Quality Improvement Plan (QIP) Narrative for Health Care Organizations in Ontario

Transcription

1 Quality Improvement Plan (QIP) Narrative for Health Care anizations in Ontario 1/3/ This document is intended to provide health care organizations in Ontario with guidance as to how they can develop a Quality Improvement Plan. While much effort and care has gone into preparing this document, this document should not be relied on as legal advice and organizations should consult with their legal, governance and other relevant advisors as appropriate in preparing their quality improvement plans. Furthermore, organizations are free to design their own public quality improvement plans using alternative formats and contents, provided that they submit a version of their quality improvement plan to Health Quality Ontario (if required) in the format described herein. 1

2 Overview The Thames Valley Family Health Team (TVFHT) is one of the largest family health teams in Ontario. With more than 115 physicians across 18 sites within London, and Middlesex, Oxford and Elgin counties, the Thames Valley Family Health Team is committed to providing comprehensive intercollaborative primary health care to over 155,000 patients. TVFHT continues to focus on ongoing development of high functioning teams of over 140 interprofessional staff, integrated within 15 family health organizations (FHOs) and networks (FHNs) providing acute and episodic care, chronic disease prevention and management, and health promotion programs. With the size and scope of our organization comes the ability to offer a broad perspective in working with our system partners. We participate in numerous regional partnerships spanning the southern portion of the South West LHIN. QI Achievements From the Past Year In the year, TVFHT clinicians have maintained a focus on delivery of services to meet the needs of the populations we serve. Some of our achievements have included: Enhancement and spread of a model to improve access to mental health services. This model has seen wait times decrease from over 8 weeks to less than 2 weeks with no reduction in service. This model was chosen as a presentation at the 2016 Association of Family Health Teams of Ontario (AFHTO) annual conference and as a poster presentation at the 2016 Health Quality Transformation annual conference. Expansion of the Mind Over Mood program, enabling FHT-wide access to this program that assists patients dealing with mental health challenges related to anxiety and depression. Initiation of a hub-based model for program delivery to improve equitable access to programs focusing on chronic disease management, mental health and lifestyle challenges, chronic pain, and others. A poster was accepted at the annual AFHTO conference entitled Healthy Bones: Preventing Fractures Before They Happen which showcased an on-going osteoporosis screening program developed in collaboration with our physician partners. In addition to service delivery, TVFHT has begun to build capacity for QI-related work through the development of super user roles within our clinic administrative staff to better leverage EMR-related opportunities for evaluation of clinical interventions. The role of clinical and administrative staff in improving the quality of the data we capture within our various EMR systems will be a focus in the coming year. Population Health TVFHT was a key member of the Understanding Health Inequities and Access to Primary Care in the South West LHIN Steering Committee, a group which focused on developing an understanding of the population health needs both across the LHIN and at a sub-region level. This group included care providers, administrators and researchers from across the region. The result of that work was a comprehensive report and set of recommendations that will help inform next steps in population health planning. Equity As a component of the above mentioned work on access to primary care and population health, particular attention was paid to equity for those individuals living in the southwest. That included evaluations of access, culturally safe care, those with a first language other than English, and the 2

