Concurrent session III: Performance measurement and innovations in practice

Friday, March 10, 11:00 am – 12:00 pm
Salon C
Chair: Ruth Lavergne

Performance measurement in primary health care: EMR as an emerging data source

Presenting author: Mary Byrnes, Canadian Institute for Health Information

Co-authors: Charisa Flach, Tanya Khan

There is currently a gap in pan-Canadian primary health care (PHC) data and this has posed a challenge in measuring performance and outcomes of various aspects of PHC, including reform efforts. Improving the availability of high quality PHC data will help to support comparative performance measurement across Canadian jurisdictions.
CIHI has collaborated with PHC partners in Ontario to undertake two demonstration projects piloting different aspects of CIHI’s PHC Electronic Medical Record (EMR) Content Standard. This presentation will highlight key learnings from the demonstration projects and, in this context, discuss opportunities in using EMR data to measure PHC performance.
In 2015, demonstration projects were initiated with two PHC organizations in Ontario. One project was with the Association of Ontario Health Centres (AOHC) and the other was with the Centre for Family Medicine Family Health Team (CFFM) and the Connecting South West Ontario (cSWO) Program. Each project included an evaluation component which explored the impact of implementing the Content Standard on data collection (including clinician change management), data quality and the ability to calculate PHC indicators.

Key findings are as follows:

  • Both project partners were able to extract and submit usable EMR data for analysis regardless of the implementation approach and despite the varying project challenges.
  • The front-end point-of-care implementation approach emphasized a strong need for clinician change management and education.
  • Further vendor engagement may facilitate more efficient problem-solving and minimize challenges related to data extraction.
  • Using the PHC EMR CS improved data structure by increasing the number of standardized records.
  • Structured data decreased the time and resources required to analyze EMR data for calculating performance measures.
  • There was high interest in practice profile and clinical indicators. However, more refined technical specifications and longer period of data collection are required to derive benefit for performance measurement.

Continued progress in EMR data standardization efforts through the PHC EMR CS will help to fill the PHC data gap. In turn, higher-quality data will enhance comparative PHC performance measurement across Canadian jurisdictions and may potentially support evaluation of PHC reform initiatives in the longer-term.


Exploring opportunities to delay or avoid admission to residential care

Presenting author: Kim Nuernberger, Canadian Institute for Health Information

Co-authors: Steve Atkinson, Brandon Wagar, Jacqueline Gregory

Objectives: The objective of this study was to discover factors that influenced admission to residential care and identify opportunities to delay or avoid admission to residential care.

Approach: In consultation with a working group comprised of health care system professionals, CIHI’s Seniors in Transition project examined seniors (age 65+) newly entering the publicly funded continuing care system across 35 health regions in Ontario, Manitoba, Saskatchewan, Alberta, British Columbia and Yukon, and linked 3 years of data (2012-13 to 2014-15) from CIHI’s HCRS, CCRS, DAD and OHMRS databases. Initial care setting (home and community care relative to residential care), subsequent transitions in care and the role of hospitalization in initial setting and transitions were examined to identify factors that influenced admission to residential care and opportunities to delay or avoid admission to residential care.

Results: Hospitalization, living alone, cognitive and functional impairment, and wandering were associated with an increased likelihood of residential care relative to remaining at home. Overall, one third of seniors admitted to residential care may have been maintained in the community with appropriate supports. Those with moderate or higher needs were significantly more likely to be admitted to residential care if the initial assessment took place in hospital rather than a community environment.

Conclusion: A better understanding of factors associated with residential care placement, as well as increased integration and alignment between hospital and continuing care policies and practices could contribute to ensuring that community-based services are available to meet the needs of seniors now and into the future.


Cognitive behaviour therapy (CBT) skills group medical visits successful in enhancing mental health care in primary care

Presenting author: Christine Tomori, Victoria Division of Family Practice and Island Health

Co-authors: Joanna Cheek, Erin Burrell

The Shared Care Committee and the Victoria Division of Family Practice are funding local psychiatrists and family physicians to pilot a program utilizing publicly funded Group Medical Visits in order to provide self-management skills training for mental health, a previously inaccessible service for patients with mild to moderate anxiety and depression in primary care.

Consultations with psychiatrists, family physicians, and patients have highlighted family physician’s lack of capacity and comfort in serving mental health patients and limitations in primary care fee codes to treat mental health patients effectively and efficiently on an individual basis. Additionally, there is a challenge of accessing behavioural interventions for patients with mild-moderate concerns, other than self-help or private pay resources. The purpose of the pilot is to (1) evaluate the possibility of providing timely, publicly funded, cognitive-behaviour-therapy (CBT) -based treatment in group format for patients in primary care; (2) develop partnerships and collaboration between family physicians and psychiatrists to facilitate the intervention, building capacity among family physicians to continue this service, (3) develop manuals and other materials to support sustainability of the service and potential spread of the model; and (4) establish a community-wide referral centre to ensure full-capacity groups and, thus, provider feasibility. The groups are comprised of 15 patients; Part 1 involves an 8-week series co-facilitated by family doctors and psychiatrists and Part 2 has family physicians facilitating their own CBT Skills Groups.

The pilot been successful over the first year of evaluation. A small group of physicians have supported over 800 patients, with high satisfaction ratings from both patients and referring physicians. Patient symptoms have shown statistically significant improvements on three outcome measures. Most patients improved from moderate severity of illness to mild or remitted over the 8-week program (large effect sizes). Referring physicians have reported decreased need for more intensive psychiatric referrals and medications, and have described patient empowerment and improved social and occupational functioning. The program will continue indefinitely in the Victoria area and opportunities for spread are being explored.


Audit and feedback in primary care: Ontario’s lessons learned

Presenting author: Jonathan Lam, Health Quality Ontario

Co-authors: Wissam Haj-Ali, Chloe Sherr, Tina Obwanga, Maria Krahn, Stephanie Lagoski, Gail Dobell, Dave Zago

This presentation will outline the challenges and lessons learned in the development and evolution of the Primary Care Practice Reports since their inception in 2014.

Health Quality Ontario provides audit and feedback reports (the Primary Care Practice Reports) to over 800 primary care physicians and 200 primary care organization administrators about their practice. Audit and feedback is the provision of data over time to enable self-assessment of clinical performance, and has been shown to be an effective intervention in improving care processes. The Primary Care Practice Reports include practice level data, ranging from diabetes management to health services utilization indicators, as well as relevant change ideas that can be used by physicians to drive quality improvement. The reports also include comparators at the provincial and regional levels.

Health Quality Ontario is continually evolving these reports in an effort to incorporate the best available evidence in the audit and feedback literature and input from physician end users, experts in audit and feedback science, and other relevant stakeholders (e.g., primary care organization administrators, quality improvement specialists). This presentation will share Ontario’s lessons learned since the 2014 program launch, describe primary care physician engagement in the process, types of feedback received from report users, evolution of the program and opportunities for further report enhancement.