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  • Data to Decisions eBulletin #6 – March 5, 2015

    Contributing to D2D 2.0 

    Indicator selection: The indicators for D2D 2.0 have been approved by the AFHTO Board. Please review to decide which indicators your team could and would submit to the report. You may want schedule meetings with your clinical lead(s) and/or Board of Directors to review the data and approve it for submission. The deadlines for data submission are projected for early April – dates will be confirmed shortly. Data submission tool: For D2D 2.0 teams will enter their data directly into a tool that is now being developed (instead of sending in an excel file). Teams participating in D2D 2.0 will be asked to designate one individual from their team with authority to submit data. Several QIDSS will be testing the tool for usability starting on March 19th. Contact Puja Ahluwalia or Greg Mitchell for more information.

    Using D2D 1.0 to improve data quality and care

    Hire a student to improve data quality in your EMR: The toolkit to assist members in hiring a student has been posted on the members-only website. The toolkit was developed with input from members that have successfully engaged students to improve data quality in their EMRs. If you are considering getting a student, particularly if it is for this summer, it is important to start the process now. See the toolkit for next steps. Build a COPD registry in Telus PSS and Accuro EMRs: A query will soon be available from the QIDSS to generate a list of COPD patients. The QIDSS have developed the query in collaboration with CPCSSN, EMRALD and the ALIVE project. It is not perfect – about 15% of the patients found might not actually have COPD – but this may be an easier way to start finding these patients than starting from scratch. The query and instructions will be released in the next eBulletin. In the meantime, contact Greg Mitchell for more information. Pilot project for a patient contact system (for patient experience surveys etc): Proposals are under review for a vendor to develop and implement a service to automate the process of contacting patients.We will be looking for 10 teams to pilot the service by March 31, 2015. If your team is interested in participating, please contact  Marg Leyland. A more detailed call for volunteers will be issued shortly. In the meantime, please see the Request For Quotes for more details. QIDSS attended learning sessions to improve quality of clinical data in EMRs: Cancer Care Ontario (CCO) hosted the third of five regional sessions this week with QIDSS and the CCO Regional Primary Care Leads in Sudbury. Among topics discussed were: strategies to make it easier for QIDSS to support physicians in accessing their SARs; the extent of similarity between EMR and SAR cancer screening rates; and information and resources available to QIDSS and AFHTO members from CCO’s Primary Care Leads. There are upcoming sessions scheduled for QIDSS in Toronto and Thunder Bay.

    Other news about manageable meaningful measurement

    Thanks for completing the EMR migration survey: Responses were received from about one quarter of AFHTO members and are now being compiled. Further details will be available over the next month. In the meantime, contact Marg Leyland for more information.

    What do you think?

    We hope you find value in the D2D eBulletin and will continue to subscribe to this newsletter. Other members of your team can sign up by clicking here. Once they complete the sign-up form a confirmation e-mail will be sent within 24 hours. In the meantime, if you have any comments or questions about the eBulletin, please let us know by e-mail to improve@afhto.ca. What is D2D? Data to Decisions (D2D) is a member-wide summary of performance on indicators that are both possible for members to measure and that are meaningful to members. See the D2D page on AFHTO’s web site for more information.

  • Governance Education Webinars for Primary Care Leaders – Video recordings and slide deck

    AFHTO offered free educational webinars for our members from February 18 to March 4, 2015 in order to:

    1. Help primary care leaders meet the requirements in the ministry’s Accountability Reform Initiative and the Governance and Compliance Attestation;
    2. Share best practice and strategies to improve governance;
    3. Identify and address common issues in FHT/NPLC governance.

    There were 3 separate 90 min webinars, each webinar offered twice. See below for links to webinar recordings, slide decks and Q & A. Presenters: Melodie Zarzeczny (The Osbourne Group) Susan Davey (The Osbourne Group) Peer Facilitators: Michelle Karker (East Wellington FHT) Shirley Borges (Minto-Mapleton FHT) Terry McCarthy (Hamilton FHT) Sue Griffis (North York FHT) For video recordings, slide decks and Q& A for each session, please click on the links below:

    For further details on the webinars, click here.