3 elderly. The recommendations that came from that report aim to address health equity within the region. In collaboration with the London Middlesex Health Providers Alliance, TVFHT was involved in the development and delivery of the Introduction to Health Equity Workshop for healthcare providers in the region. Integration and Continuity of Care In the year, TVFHT began a refresh of our Strategic Plan. As a component of that work, we sought feedback from numerous care partners within our region. The feedback we received will be invaluable as we continue to enhance the partnerships we have with our care partners. As the lead organization for the London Middlesex Health Link, and as members of the steering committee for both the Oxford and the Elgin Health Links, we continually assess how the services we provide integrate with those of other organizations in providing care for the people of our region. Some examples of the partnerships we have include: South West CCAC ongoing partnering in programming for Chronic Disease Self-Management, Diabetes Self-Management, and Chronic Pain Self-Management workshops London Health Sciences Centre - partnership with Traumatic Stress Services Centre for Addiction and Mental Health - Smoking Treatment for Ontario Patients London Middlesex Community Health Collaborative, in partnership with London Middlesex Health Unit and United Way Memory Clinics in partnership with the Alzheimer Society Collaborative care with local Diabetes Education Programs (DEPs) Addiction Services Thames Valley for opioid dependency Western University - Global Health Promotion Community Engaged Learning to provide students with valuable learning opportunities London Health Sciences Centre, St. Joseph s Health Care London and the South West CCAC - Connecting Care to Home (CC2H) project South West LHIN Primary Care Capacity Steering Committee Member of the London Middlesex Health Providers Alliance, Elgin Heath Services Council, and the Oxford County Health Planning Committee Access to the Right Level of Care - Addressing ALC Issues TVFHT has developed strong working partnerships with hospitals in our region. While TVFHT has not focused on ALC issues specifically, we may identify opportunities as we continue to engage with our hospital partners. In collaboration with the London hospitals, we aim to have complementary QIP indicators that will facilitate us working together in different ways. Engagement of Clinicians, Leadership & Staff We consider our interdisciplinary health professionals and staff our greatest asset and we are proud of the work they do. In the spring of 2016, we undertook an organizational re-design process which included obtaining feedback from staff across the organization. This feedback helped inform the building of the right administrative structure to allow TVFHT to better support our clinical staff in focusing on the exceptional care they provide to our patients. 3

4 We support our staff in attending a wide range of professional development opportunities and support them in sharing their learnings and experiences amongst their peers both within professions and across the sites with whom we partner. In June 2016, we organized a half-day conference for our staff, physicians, board members, and community partners which included numerous educational sessions and a keynote address from a local media personality who has struggled with mental health challenges. One of the most significant challenges we face is that of recruitment and retention. When increased funding to primary care teams was announced in March 2016, it was received with great anticipation by staff, many of whom have received no wage increase in over seven years. However, the implementation of this recruitment and retention funding was nothing short of insulting. If Primary Care is to play as key a role as outlined in the Patients First plan, it needs to have the fair, reasonable, and meaningful financial resources to do so. Resident, Patient, Client Engagement During 2016, TVFHT initiated the formation of a Patient and Caregiver Advisory Council. This council will bring together a diverse group of patients and caregivers with a variety of experiences with TVFHT to participate in the development of new programs and services, collaborate as partners with staff and administration, and to advance patient engagement and patient-centred care at TVFHT. Recruitment for the Council began in November 2016 and continues presently. As one of few family health teams with a Patient and Caregiver Advisory Council, we look forward to having patient involvement in the preparation of our Quality Improvement Plan as we believe that their voice will provide great value in our quality improvement efforts. Staff Safety & Workplace Violence TVFHT has an Occupational Health and Safety Best Practice Committee that, over the past year, has been involved in a roll-out of new and updated health and safety policies and procedures. These cover topics including (but not limited to): Workplace Violence Emergency Duress Working Alone Infection Prevention, Control, and use of Personal Protective Equipment Home Visit Safety Harassment and Discrimination The Best Practice Committee has membership from both leadership and staff, and we have designated representatives from each of our physical locations. Monthly site inspections are usual practice and are reported and reviewed regularly. Violence risk assessments from all sites and staff were completed and reviewed. All staff are required to have up-to-date WHMIS training, fit testing and fire safety. Contact Information TVFHT is located at: 1385 North Routledge Park, Unit 6, London, Ontario, N6H 5N We can be contacted through our website, and at info@thamesvalleyfht.ca. 4

5 Other TVFHT s ability to access the Primary Care Practice Reports continues to be welcome. The challenge, however, remains that the data in these reports is out-of-date by the time it is received. For reference, the most current data we have available to us through these practice reports is to the end of March 2016, a year out of date in planning for the -18 QIP. To effectively monitor quality improvement initiatives requires real-time metrics that are responsive to change efforts. Having data that is more than one year old does not allow true evaluation of changes in practice. Alternative ways of measuring improvements in a more timely manner would rely on different data sets which may not correlate with the data sets required within the priority indicators and which may not allow comparisons between organizations. As a result, TVFHT is focusing on internal metrics that may better inform our quality improvement efforts. The size and scope of TVFHT offers a wealth of diversity. We are fortunate to have the skillset of a Quality Improvement Decision Support Specialist (QIDSS) within our team. However, having 15 FHOs, with 4 different EMRs, creates significant challenges both in data quality and data standardization. Through our involvement with AFHTO and the provincial QIDSS partnership, we continue to collaboratively explore ways to better utilize the EMR systems we have in driving quality improvement efforts. Sign-off We have reviewed and approved our organization s Quality Improvement Plan Dr. Tom Freeman Board Chair Dr. Shamidah Noorani Quality Committee Chair Ms. Keri Selkirk Executive Director 5

