Blog

People across Ontario and North America are keen to learn about the ground-breaking advances AFHTO members are making to meaningfully measure and improve primary care. Presentations are listed by theme below, with brief descriptions.

Presentations on AFHTO members’ approach to the Starfield Principles:

• Ontario data support Starfield’s theory on primary care quality and cost.  Evidence shows that quality can be measured according to what matters to patients, and higher quality in primary care is associated with lower costs to the health care system
• Demonstration of Starfield’s observations about relationship between primary care quality and health system cost at the level of primary care teams in Ontario (with Paul Faguy, ED of OakMed FHT).

Presentations on approaching measurement that is meaningful to providers and patients:

• Changing primary care performance measurement: Honey, we need to talk. This presentation describes the process, findings, and outcomes of D2D, as well as the role of conversations as both a means and an end in efforts to improve performance measurement.  (with Ross Kirkconnell (Guelph FHT), Rob Annis (North Perth FHT), Alan MacLean (Superior FHT), and Allan MacPherson (University of Liverpool)). Abstract.
• Balancing patient priorities in a measure of primary care quality. This presentation examines which indicators patients feel are most important in reflecting patient-provider relationship, the impact of socioeconomic and health status on these priorities.
• Self-assessment of a composite measure of quality of primary care (with R. Glazier). The  Quality Roll-Up Composite Indicator (QRU) was examined for alignment with the National Quality Forum Composite Measure Evaluation Framework (UK). Abstract.
• Factors affecting patient priorities for measurement in primary care (With S. Burrows). This presentation describes the results of our 2017-18 patient priorities survey. Regardless of health and socioeconomic status, patients had similar priorities, with a small number of exceptions. For the most part, patients give high priority to indicators they perceive as measures of high performance (i.e. biomedical indicators). Abstract.
• Measuring Quality in Primary Care: How do we know what we’re doing is working? (With R. Kirkconnell, A. Macpherson, and R. Annis). This presentation describes the outcomes of 7 iterations of D2D. D2D has been successful in terms of participation, increased EMR maturity, and demonstration of Starfield’s observation about the relationship between high quality primary care and lower system costs, but we overall performance on quality and cost measures remains the same.
• Patient Priorities for Primary Care Performance: Changing Measurement to Reflect the Patient-Provider Partnership (with A. Maybee, S. Burrows, and B. Clark, patient advisors). This poster and oral presentation describe how we used a survey and focus groups to learn more about what patients value most in the patient-provider relationship, and how it should be measured.
• Measuring the value of interprofessional primary care teams. This poster describes a qualitative study undertaken to examine performance measurement in IPC teams (with Nicole Bobbette, Catherine Donnelly, and Amanda Mofina (Queen’s University) and Rachelle Ashcroft (University of Toronto)).
• Performance Indicators for Interprofessional Primary Care Teams: Measures of Collaboration. This poster describes a qualitative study aimed at identifying current supports for and measures of collaboration in interprofessional primary care teams, and to identify performance indicators that can be used to measure the outcomes of collaboration (with Catherine Donnelly and others from Queen’s University and the University of Toronto).
• Building patient perspective into the “hard data” of primary care performance measurement. This presentation, developed in partnership with patient representatives, describes how AFHTO is using the Patient Priorities Questionnaire to determine what matters most to patients in their relationships with their primary care providers. Through this process, we are building patient priorities into primary care measurement.
• Are we REALLY measuring what matters most to patients? Validating the patient-centredness of Ontario’s composite measure of quality in primary care. This poster described a study currently underway to validate the Quality Roll-Up Composite Indicator (QRU) as a measure of patient-centredness by comparing participating teams’ QRU scores with their scores from the Patient Perception of Patient-Centredness Questionnaire (PPPC).
• Measuring improvement to improve measurement: Action research to validate a composite measure of quality.  This poster describes a study currently underway to demonstrate the statistical reliability the Quality Roll-Up Composite Indicator (QRU).
• Making Sense of Measures of Success in Primary Care Programs. This workshop describes a ground-up approach to program performance measurement which balances consistency and relevance. This approach helps ensure that the focus is on improvement rather than just compliance with measurement requirements and it reduces the inherent need of top-down approaches to generate buy-in.
• Impact of a ground-up voluntary performance measurement initiative on the use of data for QI in primary care. An exploration of how D2D has changed conversations around using performance data by framing measurement as a means to improving quality, not an end in itself.
• Developing a more meaningful way to measure performance in primary care:the impact of getting started.
• Getting started with involving patients in improving quality. Through evaluation of QI workshops involving patients and QIDS Specialists, barriers and enablers to patient engagement were identified and subsequently validated by care providers.
• What do interprofessional healthcare providers need and want to get better at what they do? Interprofessional health care providers told us what support they need for quality improvement, identifying interprofessional collaboration and patient engagement as important enablers for quality in primary care.
• Building a Mosaic: Using locally-gathered data to develop a province-wide program planning tool. This poster describes how, through the Schedule A Indicator Catalogue, AFHTO members have compiled and disseminated locally-developed innovations and evaluation indicators in order to drive evidence-based quality improvement initiatives which balance the need for local relevance with the need to demonstrate collective value and system-wide impact.
• Scaling up QI support in Ontario’s primary care sector: Co-design a stopped-wedge clinical trial In this workshop, participants will draw on the learnings of D2D to inform the design of a stepped-wedge randomized trial for spreading QI support and measurement in primary care settings.
• Measuring quality according to what matters to patients. This presentation describes a survey of patients we conducted to determine which common performance indicators they feel are most relevant to their relationships with primary care providers, taking health and social determinants into account.
• Making sense of measures of success in Primary Care programs. This presentation describes the development and use of the Program Performance Measures Catalogue, a ground-up tool developed by and for AFHTO members to help with program planning and Schedule A completion.

