PHC Opioid Response Initiative: Zone Proposal Package Guide Criteria & Guiding Principles Overview: What is the Primary Health Care Opioid Response Initiative? Tackling the opioid crisis in Alberta will require new approaches and an immediate response of the entire health system to change its trajectory. The engagement and response of primary care physicians, their teams and Primary Care Networks (PCNs) in Alberta will be essential in defining new primary health care approaches to address the crisis and the systemic issues that contribute to the crisis. The Alberta College of Family Physicians (ACFP), Alberta Medical Association (AMA) and Alberta Health Services (AHS), together with Alberta Health (AH) are aligned to lead this essential work to focus the primary care response. The primary care response will include: An Urgent Opioid Response - addressing the urgent needs of those in crisis through the distribution of Overdose Response Kits (naloxone kits) and the provision of Opioid Agonist Therapy (OAT) within primary care settings; Enhanced Provider Decision Support, Knowledge Translation and Education - ensuring basic knowledge and competencies to support patients with addiction, mental health and pain issues, and changing current practice within primary care clinics and PCNs to better care for individuals using opioids; Enhanced Opioid Related Service Delivery through PCN Zone Committee Engagement, Planning and Implementation developing new integrated service delivery models coordinated with partners including Alberta Health Services (AHS), AHS zone Addiction and Mental Health services, community services, and others. The Zone PCN Committees, newly established in Alberta, will play an essential role in the primary care response and will be accountable for planning, design and implementation of key deliverables within each of Alberta s five zones. Zones will be supported to follow a health service planning approach for opioids to develop a proposal, outlining their zone-specific strategies to improve opioid care. Strategies will be specific to achieving the goals and objectives as set forth by the Primary Health Care Opioid Response Initiative (PHC ORI) Steering Committee. Each zone will be provided one-time funding to jump start this work and build coordinated plans to sustain the focus with other service delivery partners. Zone PCN 1
Committees are strategically positioned to lead population focused integrated care initiatives, and facilitate the engagement of key stakeholders including primary care, community services, and AHS service delivery programs including primary and specialty care. This service level integration allows for better, timely, more accessible, and sustainable patient care in the prevention, early intervention and treatment of Opioid Use Disorder. This detailed Zone PCN Proposal Package Guide has been developed to lead Zone PCN Committees in their proposal planning efforts, and to facilitate access to support from the AMA, AHS, ACFP and AH toward accelerating their work. This approach to improve opioid care is meant to build on the foundational work already underway to strengthen the primary health care system in Alberta, aligning with the four primary care objectives as set forth by the Minister of Health: Accountable and effective governance Establish clear and effective governance roles, structures and processes that support shared accountability and the evolution of primary health care delivery. Strong partnerships and transitions of care Coordinate, integrate and partner with health services and other social services across the continuum of care. Health needs of the community and population Plan service delivery on high quality assessments of the community s needs through community engagement and assessment of appropriate evidence. Patient s Medical Home Implement patient's medical home to ensure Albertans have access to the right services through the establishment of interdisciplinary teams providing comprehensive primary care. This growing recognition of the value of strengthening the primary health care system will optimize the ability of primary care to respond to the opioid crisis. However, this will require changes to knowledge and competencies, and in the way physicians and interdisciplinary teams work within primary care practice. These changes require primary care teams to redesign how they organize and delivery care for a defined panel of patients, including populations who use opioids e.g. addiction, mental health, pain, recreational), by expanding their focus to the needs of the population(s) within their communities to address the tough challenges that have arisen within our healthcare system. 2
Provincial Response and Support The overall provincial response will include: Overall project management, communication, coordination and engagement plans for the initiative Development of an evaluation framework and logic model, and a rapid evidence review of relevant evaluation measures. Evaluation activities will include also include the development of a Zone Evaluation Support Plan. Note: Data collection for Zone PCN Committee proposed outcomes will be the responsibility of the zone. As provincial partner organizations, the zone proposal planning will be supported as follows: Zone Support Teams, with member representatives from AMA, AHS, and AH, will be focused on: Assigning team members to engage and support Zone PCN Committees in: Accessing and utilizing the opioid proposal planning tools and resources Developing their health service plans for opioids using a population health approach, considering transitions of care across the continuum of care including: primary care, specialty care, specialists, ER, urgent care, hospitals, community and social supports Developing their methods and approach to engage PCNs, primary care providers and teams with a focus on improving opioid care The Alberta College of Family Physicians will be focused on: Developing of evidence informed, and practical provider tools built for primary care reflecting new guidelines, evidence and standards Supporting the dissemination, continuing professional development and implementation of tools and supports for primary care providers and individuals using opioids Establishing a collaborative mentorship network Creating a business model for zone opioid mentorship collaborative networks to facilitate best practices and lessons learned, and to achieve integrated approaches across all zones Support the development of collaborative mentorship networks in each of the zones (connect family physicians with mentors to provide ongoing case-based support and continuing professional education) 3
