Primary Health Care The foundation of our health care system

Transcription

1 Primary Health Care The foundation of our health care system October, 2015 Lynn Edwards Dr. Tara Sampalli

2 National and Local Context PRIMARY HEALTH CARE

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4 How PHC has Evolved in Canada Late 1990s Recognition PHC is critical to health system 2000 Primary Health Care Transition Fund 2002 Romanow Report 2008 Reports on PHCTF released with status of progress 2015 Pockets of innovation across the country; no consistent vision or approach nationally Increasing evidence that PHC is cost-effective, improves health outcomes, and addresses the social determinants of health (Hutchison, 2008; Barclay & Fletcher, 2010)

5 Canadian Perspective Various models of PHC organization exist across Canada wide variety of governance and leadership models, payment and funding mechanisms, and level of provincial direction Key theme: Local geographic networks & interprofessional team development Primary Care Networks Alberta, Manitoba, and PEI Family Health Teams in Ontario and New Brunswick Divisions of Family Practice and Integrated Health Teams in British Columbia Family Medicine Groups in Quebec Wide scope of providers in practice: nurse practitioners, family practice and chronic disease nurses, physician assistants, pharmacists, dietitians, social workers, etc Variety of funding models for physicians

6 What do our citizens tell us is important? Accessibility Continuity (management, relational) and coordination Interpersonal communication & trust Health promotion Impact of care Local health priorities Haggerty, J. (2011) Measurement of PHC attributes from a patient perspective; Wong & Haggerty (2013) Measuring Patient Experiences in PHC

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8 Our Vision Healthy people, healthy communities for generations

9 Our People at a Glance Employees: (unionized and non-unionized): 23,400+ Physicians: (2,043 specialists 1,064 family physicians) 3,107 Medical Residents: 500+ Volunteers: 7,000+ Learners: 5,500+ Foundations: 41 Auxiliaries: 33 Community Health Boards: 37

10 Our Locations at a Glance Atlantic specialty multisite hospital complex: 1 QEII Health Sciences Centre Regional Hospitals: 9 Community and other locations: 35

11 Our Work at a Glance Budget: $1.9 billion Beds: 3,198 Annual Emergency visits: 599,502 Annual surgical visits: 144,093 Hospital outpatient visits: 1,429,297 Community health services visits: 365,526 Diagnostic Imaging exams: 904,100 Active research projects: 1,231

12 Investing in the PHC System Primary Health care

13 Primary Health Care is a multidimensional system that has a responsibility to organize care for individuals across the continuum of care (from pre-conception to palliative care) and understand and work with our partners to improve the health of communities. Primary health care is the foundation of our health care system. (adapted from Kringos, 2010; Annapolis Valley Health Authority, 2005)

14 Highlights from across the Province FUNCTIONS AND ENABLERS OF PRIMARY HEALTH CARE

15 Functions Community responsiveness and outreach: engagement, community development, priority populations Enablers Research, surveillance, knowledge sharing, and evaluation through a Population Health* approach and in partnership with Public Health and others Leadership & Governance Economic Conditions Workforce Engagement Platform Quality, Safety, & Risk Infrastructure Accountability Culture Functions and Enablers for the Nova Scotia Primary Health Care System

16 Western Zone Geographic Framework for Planning Nova Scotia Health Authority Northern Zone Community Health Networks Community Clusters The Nova Scotia Health Authority is responsible for health care delivery across the province The Nova Scotia Health Authority is divided into four management zones Community Health Networks are geographic based and serve as a mechanism to facilitate linkages across all health system and community partners, linking primary, secondary, tertiary, and diagnostic care across settings (hospital, community, long term care) Providers (solo, group) & Collaborative Primary Care Teams Person, Family, Community Eastern Zone Community Clusters represent communities in NS that have been clustered together to share health care resources, promoting access at a local level [minimum 7000 citizens to support sustainable access] Collaborative Primary Care Teams form the basis of the patient-centred medical home; different types of PHC providers collaborate and promote accessible, coordinated, comprehensive, continuous, primary care, sharing responsibility and resources for a practice population. Central Zone Providers working in the community may be working in groups or independently. All providers working in the community should be supported by a broader team with access to resources regardless of remuneration model. All working in partnership with an informed and activated person, family, and community