Presentations on optimizing the use of EMRs for quality improvement:

• Putting your EMR to work for you: How expert-built tools can help you improve patient care. This presentation describes how the Algorithm Project Team has developed tools to help you identify patients with chronic conditions using expert-built EMR queries and how they are now collaborating with experts to develop tools, which will help teams improve care for these patients.
• Reduce, reuse, recycle: digging for gold in EMR data. This presentation outlines standardized EMR queries developed by AFHTO’s QIDS Specialists and shows how they can help us move from “garbage in, garbage out” to “reduce, reuse, recycle.”
• Feasibility and impact of using EMR to trigger automated patient experience surveying. An observational study of 8 primary care teams who used an automated patient contact management system to survey patients by phone or email.
• Moving the needle on diabetes care.This presentation describes the AFHTO member-built Diabetes Care Composite Indicator, which employs standardized EMR queries to identify patients with diabetes and quantify the quality of care they receive according to a small number of evidence-based measures. With this tool, teams can evaluate their progress in a more accurate way that reflects the contribution of the entire team. This presentation was awarded Abstract of Distinction at Health Quality Transformation.
• Data stewardship and primary & community care transformation partnerships (with Darren Larson of Ontario MD and Gail Dobell of HQO).
• Evidence of improving EMR data quality in primary care teams. This poster provides both qualitative and quantitative evidence that the EMR Data Quality (EMR-DQ) composite indicator has led to improved data quality, increased use of EMR data, and better care.
• Improving Primary Care Management of Depression: Buddy up, Start Where you can, Learn and then Take the Next Step Together/ Start here, start now: Cross-Sectoral Partnership in Improving Depression Management in Primary Care. This presentation describes how AFHTO and the Centre for Addictions and Mental Health (CAMH) teamed up to help primary care teams use their EMRs to identify two groups of patients with or at risk of depression and create programs to improve their care.

Presentations on moving beyond measurement to improvement:

• Quality Improvement in Dietetics. This presentation introduces several QI tools that are effective in interprofessional primary care settings. It then explores in-depth several real-life examples of QI initiatives. Participants are then invited to practice using the tools to develop QI plans for challenges they are experiencing in their own teams.
• Learning How to Get Lucky: Enablers of High-Performing Teams. This presentation describes what D2D is telling us about enablers of high performance in primary care teams. Some of these factors may be out of teams’ control (e.g. panel characteristics), others, such as single- vs. multi-site design, EMR management, and governance may be amenable to change.
• The Care and Feeding of QI Specialists in Ontario: The First Five Years. This poster describes the experience of the first five years of the QIDS program, from the perspective of those coordinating, delivering, and receiving QIDS Specialist support.
• Using Mobile Technology to Collect Patient-Reported Outcomes for Quality Improvement in Primary Care: There’s an App for That (with C. Steele Gray, J. Nie, J. Gravesande, P. Hans, and C. Cott). This presentation demonstrates how mobile technology can be used to improve care for patients with multiple chronic conditions and complex needs and to gather data which support research and system-level planning. Abstract.
• Readiness for Patient Engagement in Ontario’s Primary Care Teams (with N. Sunderji, V. Tang, A. Ion, and J. Rayner): This poster/presentation describes research into the question of how ready and willing primary care teams are to practice meaningful patient engagement in quality improvement related to mental health care. Abstract.
• Engaging Ontario’s Primary Care Teams: Learning the secrets of success from those who have achieved it. D2D data reveals that patients of single-site teams had statistically lower per capita health system costs, even when patient complexity is considered, regardless of whether the team is rural or urban. This paper explores how single-site design might be a useful place to start exploring what drives better outcomes in primary care teams.
• Evidence of the positive impact of co-location on quality and healthcare system costs in Ontario’s primary care teams. This poster describes the finding, observed over 6 iterations of D2D, that single-site teams are associated with lower system costs, and it explores the implications for quality improvement in all team, including multi-site teams.
• Ontario’s primary care teams are moving beyond measurement to improvement . This poster described patters of improvement observed over the first five iterations of D2D. “Increasers” began below average in the first iteration but were among the highest overall performers by the most recent iterations. “Decreasers” began among the highest performers but became the worst performance in the most recent iterations. Differences in characteristics between these groups are being examined and will be shared in the poster.

List of upcoming presentations

List of past presentations