AMA Integrated Programs (TOP, PMP, PCN PMO) will be focused on Developing primary care toolkits / change packages for Zones and PCNs to access when supporting primary care practices with their change efforts. The toolkit will include clinical decision support tools developed by ACFP, education sound bites provided by content experts, primary care clinical process improvement guides, coaching guides etc. Developing processes, curriculum, tools and resources to engage and train the existing Networks of Practice, such as Improvement Facilitators, Physician Champions, EMR Champions, Panel Managers and others, to maximize the spread and scale of the opioid response Building the Patient's Medical Home foundational work in the new toolkits, with a focus on attachment between a primary care provider and patient, panel identification and maintenance, relational continuity, panel management and the Central Patient Attachment Registry (CPAR), to maximize primary care engagement and response Support PCNs in engaging primary care providers and teams in implementing new care planning approaches and processes, such as the Patients Collaborating with Teams (PaCT) initiative, delivered jointly by AMA and AHS, for individuals using opioids Support dissemination of decision support tools through the TOP CPG program Alberta Health Services (AHS) will be focused on: Bridging and supporting communication across operations for various zone service areas, specialty services, community and social service agencies. Engaging program and subject matter experts Facilitating discussions to support opioid related activities underway including those funded through MOERC, those occurring nationally and others Co-creation and development of Integrated Care Partnerships (ICPs) for collective action Support for PCNs, and Zone PCN Committees to identify opportunities, inform decisions, plan, and implement integrated service delivery within their zone Co-develop zone specific environmental scans that include a listing of current opioid related resources, services and programs such as, OAT, Overdose Response Kits, Adverse Childhood Events (ACEs), and others Enable zones to achieve a collective impact by facilitating timely reporting of information and updates, coordination of activities and sharing of resources Creation of a framework and toolkit for engaging individuals with lived experience, patients and their families Developing a Harm Reduction Module for primary care, including stigma and bias module, and patient conversation scripts and tools 4
PHC Opioid Response Initiative Goals The following goals have been developed to assist Zone PCN Committees in preparing their proposal submissions and toward achieving clear and specific outcomes. This initiative aims to: Goal 1: Improve access, continuity and care delivery within primary care settings for individuals using opioids. Goal 2: Implement relevant and practical evidence informed decision supports, and knowledge translation tools including mentorship to better equip and educate primary care providers and teams, including clinics and PCNs, to support patients using opioids and/or with Opioid Use Disorder. Goal 3: Enhance system integration and coordination of care between primary care practices and other service delivery partners for patients using opioids including those with Opioid Use Disorder. Goal 4: Using a population health based approach develop and implement a health service plan for the integrated delivery of opioid related care. Proposal Submission Process & Timelines A Letter of Intent (LOI) must be submitted by the Zone PCN Committee Dyad by March 15, 2018 at 12 noon MST that will provide notification of intent and a brief description of the project proposal being considered for further development. Complete Proposals including Application for Funding, High Level Budget, and Letter of Endorsement must be received by either intake date and time specified below. Proposals received after the initial intake will be held over for review with the second intake. Intake Proposal Submission Date Target Award Date 1 May 17, 2018 at 12 noon MST May 30, 2018 2 June 21, 2018 at 12 noon MST June 28, 2018 Please email Letters of Intent and Proposals to Cora-Lee Polansky, PHC ORI Project Secretariat, at Cora-Lee.Polansky@acfp.ca by the dates specified. Contact Cora-Lee Polansky at 780-901- 7454 if you have any questions regarding deadlines and content required. 5
Funding Allocation Funding distribution across zones is guided by the following principles: Each zone will be eligible for $500,000 to support design, development and implementation of their opioid response health service plan Each zone is eligible for additional population-response based funding Sample distribution of zonal Opioid Response funds. Zone Project Planning, Operations Design, Delivery, Education and Evaluation Population Response Total* South 500,000 280,000 780,000* Calgary 500,000 830,000 1,330,000* Central 500,000 280,000 780,000* Edmonton 500,000 830,000 1,330,000* North 500,000 280,000 780,000* 2,500,000 2,500,000 5,000,000 *Totals in table are estimates based on equal distribution. These totals may be different based on specific requests and in response to cross-zonal partnerships This allocation of funds by zone is designed to recognize the different contexts of each zone. Variation in population based need Existing services and supports within each zone Variance in geographic or sector delivery challenges and opportunities The ability for each zone to execute planning, education, practice change support, and changes to service delivery within the time frame of the initiative Shared approaches and allocations may be negotiated between the Zone PCN Committee Dyads based on existing care corridors, options for telehealth/alternative visits, mentorship and other innovative and sustainable solutions. Note: Zone PCN Committees will need to identify one PCN within their zone to act as the banker for the grant. PCN to be identified on the High Level Budget Form. 6