17 Functions in Action in Nova Scotia

18 Understanding our Populations Research, Surveillance, and Knowledge Sharing PHC has played a key role in leading/partnering in the development of Community Profiles and Population Health Status Reports This data informs where and how services are delivered across the province Work with CHBs to interpret and use data for health planning

19 Leading and Partnering in Research Research, Surveillance, and Knowledge Sharing PHC has led and partnered (with universities and others) in research initiatives across the province and Country to build the evidence base for primary health care. The vision is to embed research in all of the work that we do. 80+ Publications since Funded research grants

20 Research, Surveillance, and Knowledge Sharing Supporting use of knowledge & evidence Development of novel frameworks to inform practice

21 Working with the Canadian Foundation for Health Care Improvement Research, Surveillance, and Knowledge Sharing EXTRA Fellowships Working Together Framework e-discharge initiative Proactively Identifying Pre Frail (CARES) Patient and Family Engagement Working with our zone partners to embed patient and family engagement in our work Atlantic Collaborative (Chronic Disease) Chronic disease collaborative with the Atlantic provinces to improve care for chronic conditions. Results shared at a provincial symposium, Fall 2014

22 Community Engagement Community Responsiveness and Outreach Community engagement is a critical step in the development of PHC programs and services and is embedded into our planning Engagement frameworks guide our conversations with citizens, community partners, health care providers, and Community Health Boards Leading Practice: Community Health Team Citizen & Stakeholder Engagement Framework, Central Zone

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24 School Health Partnership Community Responsiveness and Outreach Located in the former Annapolis Valley Health, a nurse works with 42 schools in the AVRSB Supports 225 children with complex, stable health conditions to attend school The Health Authority and the AVRSB co-lead youth connections team and in the development of the early connections team Other School-based Partnerships Youth Health Centres (GASHA, Cape Breton) MOU with School Board (South West) Health and Learning Committee, NP/nursing consultant (South Shore) Rockingstone Heights School Initiative (Central Zone)

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26 Wellness Programming Wellness Promotion, Chronic Disease Prevention, and Risk Reduction Innovative Examples Led by PHC include: Community Health Teams (Central Zone), For the Health of It (Annapolis Valley, Western Zone), Tier 1 (Eastern Zone) Leading Practices: (1) Community Health Team Health and Wellness Framework, Central Zone; (2) Community Health Team Wellness Navigation Framework, Central Zone

27 Integrated Chronic Disease Management Integrated Chronic Disease Management One Door Centre in Pictou County Hants Health and Wellness Team Behaviour Change Institute Group Medical Visits PHC as a leader in system-wide CDM strategies and committees Leading Practice: Depression and Distress Screening and Management in Diabetes and other chronic conditions (South West Nova, Western Zone).

28 Integrated Chronic Disease Management Integrated Chronic Disease Management

29 Lynn Edwards and Tara Sampalli March 4, 2015 Integrated Chronic Disease Management

30 Integrated Chronic Disease Management Evidence based and practice Informed Person and family centred Engagement Active participation and commitment Coordinated and flexible approaches Adaptable to multiple settings

31 Integrated Chronic Disease Management Service Delivery Redesign Common Elements Project Hub Person, Family & Community Community Community Primary Health Care Team (Medical Home) Specialty Care

32 Service Delivery Redesign Value-stream mapping, sample view Integrated Chronic Disease Management CURRENT STATE Specification of phases of care delivery FUTURE STATE Interactions with community based services and other CDPM services criteria & identifiable phase in care pathway Further clarification of care delivery processes and required phases in place

33 Service Delivery Redesign Working Together Framework Integrated Chronic Disease Management Draft Criteria for consideration for Full Integration: Greater than 75 percent of the targeted population is the same ; The recommended best practices and clinical measurements are the same ; There is an overlap of greater than 50 percent of the program elements, e.g., education modules, exercise modules; When what needs to be treated is different; however, the approach is the same; When the provider skills and competencies overlap; Philosophy of care is similar

