Calgary Zone Pan-PCN Evaluation Working Group Dr. Bonnie Wright

Transcription

1 Calgary Zone Pan-PCN Evaluation Working Group Dr. Bonnie Wright Mosaic Primary Care Network Calgary, Alberta

2 Evaluation Working Group Evaluators from each PCN: Bow Valley, Foothills, South Calgary, Calgary West Central, Rural, Highlands, MPCN plus AHS reps Reps from AHS, new additions from KRA#6 Will be morphing into a modified EWG pursuant to operationalizing the CZ-PCN Charter Meet monthly face-to-face 2

3 Process Brought everyone together Identified ToR Adopted a framework Reviewed terms, definitions, provincial objectives, etc. Selected areas from within the framework that were a critical fit. Proceeded to operationalize the top three indicators 3

4 Three Common Indicators TNA Globally accepted indicator of access Collected from physicians practices, programs, clinics, etc. Require a minimum of one measure per month Aggregated by type of site then aggregated for all PCNs. Individual results/details remain within the PCN 4

5 MDT Functionality MDT s are the distinguishing feature of PCNs vs. physicians not attached to a PCN Tools are available to look at team function, e.g. THE Looking at reporting every 6 to 12 months Teams may or may not exist as an identifiable clinic. 5

6 Quality of Life Allows a look at service outcome collectively from the client s perspective. Particularly useful for CDM clients Two tools most common; EQ5D and SF 12 All PCNs introducing EQ5D to some extent 2 PCNs using SF12 Starting a project to assess the differences and benefits between the two tools 6

7 Going Forward Clinical Indicators next; e.g. HgbA1c done q6mo. on all diagnosed diabetics See indicators document circulated Requires panel definition and consent from each physician in each PCN working on that Would greatly benefit from SAW and the data that could be available through that venue working on that too! 7

8 FCC Performance Measurement Scott Oddie Director of Innovation and Evaluation Primary Care Innovation & Integration December 2012

9 Approach to Primary Health Care in Alberta Pressures on Primary Health Care to meet access demands and shift focus to wellness, prevention and effective CDM Family Care Clinics (FCCs) are one component of a broader transformation of the primary health care system FCCs aim to enhance quality and outcomes through the implementation of measurement 9

10 Family Care Clinic PM Objectives Manage timely access to primary health care, including same day access Provide individual and family focused, comprehensive, quality, primary health care services across the lifespan, based on population health needs Increase emphasis on health promotion, disease and injury prevention, screening, self-management, care of chronic disease and complex needs Utilize a collaborative interdisciplinary team approach working to full scope of practice within defined role Improve coordination, continuity and integration of primary health care services including effective linkages with other relevant ministries and community service providers and agencies 10

11 FCC PM Milestones February, AH and AHS collaborative working group formed and developed draft March August, 2012 FCC PM Requirements Road Show Iterative feedback from AHS provincial and zone representatives, FCCs and AH to refine Version 2 (25 indicators) to Version 20 (10 indicators) September, 2012 FCC PM Review Working Group sign Terms of Reference October, 2012 Final FCC PM Requirements approved and focus shifts to implementation 11

12 Manage timely access to primary health care, including same day access 1. Time to third next available appointment by provider type Alberta AIM Access measure & CIHI Pan-Canadian Access Indicator #32 2. Average number of extended hours (beyond 9:00 am to 5:00 pm, Monday to Friday) CIHI Pan-Canadian Indicator #31 12

13 3. % of FCC individuals responding to the following question: What would you have done if the FCC was not able to help you today? Gone to emergency Done nothing Treated myself Got family or friend advice Gone to another clinic Called HealthLink Other, specify Manage timely access to primary health care, including same day access 13

14 FCCs will be individual / family focused 4. % of FCC individuals who respond yes to care plan questions: Since you first came to the clinic, has anyone at the clinic... told you what could happen to your health with the problem you have? told you why you will need treatment or why you need to take your pills and how to take your pills? told you what tests you need to get done to check on your health problem? told you about why you should visit other health providers and how you can see other health providers? asked you what you want to do for your health problem? talked about how you could do this? 14

