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  • Data to Decisions 1.0 report launches Oct.1: Sign up now for interactive info sessions

    The on-line tool — Data to Decisions 1.0: Advancing Primary Care (D2D 1.0) — will be launched on AFHTO’s members-only website on October 1st. D2D 1.0 is a summary of primary care data that are currently available, comparable and mean the most to AFHTO members in their efforts to advance quality of care for their patients.  The report displays data submitted anonymously by 50 teams.  It can be used by ALL members – whether or not your team has contributed data. The report will be accompanied by a suite of supporting materials to help teams use the data to advance their work to improve quality for their patients. Register now for information and education on using D2D 1.0 in your team.

    • Pre-conference professional session:
      • Open to physicians and Quality Improvement Decision Support Specialists (QIDSS) registered to attend the AFHTO conference
      • Wed., Oct 15, 2014, 10:00 AM – 12:00 noon
      • Introduces physicians to D2D 1.0, with QIDSS co-facilitating
      • Click here for more information

    To help evaluate the impact of D2D 1.0 and to design additional supporting materials to further fuel local QI efforts, we are also sending out a “baseline” survey to EDs, to be completed in consultation with their clinical leaders.  An advisory panel of AFHTO members will also provide additional feedback regarding the content of supporting materials to help AFHTO members use the report to full advantage.

  • Advice on managing budgets until funding letters are received

    AFHTO met with MOHLTC’s Primary Health Care Branch to discuss questions around funding for FHTs and NPLCs.  From this we can provide the follow advice for members:

    • Funding approval process:  The process for approving any one-time funding or increases to base is still underway in the ministry. Meanwhile, FHTs and NPLCs can be confident in planning for and using their base budgets.
    • Definition of “base budgets”: While many teams experienced adjustments in their base funding last fiscal, PHC Branch has not recommended any further adjustment this year. Base budget is equal to what you currently received each month, times twelve.
    • Make full use of available funds: The ministry reports that a large number of teams are still returning unspent funds, and at the same time, requesting additional funding in their yearly budget submission.
      • FHTs and NPLCs have the right to request re-allocation of funds as needed during the fiscal year.
      • Q1 recoveries are coming soon – plan ahead and make your requests to re-purpose funds for other needs.
      • To make a request, EDs are encouraged to submit an accurate budget forecast in their quarterly financial reports, along with a request to re-purpose funds, supported by the justification for the request.
      • Ministry consultants are to collaborate with EDs to ensure that relevant program needs can be met within current budget by allowing flexibility in allocation of existing funds.
        • Example: Funding for OTN replacement equipment. OTN funding came through eHealth Ontario, and funding is no longer available. Primary Health Care Branch does not fund OTN equipment, however, they have worked with groups to re-allocate existing budgets to cover the cost.
    • Physiotherapy funding requests are still in process:  Funding for approved PT positions will be added to base. As a result, notice of approval for these positions should come just before the FHT/NPLC funding letters.

      Reminder:  Registration is still open for Leadership and Governance events

    • For board chairs, Lead MD/NPs and EDs
    • Take place immediately before AFHTO Conference at the Westin Harbour Hotel, Toronto
    • NO COST to participate.
    • Effective Governance for Quality workshop, October 14 from 10:30 am to 4:30 pm.
    • Leadership Session – Towards the next Ministry contract – on October 15 from 10 AM – 12 noon
      • Session will be informed by results of a survey sent out to board chairs, Lead MD/NPs and EDs. Please respond by Sept.26.

  • Resources and opportunities available to FHTs and NPLCs

    FHT and NPLCs are invited to participate in the following initiatives. Click on each link below for more information:

  • Invitation to participate in shaping the next Ministry contract

    You are invited to participate in shaping the relationship between the Ministry and the FHT/NPLC by:

    • Responding to a survey on the key principles and priorities for new contracts, by Sept. 26, please.
    • Participating in “Towards the next Ministry contract” – the annual leadership session immediately before the AFHTO conference–  Wednesday , Oct.15, 10 AM – 12 Noon, Westin Harbour Castle, Toronto

