Presentation to the Quality Forum February 28, 2014 SSC Co-Chairs: - - PowerPoint PPT Presentation

Presentation to the Quality Forum

February 28, 2014

SSC Co-Chairs:

• Dr. Sean Virani, Doctors of BC

Kelly McQuillen, Ministry of Health www.sscbc.ca

 To facilitate collaboration with the Government of

BC, Doctors of BC and the Health Authorities on the delivery of specialist services, and to support the improvement of the specialist care system.

SSC Mandate:

Ministry of Health Doctors of BC Kelly McQuillen (co-chair)

• Dr. Sean Virani (co-chair)

Jeremy Higgs

• Dr. Ken Seethram

Kevin Brown

• Dr. Gordon Hoag
• Dr. Ian Courtice

Health Authorities * Dr. Andrew Attwell

• Dr. Taj Baidwan (Island Health)

* Dr. Ahmer Karimuddin * Dr. Patrick O’Connor/ * Dr. Brenda Wagner (VCH) * Dr. Ken Hughes * Dr. Ron Chapman (NHA) * Dr. Steve Gray (PHSA) * Dr. Alan Stewart (IHA) * Dr. Roy Morton (FHA) * Alternates

Committee Members:

• Improving the patient and provider experience of care.
• Improving the health of populations.
• Reducing the per capita cost of health care.

IHI Triple Aim

 2013/14 MOH Health Program Spending (est.)1

68% ($11.12 billion) on Regional Services 24% ($3.98 billion) on MSP 7% ($1.18 billion) on Pharmacare

 BC Physicians2 ranked the following as most important in

terms of needing support and action:

#1: Quality and Patient Safety #2: Ensuring Physician Consultation #3: Adequate Resources and Access for Patients

1 Ministry of Health, Revised 2013/14 - 2015/16 Service Plan 2 BCMA Membership Survey, April 2012

Context

 Supporting physicians to engage in quality and help lead

improvements to patient care and to health system.

 Objectives:

 Improve physician engagement and coordination between

physicians and health authorities,

 Support specialists to deliver timely and valued patient

care, and

 Support the pursuit of quality improvement in the health

system, based on partnership between physicians and health authorities.

Quality & Innovation Strategy

SSC Work Plan

 Engage and improve relationships between specialists,

health authorities, and other partners

 Work with physicians and health authorities to jointly

identify opportunities to make system improvements, with SSC support and funding.

 Local, regional and provincial consultation to confirm

priorities for SSC strategic plan to support improved health system coordination and integration

 Improve on existing SSC initiatives:  Programs: Health authority system redesign

participation, Practice support, Leadership training scholarships

 Fees: Telephone Advice, Patient Telephone

Management, Group Medical Visits, Discharge Care Planning, Advance Care Planning, and section specific Labour Market Fees

 Implement specialist's role in prevention (via brief

interventions to address smoking, alcohol and obesity)

 Offer training in leadership, quality improvement & clinical

skills enhancement (e.g., mentoring, sub-specialist advice)

 Fund and support local Quality and Innovation initiatives,

and spread best practices and approaches provincially though collaboratives and pathway development

 Fund specialists to address care caps and provide

coordination and multidisciplinary care for patients with complex & longitudinal care needs

 Provide quality improvement infrastructure and resources

provincially, regionally and locally.

 Support specialists to lead quality improvement initiatives

with QI methodology and data analytical support.

 Leverage and bolster existing infrastructure and expertise

• f collaborative committees (Practice Support Program),

and within health authorities, the Quality Council and

• ther partners.

Quality Improvement Support

System Change:

 Pooled patient referrals & ’first available surgeon’ models  Provincial hip fracture care redesign  Enhanced Recovery After Surgery (ERAS)

Multidisciplinary Care:

 Cancer survivorship program  Young adults with chronic health conditions and disabilities

transitioning out of tertiary paediatric care

 Integration of allied health providers and multidisciplinary clinics

IT/EMR Initiatives:

 Electronic tracking and reporting of wait times and surgical

booking systems through surgeon EMRs

 Expand Telehealth for cardiology, wound care & mental health  Adopt Computerized Physician Order Entry (clinical decision

support)

Current Quality & Innovation Project Examples

RebalanceMD Multidisciplinary Orthopedic Clinic (Victoria)

Enhanced Recovery After Surgery (ERAS)

• Interior Health

 Trial at Kelowna General Hospital to implement ERAS

pathway for colorectal surgery patients:

 LOS reduced from 12.8 to 4 days,  Cost per case reduced from approximately $16,000 to

$8000.

 With funding and support of SSC and Interior Health,

ERAS is now being implemented at 8 sites in IHA

 To scale up change, SSC is also establishing a provincial

Collaborative to standardize ERAS provincial pathway for participating sites in each HA.

Evaluation of SSC Initiatives

 In 2011 SSC began evaluating initiatives launched in

2010, including the telephone advice fees.

 In 2014 SSC will complete evaluation of other initiatives

(e.g., discharge care planning, advance care planning, health authority system redesign, leadership scholarship)

 All SSC initiatives going-forward will have evaluation

component to measure level of achievement towards IHI Triple Aim.

Evaluation of Telephone Advice Fees

Agree Base 2011: All GPs (n=537)

In 2011, GPs were asked on their views on how the specialist telephone advice fees have helped GPs

2011, Ipsos Reid, SSC Midterm Evaluation Survey

“Phone advice is very helpful, particularly in hospitals that serve a large geographic area. Our members have been able to provide advice to physicians in smaller communities and in many cases prevented unnecessary transfers of patients to the regional hospital. The telephone consultations have also served a significant role in enhancing physician-physician communication. On the whole, the telephone fees were utilized widely by members of our section with a significant benefit to patient care.”

• Section of General Surgery, 2011

Feedback on telephone advice fees

“On behalf of Northern Health, I would like to express our sincere gratitude for the generous support provided by the tripartite service committees (SSC, SCC, and GPSC). This support is critical to involving physicians in quality improvement redesign activities, which in turn, ensures that these initiatives are enhanced by the creativity and expertise of general practitioners and specialist physicians.”

• Northern Heath Authority, 2011

Feedback on health authority system redesign funding

 GMV for colonoscopy patients in FHA:  Patients in GMVs seen 4-5 months sooner compared

to one-on-one appointment.

 100% patient satisfaction (patient survey results)

“This is an invasive procedure. Having the surgeon and endoscopy nurse educate the patients [in a group] about the procedure seems to diminish any lingering anxiety patients might have.” - Dr. Cowie, Surgeon

Feedback on Group Medical Visit fees

$15 million Quality & Innovation Fund

 Expression of Interest launch in April 2014  Generate ideas and collaboration between specialists

and health authorities

 Advance strategic priorities of Ministry of Health and

Doctors of BC

 Funding to support specialist-led quality improvement

prototypes, projects, and initiatives to address patient care gaps

New SSC Initiatives

Provincial Enhanced Recovery After Surgery (ERAS) Collaborative Surgical Improvement Pooled Patient Referrals/First Available Specialist

New SSC Initiatives

 Engagement of specialists and improving the relationship

and coordination between physicians and health authorities is a key objective to achieving better patient care and ensuring value for taxpayer dollars.

 This objective requires a cultural shift of both physicians

and those that fund and administer the system to work collaboratively to align focus on the common goal of improving patient care.

 The role of the SSC and the other collaborative

committees is to help build better partnerships and integration within the health system to achieve this goal.

Summary

Questions?