6 /18 Quality Improvement Plan for Ontario Primary Care "Improvement Targets and Initiatives" Thames Valley FHT North Routledge Park, London, ON N6H 5N5 AIM Measure Change Quality dimension Issue Measure/Indicator Unit / Population Source / Period anization performance Target Target justification Planned improvement initiatives (Change eas) Methods Effective Coordinating care Percentage of %/ Patients In house data 91498* CB CB TVFHT is 1)TVFHT continues to focus patients identified as meeting Health collection / Most involved in 3 on coordinating care for meeting Health Link Link criteria recent 3 month different Health complex patients. To better criteria who are period Links, only one understand this population offered access to of which is and their needs, TVFHT has Effective transitions Population health - cervical cancer screening Percent of patients/clients who see their primary care provider within 7 days after discharge from hospital for selected conditions. Percentage of acute hospital inpatients discharged with selected HIGs that are readmitted to Percentage of patients for whom discharge notification was received who were followed up within 7 days of discharge, by phone or in-person visit, with any clinician. Percentage of Ontario screeneligible women, years old, who completed at least Percentage of women aged 21 to 69 who had a Papanicolaou (Pap) smear within the % / Discharged patients with selected HIG conditions % / Discharged patients with selected HIG conditions %/ Discharged patients Implementation of a Counts / TVFHT process to screen for Sites malnutrition. % / PC organization population eligible for screening %/ PC organization population eligible for screening CIHI DAD / April March 2016 CIHI DAD / April March 2016 In house data collection / Last consecutive 12 month period. Staff survey / -18 CCO-SAR, EMR / Annually See Tech Specs / Annually 91498* This indicator does not represent current performance, but rather represents historical performance 91498* * 63.5 from the This indicator does not represent current performance, 91498* CB CB No target has been set as we work to better understand this indicator. current data on This indicator does not represent current performance, 1)In collaboration with local hospital partners, explore ways to improve follow-up through appropriate data sharing. 2)Once methods of communicating discharges have been identified (via change idea #1), better understanding patient 1)This indicator will not be a focus of QI work for the -18 year. 1)In concert with the above measure related to patients seen by their primary care provider within 7 days of discharge from hospital, we 2)Development of a method to track those patients seen within primary care within 14 days of discharge from hospital * CB CB Exploratory indicator to evaluate methods to 1)Enable early identification of those patients at risk for complications due to malnutrition. screen for 91498* CB CB We have no data 1)This indicator will not be a formal focus of QI work for the -18 year. for this indicator. Given the absence of 1)This indicator will not be a formal focus of QI work for the -18 year. This is a work in progress: TVFHT staff will be determining methods to identify those patients who would benefit most from coordinated care and what care should be provided. Data sharing agreement with one of our largest hospital partners has been created. In collaboration with our hospital partners, we will explore ways to improve communication with primary care regarding those patients recently discharged from hospital in an Process measures This work is in the early stages and, as such, appropriate process measures have not yet been determined. As the work progresses, in-year metrics will be determined. Method to inform primary care practices of recent hospital discharges. Target for process measure To be determined. TVFHT staff involved in developing care processes for patients with Communication Given the diverse process in place at nature of TVFHT a minimum of 3 sites (which pilot sites. includes rural, urban, teaching, Explore methods to track and better understand Tracking process developed. As this is an The historical patient needs for primary care follow-up after exploratory focus on followup discharge. indicator, the in primary target may be care has been determined in- limited to N/A N/A N/A While this indicator will not be specifically focused on during the - Explore methods to track and better understand patient needs for primary care follow-up after discharge. Explore methods to track and better understand patient needs for primary care follow-up after discharge. Across the TVFHT, sites will determine processes to implement a screening tool, such as the Canadian Nutrition Screening Tool (or similar). Tracking process developed at selected sites. Tracking process developed at selected sites. As this is an exploratory indicator, the target may be determined in- As this is an exploratory indicator, the target may be determined in- The historical focus on followup in primary care has been limited to Physicians have a billing code that is used to capture primary care follow up after # of TVFHT sites with a screening process in place >12 TVFHT sites Appropriate primary care screening for malnutirtion could result in N/A N/A N/A While this indicator will not be specifically focused on during the - N/A N/A N/A While this indicator will not be specifically focused on during the -