  • MOHLTC’s priorities and plans for primary care

    This message presents what the Deputy and Associate Deputy Ministers of Health and Long-Term Care said recently about the ministry’s key priorities for health system transformation, the role of primary care in this transformation, and some of the key steps ahead. While the media have asked if government “has pressed the pause button on team-based primary care” (Globe and Mail, TVOntario), the information below indicates significant movement ahead. The content of this email comes from Associate Deputy Minister Susan Fitzpatrick’s meeting with the AFHTO board on Feb. 25 (click here to access her slide presentation). Many of the same points were reiterated the next day in addresses made by Deputy Minister Bob Bell and by Susan Fitzpatrick at the Feb. 26 HealthLinks conference. Highlights:

    • “Primary care must be the strong foundation for our health system.” Both DM Bob Bell and Associate DM Susan Fitzpatrick clearly stated this view. The key question – what does this look like and how will we get there?
    • “Comprehensive regionally governed, population-based primary health services for Ontarians.” Slide 10 is a specific look at how the ministry sees primary care teams in advancing transformation, from 2005 and into the future. On several occasions the Deputy has called for movement toward “population-based risk-adjusted primary care”; this slide confirms the intent.
    • Ministry’s key priorities for primary care teams. Slide 12 lists them as follows:
      • Population health based programs and services with focus on access, integration and patient experience
      • Collect community-specific data to improve performance and quality of primary care for its population
      • Continue progress in expanding availability of same day/next day appointments and after-hours
      • Continue to provide access to integrated health care teams for Ontarians who need it
      • Establish policies to improve Quality Improvement indicators ( e.g. post-hospital discharge visits, readmission rates, ED visits)
      • Participation in HealthLinks and other local initiatives (e.g. Physiotherapy reform)
      • Leveraging full scope of practice and improving team functioning
      • Strengthening and expanding local partnerships and care coordination
    • “Sector Leadership and Excellence are Critical.” Slide 6 depicts the adoption curve; AFHTO members are clearly identified in the “Early Adopter” group. Our individual and collective work to engage patients, advance measurement, spread best practice and improve quality is recognized by the ministry, and in the results of the recent Conference Board of Canada FHT evaluation report. Team-based primary care is rich with strong leaders and champions to lead the way for this sector as the ministry and stakeholders work to transform the health system.
    • Review of interprofessional primary care models. On both occasions Susan Fitzpatrick stated it was time to review the team-based models from the perspectives of performance and accountability, funding, and use of interprofessional teams (recruitment and retention, ratios of team members, opportunity to leverage these resources). FHTs and CHCs will be included in the review. The ministry is developing terms of reference for this review, and is considering the range of team-based models to be included.

    AFHTO continues to work with and on behalf of members to show the way forward. We are ready with clear direction from the leaders of our member-organizations on the necessary principles – for the governance of primary care organizations; for accountability and reporting to funders; for determining accountability measures; for funding allocation; and for the support teams need to deliver timely, high-quality, comprehensive team-based care. Collectively we continue to advance measurement capacity to give solid evidence of the value of team-based care, and develop governance and leadership capacity to lead the way. We will ensure our members’ successes are seen and voices heard by the ministry and stakeholders. We look forward to showcasing and further invigorating this work at the AFHTO 2015 Conference in October — Team-Based Primary Care: The Foundation of a Sustainable Health System.

  • Governance Education Webinar #3: Looking Forward

    Session 3:  Looking Forward – using good governance to enhance organizational performance

    • Monday, March 2 from 12:15 – 1:45pm &
    • Wednesday, March 4 from 8:00 – 9:30am

    Learning Objectives Understanding some of the more advanced elements of good governance and how they impact organizational performance Topics Covered

    • Strategic planning
    • Strategic plans, operational plans, and KPIs
    • Partnerships and community linkages
    • Board evaluation
    • Public complaints and resolution policy
    • Governing for safety and quality
    • Generative governance

    Resources

      • Monday, March 2 recording

     

    • Wednesday, March 4 recording

  • Register now for FREE Governance Education Opportunities- hotel discount rates end this week!

    Dear Members, The Governance for Quality in Primary Care workshops are now accredited by the College of Family Physicians of Canada and the Ontario Chapter for up to 5 Mainpro-M1 credits. Reminder to register in advance for Governance education opportunities available through AFHTO: 1. “Effective Governance for Quality in Primary Care Workshops”: being offered free of charge to AFHTO member board members, executive directors and lead clinicians on March 25th and March 30th in Toronto. a. Register for workshop #1 on Wednesday, March 25th from 10:30am to 4:30pm at the Sheraton Gateway Hotel (Toronto Airport). Wednesday, March 18th -deadline for guest room rates for AFHTO members attending this workshop. Register using this link: AFHTO RESERVATIONS OR contact the Reservation’s Centre: 1-888-627-7092 and use the group name ‘AFHTO’ or group code ‘AC21AA’. Availability is limited so book now! b. Register for workshop #2 on Monday, March 30th from 10:30am to 4:30pm at the Eaton Chelsea Hotel (downtown Toronto). Friday, March 20th -deadline for guest room rates for AFHTO members attending this workshop. Register using this link: AFHTO RESERVATIONS. Availability is limited so book now! 2. “Governance Webinars” for primary care leaders. Two of the three webinars focused on the Fundamentals of Governance in support of the Accountability Reform Initiative have been completed and posted on the AFHTO members only website. The third session takes place on Mar 2 and 4. Please register in advance – space is limited.

