Primary Care: Improving Access in Alberta€¦ · Alberta Primary Care Initiative Vision The...

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Primary Care: Primary Care: Improving Improving Access in Access in Alberta Alberta

Transcript of Primary Care: Improving Access in Alberta€¦ · Alberta Primary Care Initiative Vision The...

Page 1: Primary Care: Improving Access in Alberta€¦ · Alberta Primary Care Initiative Vision The Alberta Primary Care Initiative is an agreement between AHW, AMA and RHAs to: Improve

Primary Care:Primary Care: Improving Improving Access in Access in AlbertaAlberta

Page 2: Primary Care: Improving Access in Alberta€¦ · Alberta Primary Care Initiative Vision The Alberta Primary Care Initiative is an agreement between AHW, AMA and RHAs to: Improve

Alberta Primary Care Initiative Vision

The Alberta Primary Care Initiative is an agreement between AHW, AMA and RHAsto:

Improve access to, and effectiveness of, primary care servicesThrough a collaborative, comprehensive approachEntrusting local solutions to local problems

Page 3: Primary Care: Improving Access in Alberta€¦ · Alberta Primary Care Initiative Vision The Alberta Primary Care Initiative is an agreement between AHW, AMA and RHAs to: Improve

Quality Care

The ability for a patient to receive the care he or she wants/needs when he

or she wants/needs it.Don Berwick

Page 4: Primary Care: Improving Access in Alberta€¦ · Alberta Primary Care Initiative Vision The Alberta Primary Care Initiative is an agreement between AHW, AMA and RHAs to: Improve

“ The Old Paradigm”Single physician One visit at a time

(responsible for that visit only)Focus is acute and episodicNo measurement

- Guidelines- Outcomes- Value (accountability)

High return visit ratesLow continuity of careFollow up sporadic

“The New Paradigm”Physician and Team Responsible for a patient

panel (population) Focus on:- continuity- optimizing visitsSame day accessScreening and surveillanceChronic disease managementMeasures of process and

outcomesIntegration with specialty

programs/medical specialists (service agreements)Information system to support

Page 5: Primary Care: Improving Access in Alberta€¦ · Alberta Primary Care Initiative Vision The Alberta Primary Care Initiative is an agreement between AHW, AMA and RHAs to: Improve

What Do Patients Want?

Patients want:To choose their providerTo access their provider when they chooseA quality healthcare experience

Page 6: Primary Care: Improving Access in Alberta€¦ · Alberta Primary Care Initiative Vision The Alberta Primary Care Initiative is an agreement between AHW, AMA and RHAs to: Improve

The Panel

The patient panel is key to system performance and patient outcomes

“A panel is the unique, unduplicated, discrete patient population for which the physician/team is responsible.”

Page 7: Primary Care: Improving Access in Alberta€¦ · Alberta Primary Care Initiative Vision The Alberta Primary Care Initiative is an agreement between AHW, AMA and RHAs to: Improve

Panel

Unit of measure – the yardstickDefines work (demand) by physician/teamDivided by patient characteristics (diabetes, depression, elderly, etc.)Adjusted for determinants such as age, sexDefines the population for which each provider is responsible and accountableSum of all panels encompasses the entire population (everyone is cared for)

Page 8: Primary Care: Improving Access in Alberta€¦ · Alberta Primary Care Initiative Vision The Alberta Primary Care Initiative is an agreement between AHW, AMA and RHAs to: Improve

Physicia n (FTE)

Panel (Adjuste d Panel)

# of Visits by my patients

to me

Return Visit Rate (Provider)

