Ultimate Blogging Championship

Tag: reports and relevant news

  • Ontario to introduce patient privacy amendments

    Ontario’s Ministry of Health and Long-Term Care aims to introduce amendments to the Personal Health Information Protection Act (PHIPA) in the fall. If passed, these amendments would include making it mandatory to report breaches to the commissioner’s office; lifting the requirement that offences be prosecuted within six months of an alleged breach, and doubling fines for individuals and organizations. For further details, you can read the original news release or The Globe and Mail article with video of the announcement by Min. Hoskins. AFHTO members can also log-in to access related resources:

  • HQO Report: Patient experiences of care coordination and communication

    April 15- AFHTO welcomes the release of “Experiencing Integrated Care: Ontarians’ views of health care coordination and communication”, Health Quality Ontario’s (HQO) report on patients’ experiences of their transitions between health care providers and the associated care coordination and communication. The report focuses mainly on patients’ experiences of transitions and communication between doctors, specialists and hospitals. In primary care, however, we know care coordination also involves collaboration spanning a wider array of health and social services. Care coordination is a fundamental role of primary care. This is why the Ontario Primary Care Council (OPCC), of which AFHTO is a founding member, defined a set of principles of care coordination:

    1. Care coordination is a core function of primary care and a hallmark of a high-performing primary care system.
    2. Care coordination includes communication and planning with the patient and family.
    3. Care coordination requires a population needs based approach to planning.
    4. Care coordination will emphasize the timely and continuous delivery of high-quality, person-centred, equitable, timely and continuous services and programs that are comprehensive, evidence-informed, culturally competent and appropriate.
    5. Care coordination focuses on the provision of comprehensive services across the health and social services continuum as needed.
    6. Care coordination is predicated on collaborative inter-professional teams working to full scope of practice.

    AFHTO members are working to connect patients with the care and support they need. Here are two examples from past AFHTO conferences: McMaster Family Health Team- the System Navigator– Compromised patients are required to navigate an increasingly complex health care system as well as various government and social/community systems. Acknowledging the challenges presented by the social determinants of health to the delivery of care, the McMaster FHT applied for and received funding for the position of a Case Manager/System Navigator. This unique role was developed in recognition of the many issues, medical and non-medical, a patient faces that affect their health and well-being. Rural Wellington Shared Governance Across Health Care Partners – Nine health provider agencies – four family health teams (East Wellington FHT, Minto-Mapleton FHT, Mount Forest FHT, Upper Grand FHT) , two rural hospitals with three sites, CCAC, Community Mental Health and a mental health and addictions hospital- work together to create integrated and responsive care for patients. Effective care coordination benefits patients and their families by creating more seamless transitions of care, facilitating access, reducing duplication and increasing quality of care. HQO’s report acknowledges this is an exploratory study and states further studies are being considered. Given the importance of primary care for effective care coordination, such studies, reflecting the broader reality of Ontario’s health system, would be welcome.

  • Media coverage highlights value of team-based primary care

    Recent media coverage about family health teams and team-based primary care as a whole have pointed to its value to patients in Ontario and the government’s intent to review primary health care models and balance healthcare spending.

    Total cost of care – Team-based care improving the bottom line

    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.

    Recent Media Coverage

    Mar 24 – The Spectator’s View: Family health teams still make sense The Hamilton Spectator editorial states, family health teams “are a more holistic approach to primary care”. In this editorial managing editor Howard Elliott makes the case for continued government support of the family health team model. Mar 26 – The Hamilton Spectator published AFHTO’S response “Investment in primary care lowers costs.” It quickly became the most popular letter of the day. Feb. 25 – The Agenda with Steve Paikin, Healthcare in a Time of Austerity On TVO’s The Agenda with Steve Paikin, Claudia Mariano, Nurse Practitioner at West Durham FHT and AFHTO Board Member, appeared on the show to discuss the need for increased support for recruitment & retention in primary care. Panelists discussed OMA negotiations and the government’s intentions towards team-based primary care. Feb 16 – Globe and Mail highlights value of team-based primary care The Globe and Mail reported, “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.

