Primary Care Performance Measurement Framework: A Foundation for Primary Care Quality and Best Practice in Ontario

Transcription

1 Primary Care Performance Measurement Framework: A Foundation for Primary Care Quality and Best Practice in Ontario Anna Greenberg, VP, Health System Performance November 25, 2015 Health Quality Ontario The provincial advisor on the quality of health care in Ontario

2 Our Vision for Quality

3 Primary care in Ontario: key facts 94% Ontarians attached (over 10 million) 200+ teambased practices 4 million Ontarians with access to interprofessional care Over 12,500 Family Physicians PC providers: Physicians, Nurses, Nurse Practitioners, Pharmacists, etc. Over 11,600 providers in EMR adoption program 2

4 Four recent tools for primary care 1. Theme report 2. Online reporting 3. Practice Report 4. Priority Measure Set 3

5 Some reactions I think that the metrics [the report] highlights really reflect the relationship pieces (access, timely access, responsiveness and patient centredness).it reflects indicators that make the most difference in terms of really supporting the value of family physicians and other primary care providers in supporting their patient-provider relationships. - Family Doctor, Northern Ontario [The theme report] is as thorough a document as you will see on the topic, and is a must-read for anyone with any interest in performance and quality in primary care. - Dr. Mario Elia Wow, this is exciting It makes me truly feel like I am doing something that matters and therefore makes everything that I went through worthwhile. - Madonna (patient on cover who told her story) 4

6 Putting the tools in context: QI Identify measureable outcome Performance Measurement Framework, routine reporting Provide meaningful data to providers Practice Reports Understand patient perspectives, experiences Patient Experience Survey Develop capacity for improvement IDEAS program, other educational offerings (OMA OCFP etc.) Connect with others Communities of practice, OMD Peer Leaders, Health Links Plan Quality Improvement Plans (25% of primary care)

7 Impetus to develop these tools Primary care is cornerstone of high-performing health system (Starfield et al) Historically, little to no information about primary care practice Limited ability for practices to plan, manage, improve, compare to others Difficult to measure impact of policy changes, investments Ontario performance* lags other jurisdictions: Access to organized, team-based primary care EMR systems to support high-quality care Processes for performance measurement, improvement *Commonwealth Fund International Surveys 6

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9 Primary Care Performance Measurement Framework 1. Identify aspects of primary care performance most valuable to measure on regular basis at practice, system levels 2. Recommend specific indicators and infrastructure required for collection, analysis and reporting Commitment of 20 organizations to take common approach to performance measurement in primary care Until now, coordinated performance measurement in primary care hadn t been possible Foundation: CIHI s development of pan-canadian indicators of primary care 8

10 Shared commitment across 20 organizations 9

11 Aligned recent efforts (Foundational to PCPM) CIHI pan-canadian primary care indicators Canadian Primary Care Sentinel Surveillance Network First multi-disease surveillance system based on primary care electronic medical record (EMR) data 10 practice-based research networks across Canada, extracted from multiple EMR systems ICES - Electronic Medical Record Administrative Data Linked Database Linking of EMR data to administrative data sets EMR Data from 350 family physicians, 400,000 patients Practice reports (CCO, HQO, AFHTO, AOHC) 10

12 Development of PCPM framework June 2010 Fall 2010 December 2011 November to 2015 McMaster Health Forum Participants identify need to strengthen primary care performance. Primary Healthcare Planning Group established Planning Group recommends developing PCPM framework. PCPM Initiative launches (HQO leadership) HQO/CIHI establish PCPM Steering Committee Committee identifies a framework & domains. Ontario PCPM Summit Participants identify priority performance measures. Steering Committee conducts Sector Stakeholder Survey Steering Committee finalizes framework measurement priorities informed by Summit & Stakeholder Survey results. PCPM Steering Committee, Measurement & Technical Working groups select/develop specific measures for PCPM Framework measurement priorities. Finalized PCPM measures are prioritized 11

13 Top measurement priorities identified Medication management Timely access to care Screening for and management of risk factors for heart disease and other chronic conditions Management of multiple chronic conditions Shared clinical decision-making between patients and providers Continuity of care and coordination with other health care providers Information sharing across the continuum of care Patient experience Recognition and management of adverse events Meaningful use of EMRs 12

14 Selection Criteria Information is valuable to have on regular basis: for one or more purposes (planning, management or quality improvement) at the practice and/or system (community, regional or provincial) levels. Comparable across practices, communities, regions, provinces/territories, countries Linked in evidence to at least one component of Triple Aim: Improving the patient experience of care (better care) Improving population health (better health) Reducing/controlling the per-capita cost of health care (better value) 13

15 PCPM Measures Iterative selection process resulted in comprehensive inventory: 179 system-level measures 112 practice-level measures Measures prioritization process resulted in: 12 system-level priority measures 16 practice-level priority measures 14