# of Visits by my

patients to anyone in the clinic

Return Visit Rate

(To Clinic)Continuit

y Rate

A (1.6)1622

(1934) 4244 2.6 4401 2.7 96.4%

B (1.0)1703

(1799) 5957 3.5 6519 3.8 91.4%

C (2.0)2453

(2796) 13773 5.6 14884 6.1 92.5%

D (1.2)1904

(2063) 9143 4.8 10603 5.6 86.2%

E (1.2)1956

(2104) 9733 5.0 11783 6.0 82.6%

F (1.7)2885

(3238) 18314 6.3 22171 7.7 82.6%

G (0.1) 267 (234) 853 3.2 1055 4.0 80.9%

Page 9: Primary Care: Improving Access in Alberta€¦ · Alberta Primary Care Initiative Vision The Alberta Primary Care Initiative is an agreement between AHW, AMA and RHAs to: Improve

Continuity

The percentage of time a patient sees his/her own physician• Chance of a return visit in 2 weeks

• X if see own Family Physician• 2X if see “allied” Family Physician• 4X if see “unallied” physician (Ie. - ER)

Page 10: Primary Care: Improving Access in Alberta€¦ · Alberta Primary Care Initiative Vision The Alberta Primary Care Initiative is an agreement between AHW, AMA and RHAs to: Improve

“ The Old Paradigm”Single physician One visit at a time

(responsible for that visit only)Focus is acute and episodicNo measurement

- Guidelines- Outcomes- Value (accountability)

High return visit ratesLow continuity of careFollow up sporadic

“The New Paradigm”Physician and Team Responsible for a patient

panel (population) Focus on:- continuity- optimizing visitsSame day accessScreening and surveillanceChronic disease managementMeasures of process and

outcomesIntegration with specialty

programs/medical specialists (service agreements)Information system to support

Page 11: Primary Care: Improving Access in Alberta€¦ · Alberta Primary Care Initiative Vision The Alberta Primary Care Initiative is an agreement between AHW, AMA and RHAs to: Improve

Access: Why Focus on Delay?

Delays cost moneyDelays adversely effect clinical outcomesWe can only go as fast as the slowest stepPerception that delay = lack of resourceDelays lead to patient dissatisfactionDelays lead to staff dissatisfactionDelays lead to provider dissatisfaction

Page 12: Primary Care: Improving Access in Alberta€¦ · Alberta Primary Care Initiative Vision The Alberta Primary Care Initiative is an agreement between AHW, AMA and RHAs to: Improve

DemandforAppointments

Panel

The “Universe” From Which Demand Comes Is……

Variation

BacklogNo ShowsTriageRework

Supply

ThePanel

Page 13: Primary Care: Improving Access in Alberta€¦ · Alberta Primary Care Initiative Vision The Alberta Primary Care Initiative is an agreement between AHW, AMA and RHAs to: Improve

Clinic Weekly Demand and Supply

Clinic Weekly Demand, Supply and Supply Used

0

50

100

150

200

250

300

Demand Suppl y Suppl y Used

Page 14: Primary Care: Improving Access in Alberta€¦ · Alberta Primary Care Initiative Vision The Alberta Primary Care Initiative is an agreement between AHW, AMA and RHAs to: Improve

Time to 3rd Next Appointment

Average Clinic Delay

0

5

10

15

20

25

30

35

40

8/1/2 0059/1/2 005

10/1/200511/1/200512/1/2005

1/1/2 0062/1/2 0063/1/2 0064/1/2 0065/1/2 0066/1/2 0067/1/2 0068/1/2 0069/1/2 006

10/1/ 200611/1/200612/1/2006

1/1/2 0072/1/2 0073/1/2 007

Page 15: Primary Care: Improving Access in Alberta€¦ · Alberta Primary Care Initiative Vision The Alberta Primary Care Initiative is an agreement between AHW, AMA and RHAs to: Improve

Results

Patient satisfaction improvedStaff satisfaction improvedProvider satisfaction improvedDelays reducedContinuity improvedQuality improvedUnnecessary visits reducedIncreased capacity

Page 16: Primary Care: Improving Access in Alberta€¦ · Alberta Primary Care Initiative Vision The Alberta Primary Care Initiative is an agreement between AHW, AMA and RHAs to: Improve

“ The Old Paradigm”Single physician One visit at a time

(responsible for that visit only)Focus is acute and episodicNo measurement

- Guidelines- Outcomes- Value (accountability)

