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 25^th from 10:30am to 4:30pm at the Sheraton Gateway Hotel (Toronto Airport). Wednesday, March 18^th -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 30^th from 10:30am to 4:30pm at the Eaton Chelsea Hotel (downtown Toronto). Friday, March 20^th -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.

• Register for Session 3 (Mar 2 or 4): Looking Forward – using good governance to enhance organizational performance
• The following sessions are completed with recorded webinars, slide deck and Q&A available on AFHTO’s website:
  •  Session 1 (Feb 18 & 20): Getting Started
  • Session 2 (Feb 23 & 27): The Board’s Responsibilities

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.

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.

FHTs and NPLCs are invited to take advantage of the following opportunities, some of which are time-sensitive. Click on each link below for more information:

• • Ontario Budget Talks portal: ask the government to address recruitment and retention
  • Seniors Community Grant funding – Application deadline March 27, 2015
  • Call for Expressions of Interest (EOI) for Integrated Funding Models – Deadline March 18, 2015
  • Nominations for OCFP Awards now open – Deadline April 10, 2015
  • Free workshops on medication reconciliation with transitions of care – March 2, 4 and 11, 2015
  • Hiring and screening resources for including physiotherapy in your team
  • Information to share with Patients: Ontario Health Study & MyCancerIQ
    • Ontario Health Study – patients invited to participate in study
    • MyCancerIQ: Cancer risk assessment tool from Cancer Care Ontario
  • Opportunities to provide input on prenatal resources and best practices in primary care
    • Invitation to provide feedback on The Best Start Resource Centre prenatal education resources for primary care in Ontario
    • Research study on gestational weight gain by the University of Alberta

Ontario Budget Talks 2015: ask the government to address recruitment and retention in their budget plans

While AFHTO has consistently brought the need for sufficient funding for recruitment and retention to the government’s attention, AFHTO members have also been active in meeting with their MPPs to discuss this issue. Now there’s another opportunity to raise awareness. The Ontario government has recently opened Budget Talks 2015, an online portal for Ontarians to offer feedback to the government on 2015/16 budget planning. In keeping with the work already begun, you can visit Budget Talks 2015 to lend your voice to the call to support recruitment and retention in primary care teams. For resources to assist you, click here (log in to the Members Only section first.)

Seniors Community Grant funding – Application deadline March 27, 2015

Ontario is accepting applications for the Seniors Community Grant Program until March 27, 2015.  According to the submission guidelines, eligible applicants “must represent seniors groups or offer programs or services which directly benefit seniors living in Ontario.” In the case of AFHTO members, this may include programs offered promoting seniors’ health, fall prevention, etc. Update: On page 11 of the guidelines it states ineligible organizations include those whose “primary source of annual base funding is from the province of Ontario”. We believed all FHTs and NPLCs were eligible based on the cover/introductory information we received which stated eligible applicants “must represent seniors groups or offer programs or services which directly benefit seniors living in Ontario.” If you are concerned your program will not be eligible please contact the Seniors Community Grant Program, seniorscommunitygrant@ontario.ca or 1-844-SCG-2015 (1-844-724-2015). You may also consider partnering with another community organization for your program proposal as well (if it is appropriate for the proposal you are putting forward).

Call for Expressions of Interest (EOI) for Integrated Funding Models- deadline March 18, 2015

The Ministry recently issued an Expression of Interest (EOI)  for models that will test innovative approaches to integrate funding over a patient’s episode of care, regardless of who is providing the care, or the location where care is provided. Click here for a recording of the ministry’s information session on Integrated Funding Models (1hr 11min).

Nominations for Ontario College of Family Physicians awards now open – Deadline April 10, 2015

AFHTO members were well represented at the 2014 President’s Installation and Awards Ceremony. Take the opportunity to acknowledge the great work being done by interprofessional primary care teams by nominating your team, physician colleague (or even yourself) for an OCFP award. Categories include Regional Family Physician of the Year, Family Practice of the Year and Awards of Excellence. Click here to nominate a team or colleague before April 10, 2015.