    The content covered in the Governance Webinars is separate from the information provided in the Governance for Quality Workshops – please read the details for each to determine which education session(s) best meet your needs! Please click on the links for further information on the workshops and the webinars respectively.

  • Valuing comprehensive primary care: The Starfield Principles

    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)[i],[ii],[iii] ,[iv]. 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/patients/year. Patients with close alignment to primary care had a system cost of $12,000/patients/year[v]. The value of comprehensive primary care comes from the focus on the whole person, in their family and community context, over their lifetime. It is based on long-term, trusting relationships. This must be reflected when measuring performance in comprehensive primary care. In collaboration with members and research partners, AFHTO has been developing a system of measurement, based on the principles revealed through Dr. Starfield’s work.  Its objective is to enable teams delivering comprehensive primary care to optimize their performance and to evaluate the benefits over time. Using indicators from Health Quality Ontario’s Primary Care Performance Measurement Framework, it measures quality, capacity and total health system cost of care for patients. Click to read more about:

      References: [i] Shi L, Starfield B, Kennedy BP, Kawachi I. Income inequality, primary care, and health indicators. J Fam Pract. 48 (1999), 275–84. [ii] Starfield B. Family medicine should shape reform, not vice versa. Fam Pract Man. May 28, 2009; Global health, equity, and primary care. J Am Board Fam Med. 20(6) (2007), 511–13; Is US health really the best in the world? JAMA. 284(4) (2000), 483–4; Research in general practice: co-morbidity, referrals, and the roles of general practitioners and specialists. SEMERGEN.  29(Suppl 1) (2003), 7–16, Appendix D. [iii] Starfield B, Shi L. Policy relevant determinants of health: an international perspective. Health Policy. 60 (2002), 201–18. [iv] Starfield B, Shi L, Macinko J. Contribution of primary care to health systems and health. Milbank Quarterly. 83(3) (2005), 457–502. [v] Increasing Value for Money in the Canadian Healthcare System, Hollander et al. Healthcare Quarterly Vol 12 No. 4 2009

  • Introducing the indicators for D2D 2.0 / help in hiring summer students to clean data

    The vote is in!

    The indicators for D2D 2.0 have now been selected according to input from the members. There are still only about a dozen indicators along with a few more “explanatory” measures to help teams better identify peer groups to compare to. Please see the list below to start the conversation with your team about which measures (if any) you want to contribute data for. D2D 2.0 is AFHTO’s second membership-wide report on performance in primary care. It helps local teams see where they stack up against their peers on a small number of measures. For teams that are just getting started on their QI journey, it can help set a focus and a goal. No matter where your team is with getting or using data for improvement, D2D is a tool that makes it easier for us all to advocate for what it takes to keep doing the kind of primary care we believe in. For example, D2D 1.0 showed that patients of at least 30% of AFHTO members had better access to care than patients in other primary care models. They had better experiences on several other measures as well. Imagine how powerful that message will be when D2D 2.0 includes data from 100% of AFHTO members! The recent article in The Globe and Mail is a good reminder of how important it is for AFHTO members to be able to share this message with the wider community. There are several steps between selecting the indicators, releasing of D2D 2.0 and eventually using it to help your team advance. The QIDSS (and many others) are working hard to make the process easier and more meaningful. An example is a toolkit to help members recruit and use summer students to clean their EMR data. The toolkit is based on the work of teams who have already had great success in using summer students to make it easier to put good data into the EMR and get good data out, engaging physicians with the potential for increased revenue along the way! Contact Catherine Macdonald for more information on hiring a summer student. And for more details and instructions for contributing data to D2D 2.0, watch for updates to the ebulletin coming to you every other Thursday afternoon. If you have any questions or comments that come up as you discuss with your teams, please drop Carol Mulder a line. And, as noted above, watch the ebulletin for updates on how your team can contribute to D2D 2.0.

    Performance Indicators

    • colorectal screening
    • cervical screening
    • patient involved in decisions
    • readmissions
    • Cost
    • childhood immunizations
    • Same/next day appointment
    • Reasonable wait for appointment
    • regular care provider
    • Courtesy of office staff
    • A diabetes outcome measure such as % of diabetics with appropriate levels of HbA1C (definition being finalized in consultation with QIDSS)
    • FTE of doctors and NP (definition being finalized in consultation with QIDSS)

    Explanatory Indicators:

    These indicators are intended to help teams identify peers for the purposes of meaningful comparisons between teams

    • rural/urban
    • Number of patients served by team
    • access to hospital data
    • teaching status
    • data quality measure

    Developmental Indicator

    • follow-up after hospitalization: teams will be invited to submit data generated by and, more importantly, descriptions of their approach to monitoring follow-up after hospitalization, with the intent of informing the eventual development of consensus on a meaningful and manageable approach to measuring this concept in a consistent way across AFHTO membership

    For more in-depth information about these indicators, click here.