High return visit ratesLow continuity of careFollow up sporadic

“The New Paradigm”Physician and Team Responsible for a patient

panel (population) Focus on:- continuity- optimizing visitsSame day accessScreening and surveillanceChronic disease managementMeasures of process and

outcomesIntegration with specialty

programs/medical specialists (service agreements)Information system to support

Page 17: Primary Care: Improving Access in Alberta€¦ · Alberta Primary Care Initiative Vision The Alberta Primary Care Initiative is an agreement between AHW, AMA and RHAs to: Improve

200 not seen

Page 18: Primary Care: Improving Access in Alberta€¦ · Alberta Primary Care Initiative Vision The Alberta Primary Care Initiative is an agreement between AHW, AMA and RHAs to: Improve

Key Quality Indicators for Primary Care

PREVENTIVE MEASURES:Breast Cancer Screening (Mammography)

Percent of eligible women, age 50-69, screened every two years for breast cancer

Cervical Cancer Screening (Pap Smears)Percent of eligible women, age 18-69, screened every three years for cervical cancer

Page 19: Primary Care: Improving Access in Alberta€¦ · Alberta Primary Care Initiative Vision The Alberta Primary Care Initiative is an agreement between AHW, AMA and RHAs to: Improve

PREVENTIVE MEASURES:Colorectal Cancer Screening

Percent of eligible patients, age 50-80, who are up to date with screening for colorectal cancer (depending on personal risk, type of screening used and recommended frequencies)

Blood Pressure Screening and ControlPercent of eligible patients who had a blood pressure reading done at the most recent clinic visit, or in the last 6 months (if BP reading was less than or equal to 140/90)Percent of eligible patients whose most recent blood pressure (within the last 6 months) was less than or equal to 140/90

Page 20: Primary Care: Improving Access in Alberta€¦ · Alberta Primary Care Initiative Vision The Alberta Primary Care Initiative is an agreement between AHW, AMA and RHAs to: Improve

CHRONIC DISEASE SCREENING & MANAGEMENT MEASURES:Diabetes HgbA1c Testing

Percent of diabetic adult patients having at least one HgbA1c test done in the past 6 monthsPercent of diabetic adult patients whose most recent HgbA1c reading (within last 6 months) was less than or equal to 7.0

IMMUNIZATION MEASURES:Influenza Vaccination

Percent of patients, age 65 and older, who received influenza vaccination within the previous 12 months

Pneumococcal VaccinationPercent of patients, age 65 and older, who have received pneumonia vaccination

Page 21: Primary Care: Improving Access in Alberta€¦ · Alberta Primary Care Initiative Vision The Alberta Primary Care Initiative is an agreement between AHW, AMA and RHAs to: Improve

38%

47%

57%

15%

55% 56%

18% 18%

30%

0%

10%

20%

30%

40%

50%

60%

% Patients with Timely Screening

Breast Cervical Colorectal

Types of Cancer Screening

Cancer Screening RatesRandom samples of 10 eligible patient charts per provider were pulled and reviewed for each of the below measures to

determine if timely cancer screening was performed for each patient

Clinic A Clinic B Clinic C

Page 22: Primary Care: Improving Access in Alberta€¦ · Alberta Primary Care Initiative Vision The Alberta Primary Care Initiative is an agreement between AHW, AMA and RHAs to: Improve

33%

80%

24%

76%

71%

84%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

% o

f Pat

ient

s

Clinic A Clinic B Clinic C

Blood Pressure Monitoring and OutcomesRandom samples of 10 eligible patient charts per provider were pulled and reviewed to determine if BP was measured at

each patient's most recent visit and if the most recent BP for each patient was normal (< 140/90)

BP Done at Last Visit BP in Control

Page 23: Primary Care: Improving Access in Alberta€¦ · Alberta Primary Care Initiative Vision The Alberta Primary Care Initiative is an agreement between AHW, AMA and RHAs to: Improve