7 Patient-centred Safe Population health - colorectal cancer screening Population health - diabetes Medication safety Percentage of Ontario screeneligible individuals, years old, who more glycated Person experience Percent of patients who stated that when they see the doctor or nurse practitioner, they or Percentage of patients with medication reconciliation in the past year Timely Timely access to Percentage of %/ PC In-house survey / 91498* Based on care/services patients and clients able to see a doctor or nurse practitioner on the same day or next day, when needed. Implementation of the "Rapid Assessment" model by Social Workers within TVFHT. % / PC organization population eligible for % / PC organization population (surveyed sample) %/ All patients In house data collection / Most recent 12 month period organization population (surveyed sample) Counts / Site Social Work services See Tech Specs / Annually were overdue for screening Percentage of screen %/ PC See Tech Specs / eligible patients aged organization Annually 50 to 74 years who population had a FOBT within eligible for the past two years, screening Percentage of patients with %/ patients with ODD, OHIPdiabetes, aged 40 CHDB,RPDB / diabetes, aged 40 or or over Annually over, with two or In-house survey / April March April March Staff survey / * CB CB We have no data 1)This indicator will not be a for this indicator. formal focus of QI work for Given the the -18 year. absence of current data on 91498* This indicator does not represent current performance, 91498* This indicator does not represent current performance, 91498* performance is reasonable to maintain * CB objective measurement of access (third next available appointment tracking), our current performance is 66.3% * This model of assessment has been shown to improve access to mental health CB This data is not something that we track at present. 1)This indicator will not be a formal focus of QI work for the -18 year. 1)This indicator will not be a formal focus of QI work for the -18 year. N/A N/A N/A While this indicator will not be specifically focused on during the - N/A N/A N/A While this indicator will not be specifically focused on during the - N/A N/A N/A While this indicator will not be specifically focused on during the - 1)Offer patients greater Explore options to increase response rate such as ability to provide feedback. electronic methods of obtaining patient feedback. 1)This indicator will not be a formal focus of QI work for the -18 year. 1)Improved communication to TVFHT sites regarding access to acute/episodic services. 2)In addition to access to physicians and nurse practitioners, TVFHT monitors access to all our other IHPs via "third next 1)Social Workers within TVFHT will be assisted in implementing the "rapid assessment" model to improve access to mental Number of sites offering alternative methods for patients to provide feedback regarding their experience. >3 additional sites In the year, we observed that patients were much more likely N/A N/A N/A While this will not be an area of formal QI efforts, TVFHT clinicians fully appreciate Historically, reporting of access to physicians and nurse practitioners has been done on an individual basis. Starting this year, reporting will be done in a more widely accessible fashion so that teams may explore options to improve access to primary care services for Weekly tracking of time to appointment for providers other than just physicians or nurse practitioners. Sites receiving regular reporting of access to all services. Time from referral to appointment. All social workers will be supported by their Number of TVFHT sites that have implemented the operational and practice leadership in determining the Rapid Assessment model. best way to implement this method of assessment, taking into account some of the unique factors at different sites. All TVFHT sites Targets are as follows: - Pharmacists: 90% of patients offered an appointment All sites will have an awareness of access to all providers at that site. Sites will We believe that access to all providers is essential to the care that TVFHT >12 We believe that this model is "best practice" and are encouraging its