15 FCCs will be individual / family focused 5. % of FCC individuals who indicate that they are happy or very happy with: how much your family is involved in your care and the level of social supports in your care? with the care you get from the Family Care Clinic? 15

16 FCCs will be individual / family focused 6. % of FCC individuals who Strongly agree or somewhat agree to the following question: When you think about your health care, how much do you agree or disagree with this statement: "I receive exactly what I want and need, exactly when and how I want and need it. CAHPS 16

17 Patient experience and satisfaction are key measures for service integration and coordination quality improvement Return Visit Survey combined responses Has anyone at the clinic told/asked you (% Yes ) happen with the problem you have 75% tests you need 88% why you need treatment and how to take pills 86% visit other providers and how 49% what you want to do 68% how to do this 70% who to contact if gets worse 78% Happy with family/social supports Happy with care of FCC I get what I want and need, when and how I want and need it 88% happy or very happy 92% happy or very happy 88% somewhat or strongly agree 17

18 Primary care is connected to prevention and health promotion across the life cycle 7. % of FCC individuals, 12 years and over, who were screened by their PHC provider for the following common health risks over the past 12 months (CIHI #13): tobacco use unhealthy eating habits problem drug use physical inactivity overweight status unsafe sexual practises unmanaged stress and/or depression 18

19 Screening Each FCC will develop evidence-based clinical practice guidelines for screening AHS SCNs - Canadian Cardiovascular Harmonization of National Guidelines Endeavour (C-CHANGE) Dr. Donna Manca, Director of Research in the Department of Family Medicine, University of Alberta 19

20 Provide clinical treatment to those with chronic - complex conditions 8. For patients diagnosed with chronic disease(s): The percent of FCC individuals maintaining or improving quality of life. Allows the determination of Quality Adjusted Life Years (QALYs): examine improvements of CDM programming 20

21 Utilize a collaborative interdisciplinary team approach 9. The % of FCC teams maintaining or improving measures of key elements of healthcare team effectiveness (HTE; e.g., collaboration, continuity of care, professional development, team functioning, work satisfaction) Each FCC will report on development initiatives and measures related to key elements of HTE provider satisfaction of working to full scope 21

22 Formally enrol patients 10. Total number of current formally enrolled individuals to the FCC FCCs will support collaborations to develop and pilot voluntary formal enrolment processes 22

23 Data Set Requirements Service Event Data Broader determinants of health ethnicity, housing status, employment and income # of FCC individuals screened for: Diabetes Mellitus, Asthma, Congestive Heart Failure, COPD, Coronary Artery Disease, Hypertension, and Cancer 23

24 Next Steps Developing IMIT infrastructure to support measurement Establishing quality of life measures Defining screening guidelines Developing culture of PM to support QI initiatives Embed measurement into clinic workflow 24

25 Next Steps Developing a culture to support measurement with providers and communities 25

26 Social Determinants of Health Della: Hurdles to Health a YouTube video about Della, an Aboriginal woman with diabetes and significant challenges related to the SDH. Go to Making The Connections: Our City, Our Society, Our Health a YouTube video that describes the interconnectedness among social determinants in our community and their relationship to our health. Go to ded&v=-keqfiq11ce 26

27 Questions? 27

28 Patient Reported Outcome Measures (PROMs) in primary care Stirling Bryan, PhD Director, C2E2, VCHRI Professor, School of Population & Public Health, UBC

29 Overview PROMs primer Review of generic instruments for use in primary care Experience in using PROMs: UK, BC Using PROMs levels of decision making 2

30 PROMs some basics Self-report instruments used to obtain healthcare recipients appraisals of health outcomes that are relevant to their quality of life and well-being. Typically multidimensional address various domains of human experience, including those related to symptoms, functional status, and psychological and social wellbeing PROMs provide information about patients perspectives of their health outcomes without interpretation by a clinician or any other person. PROMs typically do not include Patient-Reported Experience Measures (PREMs) that measure satisfaction or experience with care. 3

