ECHO continues to offer videoconference sessions to support primary care providers with complex and chronic conditions, such as chronic pain/opioids, liver diseases, rheumatology, and mental health and addictions. They have two upcoming evening series to accommodate health care providers who can’t join the weekday sessions. Anyone can register and there is no fee. These are ECHO Ontario CME accredited sessions. ECHO Evening SeriesChallenging Situations in Opioid Tapering: Managing Symptoms of Withdrawal.
Date: Monday, May 7
Time: 7 PM to 8 PM
Register hereLiver Disease in Primary Care: Approach to Hepatitis B
AFHTO has partnered with the Governance Centre of Excellence (GCE) to offer our members a series of webcast and online learning modules to better serve your governance needs and empower board leadership:
Financial Literacy Training for FHT and NPLC boards (online course): Financial literacy equips board members with the tools they need to mitigate risk and support the success and mission of their organization. AFHTO developed this course in partnership with the Governance Centre of Excellence. It provides FHT and NPLC board members with the financial knowledge and skills to make effective and informative financial decisions. This is a free online learning module that can be completed in your own time. Here’s how to sign up
Strategies for Building and Maintaining an Effective Board in Primary Care was webcast on July 11th – a recording is available here.The interactive discussion was presented by Richard Powers, National Academic Director, Directors Education Program and Governance Essentials Program, at Rotman School of Management. It was focused on strategies for building a skills-based board, governance insights from MOHLTC, and examples from the field on strengthening governance practices.
Privacy and Enterprise Risk Management webinar was watched by over 80 AFHTO members on November 22nd – a recording is available here. The webinar was presented by Miller Thomson, a law firm specializing in working with not-for-profit organizations as well as financial institutions and governments. The presentation defined Enterprise Risk Management, its importance to the EDs and the Board, and its relevance to the operation and governance of FHTs. You can access the slide deck to learn about the privacy issues: Privacy and Enterprise Risk Management webinar 22-11-2017 .
Online learning modules are being developed now and will be made available to AFHTO members. In the meantime, you may wish to look at the following governance resources:
Financial literacy equips board members with the tools they need to mitigate risk and support the success and mission of their organization. AFHTO developed this course in partnership with the Governance Centre of Excellence. It provides FHT and NPLC board members with the financial knowledge and skills to make effective and informative financial decisions. This learning module can be completed in your own time. Here’s how to sign up:
Sign into the OHA Education website. You may have to re-create a password.
Fragility fractures, a symptom of osteoporosis, are the cause of unnecessary morbidity and mortality in Canada. With early identification many cases of osteoporosis are manageable. Despite the knowledge that prior fractures are predictors of future fractures, fewer than 20% of women and less than 10% of men receive preventative treatment. To help health professionals gain an increased familiarity with preventative management and diagnostic techniques of osteoporosis, McMaster University together with the Ontario College of Family Physicians, Osteoporosis Canada, and other osteoporosis experts across Canada have developed a free, online, certified course. The course, ‘Osteoporosis: What is Your Patients Fracture Risk?’, helps Canadian health professionals understand the best practices associated with diagnosing, managing, and preventing the harmful consequences associated with osteoporosis. About the Certified Course
The course can be accessed by anyone interested in learning about osteoporosis from a health-care provider’s perspective. It was designed primarily for family doctors and other primary care providers.
Just follow the prompts. You won’t be able to complete the course without logging in.Registering will also allow you to revisit the course if you don’t finish it in one session.
The course meets the Certified criteria of the College of Family Physicians of Canada has been certified by the McMaster University Continuing Health Sciences Program for 1.5 Mainpro+credit. It is also an Accredited Group Learning Activity as defined by the Maintenance ofCertification program of The Royal College of Physicians and Surgeons of Canada, and approved by the Canadian Association of Emergency Physicians). This program has been approved by theCanadian Society of Respiratory Therapists for 1.0 CSRT CE/CPD credit.
The course was created by the Division of e-Learning Innovation at McMaster University incollaboration with Osteoporosis Canada and the Ontario College of Family Physicians.