8 Excellent Care for All Quality Improvement Plans (QIP): Progress Report for QIP The Progress Report is a tool that will help organizations make linkages between change ideas and improvement, and gain insight into how their change ideas might be refined in the future. The new Progress Report is mostly automated, so very little data entry is required, freeing up time for reflection and quality improvement activities. Health Quality Ontario (HQO) will use the updated Progress Reports to share effective change initiatives, spread successful change ideas, and inform robust curriculum for future educational sessions. ID Measure/Indicator from 1 HbA1c improvement within 6 months of diagnosis ( HbA1c; Patients newly diagnosed with diabetes; ; EMR/Chart Review) as stated on QIP Target as stated on QIP CB CB % of patients newly diagnosed with diabetes that were seen by TVFHT IHPs met an A1c target of 7% or less. Comparatively, for those patients that were not seen by TVFHT, 51% of patients met their A1c target. Change eas from Last Years QIP (QIP ) Develop a method to quantify the effectiveness of care for those patients newly diagnosed with diabetes. Lessons Learned: (Some Questions to Consider) What was your experience with this indicator? What were your key learnings? Did the change ideas make an impact? What advice would you give to others? Based on the information we have collected, patients newly diagnosed with diabetes seemed to do better in meeting their A1c targets if seen by TVFHT IHPs than if not. In some cases, those patients seen by TVFHT even fared better than those patients that were seen by local Diabetes Education Programs (DEPs), however it may be that those patients referred to DEPs were more complex than those not referred. Having some way of quantifying complexity may assist in determining which individuals should be referred for care beyond that which might be offered by TVFHT IHPs. We were limited at some of our locations by the capabilities of the EMRs in easily extracting this information.

9 ID Measure/Indicator from 2 Implementation of a screening tool to screen for depression ( Social Worker uptake of screening tool; Mental health patients; ; Staff survey) as stated on QIP Target as stated on QIP CB CB NA See Lessons Learned. Change eas from Last Years QIP (QIP ) Enable early identification of patients who may require intervention related to depression. No Lessons Learned: (Some Questions to Consider) What was your experience with this indicator? What were your key learnings? Did the change ideas make an impact? What advice would you give to others? This change idea was not implemented. Early on in our discussions to identify appropriate screening tools, concerns were raised by some of our clinicians and physician partners that identification of depression documented in the chart may have future implications for patients should they have insurance claims (as they would be considered having a pre-existing condition). This concern over the potential financial impact resulted in this initiative not being implemented per se. However, while this formal process was not introduced, our clinicians remain mindful in identifying those individuals who may benefit from receiving care for mental health challenges that may impact them: all of our teams have mental health providers (social workers and/or psychologists) as a part of the team and our collaborative nature allows interprofessional consultation to address these issues.

10 ID Measure/Indicator from 3 Percent of patients who responded positively to the question: "When you see your doctor or nurse practitioner, how often do they or someone else in the office spend enough time with you?" ( %; PC organization population (surveyed sample); April March 2016 ; In-house survey) as stated on QIP Target as stated on QIP Based on a sample size of 978 patients. Change eas from Last Years QIP (QIP ) Get to a state of requesting patient experience feedback as a "usual practice" Positive responses to the question related to provider time spent with patients to be greater than 90%. Lessons Learned: (Some Questions to Consider) What was your experience with this indicator? What were your key learnings? Did the change ideas make an impact? What advice would you give to others? This has been variable across the different sites within TVFHT. Our best success has been through electronic communication with patients via , but this has been an option at only a few sites. Principles for appropriate electronic communication with patients are still being finalized; once completed, we may see changes in our ability to engage with them to obtain feedback. This continues to be positive as we have seen from previous QIP submissions. TVFHT providers consistently strive to provide an excellent patient experience and our goal is to continue doing so.

11 ID Measure/Indicator from 4 Percent of patients who stated that when they see the doctor or nurse practitioner, they or someone else in the office (always/often) involve them as much as they want to be in decisions about their care and treatment? ( %; PC organization population (surveyed sample); April March 2016 ; In-house survey) as stated on QIP Target as stated on QIP Based on a sample size of 978 patients. Change eas from Last Years QIP (QIP ) Get to a state of requesting patient experience feedback as a "usual practice" Positive responses to the question related to patient involvement in decisions about care to be greater than 90%. Lessons Learned: (Some Questions to Consider) What was your experience with this indicator? What were your key learnings? Did the change ideas make an impact? What advice would you give to others? This has been variable across the different sites within TVFHT. Our best success has been through electronic communication with patients via , but this has been an option at only a few sites. Principles for appropriate electronic communication with patients are still being finalized; once completed, we may see changes in our ability to engage with them to obtain feedback. This continues to be positive as we have seen from previous QIP submissions. TVFHT providers consistently strive to provide an excellent patient experience and our goal is to continue doing so.