Submission Checklist Proposal submissions must include all the following components to be considered complete: Part A - Proposal Submission Completed Application for Funding Form Completed High Level Budget Form Leadership Endorsement Letter, signed by the Dyad Leads for the relevant Zone PCN Committee Part B On Approval Design and Development Detailed Budget Draft Project Plan including identified timelines and deliverables Risk Management and Mitigation Plan that takes into consideration change management Letter of Commitment outlining support from project partners, may include a signed compact Accessing Support: Proposal and Health Service Plan Development Zone Support Teams, including members from AMA, AHS and AH, are available to support Zone PCN Committees in advancing their proposals and health service plans. Please reference the Primary Health Care Opioid Response Initiative Contact List. Proposal Planning Toolkit The Proposal Planning Toolkit contains tools and resources to assist with proposal planning. The initial release of the toolkit contained: Zone Level Opioid Related Population Health Data Package PHC Opioid Response Initiative Overview Presentation Key Messages PHC Opioid Response Initiative Goals and Objectives PHC Opioid Response Initiative Governance Contact List MOERC Funded Initiatives List Glossary of Terms Physician Remuneration Guidelines 7
Throughout the proposal planning phase, additional resources will be developed and distributed. If there is a tool or resource you require, please email or call Cora-Lee Polansky, PHC ORI Project Secretariat, at Cora-Lee.Polansky@acfp.ca or 780-901-7454. 8
Application for Funding Guidelines The Application for Funding includes completion of: Application for Funding Form High Level Budget Form Leadership Endorsement Letter The following section outlines how to complete the Application for Funding Form. It includes the criteria included in the PHC ORI Proposal Assessment Tool and references the Primary Health Care Opioid Response Initiative Goals and Objectives. 1. Contact Information Identify below a key point person who can answer questions and provide follow-up as needed Name: Position/Title: Organization /PCN: Address: Phone Number: E-mail: PCN Zone Committee Contact: 2. Proposal Overview In approximately 300 words please describe the purpose of your project and what will be accomplished. This is an executive summary and must include: Link to how findings from population health data have been used to inform zone activities (planning) Link to zone alignment and coordination Goal(s) of the proposal (project) Proposed total budget Summary statement of the key outcomes (and related activities). These anticipated outcomes, at a minimum, must include or show how the zone will meet the following: 9
o Increase in the number of interdisciplinary team members in PHC supporting Opioid Agonist Therapy (OAT) o Increase in the number/percentage of providers prescribing buprenorphine/naloxone (Suboxone) and methadone. o Increase in the number of clinics providing Opioid Overdose Response (naloxone) Kits o Increase in the number of physicians taking training in areas related to OAT and clinical competencies related to opioid dependence o Formation and/or enhancement of Integrated Care Partnerships within each zone bringing together key groups to inform and enable the zone's opioid response An outline of the long range plans and consideration for ensuring sustainable actions and progress once the grant is concluded 3. Health Service Planning Approach This section aligns with Goal 4: Health Service Planning: Using a population health based approach, develop and implement a service plan for the integrated delivery of opioid related care. For this section: Outline the zone health service planning approach taken including assessment, design and implementation plans for service improvements that support the opioid response and proposal development. The approach to include: o Description of the population health data used and how it informed identification of population needs, assessment of services for gaps and duplication, and opportunities for improvement based on trends within population groupings, community (LGA) profiles and PCN services o A process for understanding how gaps in the patient journey will be identified (e.g. describes who will be involved and considers experiences of family physicians, individuals with lived experience, Indigenous populations, interdisciplinary team members, etc.), including how identified gaps will be prioritized o An approach for planning of service level improvements, including relevant reporting and quality improvement activities 10
o The alignment and approach to support coordination of PCN business plans with zone activities that meet opioid related population needs within the health home 4. Proposed Approach and Outcomes Describe the high level Zone PCN Committee structure and approach (e.g. solutions; goals and objectives, inclusion of individuals with lived experience, patients and their families) used in the development of the proposal. 4a. Improve Access and Continuity Goal 1: Improve access, continuity and care delivery within primary care settings for individuals using opioids. For this section: Describe the desired outcomes, activities, areas of focus and support for data collection relative to Goal 1. Based on your populations of focus, describe how you are/will consider: o Building or leveraging processes for facilitating attachment between family physicians/nurse practitioners and patients with opioid dependence/opioid Use Disorder and/or pain o Building on foundational work from the Patient's Medical Home (e.g. Panel identification and maintenance, continuity campaign, panel management, Central Patient Attachment Registry) o Engaging PCN Improvement Facilitators, EMR Champions, Panel Managers and Physician Champions to support members in desired practice changes o Identifying processes to engage PCNs and AHS zone services toward supporting primary care clinics to appropriately increase the distribution of Opioid Overdose Response (naloxone) Kits for registered distribution sites of the Provincial Naloxone Program within the zone o Identifying steps and/or plans for increasing access to OAT services in the zone (e.g. creation or enhancement of zone based Communities of Practice (CoP)) 11