    Contracts and public governance Contracts are the means through which an organization receives money and is held accountable for delivering what’s expected in exchange for those funds. In the public sector, they articulate what government, on behalf of the public, wants the publicly-funded organizations to do, what it’s prepared to pay, and how accountability will be enforced. The contract is a critical ingredient for effective governance between government (on behalf of the public) and the organization’s board of directors, and through the board, to govern the use of public resources for optimal public benefit. Governance and quality of care In primary care, emerging evidence tells us that the governance and leadership are key factors affecting the ability to develop high functioning interprofessional teams that see improvements in “Triple Aim” measures – better health, better patient experience, lower cost of care. The question is, to what extent do existing Ministry-FHT/NPLC contracts help or hinder boards in achieving these outcomes? Opportunity to shape contract content For FHTs, current contracts will expire on March 31, 2016. For NPLCs and all models of interprofessional primary care, contracts are expected to evolve toward greater consistency and alignment among the various models. Through AFHTO, members have the opportunity to influence the content of the next set of contract templates – how interprofessional primary care organizations and their purpose is described in the contract and the nature of the funding and accountability arrangements. This content can greatly influence the next stage of evolution for interprofessional primary care. Current state of contracts A number of governance and operational issues have been raised which can be related directly to the terms of the contract and the limitations set by the framework. For example:

    • Reporting focuses on activities, not outcomes.
    • The people who make critical contributions toward achieving those outcomes are not all included within the scope of accountability within the contract. Currently it is limited to those positions directly funded through the contract and excludes people who work within the team but are employed by other publicly-funded organizations (e.g. CCAC case managers, diabetes educators).  For all but NPLCs and FHTs with blended-salary model physicians, current contracts exclude the key role of physicians.
    • The reporting burden is seen to be very high, with relatively low value in the data collected.
    • There are significant restrictions on how funds can be used.
    • Many have expressed the need for greater clarity in the relationship between funding and meeting patient/community needs and expectations.

    Participate in the survey (by September 26, please) and the October 15 Leadership Session This survey is the first step in shaping the relationship between the Ministry and FHTs/NPLCs, through the contractual agreement. The results will be used to design the content for “Towards the next Ministry contract” – the annual Leadership Session immediately before the AFHTO conference, taking place Wednesday, Oct.15, 10 AM – 12 Noon. The objective for the Session is to develop a common statement of principles and a set of agreed priorities to guide AFHTO’s work toward new contract template.

  • Public Health guidance on Ebola and MERS-CoV / Health Care Provider Hotline – 1-866-212-2272

    AFHTO is forwarding the following updates from Ontario’s Chief Medical Officer of Health. We have learned that only some of our members are receiving these updates from local Public Health Units, and so we are sending these updates to ensure all are informed. Apologies to those who are receiving it twice.

    As stated in both memos – the ministry is available to support you during urgent situations that may arise. You can contact the ministry on a 24/7 basis through the Health Care Provider Hotline at 1-866-212-2272.

  • Update on AFHTO’s Governance and Leadership Program

    To Board Chairs, Lead MD/NPs and EDs of AFHTO-member organizations: Over the past 20 months many of you have interacted with Clarys Tirel, our Provincial Lead of the Governance and Leadership program, and former ED of the North York FHT and Mount Sinai FHTs. With deep sadness I am informing you that Clarys is leaving AFHTO.  We are very grateful that she will stay to see us through to the end of the AFHTO annual conference (Oct.15-16). As some of you will know, Clarys has been caring for a number of people in her extended family and has felt the need to take a pause in her career. Clarys has been a huge contributor to AFHTO’s work.  Among her accomplishments, she has:

    For AFHTO members, Clarys has been the voice of experience and encouragement to build confidence strengthen their capacity to lead and govern. For AFHTO staff, she has been an anchor to keep us strongly rooted in the reality of governing, managing and delivering patient care in an interprofessional primary care organization.  She will be greatly missed. Recruitment for a new Provincial Lead for our Governance and Leadership Program begins immediately. Angie Heydon Executive Director

  • EDAC meeting report: Shaping the future of MOHLTC contracts and the “Primary Care Guarantee”

