Forwarded on behalf of Cardiac Care Network of Ontario: In the next few months, the Cardiac Care Network of Ontario (CCN) will be releasing the Ontario Heart Failure Strategy. With no cohesive provincial approach to managing heart failure (HF), the current system of care is fragmented with patients often falling through the cracks during transitions leading to suboptimal care and resulting in potentially avoidable Emergency Department use, hospitalizations, and diminished quality of life. One of the solutions to addressing barriers to optimal HF care is the identification of how and where care is currently being provided. The easy part is finding self-identified Heart Failure Clinics and Specialists who are managing HF. While this is valuable information, we believe the true key to successfully designing a province-wide HF management system that will function in a large and heterogeneous province like Ontario lies with Primary Care Practitioners. This is where we need your help. We want to make sure that any Primary Care Practitioner in the province of Ontario who has an interest or expertise in HF will take this survey. The ultimate goal is to collate the results into a map of HF services across the province. This will make it easier for patients and healthcare providers to locate and access care, and will inform opportunities to enhance or augment services in communities that are lacking access. The link to the survey is https://www.surveymonkey.com/s/CCNHeartFailure.  It takes about 20 minutes to complete. We thank you in advance for taking the time to complete the survey. Your efforts will help to ensure that we generate a complete and accurate list of HF providers in the province. ______________________________________________________________ Sudha Kutty Director, Knowledge Management Cardiac Care Network http://www.ccn.on.ca

The first set of data from the Ministry-sponsored five-year FHT evaluation study was released last week to 118 FHTs. These FHTs had participated in at least one of three 2009 surveys – facility, patient, and provider – conducted by the Conference Board of Canada evaluation team.

In 2009, the 134 FHTs in waves 1 – 3 were invited to participate in these surveys. Last week all 134 received a request to complete the follow-up Facility Survey and to distribute the Provider Survey to everyone in the FHT who provides direct patient care.

The 118 FHTs who had participated in at least one of the 2009 surveys also received a summary of those results – for their individual FHT and the aggregate for all responding FHTs.  The Conference Board researchers confirmed that individual results have been distributed solely to the respective FHT; the Ministry receives only aggregate data.

The report combines responses from several questions to provide scores in the domains of access, comprehensiveness, teamwork, coordination, quality and chronic disease prevention and management. Almost all scores are expressed on a scale of 0-100. There is no cutoff between “good” and “bad”, but the ideal is to score 80 or above.

The following report gives AFHTO’s observations on this first set of data.  The Ministry is currently compiling a more detailed report on the full set of results from the first three years of the FHT evaluation.

Median scores – the middle number with an equal number of responses above and below – indicate the following for FHTs overall in 2009:

• Patients report the median wait for minor health problems was 0.5 days and they generally have little or no difficulty accessing care (median score of 81). However, the overall median patient score for accessibility of care was 73.
• Overall, providers report that several critical aspects of teamwork are in place, with median scores of 82 for the way in which team members communicate and interact, 78 for collaboration with members of their immediate team, and 74 for collaboration among all providers in the FHT.
• When it comes to coordination and quality, both providers and patients gave relatively high scores for factors internal to the FHT. Examples include median patient scores of 90 for their experience of interaction with their health care provider and for care coordination within the FHT, 94 for satisfaction with their providers and care, 84 for cultural competency, and 79 for family-centredness. Providers seem to be somewhat harsher in looking at themselves in these same domains, with median scores of 80 for care coordination within the FHT, for satisfaction with their role and FHT team; 74 to 76 on their interactions with patients and family-centredness, and 65 for their cultural competency.
• Related to the operation of their FHT, providers gave a median score of 80 for the extent to which their FHT has key governance-related policies in place, 73 to the extent to which their FHT uses data to support patient services and care, and 56 to the extent to which they are participating in quality improvement activities.
• Patients gave relatively high scores related to some aspects of chronic disease prevention and management (CDPM) – median score of 82 for satisfaction with the services they receive for their chronic diseases and 85 for their level of confidence in self-management. In addition 93% of patients with the relevant chronic conditions reported their blood pressure was under control, and 83% said likewise for blood sugar. The lowest median score in the whole report, however, was 31 for questions related to services received to manage their chronic disease (e.g. lists, reminders, treatment plans). One would expect this score to improve with time as FHTs have further developed and strengthened CDPM programs since the early days of setting up multidisciplinary programs.
• External linkages are also expected to strengthen as the FHTs mature. Median scores were relatively low in these early days, with an overall median score of 55, presumably since FHTs were focused on getting their teams up and running. Patients gave an aggregated median score of 46 on questions related to their FHT’s community orientation. Providers gave a median score of 63 to their experience of patient care coordination with external providers; interestingly though, patients gave this a median score of 95.
• The results also point to room for improvement when it comes to discussions about health and well-being (e.g. diet and exercise, medications, preparation for aging). Median score from the patient survey was 66, and 71 in the provider survey.

Outside of the few areas listed above, median scores are above 70.  While FHTs overall may be performing relatively well, the scores for individual FHTs range from 25 to 100 for most items.  FHTs that received these individualized reports may find some additional areas for improvement.

Three years later the three surveys are being repeated.  The results will be valuable in showing how FHTs as a whole are developing over time.  Participating FHTs will have the added advantage of seeing how their individual performance is evolving.

FHTs that have received the 2012 facility and provider surveys are encouraged to complete them.  If you require the link to the survey or have any questions, please contact the evaluation team through Garry Armitage at 1-888-689-1847 or g.armitage@malatest.com .

BACKGROUND

MOHLTC contracted the Conference Board of Canada to conduct an evaluation of the FHT initiative over the period from Dec. 2008 to Nov.2013. The study has included key informant surveys, site visits, patient focus groups and administrative data analysis, in addition to the two rounds of facility, provider and patient surveys in 2009 and 2012. Comparative data is also being collected from Community Health Centres and Family Health Groups. The evaluation domains are:

• Access
• Comprehensiveness of care
• Coordination and continuity of care
• Information management systems to support quality and coordination
• Interprofessional team functioning and effectiveness
• Quality and appropriateness of care
• Health promotion and chronic disease prevention and management

In 2009, all FHTs were invited to participate in facility and provider surveys. As well, randomly selected FHTs were invited to participate in site visits and patient surveys. In total: 84 per cent of FHTs responded to the facility survey; over 800 FHT providers, including physicians, registered nurses, mental health workers, nurse practitioners, dietitians, pharmacists, and others responded to the provider survey; and more than 2,600 FHT patients shared their views about the care they receive at their FHTs through the patient survey.