Acknowledgements/Disclaimer

Transcription

1 Louise Nasmith University of British Columbia 1 Acknowledgements/Disclaimer Focus on Canadians with chronic health conditions Based on the Canadian Academy of Health Sciences panel assessment Transforming Care for Canadians with Chronic Health Conditions: Put People First, Expect the Best, Manage for Results 2 The Expert Panel Co Chairs: Louise Nasmith & Penny Ballem Raymond Baxter Kaiser Permanante, USA Howard Bergman Fonds de la recherche en santé du Québec David Colin Thomẻ Department of Health, United Kingdom Carol Herbert University of Western Ontario Nora Keating University of Alberta Richard Lessard Agence de la santé et des services sociaux de Montréal Renee Lyons Bridgepoint Health and University of Toronto Dale McMurchy Dale McMurchy Consulting Pamela Ratner University of British Columbia Peter Rosenbaum McMaster University Robyn Tamblyn McGill University Ed Wagner MacColl Institute for Healthcare Innovation, USA Brenda Zimmerman York University 1

2 Context: The Canadian Health System & Chronic Disease The basic premise: that the health system needs transformation to better meet the needs of the millions of Canadians who have one or more chronic diseases. Morbidity: 16M Cdns live with chronic disease Health of Communities and Quality of Life: especially for poorest Canadians Inefficiencies: 60% of hospitalizations are due to chronic disease. Access to Care: 76% of people with breast cancer, versus 45% of people with diabetes receive the recommended care Economic Impact:if trend continues, ON Ministry of Health expenditures could make up 80% of total government program spending by 2030 Tensions: Canadian Health Care System Half of physicians work in primary care, where most visits relate to CD Resources of system focused on acute care and diseasefocused Regionalization of health services in most parts of the country, enabling population p need based planning Universal access to health services =shared value Innovations in primary care are underway in a number of jurisdictions across Canada. Health system primarily reactive to patient crisis, not proactive to population needs. People in poor communities have higher CD and lower life expectancy No universal EHR to support integration. Tensions: Canadian Health Care System Multiple statutory roles with responsibility for quality of care and protecting public interest Weak accountability for health outcomes of patients living with chronic illness. Canada internationally recognized as a leader in tobacco control and other health promotion initiatives. Increasing move to collaborative practice and inter professional education.. Rate of daily tobacco smoking among aboriginal populations is more than double that of the general population. Health system largely siloed health disciplines and single diseases/organs 2

3 Canada: Current Status 15% of Canadians do not have a family physician High utilization rates of ER by patients with chronic health conditions Long wait times to access specialty care Predominant FFS payment method for physicians Lowest rate of training in QI among primary care physicians 7 Canada: Current Status Pharmaceutical management processes vary widely across jurisdictions Canada has EHR infrastructure for 50% of Canadians but only ~40% of physicians use an EMR Less than 50% of the population have access to primary care teams Little investment in patient self management Focus on diseases not patients 8 What would success look like? If we were building a health care system today from scratch, it would be structured much differently from the one we now have and might be less expensive. The system would rely less on hospitals and doctors and would provide a broader range of community based services, delivered by multidisciplinary teams with a much stronger emphasis on prevention. We would also have much better information linking interventions and health outcomes. (National Forum on Health, 1997) 3

4 Inter and Intraprofessional Models Primary Care Networks (PCNs) Family Health Teams in Ontario RACE in BC Expanded scope of practice for pharmacists 10 Quality Improvement Canadian Working Group for Primary Care Improvement (CHSRF) Saskatchewan Health Quality Council Quality Improvement and Innovation Partnership (QIP) in Ontario 11 Education IPE initiatives across the country Patient s Voice project at UBC AIPHE FMEC UG & PG 12 4

5 Self Management MyOscar and PHR Chronic Diseases Self Management Program 13 Health Information Drug Information Systems Sault Ste. Marie Group Health Centre Alberta provincial system 14 Research Bridgepoint Collaboratory for Research and Innovation in Complex Chronic Disease Canadian Strategy on Patient Oriented Research 15 5

6 Now What? We know where we are still lagging behind. We have good models to build on How can we make these mainstream? 16 Overarching Recommendation What needs to happen? Enable all people with chronic health conditions to have access to a system of care with a specific clinician or team of clinicians who are responsible for providing their primary care and for coordinating care with acute, specialty, and community services throughout their life spans 17 Enabling Recommendations Aligning system funding and provider remuneration with desired health outcomes; Ensuring that quality drives system performance; Creating a culture of lifelong education and learning for healthcare providers; Supporting self management as part of everyone s care; Using health information effectively and efficiently; Conducting research that supports optimal care and improved outcomes. 18 6

7 Strategy for Transforming Care for Canadians with Chronic Health Conditions 19 Core Principles Focus on patients not diseases Ensure equitable access Use population health data Create a culture of CQI 20 linked by functioning EHR to other sectors have access to data; used for CQI are patient not disease focused serve as educational hubs serve as research hubs for complex patients, complex care (multimorbidity) 21 7

8 Linked by functioning EHR to other sectors invest in implementation of EMRs across community and acute care sectors access to population health data 22 Have access to data; used for CQI link family physicians and consultant specialists into regional structures (accountability) create CQI programs that are population outcomes based and feedback to practice performance 23 Are patientnotdisease focused Are patient not disease focused remuneration for primary care providers linked to whole patient indicators consultants paid to be available and on site flexible payment models for other team members move resources out of hospitals and cluster in primary care practices 24 8

9 Serve as educational hubs new pedagogic models to teach interprofessionally new payment schemes for teaching explicit teaching about IPC, CQI and patient vs disease focused care 25 Serve asresearch hubsfor complex patients, complex care (multimorbidity) build research capacity at the coal face CIHR funding for multimorbidity good models of care 26 Who is responsible? 27 9

10 Strategy for Transforming Care for Canadians with Chronic Health Conditions 28 Core direction for healthcare system transformation in Canada Put people first We need system wide changes to focus on and to further engage people and their family or friend caregivers who want and need to be partners in their care. Clinicians need to be involved in changing and continuously improving the system. Expect the best We know what is needed. Many examples of innovative services and systems already exist. We need to learn from and, where possible, to build on these pockets of excellence so that all areas in Canada can expect the best health services. Manage for results We need to consistently monitor what we are doing so that we know what to change. We need to learn from our mistakes and near misses as well as from our successes. 29 For more information Visit: acss.ca to access summary document and the full report 30 10