    Yesterday’s meeting (Aug. 20) of AFHTO’s Executive Director Advisory Council (EDAC) included preliminary discussion to prepare AFHTO for advocacy on behalf of members on two key topics:

    • The contractual relationship between Ministry and primary care organizations
    • Shaping the Ontario government’s “Primary Care Guarantee”

     Towards the next Ministry contract Current contracts between MOHLTC and FHTs will expire on March 31, 2016. MOHLTC has signalled its intent to maintain consistency in contractual requirements across NPLCs, FHTs and other interprofessional models. Over the next year AFHTO members – through their association – have a critical, time-sensitive opportunity to shape their contractual relationship with their primary funder. Ideally, the MOHLTC contract would set up a framework that would allow for things such as:

    1. Accountability based on patient outcomes, access/quality of comprehensive primary care, and appropriate use of public funds.
    2. Funding that supports optimal use of resources to deliver quality care and patient outcomes.
    3. Measures to harmonize work where more than one organizational entity (e.g. FHT and physician group, FHT/NPLC and embedded CCAC or other staff) is involved, to optimize the performance of the clinical team

    EDAC members were asked for feedback on the process for engaging board chairs, MD/NP leads and EDs of AFHTO member organizations. The annual Leadership Session on October 15, immediately preceding the AFHTO annual conference, will be the first step in engaging members to define their collective vision and priorities for shaping this contractual relationship with the Ministry. Prior to the session, a survey accompanied by a concise backgrounder on the issues will be sent out to all board chairs, MD/NP leads and EDs. The purpose of the survey will be to both inform all of the leaders in our membership as well as to assess which issues are central to developing guiding principles. The survey will be piloted with a small group of volunteer EDs from EDAC in late August. The survey will be sent to all our members by September 17. Shaping the “Primary Care Guarantee” In the recent election campaign, the now-governing Liberals declared a “Primary Care Guarantee” – it “will ensure that every Ontarian has access to a primary care provider by 2018”. This document stated: To make the Guarantee a reality, Premier Kathleen Wynne’s Liberals will:

    • Focus on northern, rural, and fast-growing communities to improve availability and access to primary care, including the use of Community Health Centres and satellites.
    • Work with our physician partners to help them take on more patients, faster.
    • Improve the recruitment and retention of community-based primary care teams.

    On behalf of members, AFHTO’s priority issues have been recruitment and retention of primary care staff, expanding access to interprofessional teams, and support for measurement. These were the three key messages in AFHTO’s “Better Care. Healthier Families. Best Value” campaign before and during the provincial election. As a sector, we now have the opportunity to work with government to shape its direction for achieving the “Guarantee”, in line with what our members believe to be the priorities and needs for advancing the membership’s vision – that all Ontarians have access to high-quality, comprehensive primary care, that is informed by the social determinants of health, delivered by collaborative teams, anchored in an integrated, equitable and sustainable health system. EDAC was asked for input in the early development of advice for government. Discussion resulted in the following list of factors to explore:

    • Staffing:
      • Extent to which reduction in current vacancy and turnover rates could improve access to primary care
      • Opportunities to expand “grow your own” programs to address skills shortages in some communities
    • Opportunities to support and deploy teams as effectively as possible:
      • Need for appropriate IT infrastructure: deficiencies impact the capacity of health professionals to provide care and present challenges in a competitive recruiting environment.  Solutions to the barriers/limitations of current IT funding models may enhance capacity to care for more patients.
      • Opportunities within the team:  patient needs met by right professional at the right time, working to full scope of practice. Flexibility to shift skills mix as needs change
    • Need for community-based planning:
      • Planning to meet needs must be done at the local level
      • Interprofessional teams can (and do) play a key role in assessing and addressing community needs
      • Explore opportunities to improve access by expanding existing teams
    • Need for measurement that allows for capacity and quality to be tracked, to better inform on what’s working and where further support/investment is needed:
      • The Starfield Model, AFHTO’s approach to primary care measurement will by a key factor. It focuses on the relationship with patients and 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 Framework. The model and a case study of its implementation was just published in the Healthcare Management Forum – The Starfield model: Measuring comprehensive primary care for system benefit.

    AFHTO looks forward to working with members to continue to develop and refine our advocacy priorities and recommendations on these topics.

