CIHR Institute of Health Services and Policy Research UBC CHSPR - - PowerPoint PPT Presentation

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CIHR Institute of Health Services and Policy Research UBC CHSPR - - PowerPoint PPT Presentation

Sep 23, 2022 16 likes •250 views

The Science of Performance Measurement: Next Frontiers in Research Robyn Tamblyn Scientific Director CIHR Institute of Health Services and Policy Research UBC CHSPR Conference: Performance Anxiety February 25, 2014 2 Societys Expectations

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The Science of Performance Measurement: Next Frontiers in Research

Robyn Tamblyn Scientific Director CIHR Institute of Health Services and Policy Research

UBC CHSPR Conference: Performance Anxiety February 25, 2014

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Society’s Expectations

Optimal Course Possible for Condition X, Y Natural Course Health Status Time Effect of Health care Adverse effects

  • f treatment

Contribution Of Health Research

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Best Case Scenario: Optimal Course with Low Variability in Outcomes for Equivalent Resources

Optimal Course Possible Natural Course Health Status Time High performing system

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Poorly Performing System: High Variability in Expected Output for Equivalent Resources

Optimal Course Possible Natural Course Health Status Time Great, Good, No Impact, Unsafe

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Moving the Dial on Health: Early Wins Focus on Common Problems with Big Intervention Effects

Optimal Course Natural Course

Health Status Time

Effect of Health care Adverse effects

  • f treatment

Optimal Course , Natural Course

Health Status Time

Adverse effects

  • f treatment

Targets for Health System/ Provider Performance Targets for Biomedical/ Social/ Epigenetic Discovery

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What’s In the Secret Sauce to Op Optimi timize ze Sy Syst stem em Per erforma

  • rmance

nce

Measurement, Feedback, Incentives Effective Interventions Organization of People, Programs, Policies to Deliver Effective Interventions

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Interventions Health Policies Programs

Towards Evidence-Based Policies, Programs, & Interventions

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Interventions Health Policies Programs

Non-Evidence-Based Quality Process Measures Can Cause Harm

Infant Positioning  SIDS Hormone Replacement  MI/Stroke O2 for Premies Retrolental Fibroplasia

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Interventions Health Policies Programs

Towards Evidence-Based Policies & Programs

Weak Links

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Impr proving ing Acce cess ss to P Pri rimary mary Care re

Case study: Primary health care reform in Ontario

  • ~$1B/year for patient rostering,

interdisciplinary care teams, blended payment models, bonus payments and incentives (for screening, prevention, etc.)

  • penalty for utilization outside the group

practice

  • The result?

Glazier et al. All the Right Intentions but Few of the Desired Results: Lessons on Access to Primary Care from Ontario's Patient Enrolment Models. Healthcare Quarterly 2012; 15(3)

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No Change ge In Access ss to Primary mary Care or ED Use Are there Missin ssing g Ingred edients? ients? Are these se Process ess Measu sures res Approp

  • priate

riate?

Glazier et al. All the Right Intentions but Few of the Desired Results: Lessons on Access to Primary Care from Ontario's Patient Enrolment Models. Healthcare Quarterly 2012; 15(3)

“Many patients continue to be without timely access to care, and the use of walk-in clinics and emergency departments remains high…the details of how incentives are structured matters.”

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Restructuring the Care Team: Reduction in Mortality/Disability with Stroke Programs vs tPA

Systematic Review tPA: Cochrane, 2010

BETT

Stroke Units vs. Usual Care tPA vs. Usual Care 15.8%

New Protocol for Stroke Mortality,

  • Disability. Gandey, A. (2011). Lancet.

4.9%

Absolute Reduction in Mortality/ Disability WORSE BETTER WORSE BETTER

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Re-Designing Pre-Hospital Emergency Care

  • “The Golden Hour”
  • Improved survival in

trauma cases

  • Trained healthcare

professionals to work specifically in emergency medical situations

– Ex: Paramedics

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Impact of Re-Designing Pre-Hospital Care in Trauma Cases

The importance of pre-trauma centre treatment of life-threatening events on the mortality of patients transferred with severe trauma. Gomes et al., 2010.

Patients were more likely to survive when their life-threatening events were managed in the pre-hospital phase.