  • “Health Care in a Time of Austerity” on TVO’s The Agenda

    Feb. 25 – On The Agenda with Steve Paikin, Claudia Mariano, Nurse Practitioner at West Durham FHT and AFHTO Board Member, appeared on the show to discuss the need for increased support for recruitment & retention in primary care. The program, “Health Care in a Time of Austerity” focused on primary care reform in a time of fiscal restraint.  Panelists discussed OMA negotiations and the government’s intentions towards team-based primary care. Panelists included:

    • Claudia Mariano, Nurse Practitioner, West Durham FHT & AFHTO Board Member
    • Dr. Rick Glazier, Institute for Clinical Evaluative Sciences
    • Adrianna Tetley, Executive Director of the Association of Ontario Health Centres
    • Dr. Ved Tandan, OMA President

    A recording of the show is posted on The Agenda’s website.

  • Hire a Student Toolkit – Planning and Funding

    Decide that you want to clean up your historical data

    a)       Why should you do this? What’s Important to YOUR Practice? Some examples are:

    • The incentive bonus programs for physicians provide financial rewards for better coded data and may provide some funding for this exercise.  (eg Auditing of Medications, preparation of care reports)
    • Teams are better able to identify candidates for chronic disease management programs
    • Patients with Chronic Diseases can be tracked to ensure they are getting the kind of follow-up they need
    • It will be easier for your practice to do QIP reporting and participate in D2D, adding your voice to strengthen your associations ability to advocate for what you need

    b)       Funding Sources for Hiring a Student i.   Estimate how much bonus your physicians are currently foregoing, based on the current data quality, and therefore how much money is likely to be returned with improvements in data quality via the student.   See table to be completed by the team for each doctor, as a tool to estimate the potential value of the data cleaning project.

    • Assume, or estimate the number of patients based on the prevalence of the various conditions in the practice.
    • Assume, or estimate the actual bonus received by each doctor from the average amount received in previous years or by others in the team, if actual amounts not available directly
    • Consider that the very high end maximum cost of a summer student is about $20,000, with a more reasonable cost being $12-15,000.   See Appendix A for a table on calculating the potential bonus.

    Check with your physicians to see how much money they are willing to spend for a student placement, given the above calculations. ii.  If necessary, consider how much money your team can afford to pay (vacancy or one-time money that can be spent now and/or accrued to the next year).  For example, a 4 month vacancy for any clinician in the previous year would likely generate enough vacancy money to pay for the summer student, assuming the vacancy monies were not already allocated elsewhere.  Note: teams may need to request permission from MOHLTC representatives to reallocate vacancy money to this project, but the MOHLTC has assured AFHTO that they would be supportive of such requests.  Teams who qualify for ARI may be able to reallocate these resources without specific permission from MOHLTC.  Please contact Bryn Hamilton or a/your/the MOHLTC representative for more information about ARI. iii.  Regardless of who pays, ensure your physician(s) are supportive of this work.  See Appendix B for a sample draft note for physicians to sign. iv.  Provincial or Federal Government incentives may provide some funding to assist in hiring a student.  Some of these options are dependent on the type of student involved.

    • Northern Ontario Internship Program
    • Youth Employment Fund
    • Canada Summer Jobs
    • Employment Ontario — $2 per hour summer incentive
    • Co-Operative Education Tax Credit
    • Abilities Connect Fund

    c)       Consider the different types of students potentially available  There are numerous programs in the province offering different types of students, each with different funding models and placement duration for the students participating in the placement.  Some programs have their students participate in a placement specifically as part of their education and have rules in that they cannot receive wages as part of the placement.  Whereas others do require the student to be compensated. Even though you can use students from almost any education institution in the province this toolkit uses the following institutions:

    • Health records student placement (CHIMA accredited institutions across Ontario)
    • McMaster eHealth Masters student placement
    • Any summer student (see government programs for hiring students)

     

  • Governance Education Webinar #2: The Board’s Responsibilities

    Session 2: The Board’s Responsibilities

    • Monday, February 23 from 12:15 – 1:45pm &
    • Friday, February 27 from 8:00 – 9:30am

    Learning Objectives Understanding the Board’s role and responsibilities Topics Covered

    • Directors’ obligations (individual & collective)
    • Fiduciary responsibility
    • Governance policies
    • Creating an effective Board
      • Recruitment
      • Orientation & training
      • Board Chair
      • Conflict of interest
      • Code of conduct
      • Oversight and monitoring
        • Finance
        • Human Resources
        • Quality

    Resources

      • Monday, February 23 recording

     

    • Friday, February 27 recording