12 ID Measure/Indicator from 5 Percent of patients/clients who see their primary care provider within 7 days after discharge from hospital for selected conditions. ( %; Discharged patients with selected HIG conditions; April 2014 March 2015; CIHI DAD) as stated on QIP Target as stated on QIP of 39% for the year (as provided by MOHLTC). for the year is not available. Change eas from Last Years QIP (QIP ) Investigate methods to obtain the necessary hospital data to impact this indicator. Lessons Learned: (Some Questions to Consider) What was your experience with this indicator? What were your key learnings? Did the change ideas make an impact? What advice would you give to others? A significant barrier to impacting this metric is timely notification to primary care providers of patient discharges from hospital. During the year, a data sharing agreement was finalized with one of our hospital partners. At the time of writing, we continue to explore ways to determine next steps in impacting this indicator. Our goal continues to be to find ways to benefit both organizations in meaningful ways that may then be more broadly spread. As we proceed, the ability to have realtime data may allow better evaluation of change efforts which is not currently realistic given the time lag in the data provided to primary care organizations.

13 ID Measure/Indicator from 6 Percent of respondents who responded positively to the question: "When you see your doctor or nurse practitioner, how often do they or someone else in the office give you an opportunity to ask questions about recommended treatment?" ( %; PC organization population (surveyed sample); April March 2016 ; In-house survey) as stated on QIP Target as stated on QIP Based on a sample size of 978 patients. Change eas from Last Years QIP (QIP ) Get to a state of requesting patient experience feedback as a "usual practice" Positive responses to the question related to patient opportunity to ask questions to be greater than 90%. Lessons Learned: (Some Questions to Consider) What was your experience with this indicator? What were your key learnings? Did the change ideas make an impact? What advice would you give to others? This has been variable across the different sites within TVFHT. Our best success has been through electronic communication with patients via , but this has been an option at only a few sites. Principles for appropriate electronic communication with patients are still being finalized; once completed, we may see changes in our ability to engage with them to obtain feedback. This continues to be positive as we have seen from previous QIP submissions. TVFHT providers consistently strive to provide an excellent patient experience and our goal is to continue doing so.

14 ID Measure/Indicator from 7 Percentage of patients and clients able to see a doctor or nurse practitioner on the same day or next day, when needed. ( %; PC organization population (surveyed sample); Apr 2015 Mar 2016 (or most recent 12-month period available); In-house survey) as stated on QIP Target as stated on QIP Access is variable across our different sites: in most locations there are processes in place to allow for patients needing to be seen to be triaged to the appropriate IHP which allows greater access than to just doctor or nurse practitioner. For example, same/next day access to RNs was 72.1%. Change eas from Last Years QIP (QIP ) Regular state of reporting to clinicians re: patient reported access to care. Get to a state of requesting patient experience feedback as a "usual practice" Lessons Learned: (Some Questions to Consider) What was your experience with this indicator? What were your key learnings? Did the change ideas make an impact? What advice would you give to others? Quarterly reporting to sites is based on objective measurement of "third next available appointment" (TNA) which is tracked on a weekly basis for all providers. This measurement is useful as it allows us to track trends over time and by site/provider/profession in ways different than patient responses can be. This has been variable across the different sites within TVFHT. Our best success has been through electronic communication with patients via , but this has been an option at only a few sites. Principles for appropriate electronic communication with patients are still being finalized; once completed, we may see changes in our ability to engage with them to obtain feedback