34 Common Elements Community Self-management Supports Integrated Chronic Disease Management Functional Health Management Supports Clinical Information Systems Decision Support CDPM Competencies Adult Education and Health Literacy Coordinated Care pathways Adapted from: Barr,et,al (2003);Wagner, et.al ( 2002); Institute of Medicine( 2012), Kaiser Permanente, Koh,et.al(2013)

35 Project Hub Integrated Chronic Disease Management Leadership, governance and quality Organizational Quality committee for CDPM Guiding frameworks and core curriculum Coordination of programming across program areas and settings Expertise and mentor pool Across organizational units, programs and settings Program Elements Coordination of resources that support across program areas and settings

36 Primary Care Delivery An Average Day in Nova Scotia 9,634 Family Physician and 264 Nurse Practitioner Visits Daily 1643 ER Visits 394 Surgeries 204 Admissions (NS Department of Health and Wellness BIAP Division, based on MSI Billing Data and ; Nova Scotia Health Authority About Us

37 Primary Care Delivery Top 5 Diagnoses by Family Physicians in Nova Scotia 1. Essential Hypertension 2. Unspecified Diabetes Mellitus Without Complication Type II 3. Anxiety State Unspecified 4. Backache Unspecified 5. Depressive Disorder Not Elsewhere Classified (NS Department of Health and Wellness BIAP Division, based on MSI Billing Data and )

38 Primary Care Delivery Collaborative Primary Care Teams Family practice is the largest physician department in the NSHA, representing 48% of all physicians in the province Variety of practice, governance, and funding models: Collaborative teams (physician led and health authority led) Group practices Solo practitioners Community Health Centres (self governed) Practice panels are not well defined; example of rostering in Pictou County Providers participate in a variety of activities dependant upon geography and interest: Emergency care (EDs and/or CECs Long Term Care Hospitalist Care Urgent Care Others (obstetrics, surgical assist, palliative)

39 Collaborative Primary Care Teams Primary Care Delivery Fee-for-service FP hires FPN Minimal collaboration with others Spectrum of Collaboration Approx. 20%+ Family Physicians work in teams APP NP, FPN, and other funded health professionals (e.g., PDt, SW) 1,194 Family Physicians total (not FTE) 66% family physicians using Electronic Medical Records (EMR) up to 90%+ in some former districts Approximately 101 FPs are on Alternate Payment Plan (APP) = 9% of all FPs or 40% of all FPs working in teams (Western: 31% Northern: 19% Eastern: 36% Central: 13%) 58 FTE Primary Care Nurse Practitioners (Western: 23 FTE; Northern: 13.5 FTE; Eastern: FTE; Central: 6:0 FTE)

40 Frailty Strategy Logic Model Primary Care Delivery

41 Frailty Portal Primary Care Delivery

42 Highlights from across the Province FUNCTIONS AND ENABLERS OF PRIMARY HEALTH CARE : QUALITY

43 Quality in Primary Health Care 100,000 ft Organizational Strategic Directions and NSHA KPI s 50,000 ft 30,000 ft PHC Quality Framework PHC Dashboard Primary Health Care Teams Program/Initiative Evaluation Frameworks, Logic Models, & ROPs/Accreditation Standards Family Practice Teams Program/Initiative Evaluation Frameworks, APP, Collaborative Practice indicators, Medical Home Embedded Research & Evaluation Program/Initiative Specific Scorecards MOU, Regular Reporting 0 ft Supported by Quality Teams & Practice Facilitator

44 PHC-DFP Quality Structure Key Links Department of Family Practice Quality in Practice Program (Practice Facilitation) PHC Research PHC IT Lead Affiliated quality and safety groups (e.g., hospital based quality councils, quality team lead meetings for NSHA, JOHSCs) IT, Decision Support, Performance Excellence

45 PHC Quality Framework

46 PHC-DFP Scorecard Example

47 The Work Ahead PLANNING FOR A PROVINCIAL PRIMARY HEALTH CARE SYSTEM

48 Thank you. Questions? Coming together is a beginning Keeping together is progress Working together is success Henry Ford ( )