurement system for all of the teams.
    • Measures are adjusted to reflect the complexity in the case-mix of patients.
    • The measurement system is dynamic. Periodic review of indicators enables measurement to adapt to changing public expectations and evolving scientific evidence, thereby increasing accuracy over time.
    • Source data must be reported. This would entail reporting on each rostered/registered patient on all discrete data elements necessary to generate the desired indicator outcomes. This enables:
      • Multiple ways of analysing data and indicators.
      • Efficient verification of the accuracy of data.
      • EMR vendors do not have to analyse data.
    • Teams receive financial support to access the goods and services they require to collect and submit such data. Funds could be used for such things as EMR upgrades, electronic devices, data clerk, decision support analyst, project management. The team’s accountability is to deliver the data as a condition of funding; choices about the support needed to do so is up to the team.
    • Reporting to the participants is at the team level (not the provider level). Teams could receive provider level performance data confidentially for their internal use only. Reports will also be delivered to MOHLTC and the steering body for the pilot, with level of analysis to be determined in consultation.
    • Improvement based on internal human drive for purpose, autonomy and mastery.

    The expected benefits of implementing the Starfield Model:

    • Better value for the health care dollar.
    • Improved outcomes for patients.
    • Greater autonomy for health care providers to innovate and improve to achieve outcomes.
    • Measurement results provide greater evidence for investing in achieving the outcomes.

    The Starfield Model is named in honour of the late Barbara Starfield, researcher and champion of the value of strong primary care systems worldwide. Her name is used with permission from her family.

    Defining Comprehensive Primary Care

    In Ontario, comprehensive primary care is often described by the Provincial Co-ordinating Committee on Community and Academic Health Science Centre Relations (PCCCAR) Basket of Services. Outside of this, there is no mention of the term in Ontario’s Action Plan for Healthcare, and passing mention in the Strategic Directions for Strengthening Primary Care report. The MOHLTC website on “your healthcare options” lists “walk-in clinic” as the first option! The concept of comprehensive primary care is congruent with that of the Patient Medical Home. The US National Committee for Quality Assurance–Patient Centered Medical Home identified the key elements as follows:

    • Enhance Access/Continuity
    • Identify/Manage Patient Populations
    • Plan/Manage Care
    • Provide Self-Care Support/Community Resources
    • Track/Coordinate Care
    • Measure/Improve Performance

    Measuring Comprehensive Primary Care:

    AFHTO’s approach to primary care measurement focuses on the relationship with our patients and our ability to deliver the care patients value. Its objective is to optimize quality, access and total health system cost of care for patients, using indicators from Health Quality Ontario’s Primary Care Performance Measurement (PCPM) Framework. An article describing the model and a case study of its implementation was published in Healthcare Management Forum – The Starfield model: Measuring comprehensive primary care for system benefit. Barbara Starfield said, “Any country that is serious about primary care would eschew a sole focus on disease-oriented quality goals. Yet Canada has adopted lock, stock and barrel the ‘micro’, biomedically oriented approaches to quality, and payment for performance focused narrowly on diagnosis and management of specific diseases.” To get a true picture of the quality of comprehensive primary care, one must consider the balance of multiple indicators at the same time. The PCPM framework includes many of the key indicators that are important for identifying the key attributes and services of comprehensive primary care; however the framework includes more than 50 measures grouped under 8 domains. It will be necessary to roll up individual measures into domain summary measures in order to maximize the usefulness of the PCPM framework for practices. To facilitate comparisons between practices it will also be useful to develop an overall summary measure that includes all of the domains. To reflect the value of comprehensive primary care, it will be advisable to weight each measure according to its societal value. Appropriate weights could be established through a process that engages the public, patients, providers and decision-makers. The resulting domain and overall summary measures would then be useful measures of the value that comprehensive primary care has for society.