    • Members are welcome to send comments on these advocacy topics to AFHTO’s Executive Director – Angie.Heydon@afhto.ca.
    • Questions and comments regarding EDAC can be sent to AFHTO’s Provincial Lead for Governance and Leadership – Clarys.Tirel@afhto.ca.

  • Invitation to primary care team members to join province-wide communities of practice

    We invite all staff in AFHTO member organizations to participate in a community of practice for their profession. AFHTO members are made up of diverse teams of professionals working together to provide excellent patient care. Communities of practice provide invaluable help in fostering a culture of interprofessional collaboration which enhances patient-centred care. AFHTO has been supporting the development of communities of practice for the different professions working within FHTs and NPLCs.

    Benefits of participation in a community of practice:

    • Online community of people working in similar roles within primary care teams:
      • Optimize teamwork within and across disciplines by sharing best practices and experiences.
      • Explore opportunities to enhance interprofessional collaboration within FHTs, NPLCs and other team-based settings.
      • Free half-day networking session on October 15, 2014 in Toronto (before the start of the AFHTO conference):
        • Meet and mingle with peers to identify common practices and optimize teamwork.
        • Click here to register for the conference or contact the community of practice contact below to sign up for the session.

    How to sign up for a community of practice:

    To join a network, staff should send an e-mail to one of the contacts listed below. They will follow up with more information about their network and instructions to join.

    Community of Practice Lead / Contact Organization
    Administration Michelle Smith Guelph FHT
    Chiropractor Craig Bauman Centre for Family Medicine FHT
    Health Promoter Sandy Turner Minto-Mapleton FHT
    Mental Health and Social Workers Catherine McPherson-Doe Hamilton FHT
    Nurse (RN/RPN) Tara Laskowski Hamilton FHT
    Nurse Practitioner Claudia Mariano West Durham FHT
    Occupational Therapists TBD contact Marg Alfieri for information
    Pharmacist Lisa Dolovich McMaster FHT
    Physician Assistant Melissa Holm Hamilton FHT
    Psychologist Veronica Asgary-Eden Family First FHT
    Registered Dietitian Jacquie Reeds Andrea Firmin Hamilton FHT Markham FHT

    Our community of practice leads emerged from within the FHT/NPLC community to create forums to exchange knowledge and share best practices with peers in similar roles from across the province. Thank you to all of our volunteer community of practice leads and to their EDs for supporting their leadership role in the community of practice.

  • Ontario election update: responses from the political parties

    As promised, we are sharing with you the response we received from each of the three main political parties to the questions we had posed (see below). Click on the links to see responses (listed in the order they were received) from the:

    Please make sure to vote! Angie Heydon Executive Director, AFHTO

    1. For a summary of where each of the three main parties stands on health issues see below.
    2. By June 10, AFHTO will share responses received from the parties on 5 questions about interprofessional primary care. Scroll down to see the questions.
    3. Thank you to AFHTO members for raising awareness among candidates of the value interprofessional primary care delivers to patients and the health system and the need to support recruitment and retention of staff to deliver this care. Scroll down for more information.

    1. PARTY PLATFORMS:

    Lib – http://ontarioliberalplan.ca/#plan;

    Liberals have pledged to “Guarantee that every Ontarian has access to a primary care provider.” Details on this pledge were released this morning; it includes the statement – “Improve the recruitment and retention of community-based primary care teams.”  Read more at http://kathleenwynne.ca/guaranteeing-primary-care-ontarians/ Other details about their health platform is found at – http://ontarioliberalplan.ca/wp-content/uploads/2014/05/Access-to-the-Right-Health-Care-at-the-Right-Time-in-the-Right-Place.pdf .