    In response to The Globe and Mail, 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

  • Primary care recommendations in Home and Community Care Report

    Today the Ontario government announced “Ontario Endorses Expert Report on Home and Community Care” as it released Bringing Care Home, a report from the expert group on home and community care led by Dr. Gail Donner. The release stated, “This report will help inform the next steps in Ontario’s home care strategy which will be announced in the coming months.” The report presents what the expert group heard from stakeholders, and the experts’ response to what they heard – leading to 16 recommendations plus enablers required for their implementation. Key points for AFHTO members are the report’s calls for:

    • Clear, consistent definition of the “basket of services” and eligibility to receive them
    • Improved communication between home and community and primary care
    • Role of LHINs in both home and community care and primary care
    • Performance measurement, management and results-based funding, for both home and community care and primary care
    • Human resource planning, including strategies to address the wage gap between sectors

    These themes appear to be aligned with points recently reported from ministry meetings in recent emails to AFHTO members –  MOHLTC’s priorities and plans for primary care and What’s ahead for FHTs + NPLCs . AFHTO members will be pleased to see the report acknowledges the key role of primary care. Some excerpts:

    • The delivery of primary care should be better aligned with home and community care. Communication between primary care providers and service providers is poor (e.g., discharge summaries not sent or sent too late to be useful, communication between physicians and care coordinators is poor). Primary care providers are not always consulted in the development of home and community care plans, nor are they provided with provider assessments, care plans and reports.
    • One of the greatest opportunities to improve home and community care is to improve primary care so it is better equipped to serve its required role as a strong foundation for the rest of the health system.
    • Having an involved primary care provider is critical to the success of any home care plan.

    HIGHLIGHTS FROM REPORT RECOMMENDATIONS

    Clear, consistent definition of the “basket of services” and eligibility

    Recommendation 3 calls for the ministry to explicitly define which home care and community services are eligible for provincial funding, under what circumstances, determined using a common standardized assessment tool. Not only will this help patients and families, primary care providers would benefit from clear, consistent understanding of available support.

    Improved communication between home and community and primary care

    Recommendation 1 calls for a Home and Community Care Charter (found on p.18 of report) to be endorsed by the ministry and the principles incorporated into the development of all relevant policies, regulations funding and accountability strategies for this sector. The 11 statements in the charter include: 2.  A single care coordinator will work with the client and family to identify their needs and the most appropriate services to meet those needs. 3. The care coordinator and primary care providers will communicate regularly and in a timely fashion. Where appropriate, technology will be used to facilitate timely and ongoing communication among members of the circle of care.

    Role of LHINs in both home and community care and primary care

    The report points to a number of current challenges. Some excerpts:

    • Home and community care is funded through the LHINs, whereas most primary care practitioners are funded directly by the MOHLTC. Many of the strategies and services needed for more integrated care may already be part of the service agreements between primary care providers and the MOHLTC, and integration could be improved by assigning responsibility for managing those agreements to the LHINs.
    • Primary care was not explicitly in the Expert Group’s mandate; however, the engagement of primary care is a critical success factor for home and community care reform and many stakeholders, both families and providers, identified it as an issue of concern. Unless primary care and home and community care are well aligned, the needed transformation will not be possible. A critical enabler for this alignment is to manage the delivery of primary care through the same entity that manages other elements of home and community care: the LHINs.

    Recommendations 8 and 9 (see next section below) call for a direct role for LHINs with primary care.  To the extent that FHTs and NPLCs could be interested in becoming “lead agencies”, recommendation 11 is also of interest. Recommendation 8: That Local Health Integration Networks, in collaboration with the LHINs’ Primary Care Leads, develop and implement strategies to improve two-way communication between primary care providers and home and community care providers. Recommendation 11: That the Ministry of Health and Long-Term Care direct the Local Health Integration Networks to select and fund the most appropriate lead agency or agencies to design and coordinate the delivery of outcomes-based home and community care for populations requiring home and community care for a long term within their LHIN. (See p.28 of report for minimum requirements for the lead agency.)

    Performance measurement, management and results-based funding

    The report identifies several prerequisites for the successful implementation of its recommendations. One of these states, “Until all primary care providers are held accountable for the terms of their services agreement, primary care will not be fully and successfully aligned with home and community care.” Recommendation 9 states that, where performance agreements with primary care providers exist (e.g. with Family Health Teams and Community Health Centres), the Local Health Integration Networks take responsibility for managing performance against the service standards in these agreements and making these results publicly available. Following this recommendation, the report goes on to state:

    Although many family health teams have service agreements with the MOHLTC, most of the performance standards are currently related primarily to volume of services. The Primary Care Performance Measurement Steering Committee at Health Quality Ontario is working on system-level indicators and practice-level indicators that will be publicly reported. These indicators should be incorporated into all relevant performance agreements. The Committee’s work will enhance the LHINs’ ability to monitor performance of some primary care providers in their region.
     

    AFHTO’s work with members on the QIDS program and Data to Decisions (D2D) initiative, is giving leadership to advance primary care measurement in a manageable and meaningful way. Recommendation 15 goes further to propose that the Ministry of Health and Long-Term Care tie funding for home and community care services (e.g. home care, community support services, primary care) to the achievement of clearly defined outcomes and results.

