Primary Care Data Use in Quality Improvement and Research
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- Dominick Bradley
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2 Department of Family Medicine Primary Care Data Use in Quality Improvement and Research March 31, 2017 Sonny Cejic MD
3 Conflict of Interest Disclosures I have not had in the past 3 years, a financial interest, arrangement or affiliation with one or more organizations that could be perceived as a direct or indirect conflict of interest in the content of this presentation.
4 How we do research & quality improvement
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6 Our Department Five core teaching centres around London, distributed teaching sites including rural and solo practices Strong commitment to teaching, research & QI Several Committees involved in research & QI
7 Centre for Studies in Family Medicine: Research Committee Centre for Studies in Family Medicine Many projects including Deliver Primary Healthcare Information Project (DELPHI) Composed of many representatives including those from the teaching centres, Centre for Studies in Family Medicine & other Many mandates including: helping clinicians with research projects reviewing research projects for scientific merit
8 Teaching Centres: Research and QI Committees Composed of clinical staff (nurses, IHPs, staff & resident MDs) & research coordinators from department Several mandates include: - reviewing research/qi requests to be done at centre - help staff to do research or QI in their centre - mandatory resident projects
9 Ideas for Research/QI Medical centre questions that come up Chronic disease management Cancer Care Ontario (prevention) Screening Activity Report paps, mammograms, FOBT Health Quality Ontario (prevention & chronic) Physician Reports include above plus others
10 QI PDSA Cycle
11 Sample Resident Projects: QI based: -Increasing Zostavax Immunization at Southwest Middlesex Health Centre -Interventions to improve Pap smear outcome in BFMC medical centre -Standardize long-term opioid prescription monitoring -Increasing preventative mammography screening at VFMC medical centre -Standardizing Pediatric Fever Discharge Instructions Research based: -Does Having a Primary Care Provider Influence Non-Urgent Emergency Department Visits? - Evaluation of physician experiences and clinical utility of automated drug-drug interactions interaction alerts primary care
12 Lessons Learned - General: - realistic scope - limitations of doing data queries - need experienced person to help properly do queries - also create how to guide - processes in place to make sure privacy is maintained: - minimum info in reports, encrypted USB sticks, destroy data - periodically clean data: - for chronic disease management - identification - decide on how data goes in as a group (centre) and how
13 Records & Quality Improvement (REQI) Committee Composed several representatives including teaching centres, members of the Centre for Studies in Family Medicine & other Several mandates to the department including: help teaching centres improve the quality of medical documentation through chart audits Construct/refine audit, analyze results and disseminate recommendations for improvement Upcoming: working with HQO Physician Practice Reports
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16 REQI Committee: Sample Comments This is my first audit. It is good to see other charts and what level of detail is in them, reinforces the importance of good notes. I will be more diligent in documenting smoking history, along with family history. To work to ensure that all immunizations are up to date, esp tetanus, which sometimes get forgotten unless patients are coming in for PHEs [periodic health exams].
17 REQI Committee: Findings Medical documentation has improved through the years Example - Family History and making sure the Patient Summary (CPP) was maintained Chart Audit is an effective way to expose learners & practicing MD to good record keeping
18 REQI Committee: Lessons Learned Having a Committee: - improved instructions for auditors, result interpretation, formulation & dissemination of recommendations based on trends from all centres At Teaching centres: - important to engage entire centre in creating a plan for improvement - comparison to peers both within a centre and other centres helps to drive change - hope that this process may improve data within EMRs to do research and QI projects as well
19 Future EMR - evolution will allow easier structured data collection and real-time analysis on your practice population - more sophisticated data mining tools Other sources of data will improve (CCO, HQO, others) Patient portals - help to add new & validate existing medical info - easier participation into research & QI
20 In closing Very committed department in helping with research and quality improvement Improving research/qi through various committees Ultimately improve patient care
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24 Hello Dr. Cejic: The INSPIRE-PHC Management Committee would like to invite you to be a part of a "keynote panel" at the Trillium Primary Health Care Research Day. The event is scheduled for Wednesday, May 31, 2017 at the Sheraton Toronto Centre Hotel in Toronto. This conference attracts approximately 110 Primary Health Care (PHC) related researchers, trainees, decision makers and patients. INSPIRE-PHC is the primary health care centre of the Ontario SPOR SUPPORT Unit (OSSU). The theme of the panel will be Primary Health Care EMR data and how to use it for quality care and research. The panel would consist of 4 stakeholders: Policy - representative/organization who is involved in EMRs and their use at a policy level and have an opinion on how it could be better integrated (Dr. Joshua Tepper, President and CEO of Health Quality Ontario has accepted the invitiation) Practitioner -representative who uses EMRs in their practice and could comment on the level they are used in quality of care/research Patient - representative who could speak to how they feel about their doctor/nurse using EMRs and their data being used for quality improvement/research and/or someone who has used a patient portal Researcher - someone who uses EMR data in their research to talk about how this works and how it could be improved; perhaps give examples of current projects We are approaching you to speak as a Practitioner representative. Your work in the Records and Quality Improvement Committee in the Department as well as your involvement as the Liaison Physician with the DELPHI project give you a unique and important perspective as a practitioner using EMRs for quality improvement and/or research. Each person would be given 10 minutes to speak with a 20 minute Q and A at the end with the audience. If you have suggestions on content for this panel, please feel free to share with us through Leslie.Meredith@schulich.uwo.ca. The panel would run from approx 12:30-1:45 on May 31, 2017 at the Sheraton Toronto Centre Hotel in downtown Toronto. All expenses for you to attend this event would be covered along with free registration. We would be especially pleased if you would join us for the full day (9-4) of Primary Health Care research presentations and workshops. Thank you very much for considering this request. Please let me know as soon as you can if you are interested and available for this opportunity. Leslie Meredith on behalf of Dr. Moira Stewart, lead, INSPIRE-PHC Program. Leslie Meredith MEd Manager, INSPIRE-PHC Program Schulich School of Medicine and Dentistry
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