South West Health Links Quality Improvement & Health Links

Transcription

1 South West Health Links Quality Improvement & Health Links Webcast Part 3

2 Overview of Presentation Introduction to Quality Improvement (QI) approach Quality Improvement & Health Links Quality Improvement Enabling Framework (QIEF) Driver Diagram Huron Perth Measurement Plan Institute for Healthcare Improvement (IHI) Open School

3 Quality Improvement Approach QI is the systematic approach to making changes that lead to better patient outcomes (health), stronger system performance (care) and enhanced professional development. It draws on the combined and continuous efforts of all stakeholders health care professionals, patients and their families, researchers, planners and educators to make better and sustained improvements.

4 Quality Improvement & Health Links Health Links contribute to the MOHLTC s vision for system-wide quality improvement by promoting collaboration and coordination of quality improvement objectives across partner organizations Provides opportunity for health sector partners to learn from peers on the types of actions that can be taken to achieve quality objectives

5 Health Links Quality Improvement Plan Front-line interdisciplinary teams will learn to apply QI tools and methodology to implement and spread change ideas (IDEAS, Collaborative Learning, IHI Open House, etc.) The goal of Health Links is to empower teams to set goals for improvement; conduct tests of change; and collect and analyze data to determine change success

6 Quality Improvement Enabling Framework (QIEF) Represents the foundation for improvement and includes the key enablers or pillars for Boards and Senior Leaders within organizations to consider when creating an optimal environment for improvement (internal and external) Integral to the success of QI program are [enablers] strong leadership, a supportive culture, and staff who are versed in quality improvement methodology (QIEF Pillars)

7 Health Links a quality improvement journey Health Links Leadership Collaborative as oversight MOHLTC directly involved Strong case for change Potential improvements for patients and providers known Motivating Leading Population Health Building System Capacity Health Links Learning Collaborative in development IDEAs, CHFI INSPIRE participation Leverage Partners (e.g. HQO, PFQ) Patient/Family Engagement Plan Communication Plan inclusive of HSP, primary care, provider networks, municipalities Person Experience Engaging Right Care, Right Time, Right Place Cost Applying Evidence in Decision Making Base changes on evidence (e.g. BestPath, care coordination) Patient Experience as evidence Goal: electronic sharing of coordinated care planning CCT Pilot (Huron Perth) Leverage enablers such as Clinical Connect, econsult, RIDS Enhancing Health Information Systems Drafted Aug 21/14 Revised Oct 23/14, Jan 29/15, Feb 10/15

8 What is a Driver Diagram? Describe the system that you are working in Used to test theories about cause and effect Test your theory about how the system you are working in (and wanting to improve) actually works Meant to be updated throughout the project It shows the change program in a single diagram and also provides a measurement framework for monitoring progress

9 Driver Diagram: Aim Statement To reduce avoidable healthcare utilization in order to better meet the needs and support patients and families with the greatest health care needs in the South West LHIN.

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11 Setting the stage for coordinated care straight away 1. All complex patients will have a coordinated care plan 2. Complex patients and seniors will have regular and timely access to a primary care provider Moving the needle 1. Reduce the time from primary care referral to specialist 2. Reduce the number of 30 day readmissions to hospital 3. Reduce the number of avoidable ED visits for patients with conditions best managed elsewhere 4. Reduce time from referral to home care visit 5. Reduce unnecessary admissions to hospitals 6. Faster primary care follow-up after discharge from an acute care setting Year 1 Year 2 & beyond How you ll know you ve arrived 1.Enhance the health system experience for patients with the greatest health care needs 2.Reduced ALC rate 3.Reduce the average cost of delivering health services to patients without compromising the quality of care 11 11

12 Huron Perth Measurement Plan Provincial Health Link Indicators Strategic Alignment with LHIN (IHSP) Long-term Outcomes Current Status of Health Link Project Reduce avoidable health care utilization (ED visits/acute inpatient discharges) Reduce readmission rates within 30 days Reduce 15,000 revisits to ER and Readmissions (avoidable days saved) To reduce avoidance healthcare utilization in order to better meet the needs and support patients and families with the greatest healthcare needs in the South West LHIN Developing process indicators to accurately measure and monitor changes

13 South Grey Bruce 179 people North Grey Bruce 277 people South West LHIN 2,253 people Huron Perth 354 people London Middlesex 880 people Oxford 257 people Elgin 306 people

14 Male patient in his 70 s Lives in Huron County Has visited 3 different HSPs in 2013/14 for a total of 5 ED visits and 5 hospital admits Is currently on CCAC service Has COPD and CHF and has been admitted to hospital for treatment of both conditions

15 IMPACT - How many people like Will are using services within the South West LHIN? In , there have been 4,136 hospitalizations for 3,266 patients with COPD and CHF This has contributed to 31,062 hospital days (27,365 acute care days and an additional 3,697 ALC days))

16 How are we monitoring progress for users with high care needs? Began participating on Active Care Plan

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18 Institute for Healthcare Improvement (IHI) Open School Links include information about: 1. How to register and begin IHI Open School Courses 2. Module suggestions

19 You have now completed the pre-work webinars! Up Next: IHI Quality Improvement modules