    • Reduce wait times for referrals to specialists
    • Advocate for national drug insurance
    • Increase funding to our Mental Health and Addictions Strategy
    • Provide access to free vaccinations and newborn screening
    • Develop Community Hubs for community-driven programs that focus on health and wellness
    • Create 36 more Health Links to help those with multiple, complex conditions
    • Provide culturally appropriate care
    • Provide Ontarians with better information about chemicals linked with cancer
    • Increase funding for the seniors activity and community grants program

    PC – http://ontariopc.com/millionjobsplan/plan.pdf

    The plan largely builds on the vision advanced through the earlier PC party white papers on health care. The major health care commitments in the plan are as follows:

    • Local Health Integrated Networks (LHINs) will be eliminated and replaced by Health Hubs (which would bring together hospitals and community providers). These hubs will be run by front-line local health experts.
    • To help manage chronic conditions, the PCs would increase home care and create Chronic Care Centres. Doctors and nurses would work together to develop comprehensive care plans. Patients with the highest needs would be assigned a dedicated care navigator to ensure care is received right when they need it. This person will be a frontline caregiver such as a nurse, not a bureaucrat.
    • Home care and long-term care would be expanded.
    • The scope of practice would be updated for pharmacists, nurse practitioners and other professionals, to allow treatment where it is most convenient and beneficial for patients, particularly seniors.
    • Introduce a self-directed model of home care that would allow patients to select their services.
    • Encourage more competitive contracts for companies that provide health care services.
    • The role of modern, specialty clinics to provide more services such as dialysis and routine surgeries would be expanded.
    • Mental health services would be integrated to address the fragmented service delivery experienced by most patients today.
    • Children’s physical activity would be increased to 45 minutes per day, through school-based activities and after-school sports.
    • A secure health care database that will allow doctors and nurses to study real-world feedback on what treatments work best to help them determine the best care path for future patients would be created.

    NDP — http://ourplan.ontariondp.ca/?source=homepage

    The major health care commitments outlined in the plan are as follows: YEAR 1:

    • Open 50 new 24-hour Family Health Clinics with the capacity to serve 250,000 people, reducing the number of Ontarians without primary care access by 25 per cent.
    • Hire 250 more nurse practitioners in the Emergency Room in an effort to cut wait times in half.
    • Create 1,400 new Long-Term care beds with the goal of eliminating the waitlists for acute long-term.
    • Eliminate home care wait times for seniors with a Five Day Home Care guarantee. Clients would receive approximately two nursing visits and 7.5 hours of personal support per month.

    YEAR 2:

    • A Caregiver Tax Credit of $1, 275 per year to families caring for the ill or elderly.
    • Student debt forgiveness for doctors who choose to practice in rural, underserviced areas. The plan targets participation by 250 physicians, forgiving $20, 000 of debt per service.

    2. AFHTO’S QUESTIONS FOR PARTIES:

    Answers to the following questions have been requested by June 6. Response received will be sent to AFHTO members no later than June 10:

    1. Evidence shows that a very sick patient without high quality care can cost the province $30,000/year but the same patient with access to interprofessional family care only costs the province $12,000/year. Will your party support strengthening our family care teams and enhancing our capacity to care for more patients?
    2. Despite having family care teams in 206 communities across Ontario, 3 out of 4 Ontarians still do not have access to the benefits of interprofessional family care. If elected, what will you do to expand this care model to ALL Ontarians?
    3. Interprofessional family care teams are committed to optimizing health outcomes for patients and populations, meeting patient and public expectations, and supporting a sustainable health system.  What will your party do to advance the capacity of family care teams to capture and track the information they need to achieve these goals?
    4. Interprofessional care teams struggle to retain health professionals due to higher salaries being paid in hospitals, community care access centres, public health units and other settings. How will your party help interprofessional care teams recruit and retain more health care professionals in order to expand better care to more Ontarians?
    5. Final question is specific to each party’s platform:
      1. Lib: In your 2014 campaign platform you state that part of your 10-year plan is to support family health by guaranteeing everyone in Ontario has access to a primary care provider. How do you plan to use interprofessional family care teams to fulfill this promise?
      2. NDP: In your 2014 campaign platform, you state that you will add 50 new 24-hour Family Health Clinics. How will this commitment affect the current care model we have in place? Will it have a positive or negative effect on interprofessional family care teams
      3. PC: In your 2014 campaign platform, you state that you will help manage chronic care by increasing home care and creating Chronic Care Centres where doctors and nurses will collaborate to develop comprehensive care plans. Will this commitment compliment the current care model we have in place or have a negative effect on interprofessional family care teams?