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Re-engineering the Continuum of Care for Hip and Knee Replacement

Primary Care & Referral Pre-surgery Surgery Post-surgery

  • Referral template
  • Surgeon access
  • Benchmark/monitor
  • Centralize intake
  • Case manager
  • Patient buddies
  • Standard treatment
  • Dedicated OR team
  • Benchmark/monitor
  • Standardize rehab
  • Monitor outcomes

The Alberta hip and knee replacement project: Comparative effectiveness of clinical pathways. Gooch, K.L. et al. (2009).

33 33.5 34 34.5 35 35.5 36 36.5 37 37.5 38 Intervention Control

Change in WOMAC Arthritis Index

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Raising ising the Bar: r: Ne New Ge Gener eration ation Learning rning Health lth Care re Sy System em

Optimal Course Possible for Condition X, Y Natural Course Health Status Time The Learning Health System Effect of Health care Adverse effects

  • f treatment
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Representative timeline of a patient’s experience in the health care system

Source: Best care at lower cost: the path to continuously learning health care in America. Institute of Medicine, 2012

Analytics

Evidence – on – the - Go

Policy

LEADERSHIP CITIZEN ENGAGEMENT

International comparisons

The he Lear arning ning Heal alth th Sys ystem: tem: Tac ackli ling ng the he Tou

  • ugh

gh Pop

  • pulations

lations

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Clinical Data Research Networks (CDRNs): system- based networks that originate in healthcare systems, such as hospitals, health plans, or practice-based networks, and securely collect health information during the routine course of patient care Patient-Powered Research Networks (PPRNs): networks

  • perated and governed by

groups of patients and their partners and are focused on a particular condition and interested in sharing health information and participating in research

Changing the Health Systems Research Paradigm by Building the Living Laboratory: PCORI

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The Canadian Innovation Teams in Community-Based Primary Care

Audas Grunfeld Harris Kaczorowski Katz Haggerty Liddy Ploeg Stewart Wodchis Wong Young LEGEND

Performance measurement & reporting Accessing child/youth mental health services Community- based cancer care along the continuum Transforming Indigenous PHC delivery Transforming PHC in the remote North Improving PHC for

  • lder adults with

complex care needs Patient-centred innovations for persons with multimorbidity Community-based approaches for

  • lder adults and

their caregivers PHC for persons living with HIV/AIDs Chronic disease awareness & management Organisational innovations to improve access to PHC for vulnerable groups Transforming PHC in First Nations & rural/remote communities

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Spotlight

  • tlight: Tran

ansform sforming ing Comm mmunity nity-Based Based Prim imary ary Car are deli live very ry thr hrough

  • ugh performance

formance meas asur urement ement

Canadian NPI: Sabrina Wong (University of British Columbia) Funding Partners: CIHR & MSFHR The challenge: A comprehensive performance portrait of primary health care in Canada is lacking, and comparisons across jurisdictions are challenging. The goal: Demonstrate the feasibility and usefulness of comparative and comprehensive CBPHC performance measurement and reporting in three provinces as a foundation to inform innovation in the delivery and organization of the Canadian CBPHC system.

We will help make Canada a leader in evaluating the effectiveness of CBPHC innovations.

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Underst rstanding nding Attribut butes es of Contex ext, , Organiz nizatio tion n & Researc search h In Invest estment ment wi with th a C Commo mmon n Set t of In Indicators ators

CBPHC Innovation Teams are working together to identify and report on a common set of context and outcome indicators (in domain areas like access, health outcomes, equity, cost). Why:

  • To understand the impact of different models of CBPHC on (1)

access to care for vulnerable populations and (2) chronic disease prevention and management

  • To understand how structures (e.g., governance, financing) and

context influence the success of PHC models of care How:

  • Working group chaired by Dr. Sabrina Wong. Each team earmarked

$50K annually to support the common set of indicators.

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Network of Networks in Primary and Integrated Health Care Innovations

AB Network SK Network MB Network ON Network QC Network Maritimes Support Unit Newfoundland and Labrador Support Unit BC Support Unit BC Network AB Support Unit SK Support Unit MB Support Unit ON Support Unit QC Support Unit NS Network Newfoundland and Labrador Network Network Leadership Council Network Coordinating Centre NWT Network Nunavut Network Yukon Network Yukon Support Unit NWT Support Unit Nunavut Support Unit NB Network PEI Network

SPOR OR Net etwo work rk of N f Net etwo works rks in in Pr Prim imary ary an and d In Inte tegrated ated He Heal alth th Ca Care e In Inno novations ations

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Thank ank you

  • u

Robyn Tamblyn Scientific Director CIHR Institute of Health Services and Policy Research rtamblyn.ihspr@mcgill.ca