Building Performance Measurement Capacity in PHC Clinical Practice. Patricia Sullivan-Taylor Dr. Henry Siu May 29, 2013

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1 Building Performance Measurement Capacity in PHC Clinical Practice Patricia Sullivan-Taylor Dr. Henry Siu May 29,

2 Presenter Disclosure Speaker: Patricia Sullivan-Taylor Canadian Institute for Health Information Relationships with commercial interests: Nothing to disclose 2

3 Presenter Disclosure Speaker: Dr. Henry Siu Stonechurch Family Health Centre McMaster University-Ontario Relationships with commercial interests: Nothing to disclose 3

4 Presentation Outline Purpose Methodology Findings Conclusion

5 Key Messages CIHI is building PHC performance measurement capacity with clinicians and ministries This includes pan-canadian PHC indicators, EMR standards, survey tools and supporting EMR data collection and feedback reporting through the Voluntary Reporting System (PHC VRS) Clinicians are using these tools to understand performance and improve quality in practice 5

6 Objectives Share an approach and tools used by clinicians to build performance measurement capacity in ~ 50 PHC practices in Canada Identify key enablers and barriers to support quality improvement initiatives within primary health care 6

7 Methodology Using EMR data and PHC VRS tools, primary health care clinicians are building performance measurement capacity: Tools include: CIHI s Clinician Quality Feedback Tools Ask clinically relevant questions Assess quality care dimensions Confirm EMR data validity Deming s Plan, Do, Study and Act (PDSA) cycle 7

8 Clinician Practice Quality Tools Improving EMR Data Availability Patient Centric Provider Feedback Report (PCR) (comparative reports) Quality Management Improvement Compass (QMIC) (interactive e-tool) Continuous Quality Care Improvement Practice Management supports Outcome Trend Analysis Patient Self- Management Population-based Planning Complementary reports that improve understanding of relevant information on patient groups as well as individuals 8

9 Care coordination and EMR Data Ask Clinically Relevant Questions Patients with diabetes, hypertension and CAD with LDL > 2.0 and BP> 140/90 mmhg BMI > 30 and need a referral Patients have > 3 comorbidities and visits to PHC Referral to a specialist or a nutritionist Accuracy Relevance Validity Comprehensive Comparability Useability 9

10 Findings 10

11 Clinician Use Preventive Care-Chronic Disease Management Clinicians pursued a focus on preventive care and chronic disease management using PDSA cycle: Measure Time 1 Practice % Time 2 Practice % Time 3 Practice % PHC VRS % A1C <7 % Diabetic patients A1C> 9 % Diabetic patients BP > 130/80 Diabetic patients BP > 140/90 Hypertensive and CAD patients Reporting Period Time 1: 01JUL JUL2012 Time 2: 01OCT OCT2012 Time 3: 01JAN JAN2013 Shared with permission of Dr. Siu 11

12 Health Service Use Multi-morbidity Time 1 Practice % Time 2 Practice % Time 3 Practice % PHC VRS % Health Service Use (Encounters in Previous Year) No chronic conditions 1 chronic conditions 2 chronic conditions 3 chronic conditions Patients with 3+ chronic conditions tend to be high users What is the percent of patients with complex care needs Reporting Period Time 1: 01JUL JUL2012 Time 2: 01OCT OCT2012 Time 3: 01JAN JAN2013 Shared with permission of Dr. Siu 12

13 Clinician s Use of PHC VRS Report 1. Implementation of a group medical visit model for diabetes care P: Develop a group medical visit model for delivering diabetes care D: Implement group medical visit, collect outcome measures including A1c, blood pressures, etc. S: Study data, and identify facilitators and barriers A: Adjust group medical visit model in order to address barriers and facilitators 2. Increase patient recall to improve immunization rate P: Generate list of all patients between 0-6 that are not completely immunized, establish outcome measures and methods D: Call parents and invite them for Catch up clinics, generate immunization reports after clinics for each age group S: Look for facilitators and barriers to Catch up clinics A: Adjust methods according to facilitators and barriers 13

14 Clinician s Response to Findings 3. Chart audit to determine reasons for complex patient usage Retroactively determine those patients that are high users Review charts for the past year to determine reason for the multiple visits Identify themes common amongst different patients Target new strategies to address these themes 4. Developing smoking cessation programs to males, 65-74, with COPD Right away, notice that data completeness is lacking for patients who are smokers, and are diagnosed with COPD Recognize that before a large scale program can be designed, more rigorous care is needed to inputting smoking status and COPD status during routine visits New clinic wide policies are put into place to ensure all clinicians input smoking and COPD status 14

15 PHC VRS Clinician Practice Quality Tools Enable Answer Inform Better clinically Review data data relevant reports quality capture questions Influence complete data extraction Narrow questions to quality improvement initiatives Choose from 11 quality dimensions (e.g., Patient Centric Report) Peer collaboration Learning culture Leadership Use consistent clinical terms and structured data Refer to PHC EMR Content Standards Meaningful use of EMR data to inform patient care, quality improvement and practice management Quality measurement is a critical lever to improve quality of care 15

16 EMR Data Quality: Challenges and Solutions Challenges Non-standardized, text-based data Duplicate and uncommon terms Character recognition absent Scanned documents/ images Solutions at Point of Care Collaborate with peers to form consensus Common clinical terms Consistent data recording practices Ensure spell-check Utilize existing EMR features to capture actual diagnoses (i.e., Disease Registry)

17 Conclusion PHC performance measurement and quality initiatives can be improved with structured and standard data practices CIHI is collaborating with clinicians and ministries to support PHC performance measurement through indicators, standards, survey tools, and EMR data collection and feedback reporting 17

18 For more information please contact: Patricia Sullivan-Taylor Dr. Henry Siu 18

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