    Human resource planning and wage gaps between sectors

    AFHTO and its collaborators have been strongly promoting solutions to the problems in recruitment and retention in primary care. We are pleased to see the Expert Group also identified this among the prerequisites for the successful implementation: A human resource plan is needed to address shortages of health human resources. Such a plan should address the lack of care providers in rural and remote communities and include strategies for closing the gap in wages across the province and between sectors and working towards sustainable full-time employment for workers in this sector. As more and more primary care providers do home visits, the following prerequisite is also welcome:

    • Every worker is entitled to a safe environment. When the work place is the client’s home, it is more difficult to ensure a safe environment for both the client and the care provider. Strategies and policies are needed to provide a safe workplace for home and community care providers.

    Implementing the recommendations

    The final recommendation calls for the Ministry of Health and Long-Term Care appoint Home and Community Care Implementation Co-Leads (one Co-Lead from within and one from outside of the Ministry), with appropriate support, to guide and monitor the implementation of the recommendations in this report, reporting annually to the Minister of Health and Long-Term Care.

  • “Health Care in a Time of Austerity” on TVO’s The Agenda

    Feb. 25 – On The Agenda with Steve Paikin, Claudia Mariano, Nurse Practitioner at West Durham FHT and AFHTO Board Member, appeared on the show to discuss the need for increased support for recruitment & retention in primary care. The program, “Health Care in a Time of Austerity” focused on primary care reform in a time of fiscal restraint.  Panelists discussed OMA negotiations and the government’s intentions towards team-based primary care. Panelists included:

    • Claudia Mariano, Nurse Practitioner, West Durham FHT & AFHTO Board Member
    • Dr. Rick Glazier, Institute for Clinical Evaluative Sciences
    • Adrianna Tetley, Executive Director of the Association of Ontario Health Centres
    • Dr. Ved Tandan, OMA President

    A recording of the show is posted on The Agenda’s website.

  • Ensuring access to team-based primary care

    AFHTO continues to give top priority to advocacy for increased funding to enable our members to recruit and retain the staff needed to deliver comprehensive team-based primary care. AFHTO members have been highly effective in meeting with their local MPPs to raise awareness and political pressure.  AFHTO, together with our collaborators in interprofessional primary care – AOHC and NPAO – continue to find every opportunity to press the issue, together with our recommended solution. Today, AFHTO presented to the Ontario Legislature’s Standing Committee on Finance and Economic Affairs regarding the Pre-Budget Consultations on the urgent need for sufficient funding to enable primary care organizations to attract and keep these professionals. Click here to access AFHTO’s submission.

    On February 5, AFHTO responded to a column in the Toronto Star about home and community care and the current strike by workers in 10 Community Care Access Centres – Eric Hoskins’ best chance to fix the ailing health system. Our letter emphasizes the critical role of primary care, and points out how the work of primary care teams has been grossly undervalued in relation to other parts of Ontario’s health system.

    Please continue to do your part in this campaign. Click here to access resources to help you as you meet with or write to your local MPP.

    Ontario Budget Talks portal: AFHTO members have your say and ask the government to address recruitment and retention 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 and/or vote for messages posted by your peers:

  • External evaluation report on family health teams is now available

    The Ministry of Health and Long-Term Care has released the report: An External Evaluation of the Family Health Teams (FHT) Initiative. It is a longitudinal study over the period from Dec. 2008 to November 2013, prepared by the Conference Board of Canada under contract to the ministry. AFHTO has prepared a summary of this 311-page report. The FHT evaluation report shows clear evidence of improvement over the study period, 2009-2012:

    • Patient survey data suggests the ability to get same-day appointments in FHTs ranks among the best in the world for primary care. 79% of patients reported they could get a same day appointment. This compares to 40% for Ontario (and 72% for top-performing Germany) in Health Quality Ontario’s Measuring Up report
    • FHTs are offering a wider range of programs and services to promote health and manage chronic disease. Interprofessional teams make it possible to bring together the variety of skills needed to help people stay as healthy as possible

    AFHTO welcomes this release. The FHT evaluation report provides further evidence and direction for the Ministry, AFHTO, FHTs and other primary care organizations together with their associations, on what is needed to continue to improve. We have better understanding of factors that have improved patient experience in accessing care, including strong leadership, team culture, use of patient data, and provider involvement in quality improvement activities. The most notable findings indicate that staff make the biggest difference to patient experience; however recruitment and retention of staff is particularly challenging. The FHT evaluation report’s findings reinforce those of previous AFHTO reports – below-market compensation is a problem; adequate funding is needed to solve it. Improvement continues. Since August 2013, this has been greatly assisted through government funding for Quality Improvement Decision Support (QIDS) Specialists and AFHTO’s provincial QIDS and Governance + Leadership programs. The AFHTO membership is advancing to achieve optimal quality, access and total cost of care, in line with public and patient expectations. Click below to link to further information:

