Ontario Primary Care Performance Measurement Initiative

Brian Hutchison Chair, Ontario Primary Care Performance Measurement Steering Committee Senior Advisor, Health Quality Ontario Professor Emeritus, Departments of Family Medicine and Clinical Epidemiology and Biostatistics, McMaster University Co-Chair, Canadian Working Group for Primary Healthcare Improvement

Wissam Haj-Ali Project Lead, Primary Care Performance Measurement & Reporting www.HQOntario.ca Health Quality Ontario

Presentation Overview • Health Quality Ontario’s mandate • Need for performance measurement in primary care • Ontario Primary Care Performance Measurement Initiative

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Health Quality Ontario • Independent agency created in 2005 as a result of the Ontario Commitment to the Future of Medicare Act • Expanded role and mandate in 2011 based on the Ontario Excellent Care for All Act • HQO’s mandate: To monitor and report to the people of Ontario To support continuous quality improvement to promote health care that is supported by the best available scientific evidence

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Need for performance measurement in primary care • Planning and resource allocation • Quality improvement • Support transparency and accountability

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Ontario Primary Care Performance Measurement Initiative Working towards

A coordinated and sustainable approach to measure and report on primary care performance in Ontario

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Primary Care Performance Measurement Summit (November 21 , 2012) st

Outcomes:  The preliminary identification of a framework for primary care performance measurement priorities in Ontario; and  Commitment from participating organizations to engage in ongoing collaborative work on primary care performance measurement

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Primary Care Performance Measurement Steering Committee

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Steering Committee Member Organizations 1. Association of Family Health Teams of Ontario 2. Association of Ontario Health Centres 3. Canadian Institute for Health Information 4. Cancer Care Ontario 5. Cancer Quality Council of Ontario 6. C-Change 7. eHealth Ontario 8. Health Quality Ontario 9. Institute for Clinical Evaluative Sciences 10. Local Health Integration Networks 11. Ontario College of Family Physicians 12. Ontario Medical Association 13. Ontario Ministry of Health and Long-Term Care 14. Ontario Patient Relations Association 15. Patients' Association of Canada 16. Registered Nurses' Association of Ontario

Primary Care Performance Measurement Survey • Potential measurement areas/topics in eight domains: – – – – – – – –

• • • •

Access Integration Efficiency Effectiveness Focus on Population Health Safety Patient-Centredness Appropriate Resources

Equity as an additional cross-cutting domain 2 versions – practice lens and system lens 5-point Likert scale (not valuable →very valuable) 886 responses

Identification of Priority Measurement Areas (Steering Committee) Considerations: • Average scores and ranking for potential measurement priorities from stakeholder survey • Summit rankings of potential measurement priorities • Steering Committee member perspectives • Alignment with provincial priorities

Access (Practice lens) Summit ranking (based on voting results)

Stakeholder survey measurement priority

Timely access to care

Timely access at regular place of care

3.42 (2)

Access to care by telephone/email

Access to non face-to-face care (e.g., telephone, email, etc.)

3.01 (6)

Access to after-hours care

Access to after-hours care (call and visits)

3.11 (4)

Access to an inter-professional primary care team Access to an inter-professional primary care team

Overall importance score (Ranking)

3.23 (3)

Access to a regular primary care provider

Access to a regular primary care provider

3.61 (1)

Access to home visits

Access to home visits for target populations

2.95 (7)

Use of Emergency Department services*Integration

Extent of emergency department use (also relevant to Integration)

2.56 (9)

Use of emergency department services for a condition that could have been treated at regular place of care, if available (also relevant to Integration)

3.03 (5)

Patient access to their own health information (also relevant to Efficiency)

2.88 (8)

www.HQOntario.ca

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Access (System lens) Summit ranking (based on voting results)

Stakeholder survey measurement priority

Timely access to care

Timely access at regular place of care

3.36 (2)

Access to a regular primary care provider

Access to a regular primary care provider

3.47 (1)

Use of Emergency Department services*Integration

Extent of emergency department use (also relevant to Integration)

3.09 (4)

Access to an inter-professional primary care team

Access to an inter-professional primary care team

3.16 (3)

Access to after-hours care

Access to after-hours care (call and visits)

3.07 (5)

Access to care by telephone/email

Access to non face-to-face care (e.g., telephone, email, etc.)