31 What do PROMs measure? PROMIS domain framework Physical health Symptoms Function General health Mental health Affect Behaviour Cognition Social health The complete PROMIS domain framework is available at: Relationships Function 4

32 Diversity in PRO measures Diversity in PRO instruments: PROQOLID indexes 747 instruments that purportedly measure similar domains, including: generic PROMs disease-specific PROMs Diversity in PRO items: PROMs typically use multiple items to measure a domain and/or produce an overall score. It is important to carefully review the content of PRO measurement instruments. 5

33 Domain coverage* % of all items for each instrument 100% 80% 60% 40% 20% 0% Other Social Health Mental Health Physical Health Function Physical Health Symptoms General Health *Refers to the representation of domains in the pool of items. Note some instrument do not prove summary scores for individual domains. 6

34 Burden Time for Instrument Number of Items Word Count Completion (min) AQoL-8D 35 1,188 5 EQ-5D few minutes SF SF HUI3 15 1, NHP QWB-SA 80 1, WHOQOL-BREF PROMIS/GHS

35 Psychometrics general populations Instrument AQoL EQ-5D SF-36 HUI NHP QWB WHOQoL PROMIS Internal consistency + n/a +++? +/- n/a +/- +++ Reliability? +/ /- +/-??? Content validity Construct validity Cross-cultural validity Criterion validity /- +/- +/-? +/-?? +++? -? ? + +/- + +/-? +++?? +/-?????? Responsiveness /- - +/-? ++ + = Positive Evidence - = Negative Evidence +/- = Conflicting Evidence? = Unknown/Not Reported 8

36 Instrument Strengths Weaknesses AQoL Discriminates between groups with clinical variations in health. Smaller evidence base. EQ-5D SF-36 HUI NHP QWB Discriminates between groups with clinical variations in health. Top instrument in most psychometric categories. Widely used, multiple cultural contexts, and many versions available. Can distinguish between groups with clinical variations in health, and widespread use in a variety of cultural contexts. More responsive than SF-36 in populations with poor health. Widespread use in a variety of cultures. Good for capturing change in primarily healthy populations. WHOQoL Very strong cross-cultural validity. Correlated with groups with clinical variations in health. PROMIS Good internal consistency, responsiveness and correlation with other instruments. Not as comprehensive. Not sensitive to small changes, limited responsiveness in healthy populations. Lacking in mental health. Less reliability. Less responsive in populations of fairly good health. Not ideal for use in general population, or outside of populations with major health issues. Lacking on mental health, may overweight minor conditions. Smaller evidence base. Smaller evidence base. 9

37 Wright C et al (2002) Vancouver/Richmond Participants 138 surgeons and 5313 patients Procedures: cataract replacement, cholecystectomy, hysterectomy, lumbar discectomy, prostactectomy, hip replacement Self-reported health-related QoL before and after (3 months or 12 months) Measures: Generic measure: SF-36 Disease-specific instruments: e.g. VF-14 (visual function), Menorrhagia Outcomes Questionnaire, WOMAC (hip replacement) Feedback of information to surgeons 10

38 Change in VFA score ( after minus before ) Wright et al,

39 Some results Cataracts: 31% of patients booked for cataract surgery had a visual function score of at least 91 (100 = no visual impairment) Overall results positive (see figure) but 27% of patients showed either no change or deterioration. 47% of surgeons said the exercise was of little value and did not wish to continue receiving such information 12

40 English PROMs project Procedure Condition-specific Generic Primary unilateral hip replacement Oxford Hip Score EQ-5D Primary unilateral knee replacement Oxford Knee Score EQ-5D Groin hernia repair None EQ-5D Varicose veins procedures Aberdeen Varicose Vein Questionnaire EQ-5D 13

41 Browne et al,

42 Settings for PROM data collection Health research Program evaluation Quality improvement Routine care delivery Policy decision making Individual patient management Health research Program management Contexts for use of PROMs data 15