  • AFHTO calls for quick action on government’s Primary Care Guarantee

    800 Primary Care Providers meet in Toronto to share best practices and push for enhanced primary care.

    Toronto, ON (October 16, 2014): The Association of Family Health Teams of Ontario (AFHTO) called for the Wynne government to take quick action to implement one of its election commitments: a guarantee that every Ontarian has access to primary care. “The evidence is in. When patients have access to high quality, team-based primary care they stay healthier longer, get sick less, and we save the health system money by staying out of hospital,” said Angie Heydon, Executive Director of AFHTO. “Evidence from around the world, and more recently in Ontario, demonstrates that the introduction of primary care teams are providing patients with better care, at the best value.” The Association’s members provide primary care in over 200 communities, serving over 3.5 million patients throughout Ontario. AFHTO announced support for the government’s election commitment to guarantee timely access to primary care in Ontario. They also rolled out several key solutions they believe will help ensure the government meets the commitment:

    • Introduce immediate measures to help primary care teams recruit and retain health care professionals like dietitians and nurse practitioners that are leaving primary care
    • Expand access to interprofessional primary care teams in the province
    • Enhance the capacity of primary care teams to measure and track patient outcomes

    The Association’s annual conference is taking place October 15 and 16 in Toronto. During the conference AFHTO also announced their third annual Bright Lights Awards, which recognize individuals for their leadership and work to improve the value of services delivered by primary care teams in Ontario. Winners were selected from over 60 submissions in a nomination process that took place in August of this year. A full list of winners can be found below. Profiles of the winners and their work are detailed here. About AFHTO: The Association of Family Health Teams of Ontario is a not for profit organization representing Ontario’s interprofessional primary care teams. AFHTO works to support the implementation and growth of primary care teams by promoting best practices, sharing lessons learned, and advocating on their behalf. Evidence and experience shows that team-based comprehensive primary care is delivering better health and better value to patients.

  • AFHTO’s 2014 Annual Report to the Members is now available

    The 2014 Annual Report gives insight into the progress of AFHTO members – family health teams and nurse practitioner-led clinics – collectively supported by their association, to move toward their shared vision. This is a vision where all Ontarians would have timely access to high-quality and comprehensive primary care, and that care is informed by the social determinants of health, delivered by collaborative teams in partnership with patients and communities, and anchored in an integrated, equitable and sustainable system. The association’s achievements are firmly grounded in AFHTO’s strategic priorities.  These priorities are squarely focused on ensuring members are supported in all the key factors required to optimize quality and value – governance and leadership, measurement and improvement, integration and support for care delivery, and the ability to recruit and retain staff. Read about the past year’s achievements in each of these strategic priorities – click on the link to go to AFHTO’s 2014 Annual Report to the Members.

  • Celebrating the 10th anniversary of Family Health Teams in Ontario

    Ten years ago the concept of “Family Health Teams” was first announced. This anniversary follows a week in which two important studies have published evidence of the value of interprofessional collaboration in Ontario’s Family Health Teams, and in interprofessional primary care models across Canada. To mark this event, the Association of Family Health Teams of Ontario received recognition in Ontario’s Legislature and issued the news release below.

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    Ontario’s Family Care Teams are Providing Better Care and Better Value to Patients March 17th – Toronto – On the 10th anniversary of the creation of Family Health Teams in Ontario, the Association of Family Health Teams of Ontario (AFHTO), proclaimed the success of team-based primary care models to enhance patient outcomes, save the province money, and improve patient and provider satisfaction. “Evidence from around the world and right here in Ontario show that when patients have access to high quality, team-based primary care that patients, providers and the health care system all benefit from improved health outcomes at a better cost,” said Angie Heydon, Executive Director of AFHTO. “As a result, we believe all patients should have access to this high standard of care in the province.” A recent Ontario study concluded that interprofessional care is resulting in:

    • Enhanced access to primary care and other health care services.
    • Improved coordination, collaboration and patient-centredness.
    • Better clinical outcomes.
    • Enhanced patient and provider satisfaction.
    • More system efficiency.
    • Decreased wait times for primary care, diagnostic testing and mental health assessments.

    AFHTO is embarking on a province-wide campaign to enlist support from MPPs of all parties in the hopes of securing broad support for the expansion and enhancement of family care teams in the province as soon as possible. “Family care teams are providing care to almost a million people who didn’t previously have a doctor. They’re keeping patients out of the emergency rooms. And they’re helping enhance disease prevention and health promotion initiatives in the province.” Remarked Keri Selkirk, AFHTO President and Executive Director of the Thames Valley Family Health Team, “We’re providing better care, and saving the province money. It just makes sense to redouble efforts to ensure that more patients are benefitting from this care.” AFHTO is a not-for-profit association representing Ontario’s family care teams, which includes Family Health Teams, Nurse Practitioner-Led Clinics, and others who provide interprofessional comprehensive primary care.