Primary Health Care System Level Indicators Presentation March 2015 1
Presentation Outline Background Alberta's Primary Health Care Strategy Evaluation Framework and Logic Model Measurement and Evaluation Working Group Progress to Date PHC System Level Indicators Challenges Timing Supports 2
Faculty/Presenter Disclosure Faculty Allison Larsen Relationships with commercial interests No relationships with commercial interests 3
Disclosure of Commercial Support This program has received no financial support or inkind funding from commercial organizations Potential for conflict(s) of interest: None Mitigating Potential Bias: As the program received no commercial support or inkind funding, there are no sources of bias to mitigate Sessions were planned based on input from a planning committee that included physicians 4
Background Alberta s Primary Health Care Strategy Released in May 2013, Alberta s Primary Health Care Strategy sets the direction for the long-term primary health care (PHC) transformation and reinforces the vision for a PHC system that supports Albertans to be as healthy as they can be. Contributors: Physicians Interdisciplinary National Provincial Operations The Strategy was informed by an Advisory Committee with representatives from AH, AMA, AHS, Professional Colleges & Associations, academics and the primary care alliance. 5
Background Alberta s Primary Health Care Strategy The Strategy involves 14 goals based on three strategic directions: enhancing the delivery of care, bringing about cultural change and establishing building blocks for change. Three strategic directions will result in six key outcomes: Attachment all Albertans have a health home and are attached to a physician; Access Albertans have timely access to a primary health care team; Quality clinical and social supports come together to promote wellness Self Management Albertans are involved in their care Improvements in Health Status and Care Experience Albertans have better health overall and report positive experiences Provider Engagement and Satisfaction providers are satisfied and happy with their work lives and able to provide quality care. 6
Background PHC Evaluation Framework The PHC Evaluation Framework will guide evaluation activities and performance reporting of Alberta s PHC system and address concerns put forth by Alberta s Office of the Auditor General in their 2012 Report. The Framework includes goals from the PHC Strategy that highlight the Department s approach to performance measurement. The Measurement and Evaluation Working Group (MEWG) was established to support the implementation of the Primary Health Care Evaluation Framework by providing recommendations and advice relating to performance measurement and evaluation activities that focus on improving quality and outcomes. 7
Background: PHC Evaluation Framework Logic Model 8
Background : System Level Indicators There is a need for standardized indicators to measure the impact of ongoing innovation on patient and population health outcomes.. These System level indicators will inform Albertans of the progress being made in primary health care. The indicators flow from the Primary Health Care Evaluation Frameworkalign and align with the outcomes listed in the Primary Health Care Strategy. Selected indicators are useful in quality improvement initiatives at the PCN and provider level. PHC System Level Indicators were confirmed by the MEWG in September 2014. 9
Progress to Date Eight indicators included in the requirements of PCN funding agreements in October 2014. Guideline prepared to explain the indicators and provide a summary of expectations. Focus groups held for further input on acceptability, clarity of instructions and implementation challenges. Measurement and Evaluation Working Group to work toward an implementation package for each indicator. 10
PHC System Level Indicators The indicators furthest along in readiness for implementation: 1. Time to third next available appointment with a provider for the fiscal year 2. Percent of recommended screens that the clinic has offered to paneled patients 3. Percentage of patients answering satisfied or very satisfied to the question Overall, how satisfied are you with the care you get from the clinic? 11
PHC System Level Indicators Continued... 4. Percent of patients who are returning to the same provider at the clinic for a subsequent visit 5. The percentage of identified team members responding to a team effectiveness survey 6. Percent of paneled patients with a chronic disease who were offered self-management supports during the fiscal year 7. Percent of paneled patients with a chronic disease who report maintaining or improving quality of life as measured by the EQ-5D tool during the fiscal year 12
1. Time to third next available appointment with a provider for the fiscal year Rationale A measure of access to primary health care services. The most common measure of access in Alberta. Can be used, along with related information, to identify system constraints such as: availability of providers; information on where patients ultimately go for services when there is limited access; and need for workflow improvements in a PCN. 13
1. Time to third next available continued Calculation The number of providers: Reporting an average of 0 to.99 (same day access) Reporting an average of 1.00 to 4.99 Reporting an average of 5.00 to 8.99 Reporting an average of 9.00 to 21.99 Reporting an average of 22+ Total number of providers reporting 14
2. Percent of recommended screens that the clinic has offered to paneled patients Rationale Appropriate screening identifies health risks earlier so that action can be taken to improve health outcomes. Measurement encourages standardized screening across the province. ASaP has determined which screens are appropriate based on evidence. Tracking screening compliance provides information that can be analysed along with related information to identify: the long-term impact on health outcomes need for workflow improvements in a PCN 15
2. Percent of recommended screens continued Calculation (for each maneuver) Numerator total number of paneled patients meeting the screening criteria that were offered a screen (inferred screen may be counted where offers are not documented) Denominator total number of paneled patients meeting the screening criteria Other considerations The guideline proposes that providers can select the maneuvers to be measured (minimum of four). 16