Free workshops on medication reconciliation with transitions of care – March 2, 4 and 11, 2015

“Facilitating Medication Reconciliation in the Community: Interactive sessions for community healthcare providers in Ontario” The Institute for Safe Medication Practices Canada (with support from Health Quality Ontario) is offering two in-person workshops and an interactive webinar to support community health care providers with medication reconciliation. These sessions will help teams improve the communication of medication information and help teams provide safe transitions for their patients. Workshops will take place on:

• Monday, March 2, 2015: Thunder Bay Regional Health Centre, 4:30-8:30 pm
• Wednesday, March 4, 2015: Windsor Regional Hospital, 4:30-8:30 pm
• Wednesday, March 11, 2015: Interactive Webinar, 12:00 pm – 1:30 pm ET

For further details and registration, click here.

Hiring and screening resources for including physiotherapy in your team

The Ontario Physiotherapy Association has tools and resources available to support primary care organizations hire, screen and integrate physiotherapy services to their team. You may also contact them with any questions that may arise in implementing these positions. For further information, click here (log in to the Members Only section first.)

Information to share with Patients: MyCancerIQ & Ontario Health Study

·  Ontario Health Study – patients invited to participate in study The Ontario Health Study will be sending out a call to all Ontarians between the ages of 35 and 69 to participate in the provincial study by providing a blood sample and/or filling out a questionnaire. Primary care providers are asked to share information about the study with patients and facilitate participation if appropriate. To learn more about the study and how you can help, click here. Feel free to also contact Dr. Mark Purdue, the study’s Executive Scientific Director, at mark.purdue@ontariohealthstudy.ca if you have any questions. · MyCancerIQ: Cancer risk assessment tool from Cancer Care Ontario My CancerIQ is available for your patients’ use. The online tool allows them to find out their risk for breast, cervical, colorectal and lung cancer. Users can determine their risk of developing one of these four cancers. Primary care providers are asked to share this information with patients. For more information, go to MyCancerIQ.ca.

Opportunities to provide input on prenatal resources and best practices in primary care

· Evaluation of prenatal resources available to primary care in Ontario The Best Start Resource Centre is gathering feedback from service providers in Ontario to evaluate resources about prenatal education in Ontario. The survey is focused on the Prenatal Education Report and Prenatal Education Fact Sheets and how they have been used in practice. To participate in the survey, click here. · Research study on gestational weight gain by the University of Alberta Do you provide care to pregnant women?  The University of Alberta wants to better understand the barriers and challenges health care providers may experience related to gestational weight gain, and about what may help and support them to help women achieve healthy weights during pregnancy. For more information, click here. To participate in the survey, click here.

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 25^th from 10:30am to 4:30pm at the Sheraton Gateway Hotel (Toronto Airport)

b. Register for workshop #2 on Monday, March 30^th from 10:30am to 4:30pm at the Eaton Chelsea Hotel (downtown Toronto)

2. “Governance Webinars” for primary care leaders. There are 3 separate 90 min webinars focused on the Fundamentals of Governance in support of the Accountability Reform Initiative. Each webinar will be offered twice and posted on the AFHTO members only website. Please register in advance – space is limited. A. Register for Session 1 (Feb 18 or 20): Getting Started B. Register for Session 2 (Feb 23 or 27): The Board’s Responsibilities C. Register for Session 3 (Mar 2 or 4): Looking Forward – using good governance to enhance organizational performance

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!

To: Physician Leaders in all AFHTO member organizations The Ontario Medical Association is currently in the process of consulting with its members on access to interprofessional care to address priority populations. As part of this process, the OMA has shared their preliminary DRAFT of the ‘Integrated Health Network Policy Paper’ to their Section of General and Family Practice and Section of CHC Physicians. Since there is no OMA Section of FHT physicians, OMA asked for feedback from AFHTO’s Physician Leadership Council (PLC). Twelve members of the Council commented and agreed to a collective submission in response to this request. The draft policy paper and the collective response of PLC members were sent to all physician leaders by e-mail. Any member of the OMA is welcome to send in their own response to the OMA by February 23rd if they wish, to Peter.Brown@oma.org.  The OMA has said they will consider this input as they continue to work on this paper, before going to broader consultation on expanding access to team-based care for priority populations. We encourage each of you to read the draft Integrated Health Network Policy Paper and consider submitting your feedback to the OMA as we strive to obtain a collective vision for a strong base of high-quality comprehensive team-based primary care for all Ontarians. If you have any questions about this process of the draft Integrated Health Network Policy Paper please contact Bryn Hamilton.