    3. AFHTO MEMBERS RAISING AWARENESS:

    While AFHTO’s President and ED have been working at the provincial leadership level, AFHTO members have been active in their ridings and on social media.  Among those attending a recent meeting of the ED Advisory Council, about one-quarter had met with their MPPs and about one-third intended to contact candidates. Materials to help you spread the word on the value of continuing investment in team-based primary care are posted on the AFHTO members-only website:

  • Data to Decisions (D2D) 1.0: Contribution Instructions

    The Quality Improvement and Decision Support Steering Committee is pleased to announce the indicators to be included in Data to Decisions 1.0.  D2D 1.0 is a summary of primary care data that are currently available, comparable and mean the most to members in their efforts to advance quality of care for their patients.  Indicator selection was informed by AFHTO members through a survey conducted from April 24 to May 8. All AFHTO members are invited to contribute data for one or more of the selected indicators.  Please see table below to guide next steps for health teams. The selected indicators are as follows: From data recorded in EMR:

    1. Childhood immunizations
    2. Influenza immunizations among people over 65 years old

    From survey data:

    1. Patient experience with time spent with provider, opportunity to ask questions and be involved in their care
    2. Access, as indicated by % of patients reporting they received appointments within the same or next day of booking

    From data reported via ICES:

    1. Colorectal and cervical cancer screening
    2. Readmissions to hospital within 30 days of discharge for selected conditions
    3. Cost of care per patient (hospital, ER, diagnostic, community care as well as primary care)
    4. Regular primary care provider (% of all physicians visits with primary physician — formerly referred to as “Continuity of care”)

    See data dictionary for more complete details on the definitions and data sources for each indicator. Additional information about D2D 1.0 is available on the members-only page of the AFHTO site.  The FAQ  document, updated early June 2014 to address questions raised in the membership-wide survey, includes background on the purpose of D2D 1.0 and the indicator selection process, among other information.  It will also be updated with plans for addressing the fate of other indicators not included in D2D 1.0.  There is also a brief slide deck to share with others on your health team or Board. Please contact Carol Mulder with comments and questions about D2D 1.0. Next steps for health teams:

    Action Further information Deadline
    Choose indicators Member organizations may decide to contribute their data for all, some or none of the indicators.   See data dictionary for more information on each indicator. ASAP
    Identify a D2D 1.0 contact person The contact person works with the member organization and AFHTO to ensure submission of data in the correct format.  Possible choices for this role include QIDSS, IT staff or perhaps the author of your team’s QIP. ASAP
    Request data from ICES Submit request for ICES data for each FHO, FHN and/or FHT, signed by ED and Medical Lead, assuring ICES that all physicians in the group support the request.  D2D 1.0 will display data the FHT level only, regardless of how many FHNs or FHOs are contributing data. Jun 23, 2014
    Inform AFHTO of intent to contribute to D2D 1.0 Complete the “Data contribution sign-up form” to alert AFHTO of your organization’s intention to contribute data for one or more indicators. ASAP
    Extract data from EMR Begin consultation with your QIDSS and/or IT staff to extract data for childhood and influenza immunizations, the only 2 D2D 1.0 indicators based on EMR data.  For help, see data dictionary or contact QIDS program staff.  ASAP
    Compile patient survey data Begin to extract data from patient surveys for % of appointments on same/next day and patient experience with time spent with providers, opportunity to ask questions and be involved in their care.   For help, see data dictionary or contact QIDS program staff.  ASAP
    Complete data submission template Enter data for each of the indicators as well as descriptive data for the FHT (ie rural, urban etc) into the data submission template. Jul 25, 2014
    Acknowledge review of Statement of Confidentiality Before uploading data to AFHTO’s private dropbox, Members will be asked to acknowledge review of the Statement of Confidentiality at the time of submission of their ANONYMOUS DE-IDENTIFIED data. Jul 25, 2014
    Upload data Submit file of ANONYMOUS, DE-IDENTIFIED data to AFHTO’s private dropbox Jul 25, 2014
    Review final report Watch for release of the D2D 1.0 report in time for the annual AFHTO conference, Oct 15-16, 2014. Oct 15, 2014