    Additional Resources:

  • Preventing Childhood Obesity: A Clinical Tool

    Most primary care providers in Ontario see young patients and their families who are at risk of developing obesity. We know that adolescents with obesity are more likely to be have obesity as adults and face greater risk for heart disease, stroke, some cancers and depression. We also know obesity puts patients at higher risk for more chronic diseases, like diabetes, which has a significant impact on Ontario’s health care system. The Preventing Childhood Obesity Clinical Tool was developed in response as part of Knowledge Translation in Primary Care Initiative. This tool was developed under the clinical leadership of Dr. Yoni Freedhoff (MD, CCFP, ABOM) and was designed for day-to-day use in a typical primary care setting. 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:

  • Couchiching FHT to be named 2016 LEADing Practice

    Congratulations to the Couchiching Family Health Team for being named a 2016 LEADing Practice Initiative. The FHT is being recognized for exemplary use of digital tools to strengthen clinical practice and provider experience. Couchiching FHT’s project integrated a tablet-based system into their EMR to screen patients at risk for chronic obstructive pulmonary disease (COPD). This also allowed patients to edit demographic information stored in their patient chart in the EMR in real time, without any increase in staff time or resources. Presented at the AFHTO 2015 Conference, benefits of the system included approximately 40% (or 3000) of the total patient population completing smoking screening in a little over 4 months compared to the previous, paper-based COPD screening process in which only 200 patients were screened at baseline. There was also a 33% increase in referral to the smoking cessation program. Couchiching is now expanding the tablet program to further identify and support individuals with other chronic diseases e.g. diabetes, and using such screenings for depression. The LEADing Practice Initiative, a partnership between Canada Health Infoway and Accreditation Canada is part of a larger Clinician Education Campaign, identifying LEADing practices across Canada that demonstrate the clinical benefits of digital health. Their award will be presented at the 2016 Peer Leader Symposium: Building Peer Leader Bridges to Advance Clinical Practice event to be held on March 3-4, 2016 at the Intercontinental Toronto Centre in Toronto. Relevant Links:

  • Primary Care’s united response to Minister’s Patients First proposal

    In a letter to Minister Eric Hoskins six associations of the Ontario Primary Care Council (OPCC) have provided initial feedback on the Province’s plans to strengthen our health care system. The Council recommends that the Ministry of Health and Long-Term set out clear principles for planning aligned with OPCC’s Framework for Primary Care in Ontario, develop a plan to embed care coordinators in primary care, address the role of primary care in mental health and palliative care, and ensure a consistent primary health care population needs-based planning approach across all fourteen LHINs. Click here to read the letter submitted on January 22, 2016, in response to the Minister’s Patients First proposal, released December 17, 2015. AFHTO will continue working with members and our provincial partners to develop complete responses to the Patients First proposal.

  • Response to Ministry’s Patients First proposal: current status

    This email summarizes current status and next steps in developing a response on behalf of AFHTO members to the Ministry’s Patients First  proposal.

    Provincial-level action:

    Regional-level action:

    AFHTO members are meeting with their LHINs and working together to strengthen the primary care voice within the LHIN. AFHTO has offered support. To date AFHTO has organized 12 meetings in 10 LHINs between FHT/NPLC leaders and their LHIN CEOs. The Ministry has also invited feedback from health care providers, patients and caregivers by February 29.

    Membership input to date:

    Click here to see full report on all topics arising from the 14 web meetings.

    The top three topics were:

    • Accountability & Contractual Relationships
    • Support for Leadership Roles / Smooth Transitions
    • Primary Care HHR Planning

    Physician Leadership Council meeting:

    Click here for the full report on Physician Leadership Council meeting.

    PLC members discussed the first two topics. Dr. Sarah Newbery, OCFP President and FHT physician, joined the meeting to receive input on the OCFP’s initial work on clinical leadership. On the issue of accountability to MOHLTC vs LHIN, views were mixed, with valuable input provided as to what is most important going forward.

    Overall, the Chair summarized the top three messages from this meeting as:

    • The FHT structure fosters development of clinical leadership. Education and support is needed to further develop clinical leadership and extend it more broadly beyond teams.
    • Make change slowly – pay attention to the “critical success factors” to ensure change achieves desired improvement.  Keep accountability clear.
    • Quality improvement is fundamental to all we do in primary care, and physician leadership is essential to doing this.