3. Percentage of patients answering satisfied or very satisfied to the question Overall, how satisfied are you with the care you get from the clinic? Rationale A measure of the Patient Experience Satisfied patients tend to take a more active role in their own treatment. Regular measurement of patients experience, including satisfaction, will help PHC organizations make appropriate, evidence based changes to processes to improve patient experience and, ultimately, health outcomes. 17
3. Percentage of patients answering satisfied or very satisfied continued Calculation Numerator total number of patients answering satisfied or very satisfied to the survey question. Denominator total number of patients answering the survey question. Other considerations The single patient satisfaction results will be the information flowing to AH. The expectation is that this will be part of a broader patient experience survey. The specific survey has not been identified. Consultation with PCNs will be a very important part of the survey selection process. 18
4. Percent of patients returning to the same provider at the clinic for a subsequent visit Rationale Evidence shows that individuals who have a continuous relationship with a primary care provider or team: Receive higher rates of preventive care; Make fewer visits to the emergency department; Have lower hospitalization rates; Experience better management of acute and chronic illness; and Tend to report increased satisfaction with their care. This indicator will provide information on the extent of patient continuity. Can be analyzed along with the underlying data sets to support improved panel management leading to better health outcomes. 19
4. Percent of patients returning to the same provider at the clinic continued Calculation Numerator total number of visits by the providers panel to the provider Denominator total number of visits by the providers panel to any provider Other considerations The best approach to extracting, compiling and reporting continuity is to be determined. 20
5. The percentage of identified team members responding to a team effectiveness survey Rationale A measure of progress toward enhancing the delivery of care through the creation of health homes with teams of providers. Surveying team effectiveness and acting on the results will help PCNs make improvements over time. Survey results at the local level can facilitate improved team function leading to a more satisfying work experience for providers and better health services for patients. 21
5. Team effectiveness survey continued... Calculation Numerator number of people responding to a team effectiveness survey Denominator number of people identified as working in a interdisciplinary collaborative care team 22
6. Percent of paneled patients with a chronic disease who were offered self-management supports during the fiscal year Rationale Self-management is: one of the six outcomes identified in the Primary Health Care Strategy. consistent with the principle of person-centered care where individuals partner with their health team to meet their health goals. Self-management support is provided to help a patient physically, socially and emotionally manage their chronic condition. Can include programs, tools and policies Can be undertaken by the patient, and/or provided by non-profit or nongovernment groups, and their communities. This indicator will help PHC organizations measure their progress towards involving patients as partners in their care. 23
6. Chronic disease self-management supports continued Calculation Numerator number of paneled patients with a chronic disease who were offered self-management supports Denominator number of paneled patients with a chronic disease 24
7. Percent of paneled patients with a chronic disease who report maintaining or improving quality of life as measured by the EQ-5D tool during the fiscal year Rationale Measuring outcomes from a patient s perspective is an important aspect of determining the success of the health system. Self-reported health status is a broad multidimensional concept that includes subjective evaluations of both positive and negative aspects of life. Measurement of self-reported health status over time, particularly before, during, and after participation in a program, can inform whether health status has been maintained and/or improved in a patient-centred way. Information relating to changes over time can support program evaluation and quality improvement. 25
7. Chronic disease and EQ-5D continued Calculation (for each maneuver) Numerator number of paneled patients with a chronic disease who completed an EQ-5D survey (or equivalent) that indicated maintaining or improving functional health status Denominator number of paneled patients with a chronic disease who completed an EQ-5D survey (or equivalent 26
Summary of Opportunities and Challenges Efficient indicator reporting requires standardized definitions, consistent measurement methodology and common reporting protocols. Goal is high quality information on a timely basis to support clinical practices; Will be supported by: Challenges utilization of EMRs; automated data extracts and data sharing; and collaboration on how to best use existing EMRs. Variability across PCNs in EMR implementation; Several different EMRs are in place; and Variability in measurement and reporting process across PCNs 27
Summary of Opportunities and Challenges - Continued... Changes and improvements in service delivery will facilitate achievement of positive outcomes including: Better health outcomes Value for money Improved patient and provider experience Challenges Setting appropriate targets and expectations Support for change at the provider level including new work processes and other enablers 28
Supports Measurement and Evaluation Working Group will: Be a conduit for feedback from all parts of the system Suggest practical solutions to implementation challenges Direct the changes in indicators as they evolve Toolkit Toolkits providing more information to support implementation will be developed for each indicator Support for indicator reporting by PCNs will be provided by the PCN Program Management Office 29
Timing for Reporting Guideline Feedback from focus groups and other stakeholders will be addressed in an updated guideline The new version is expected to go to the Measurement and Evaluation Working Group in April 2015 Toolkit Work on the first toolkit for Time to Third Next Available Appointment is underway 30
Timing for Reporting - Continued... Annual Report - Results Template for reporting will be Included in the current year Annual Report template for information only PCNs will be able to report indicator results to the extent they have reliable results in 2015/16 Report on Progress First report due June 30, 2016 31
Questions? 32