Looking Back and Looking Forward A sneak peek for the 2018/19 primary care quality improvement plans (QIPs) DANYAL MARTIN & MARGARET MILLWARD | DATE: SEPTEMBER 26, 2017
Learning Objectives • Share learnings from the 2017/18 QIPs • Prepare organizations for 2018/19 QIP submission by offering advance notice of changes • Provide an overview of Health Quality Ontario’s resources to support organizations in meeting their goals and supporting change across the system 1
Quality Matters 2
… Looking Back Provincial Results 3
Provincial Observations: Looking Forward Progress in five-day wait time: personal support for Home care complex patients (79%) Worsening in hospital readmissions (77%) Progress in medication reconciliation on admission (60%) Hospital Worsening in alternate level of care rate (54%) Progress in appropriate prescribing of Long-term antipsychotics (76%) care Worsening in falls (54%) Progress in glycated hemoglobin (HbA1C) testing (71%) Primary care Worsening patient experience: ‘enough time’ (41%) 4
Provincial Observations: Looking Forward of organizations selected at least one priority 94% indicator of organizations are working on at least one of the 84% effective transition indicators of organizations are working on at least one patient 78% experience indicator is the most common target range set for 1-5% improvement 5
Patient Engagement: Spectrum of Approaches The analysis of patient engagement approaches is structured by Health Quality Ontario’s Patient Engagement Framework, which recommends that organizations use a spectrum of engagement approaches. For brevity, the next few slides use the word “patient”; this includes patients, residents, clients, caregivers and family 6
Patient Engagement: Spectrum of Approaches Engagement is a continuum and organizations are encouraged to use a variety of methods to engage patients and their families. The approaches described to the right are more participatory. There will be overlap (e.g., councils may be deliberating or consulting). 7
Focus on QIP Development Comparing percentage of organizations reporting engaging patients and families in development of QIPs or quality initiatives over time Percentage of total organizations 70% 59% 60% 50% 40% 36% 36% 31% 30% 23% 22% 19% 20% 14% 14% 12% 9% 9% 10% 0% Hospitals Interprofessional primary care Home care Long-term care organizations Sectors 2015/16 2016/17 2017/18 8
Key Observations: Patient Engagement Overall view of spectrum of patient engagement approach in the 2017/18 QIP Narratives % of organizations reporting approach Hospital Long-term care 100% 93% Interprofessional primary care organizations 90% Home care 80% 79% 80% 74% 72% 71% 70% 66% 59% 57% 60% 50% 43% 38% 40% 36% 35% 33% 33% 30% 23% 23% 23% 23% 21% 20% 14% 14% 14% 14% 14% 12% 11% 10% 9% 9% 7% 10% 4% 4% 3% 2% 0% 0% Critical incidents Complaints process Surveys Focus groups, town Advisory Council, Engage *patients in *Patients on the *Patient advisors on *Patients involved data halls, cty mtgs etc developing QIP Board QI committees in co-design 9
Key Observations: Integration and Partnerships LHINs 61% Health Links 71% Home Hospital Care 69% Primary Care 50% 100% Primary Hospital 100% Home Care QIP Health Care QIP Links 61% RP Other Other RP PC 41% HC 21% 29% LTC LTC Primary Home Multi- 21% Care 68% Care 65% sector Behavioral QIP Supports LHINs Hospital Ontario 38% 67% 55% LTC 48% Home Hospital Other Care hospital 81% Long- PC 54% 45% Hospital term Care 12% Other QIP QIP LTC RP 19% 14% Primary Long-term care (LTC) RP Home Care LTC Regional partners (RP) Care 62% 42% 19% Most frequently external partner
Key Observations: Equity Strategies Percentage of organizations citing various equity strategies in their 2017/18 QIP Narratives Percent 60% 57% 57% 57% 52% 50% 50% 47% 47% 39% 38% 40% 36% 34% 32% 30% 29% 28% 30% 27% 25% 23% 21% 20% 20% 16% 19% 19% 20% 16% 16% 13% 10% 9% 9% 8% 8% 10% 7% 7% 6% 5% 4% 3% 2% 0% 0% 11 Hospital Long-term care Interprofessional primary care Home care
w w w . H Q O n t a r i o . c a 12
… Looking Back Primary Care Results 13