3.03 (6)

Access to home visits

Access to home visits for target populations

2.92 (7)

Use of emergency department services for a condition that could have been treated at regular place of care, if available (also relevant to Integration)

2.90 (8)

Patient access to their own health information (also relevant to Efficiency)

2.79 (9)

www.HQOntario.ca

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Overall importance score (Ranking)

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Access • Extent of (avoidable) emergency department, walk-in clinic, urgent care centre use {S} • Access to a regular primary care provider {S+P} • Access to an inter-professional primary care team {S+P} • Timely access at regular place of care {S+P} • Access to after-hours care (call and visits) {S+P} • Access to non face-to-face care (e.g., telephone, email, etc.) {S+P} • Access to home visits for target populations {S+P}

Integration • Information sharing across the continuum of care including patients and family caregivers {S+P} • Care coordination with other health and community care providers and services {S+P} • Time to referred appointment with medical/surgical specialist or other specialized services {S+P} • Hospital admissions and readmissions {S+P} • Follow-up with regular primary care provider post hospital discharge {S+P} • Waiting time for community services {S+P}

Efficiency • Per capita health care cost (primary care, specialist care, hospital care, diagnostics, pharmaceuticals, longterm care, community care) {S} • Support for family caregivers {S+P} • Unnecessary duplication of diagnostic tests/imaging {S+P} • Implementation and meaningful use of Electronic Medial Records/Electronic Health Records {S+P} • Self-management support and collaboration with patients and families {S+P} • Patient wait times in office {P}

Effectiveness • Management of chronic conditions including people with mental health and addictions and multiple chronic conditions {S+P} • Advanced disease/palliative care {S+P} • Symptom management {S+P} • Negotiated care plan for patients with chronic conditions {S+P}

Focus on Population Health • Preventive care for infants and children (beyond immunization) {S} • Health and socio-demographic information about the population being served (including health status) {S+P} • Immunization through the life span {S+P} • Screening and management of risk factors for cardiovascular disease and other chronic conditions (e.g., obesity, smoking, physical inactivity, diet, alcohol and substance abuse, socio-demographic characteristics, sexual and other high risk behaviours) {S+P} • Chronic disease screening (e.g., cancer, diabetes, hypertension, asthma, depression, dementia) {S+P} • Prenatal care {S+P}

Safety • Infection prevention and control {S} • Medication management, including medication reconciliation {S+P} • Recognition and management of adverse events including medical errors {S+P}

Patient-Centredness • Respect for patients’ and families’ values, culture, needs and goals {S+P} • Process to obtain patient/client and caregiver input regarding health care services {S+P} • Respectful and understandable communication with patients {S+P} • Coordination of care within the primary care setting {S+P} • Process for addressing suggestions/complaints {S+P}

Appropriate Resources • Funds received by primary care practices {S} • Human resources availability, composition (skills mix) and optimized scope of practice {S+P} • Healthy work environment and safety {S+P} • Funding and use of electronic systems to link with other settings {S+P} • Practice improvement and planning {P} • Human resources training and professional development, including patient-centred care {P}

Next Steps Summer - Fall 2013 • Measures Working Group to identify specific performance measures guided by the measurement priorities • Technical Working Group Winter- Fall 2013/2014 • Finalize recommendations re: measures, infrastructure, analysis and reporting Ongoing • Establish a governance framework for monitoring implementation and updating measures 21

Measures Working Group Composition • • • • • • • • • •

Primary care providers and decision makers Patients/citizens Primary care researcher Measurement expert Data experts Ministry representative(s) Professional association representatives (optional) Steering Committee member HQO core team members Invited content experts as needed

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Material for Measures Working Group

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Potential performance measures with information about: – – – –

original source validity/reliability use in Ontario, Canada and internationally existing or potential data sources in Ontario

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Potential Selection Criteria • •

Validity/reliability Evidence that the measure will address one or more aspects of the triple aim: – Improving the patient experience of care – Improving the health of population – Reducing the per capita cost of health care

• • •

Alignment with existing performance measurement initiatives in Ontario Opportunity for comparison among practices, regions, provinces and countries Current availability of data (secondary consideration)

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Moving Forward

EHR/EMR data Agreement on performance measures

Survey data

Driving improvement

Administrative data

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1. Better care 2. Better health 3. Lower cost

For more information • Please visit our website: http://www.hqontario.ca/public-reporting/primary-care – Information Sheet – Summit Proceedings Report

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www.hqontario.ca [email protected]