15 ID Measure/Indicator from 8 Percentage of patients with diabetes, aged 40 or over, with two or more glycated hemoglobin (HbA1C) tests within the past 12 months ( %; patients with diabetes, aged 40 or over; Annually; ODD, OHIP-CHDB,RPDB) Target as as stated on stated on QIP QIP Based on Primary Care Practice Report Data to March Change eas from Last Years QIP (QIP ) Determine a method to assess current and accurate data related to HbA1c testing for the relevant patient population at selected FHOs/FHNs within TVFHT. No Lessons Learned: (Some Questions to Consider) What was your experience with this indicator? What were your key learnings? Did the change ideas make an impact? What advice would you give to others? Due to technical limitations of several of our EMRs and the challenges in obtaining accurate data related to A1c testing, this was not implemented. Our clinicians continue to provide care to patients with diabetes through both individual and group based methods, basing their clinical interactions and recommendations on current evidence vis a vis the Canadian Diabetes Association Clinical Practice Guidelines. To this end, we have medical directives related to diabetes care, including directives for appropriate laboratory testing. Given the challenges in tracking data for this indicator, it will not be a focus of our -18 QIP.

16 ID Measure/Indicator from 9 Percentage of screen eligible patients aged 50 to 74 years who had a FOBT within the past two years, other investigations (i.e., flexible sigmoidoscopy) within the past 10 years or a colonoscopy within the past 10 years. ( %; PC organization population eligible for screening; Annually; See Tech Specs) as stated on QIP Target as stated on QIP Based on Primary Care Practice report data as of March 2016 Change eas from Last Years QIP (QIP ) Determine a method to access current and accurate data of rates of cancer screening from selected FHOs within the TVFHT. No Lessons Learned: (Some Questions to Consider) What was your experience with this indicator? What were your key learnings? Did the change ideas make an impact? What advice would you give to others? Many of the 110+ individual physicians within TVFHT do utilize the Cancer Care Ontario Screening Activity Report in their own practices. However, this data is not available to TVFHT in any aggregate format beyond what is provided in the Primary Care Practice Report. As a result of the challenges in obtaining an accurate up-to-date TVFHT-wide indicator, we will not be continuing to focus on this indicator as a part of our formal QIP.

17 ID Measure/Indicator from 10 Percentage of women aged 21 to 69 who had a Papanicolaou (Pap) smear within the past three years ( %; PC organization population eligible for screening; Annually; See Tech Specs) as stated on QIP Target as stated on QIP Based on Primary Care Practice Report data as of March 2016 Change eas from Last Years QIP (QIP ) Determine a method to access current and accurate data of rates of cancer screening from selected FHOs/FHNs within the TVFHT. No Lessons Learned: (Some Questions to Consider) What was your experience with this indicator? What were your key learnings? Did the change ideas make an impact? What advice would you give to others? Many of the 110+ individual physicians within TVFHT do utilize the Cancer Care Ontario Screening Activity Report in their own practices. However, this data is not available to TVFHT in any aggregate format beyond what is provided in the Primary Care Practice Report. As a result of the challenges in obtaining an accurate up-to-date TVFHT-wide indicator, we will not be continuing to focus on this indicator as a part of our formal QIP.

18 ID Measure/Indicator from 11 Time to appointment for patients newly referred to certain IHP groups. ( %; PC organization population (surveyed sample); April March ; In-house survey) as stated on QIP Target as stated on QIP Please see the Lessons Learned section for further details. Change eas from Last Years QIP (QIP ) Continue to monitor time to appointment for our pharmacist, dietitian and social work professions and report access on a quarterly basis to evaluate trends and implement strategies as appropriate. Lessons Learned: (Some Questions to Consider) What was your experience with this indicator? What were your key learnings? Did the change ideas make an impact? What advice would you give to others? Time for patients newly referred to identified IHPs are as follows: - Pharmacy: 97.4% of patients offered an appointment within desired time frame (4 weeks); target of 90% was exceeded - Nutrition Services: 86.3% of patients offered an appointment within desired time frame (6 weeks); target of 90% was not achieved - Social Workers: 78.6% of patients offered an appointment within desired time frame (6 weeks); target of 90% was not achieved Additionally, targets for Occupational and Respiratory Therapists were set and were measured as follows: - Occupational Therapy: 75.8% of patients were offered an appointment within 6 weeks. A target of 80% within 6 weeks was set. - Respiratory Therapy: 74.3% of patients were offered an appointment within 6 weeks. A target of 80% within 6 weeks was set.