MOHLTC-FHT contracts expired on Mar. 31, 2016. The templates developed to replace them could significantly reshape the relationship FHTs have with the Ministry. The ministry has looked to AFHTO, in collaboration with other relevant stakeholders, to recommend performance measures aligned with the ministry’s focus on enhancing access/integration and supporting quality and sustainability in primary care. As a collective, we will continue to identify manageable and meaningful measurement and demonstrate the value and impact of interprofessional primary care as we work towards the next ministry contract. Please see below for relevant updates. Updates:
The Ministry has begun rolling out the new FHT contract. To better understand the new clauses that are in this agreement, AFHTO is hosting webinars for our leadership members, on Tuesday, March 13th from 12:00 p.m. to 1:30 p.m and Tuesday, March 20th from 11:30 a.m. to 1:00 p.m., where the Ministry will walk our members through the clauses that have had significant changes and to answer any questions our members may have. Our lawyer, Kathy O’Brien from DDO Health Law, will also be on the webinars so that she can answer questions you may have from a legal standpoint – Kathy has reviewed an earlier version of the FHT contract and has provided some advice and guidance which was shared with the Ministry as they continue to finalize the agreement. A version of the FHT contract was sent to all FHTs and the Ministry will email your FHT leadership directly with the template agreement. Given the short notice of the original invitation, the webinars will also be taped and available to the membership shortly after the session – we will also be collecting any questions that are asked during and after the webinars which we will also send out to the FHTs. Speakers:
Nadia Surani, Manager, Interprofessional Programs Unit, Primary Health Care Branch
Fernando Tavares, Program Manager, Interprofessional Programs Unit, Primary Health Care Branch
Using the Quality roll-up indicator at the local level in your team
Consider the impact of missing data.
If your team did not submit data for all 14 of the indicators included in the calculation, values for the missing data were estimated randomly to allow you to get a score for the quality roll-up indicator. Using random values ensures that the membership-wide scores which are being used to demonstrate the value of teams at an aggregate level are solid estimates. At the local team level, quality roll-up scores based on these random values are not as robust as scores based on complete data. Teams with incomplete data for the quality roll-up score may therefore want to access more data prior to drawing definitive conclusions about their local score.
Consider the role of the relationship with patients.
The quality roll-up indicator is intentionally weighted according to what matters most to patients in their relationship with primary care providers. As the table below shows, some indicators are more important to this relationship than others. You may wish to focus your improvement efforts on the indicators that are most important to patients.
Consider thresholds for performance.
AFHTO members have identified thresholds for performance on each of the 14 indicators included in the quality roll-up indicator. Indicators that are not yet meeting the lower threshold are areas to give priority consideration for quality improvement. Indicators scoring within the minimum and maximum range are performing within accepted norms but have room for improvement. Indicators scoring above the maximum threshold tell you that your team can look to other priorities for improvement efforts.
Health Data Branch portal – Percent of patients with a primary care visit within 7 days of acute discharge (discharges for selected conditions) Based on final data for FY 2016/17
Administrative data (ICES) – all primary care in Ontario
[Original Post: January 27, 2016] D2D might show you how your team stacks up. And it might be hard for your team to take action on the data in D2D. You might need more current, local, provider or patient-specific data to figure out what your team could do to make things better. Here are some ideas to help you and your team drill down into data that can kick start some PDSAs or other efforts to improve quality. Ideally, you would do the drill down in advance, preferably in collaboration with an influential clinician on your team. This will give your clinicians something to talk about with their peers right away when you start looking at D2D. In the videos below, Carol Mulder provides an orientation to the D2D data review platform. The first provides general information about the core indicators, and the other provides a more detailed orientation geared to the needs of Board Chairs and EDs or Admin Leads. Read on to learn about actions you can take regarding the three categories of indicators: Patient Experience, Administrative (ICES/HQO), and EMR-Based.
Patient experience indicators
Patient experience data is probably the most current of all the indicators in D2D. However, it may still be useful to drill down into patients of a specific program or provider or who were targeted with a particular intervention. This can help your team get a more local immediate sense of how things are going and increase interest in doing more to improve patient experience. Ideas for drill down include the following:
Track the next 10 (or other small number) patients that come in for a particular program or provider or do 2 weeks of patient surveys in the next month. This will give your team a sense of progress from D2D (ie are they holding at about the same level as in D2D or getting better/worse?) and also might help focus on specific groups or interventions.
Ask a small group of patients one of the questions from D2D that was NOT in your survey. Teams may be more interested in indicators in D2D if they have local data – but they may want to see roughly how they are doing before going to the work of revamping their patient experience survey.