63%

48%45%

55% 56%

69%

0%

10%

20%

30%

40%

50%

60%

70%

% of Patients

Clinic A Clinic B Clinic C

Diabetic HgbA1c Testing and ControlRandom samples of 10 eligible diabetic patient charts per provider were pulled and reviewed to determine if each patient

had a HgbA1c test done within the previous 6 months and if it was in normal range (< 7.0%)

HgbA1c Done in Last 6 Months

HgbA1c in Control

Page 24: Primary Care: Improving Access in Alberta€¦ · Alberta Primary Care Initiative Vision The Alberta Primary Care Initiative is an agreement between AHW, AMA and RHAs to: Improve

10%

100%

20%

90%

30%

60%

30%

70%

0%

60%

20%

70%

30%

70%

30%

80%

30%

90%

30%

60%

40%

90%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

% P a t i e n t s*Samples may be smaller f or some physician s wher e t her e wer e n ot 10 pat ien t s on t heir pan els who met

in clusion cr it er ia

P hysi c i an A Physi ci an B P hysi ci an C P hysi c i an D Physi c i an E Physi ci an F P hysi ci an G P hysi c i an H P hysi c i an I Physi ci an J P hysi ci an K

B loo d Pressure M o nit o ring and Out co mesRandom sampl es of 10* el i gi bl e pat i ent char ts per pr ovi der wer e pul l ed and r evi ewed to deter mi ne i f B P was measur ed at each pat i ent 's most r ecent vi s i t and i f the most r ecent BP f or each pat i ent was nor mal (< 140/ 90)

BP Done at Last VisitBP in Control

Page 25: Primary Care: Improving Access in Alberta€¦ · Alberta Primary Care Initiative Vision The Alberta Primary Care Initiative is an agreement between AHW, AMA and RHAs to: Improve

50%

20%

30%

40% 40% 40%

50%

30% 30%

80%

60% 60%

40%

30%

50%

90%

40% 40%

50%

70%

10% 10%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

% o f P a t i e n t s*Samples may be smaller f or some physician s wher e t her e wer e n ot 10 pat ien t s on t heir pan els who met

in clusion cr it er ia

Physi ci an A P hysi ci an B P hysi c i an C Physi ci an D Physi ci an E P hysi ci an F P hysi c i an G Physi c i an H Physi ci an I P hysi ci an J P hysi c i an K

Di abet i c HgbA1c T est i ng and Cont r olRandom sampl es of 10* el i gi bl e di abet i c pat i ent char t s per pr ov i der wer e pul l ed and r ev i ewed to deter mi ne i f each pat i ent had a HgbA1c test done wi thi n t he pr evi ous 6 months and i f i t was i n nor mal r ange (< 7.0%)

HgbA 1c Done i n Last 6 M onths HgbA1c i n Cont r ol

Page 26: Primary Care: Improving Access in Alberta€¦ · Alberta Primary Care Initiative Vision The Alberta Primary Care Initiative is an agreement between AHW, AMA and RHAs to: Improve

Supporting the Panel

The “core” family practice team is the group that support physicians in their day to day generalist work of serving their panel of patientsRHA services, including community care nurses, public health nurses, rehab, social work and mental health, community and hospital based pharmacies, and specialists support the primary care teams to be successful.

Page 27: Primary Care: Improving Access in Alberta€¦ · Alberta Primary Care Initiative Vision The Alberta Primary Care Initiative is an agreement between AHW, AMA and RHAs to: Improve

Measure Value?

You won’t fix:CPGOutcomesCare plansAccessCapacityPhysician remunerationSpecialty referralLab usageHuman resources

……………………………..Without Panels

Page 28: Primary Care: Improving Access in Alberta€¦ · Alberta Primary Care Initiative Vision The Alberta Primary Care Initiative is an agreement between AHW, AMA and RHAs to: Improve

For More Information

Please visit our website at:www.chinookprimarycarenetwork.ab.ca

Or contact the Chinook Primary Care Network office at (403) 388-6510