Quality Based Procedures. CIHI Health Data Users Day 2014 Chris Helyar

Transcription

1 Quality Based Procedures CIHI Health Data Users Day 2014 Chris Helyar

2 Experience with Quality Based Procedures (1) Review of HQO Clinical Handbook Development Challenges of satisfying both need for clinical guidance and funding tool Reviews of potential impacts of funding systems on hospitals and identification of opportunities to improve position Data quality improvement and optimization Enhancement of transitions to post-acute care Impacts of QBPs on post-acute services TC LHIN investment in post-acute rehab for strokes, joint replacements, and hip fractures 2

3 Rehab Beds per 1,000 Population Aged 65 and Older Large variation Toronto Central in availability Erie St. Clair of rehab beds Champlain North West per population Ontario Average across LHINs Miss. Halton Efficiency in South West HNHB acute care North East very Central West dependent on Central East South East access to Waterloo Well. post-acute Nth. Simcoe Musk. services Central

4 Experience with Quality Based Procedures (2) Review and Critique of HBAM Service Model Variation in Rates of Admission of TIA ED QBP Patients from 7.3% to 71.4% in one LHIN HBAM service model more likely to identify under-utilization if admit low intensity cases (?) What are QBF implications of admission avoidance? Comparison of Actual and Expected Admissions to Inpatient Acute Care from ED for Transient Cerebral Ischaemic Attack Diagnosis Group, CTAS (All), and Age Group (All) Admissions Admission Rate Ratio of Rank of Hospital Visits* Actual to Act. To Actual Expected Actual Expect. Expect. Expect. AHSC % 20.0% 54% 3 Large Urban % 16.6% 52% 4 AHSC % 20.8% 37% 6 Large Urban % 20.4% 95% 2 Medium Urban % 17.6% 407% 1 Medium Rural % 18.0% 41% 5 4

5 Hospitals with Highest Volume COPD ED Visits in 2012/ % to 63.1% Admitted Comparison of Actual and Expected Admissions to Inpatient Acute Care from ED for COPD Diagnosis Group, CTAS (All), and Age Group (All) Hospital Visits* Admissions Admission Rate Ratio of Actual to Actual Expected Actual Expect. Expect. Rank of Act. To Expect. Niagara HS 1, % 42.6% 99% 6 Quinte Healthcare 1, % 39.7% 73% 9 Ottawa Hospital 1, % 46.0% 111% 5 Lakeridge Health 1, % 42.8% 83% 7 Trillium Health Partners 1, % 53.0% 114% 4 London Health Sciences 1, % 48.3% 119% 3 Grey Bruce HS 1, % 35.4% 76% 8 Thunder Bay Regional 1, % 55.3% 72% 10 Hamilton HSC % 43.6% 138% 1 William Osler HC % 51.3% 123% 2 5

6 Experience with Quality Based Procedures (3) The 25 hospitals and the CCAC in the North East LHIN, in collaboration with the LHIN itself engaged Hay Group to explore the best approach to configuring the clinical services currently anticipated for QBP funding. It is hoped that this will provide a feasible and realizable plan for achieving the best practice models of care for the delivery of QBP services in the North East. The services considered in this project have been the QBP funded acute care services related to Stroke; Congestive Heart Failure; Chronic Obstructive Pulmonary Disease; Total Joint Replacement; Hip Fracture; Cataract; Vascular Surgery; Endoscopy; and Chemotherapy. 6

7 NE LHIN QBP/QBF Project Outcomes Recommended models of care for QBPs Identify roles of hospitals in each of the 4 NE LHIN Hubs Focus on Hub hospitals: Health Sciences North Manitoulin/Parry Sound/Sudbury hub Sault Area Hospital Algoma hub Timmins and District Hospital Cochrane and Coast hub North Bay Regional Health Centre Nipissing Temiskaming hub Projection of potential financial impacts of carve out and QBP revenue Identification of post-acute infrastructure to support models 7

8 Challenges Identified During NE LHIN Project Current per weighted case approach vs. future (?) per case approach Incentives under price per case approach will be very different Impacts of distances and transportation in north Feasibility of immediately transporting patients to site of definitive treatment Use of HBAM overall unit cost for carve out Stakeholder frustration that efficiencies gained in specific program not recognized via carve out Limitations in availability/access for post-acute services in north Health human resource challenges 8

9 Conclusions Positive direction, but (as always) devil is in the details Planning and funding should cover continuum Can t focus on silos Opportunity for bundles of care covering entire episode 9