Talk about sample size (see resources on web). Some teams are still working under the burdensome impression that they need to sample really large numbers of patients to get an idea of patient experience. This is not true. The more patients you sample, the more precise your results are. However, you can get within 5 or 10% of the ‘true’ level of patient experience with relatively small sample sizes. Often this is good enough for the purposes of tracking progress.
Work with your patients to see what they think is important. AFHTO and HQO collaborated in Jan 2016 on a series of workshops with QIDSS and patients from health teams. There may be some ideas coming out of those sessions that can help your team work with your patients to use your patient experience data to fuel improvements. Check with your QIDSS or Carol Mulder for more information on these sessions.
Administrative (ICES/HQO) data indicators
Indicators based on administrative data tend to be the oldest of all indicators in D2D. Improving the timeliness of administrative data is a priority for AFHTO and HQO and others. And in the meantime, there are things teams can do to use these “old” data to fuel current, local efforts to improve. These include the following:
Get at your hospital data: Yes, there are provincial, information-technology-based solutions under way to improve access of primary care providers to hospital data. And your team can get hospital data now even while you are waiting to be connected to more automated, provincial solutions. Check with your QIDS Specialists for ideas on how to get data from your local hospitals.
Track the next 10 or 20 (or other small number) of hospitalized patients or patients who have been to the ER. A temporary manual process to check into a small number of patients may be more possible in the short term and will serve to give you some current, local information about what is REALLY happening with your team’s readmission or follow-up rates. This data will not necessarily be comparable to what is in D2D but might be enough to start conversations in your team about what (if anything?) you can do to improve coordination of care for your patients as they go to and come from the hospital.
Get current cancer screening data from your EMR: The QIDS Specialists have developed standardized EMR queries for cancer screening. Try them. Now that they are developed, they should take very little time to run on an ongoing basis (rather than just once a year for reporting purposes). The data might not be directly comparable to what is in D2D (because it is from a different time-period and may have more information about patient eligibility for screening). However, it will give you a sense of how your team is doing over time. More importantly, have a list of specific patients that might be overdue for screening gives your team something concrete to do now about something they care about (ie patients).
Sign your physicians up for monthly screening reports via CCO SAR. Once they get through the sign-up process, most physicians agree that these reports are very helpful, especially if you or they have trouble getting or trusting your EMR data for cancer screening.
D2D indicators based on EMR data are relatively current. And because EMRs are usually current up to the minute, your team can get even more timely, ongoing data for these indicators to guide efforts to improve on these indicators. Ideas to increase the value of EMR data beyond the values reported in D2D include the following:
Drill down to the patient or provider level: The queries to get EMR data for D2D are usually run at the patient level so you may just need to run the same D2D query again and look at the results BEFORE rolling them up the team level (as you do for D2D reporting). This will tell you and your team exactly which patients of which providers could benefit from interventions like a phone call or reminder about an appointment. As with the cancer screening example above, this gives your team something concrete they can do to make a difference in the lives of their patients now. This is invariably a compelling reason for teams to participate in the measurement and QI process.
Work to improve the quality of your EMR data. Check out how your team is doing on the D2D data quality indicator relative to others. Consider picking a point of clinical interest with your team and working to improve the quality of EMR data in this very limited are. Check out the experience of your peers in cleaning up the data and getting people interested in doing that –consider hiring a student to help you clean up your data (see suggestions in this handbook for cleaning up your roster and smoking/alcohol status).
The Physician Leadership Council (PLC) played a role in enabling physician leaders from across the province to provide a sounding board on FHT-related matters and give advice to the AFHTO board and staff.
This council dissolved in spring 2019 and merged with the Executive Director Advisory Council and the Board Chair Leadership Council to form the AFHTO Leadership Council.
Members of the council continue to communicate, engage and consult with their physician colleagues to create strong communication mechanisms and a better understanding of current challenges and/or opportunities within FHT practices.
Past updates from the Physician Leadership Council:
Since March 2013, the Executive Director Advisory Council (EDAC) provided a mechanism for AFHTO member executive directors to surface operational issues, to be a sounding board on operational matters, and to give advice to the AFHTO board and staff as needed on these matters.
EDAC was dissolved in spring 2019 and merged with the Board Chair Leadership Council and the Physician Leadership Council to form the AFHTO Leadership Council.
All NPLC member organizations meet with AFHTO staff and board representative(s) on a regular basis to bring operational challenges to light, be a sounding board on a wide variety of issues, and give advice to the AFHTO board and staff as needed on these matters.