Feb. 16 – Globe and Mail reports, “Family health teams – which put doctors, nurses, dietitians and social workers in the same office — offer a holistic and convenient approach embraced by patients and doctors alike. Why then is the Ontario government backing away?” In this feature article, journalist Kelly Grant delves into the value of FHTs from the perspective of patients as well as the findings of the recent Conference Board of Canada’s evaluation of the FHT initiative. The article presents the promising benefits of team-based care. It also reports on the associated physician payment models and the challenge of recruiting and retaining other health professionals whose provincially-funded salaries cannot compete with other parts of the health system. AFHTO emphasizes that the real issue for the sustainability of our health system is the TOTAL cost of care to keep people as healthy as possible. Research in BC found that total cost of care is $30,000 for the sickest patients who don’t have a strong primary care relationship and $12,000 when well-supported by primary care. This is why AFHTO members are working to advance measurement and improvement in primary care, with the objective to optimize quality, access and total health system cost of care for patients. In response to this article, a member, Bruyere Academic Family Health Team, sent the following message to their staff:  To all staff, Several people have commented about the Globe and Mail article on Family Health Teams that appeared over the weekend. The commentary in the article gave the impression that the provincial government is moving away from family health teams, likely based upon the Auditor General’s report. We thought that this would be a good opportunity to comment on what our FHT has been specifically doing to achieve the goals of the Family Health Team model. The first thing to point out is that the government concerns about receiving value for what they have invested in the family health teams has been present for quite some time. The widespread use of the FHT model is a relatively new phenomenon for this province so some growing pains can be expected. In our FHT we have undertaken numerous activities that would be very difficult for us to accomplish if we did not have all of the members of our team or the infrastructure that supports us. We have an excellent team of providers  and staff. Access:  Since becoming a FHT in 2006, we have opened a new site (Primrose) and have moved from 4,539 enrolled patients to almost 12,000 across both sites. We continue to try and improve our enrollment numbers, and are taking Ontario patients from Health Care Connect and other sources. In addition, we serve about 4,000 non-enrolled patients for a total of 16,080 patients. We target vulnerable populations, who may have difficulty finding primary care services. Our clerical staff work hard to schedule patients when they wish to be seen and with their appropriate teams. Integration: We continue to work closely with the CCAC and discharging hospitals to deliver seamless care. Our referrals clerks achieve prompt and appropriate referrals to services within the region. Procedures on site: Within the walls of our clinics we provide patients with a very wide scope of primary care services delivered by their most responsible provider, residents and other members of the team.  This includes numerous procedures such as biopsy, excision of skin lesions, endometrial biopsy, IUD placement, and MSK injections that many other family practices have moved away from. Specialty care on site: Our work with integrating shared care has allowed our patients to access a wide scope of psychiatric services, ambulatory gynecology and orthopedic surgery. The latter two services build upon the capabilities that we derive from our MSK clinics and Women’s Procedures clinic. Preventive care: To prevent more serious health issues for our patients in the future, we have teams that provide chronic disease management, therapeutic lifestyle guidance, diabetes management, and smoking cessation. Other members of our Allied Health group provide assistance with dietary management, medication oversight, social work, kinesiology services, and foot care. We encourage patients in self-management and recommended screenings. We are embarking on a FHT wide primary preventive care emphasis this year with plans for activities centred around obesity prevention and physical activity. Outreach: The team based activity that we are engaged in does not stop at our front door. We currently deliver outreach services at St. Mary’s Home, the Bethany Hope Center, Maycourt Hospice and the Mission for men. In addition to the other services, we have other focused practice activities that are designed to assist with our educational mission such as procedures, maternal health and well-baby clinics. Quality: We also have an extremely active continuous quality improvement program that is allowing us to work in a highly reflective manner. As part of this, we are aggressively measuring multiple aspects of our operation to ensure that we are meeting the goals that we have set for ourselves and that we are being good stewards of the public money entrusted to us. One particularly important measurement is our ongoing patient satisfaction survey. What all the data is telling us is that the work that we are doing is helping us to move forward. We are doing well on our prevention targets, we are keeping patients out of the emergency departments and our patient satisfaction levels are high. We continue to be excellent teaching sites for the family physicians and other health professionals of the future, who are provided with many opportunities to learn about the FHT priorities such as collaboration and comprehensive and team based care. The debate about the value of FHTs will continue for quite some time. Debbie and I feel very strongly that we as a group have done, and continue to do, the kind of work that clearly demonstrates that with the right mix of people and resources, it is possible to profoundly improve care delivery and patient outcomes. This is precisely the goal that the FHT model was created to achieve. Regards to all, Jay and Debbie