o Mechanisms for identifying providers delivering OAT and registered naloxone sites to inform OAT and naloxone resource listing for the zone support transitions in care Outcomes must include: o Increase in the number of interdisciplinary team members in PHC supporting Opioid Agonist Therapy (OAT) o Increase in the number/percentage of providers prescribing buprenorphine/ naloxone (Suboxone) and methadone. o Increase in the number of clinics providing Opioid Overdose Response (naloxone) Kits o Formation and/or enhancement of Integrated Care Partnerships within the zone bringing together key groups to inform and enable the zone's opioid response o Increase in the number of patients attached to a primary care provider Outcomes may include: o Number of care plans developed collaboratively with patients o Increase in the capacity building strategies available to primary care interdisciplinary teams in the areas of stigma awareness and reduction, panel management, chronic disease management and care planning o Other outcomes related to improving access and continuity 4b. Decision Support, Knowledge Translation and Education Goal 2: Implement relevant and practical evidence informed decision supports, and knowledge translation tools including mentorship to better equip and educate primary care providers and teams, including clinics and PCNs, to support patients with addiction, mental health and/or pain issues resulting in use of, or risk of use of opioids and/or with Opioid Use Disorder For this section: Describe the desired outcomes, activities, areas of focus and support for data collection relative to Goal 2. Describes how you are/will consider: 12
o Processes for identifying the education, knowledge translation and decision supports required to support the education, uptake and practice change o Approaches for implementing/delivering the identified education, knowledge translation and decision support tools Outcomes must include: o Increase in the number of physicians taking training in areas related to OAT and clinical competencies related to opioid dependency o Number of primary care providers and teams who have attended evidence based training or education targeted to supporting patients with underlying health issues that may lead to opioid misuse Outcomes may include: o Number of primary care providers participating in PaCT to facilitate the identification of patient populations using or at risk of using opioids o Establish a zone specific collaborative mentorship network related to the treatment of pain, mental health including addictions and/or delivery of OAT within primary care settings (Note: collaborative mentorship network program to be developed through the grant by the ACFP PEER team; zone can choose to participate) o Other outcomes related to education, knowledge translation or decision support 4c. Enhanced Coordination of Care and System Integration Goal 3: Enhance system integration and coordination of care between primary care practices and other service delivery partners for patients using opioids including those with Opioid Use Disorder. For this section: Describe the desired outcomes, activities, areas of focus and support for data collection relative to Goal 3. Based on your populations of focus, describe how you are/will consider: o Development of a plan for partnering and integrating with additional provincial and zone supports such as AMA and AHS provincial 13
programs, SCNs, community, specialty service areas, acute care, zone quality and planning supports and others. o Identification of zone and PCN activities that support primary care practices, PCNs and AHS community based services for the priority clinical areas meeting population and community needs. o Development of comprehensive and accessible care pathways for patients using or at risk of using opioids o Processes established to monitor admissions and readmissions to ER and hospital for paneled patients Outcomes must include: o Steps taken to optimize existing and/or creation of new Integrated Care Partnerships to enable activities within proposal Outcomes may include: o Enhanced integration and collaboration, in part through Integrated Care Partnerships, for primary care, community, specialty care service areas, specialty care programs and acute care focused on opioid use 5. Sustainability and Change Management Describe how the proposal will take into consideration current zone priorities and future planning to ensure sustainable actions and progress once the grant is concluded (i.e. how the work will be operationalized, monitored and funded going forward) Describe an approach and activities that support a cultural shift beyond the duration of the grant: o Changes in provider behaviors and the culture of care o Changes in the way that care is delivered and services are developed for and with patients. 14
High Level Budget High Level Budget Form (spreadsheet) to be completed as part of the Application for Funding. Category Functions Description of Activities (summary of the activities from the proposal submission Year 1 (Feb 1/18 - Mar 31/18) Year 2 (Apr 1/18 - Mar 31/19) Year 3 (Apr 1/18 - Mar 31/19) A Design & Development $0.00 $0.00 $0.00 TOTAL B Service Delivery & Implementation $0.00 $0.00 $0.00 C Change Management $0.00 $0.00 $0.00 D Other $0.00 $0.00 $0.00 TOTAL $0.00 $0.00 $0.00 $0.00 Following is a list of eligible and ineligible expenses for grants from AH. 15
Leadership Endorsement Letter A Leadership Endorsement Letter from the Zone PCN Committee Dyad Administrative and Medical Leaders to be included as part of the Application for Funding. 16