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17 Steering Committee recommendations Accelerate efforts to strengthen vendor requirements, aligned with goals of PCPM Develop infrastructure to make priority measures available at practice, system levels: practice-level patient experience survey mechanism for pooling EMR data in order to provide regular feedback to practices over time and allow for comparison with peers mechanisms for collecting data from primary care providers and organizations mechanism for combining primary care performance measures from multiple sources Develop aggregate measures of primary care performance that reflect performance Embed PCPM Framework measures in new survey tools or updates of existing ones. Equip primary care providers, organizations, health system managers and policymakers with understanding of performance measurement, quality improvement methods and leading practices Update and revise PCPM Framework, as required, to align with emerging evidence, changing policy priorities, new data sources and evolving information needs 16

18 Data advancement priorities identified System Level Mental health Provider-reported measures Comprehensiveness of care Health promotion (smoking, tobacco, obesity, injury prevention, immunization) Maternal health Family and caregiver information Practice Level Mental health Safety EMR specifications to capture and report more practice-level measures 17

19 INTEGRATION OF PRIORITIZED PRIMARY CARE MEASURES INTO QUALITY IMPROVEMENT PLANNING Primary Care QIP QIP Priority indicators aligned with Primary Care Patient Experience Measurement Framework Timely access to a primary care provider Patient Experience survey measures HB1C tests for patients with diabetes Cervical Cancer Screening Colorectal Cancer Screening 7-day follow-up after leaving the hospital 18

20 INTEGRATION OF PRIORITIZED PRIMARY CARE MEASURES INTO PUBLIC REPORTING Primary Care Theme Report/ Primary Care Online Reporting 9 out of 12 prioritized PCPM measures were included for reporting in the HQO s Primary Care Theme Report and Primary Care Online Reporting Having a primary care provider Timely access to a primary care provider Same day response to a phone call Patient involvement in decisions about their care and treatment Medication review Overdue for colorectal cancer screening 30-day readmission Diabetes complications 7-day follow-up after leaving the hospital 19

21 INTEGRATION OF PRIORITIZED PRIMARY CARE MEASURES INTO PRACTICE-LEVE PATIENT EXPERIENCE MEASUREMENT Health Quality Ontario s Patient Experience Survey 3 questions from HQO s patient experience survey were included among the prioritized indicators. HQO s patient experience survey is currently being implemented in practices across Ontario. Timely access to a primary care provider Primary care providers spending enough time with patients Patient involvement in decisions about their care and treatment 20

22 INTEGRATION OF PRIORITIZED PRIMARY CARE MEASURES INTO PRACTICE REPORTING Health Quality Ontario s Primary Care Practice Reports HQO s Primary Care Practice Reports (PCPR) give physicians customized data about their practice, which helps assist in quality improvement efforts. Several prioritized indicators are currently reported in PCPR. Continuity of care with a primary care physician 7-day post-hospital discharge follow-up for selected conditions 30-day hospital readmission Patients with diabetes receiving glycated hemoglobin testing in the past 12 months Colorectal cancer screening Cervical cancer screening 21

23 Publicly reported measures SELECTED RESULTS

24 Adults with regular primary care provider by immigration status,

25 Same day/next day access when sick,

26 Review of medications with primary care provider in last year,

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29 12 system-level priority measures 1. Having a regular primary care provider 2. 7 day follow-up after discharge from hospital (selected conditions)* 3. Per-capita health care expenditures by category* 4. Ability to get help from a professional when dealing with emotional distress, such as anxiety or depression 5. Review of prescription medications with primary care provider in past 12 months 6. Ability to be involved as much as desired in decisions about their care or treatment* 7. Ability to see family physician or nurse practitioner on the same or next day* 8. Readmissions to a hospital within 30 days of an initial hospitalization (selected conditions)* 9. Serious diabetes complications (death, heart attack, stroke, amputation or kidney failure) in the past 12 months 10. Screen-eligible patients receiving recommended colorectal cancer screening* 11. Continuity of care (visits made to physician with whom the patient is rostered or virtually rostered)* 12. Ability to get a same-day response when calling regular family physician s office (during business hours) *Five measures that are also practice level priorities 28

30 16 Practice-level priority measures 1. Population socio-demographic information 2. Patients reporting daily/occasional smoking 3. Patients aged 65+ years with record of receiving pneumococcal vaccine 4. Patient-reported wait times from consultation scheduled to when they met with a health care provider 5. Patients reporting that family physician, nurse practitioner or someone else in office spends enough time with them 6. Two or more glycated hemoglobin (HbA1c) tests for patients with diabetes within the past 12 months 7. Pap smear for screen-eligible patients in past 3 years 8. Blood pressure recorded for patients with hypertension in the previous 12 months 9. Percentage of obese, overweight, underweight or normal weight patients 10. Patients reporting difficulty getting medical care in the evening, on a weekend or on public holiday 11. Mental health follow-up visit to primary care provider or psychiatrist within 7 to 30 days of discharge following hospitalization for a psychiatric condition 12. (See 5 measures for both system and practice level on previous slide) 29