Key Observations • Increasingly speaking of working together in small collaboratives, such as the LHIN level, or ARTIC with Choosing Wisely, or Health Links groups. • Primary care learnings from strategic measurement and reporting enhancing transparency and promoting quality – Developing targets – Indicator selection • Uptake of additional indicators including Health Links and medication reconciliation 14
Working Together: Haileybury FHT: “Towards Reducing ED Visits for CTAS 4 & 5 - Role of Primary Care“ • Who was the subpopulation? Haileybury, Great Northern & Temagami FHTs, the CHC, our QIDSS and the Temiskaming Hospital focused on primary care patients who were attending the ER for non-urgent issues • What did the Haileybury FHT do? Identified Urinary Tract Infections (UTIs) were one of the top diagnosis for CTAS 4 & 5 visits. • How did the process change to support this work? Provided targeted patient education to ensure patients knew they do not require to book an appointment with their provider for urine testing/treatment • What was the outcome? CTAS 4 & % were 10% lower. UTIs are down 19% compared with the same time period last year. Percentage of rostered patients is 18% (2016/17) compared with 26% last fiscal year. Visits in Q3 of this FY are 21% lower than in Q1. 15
” Strategic measurement and reporting enhance transparency and promote quality Quality Matters: Realizing Excellent Care for All A Report by Health Quality Ontario’s System Quality Advisory Committee 16
Progress on Priority Indicators Percentage of primary care organizations in Ontario that progressed, maintained or worsened in their performance on priority indicators, compared over two years of reporting Percent 100% 5% 7% 7% 14% 90% 80% 38% 38% 70% 46% 46% 60% 4% 3% 50% 1% 40% 30% 54% 52% 46% 20% 40% 10% 0% 2016/17 (n=277) 2017/18 (n=289) 2016/17 (n=275) 2017/18 (n=287) Timely access Patient experience - involve in decisions Priority Indicator, by year 17 Progressed Maintained Worsened N/A
Same Day, Next Day Access: Rexdale CHC • Who was the subpopulation? 70% of our target panel (76%). Highly transient population leading to larger than expected attrition rate • What did the organization do? • Orientation of all new and locum providers regarding advanced access principles, • Clients are booked with their assigned provider as often as possible. • Nurses and NP's work up to their scope of practice. • How did the process change to support this work? • two new satellite clinics • successful client recall system in 2017/18 • What was the outcome? • Third Next Available rate stands at 1.5 days 18 • No Show Rates: dropped to 9.54 % from >15%.
Progress on Cancer Screening Percentage of primary care organizations in Ontario that progressed, maintained or worsened in their performance on additional indicators, compared over two years of reporting Percent 100% 5% 5% 5% 6% 90% 24% 23% 80% 35% 38% 70% 3% 6% 60% 5% 4% 50% 40% 68% 65% 30% 55% 53% 20% 10% 0% 2016/17 (n=191) 2017/18 (n=284) 2016/17 (n=184) 2017/18 (n=283) Colorectal Cancer Screening - Up to date Cervical Cancer Screening - Up to date Priority Indicator, by year 19 Progressed Maintained Worsened N/A
Uptake of Primary Care Indicators 100 150 200 250 300 50 0 Primary Care Organizations Indicator Selection for 2018/19 (n=288) 241 7 day discharge f/u PRIORITY Patient Experience-Involve in 249 decisions 264 Timely access 107 30 day readmission-HIG 150 7 day discharge f/u- notification Colorectal cancer screening up to 201 date Colorectal cancer screening 79 overdue ADDITIONAL Cervical cancer screening (42 184 months) 105 Cervical cancer screening 206 HBA1C 114 Health Link 135 Medication reconciliation 217 Colorectal combined INDICATORS COMBINED 223 Cervical combined 268 7 day discharge combined 20
Target Setting: Same Day, Next Day Survey Data Percentage of patients and clients able to see a doctor or nurse practitioner on the same day or next day in Ontario, QIP 2017/18 Percent Better Performance 100 50 th 75 th 25 th Percentile Percentile Percentile 90 80 70 Median (53) 60 50 40 30 20 10 0 Current Performance Primary Care Organizations (n=262) Range: 7% - 100% (Associated with a target) Sample size:5-6200 Target Performance 264 PCOs selected this indicator 21
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