Strengthening Primary Care in Grey Bruceswpca.ca/Uploads/ContentDocuments/GB PCA... · Grey Bruce...

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Strengthening Primary Care in Grey Bruce Dr. Keith Dyke Sub-Region Clinical Lead November 7, 2017

Transcript of Strengthening Primary Care in Grey Bruceswpca.ca/Uploads/ContentDocuments/GB PCA... · Grey Bruce...

Page 1: Strengthening Primary Care in Grey Bruceswpca.ca/Uploads/ContentDocuments/GB PCA... · Grey Bruce Primary Care Alliance Agenda Item Time Topic or Subject Presenter 1. 4:45 (5 minutes)

Strengthening Primary Care in Grey Bruce

Dr. Keith Dyke

Sub-Region Clinical Lead

November 7, 2017

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Grey Bruce Primary Care AllianceAgenda

Item Time Topic or Subject Presenter

1. 4:45 (5 minutes) Welcome and Opening Dr. Keith Dyke

2. 4:50 (10 minutes) Introductions

LHIN Sub-region Team Dr. Keith Dyke

3. 5:00 (30 minutes)

Overview of vision for SW

PCA Nominations for Co-

Chair

Dr. Keith Dyke

4. 5:30 (30 minutes)

Current areas of focus

Opioid Strategy

SW PCA Website

New MRI/DI Tools

for the South West

• Clinical Connect

Dr. Keith Dyke

Helen Kononiuk

5. 6:00 (45 minutes) Discussion, Questions,

Concerns All

6. 6:45 Adjourn and next meeting

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South West LHINWho’s Who!

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South West LHIN Senior Leadership Team

Donna LadouceurVP, Home and

Community Care

Kelly GillisVP, Strategy, System

Design and IntegrationActing CEO

Mark BrintnellVP, Quality, Performance

and Accountability

Maureen BedekVP, Human Resources

Hilary AndersonVP, Corporate Services

Cathy FauldsChief Clinical Lead

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Grey Bruce Sub-region Team

Dr. Keith Dyke

Sub-Region Clinical Lead

Tolleen Parkin

Sub-Region Lead

Ian Reich Manager, Home and Community

Care

Lisa Rigg Executive Assistant

Rose PeacockHealth System

Planner

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Sub-Regions• Grey Bruce

• Huron Perth

• London Middlesex

• Elgin

• Oxford

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Sub-Regions “Will and Will Not”

LHIN Sub-Regions Will…

• Bring together health system and community partners, as well as clinical leadership, at the local level in health system planning and improvement.

• Enable more focus on assessing population health need and service capacity.

• Provide health system data and information for the population of the sub-region

LHIN Sub-Regions Will Not…

• Result in more bureaucracy. Sub-regions will utilize existing LHIN staff in more effective ways - no new organizations are being formed.

• Impede ministry or LHINs’ obligations to engage with provincial and regional partners and patients. These will continue.

• Infringe on traditions or established jurisdictions in the planning, delivery or improvement of health services.

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Strengthening care communities within our sub-regions

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• High performing health care systems require high quality integrated primary care. Primary care needs to coordinate itself to:– Work together as a cohesive sector

– Integrate better with other parts of the health care sector to improve patient outcomes

• Working as a cohesive sector will enable primary care to:– Provide advice and recommendations to the LHIN– Be better positioned to identify and act on sector-specific

and cross-sector issues, challenges and opportunities.– Advocate collectively for primary care providers and

patients

Why are we here tonight?

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Sub-Region Primary Care Alliances

• A core representative group of the community of primary care providers within each sub-region, representing the broader primary care sector

• Each PCA would be supported by 2 co-chairs– The South West LHIN Sub-region Clinical Lead(me)

– A representative elected from the sub-region PCA by the members (one of you). The elected co-chair will be accountable to the local primary care sector to represent their identified needs, interests and opinions

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Proposed Role and Function of the Sub-Region Primary Care Alliances

• Advance a culture where PC functions as a cohesive sector

• Empower and encourage any member of the PC sector to identify and raise issues, challenges and opportunities

• Be accountable to ensure that issues, challenges and opportunities that they are made aware of are discussed and a best course of action is identified. Be action oriented

• Act as the communication/feedback conduit for issues requiring PC input

• Foster an environment of shared responsibility

• Work together to reduce duplication and increase integration of services

• Influence, inform and guide practice change

• Be accountable to follow through or indicate that they will not action something (so things don’t get dropped)

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Cohesive Primary Care Sector

Primary Care Alliance

Primary Care Alliance Co-Chairs

Relationship Between Primary Care Sector and PCA

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Sub-Region Integration Table (SRIT) Overview

• Sub-region Integration Tables will be supported by the LHIN sub-region Administrative Lead and Clinical Lead

• The tables will each consist of 10 to 15 members (tables with large populations and/or specific priority populations may increase up to 18 members)

• Time-limited work groups may also be formed to support the work of the sub-region integration tables

• The tables will meet monthly- Before PCA in GB

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SRIT Actions and Deliverables• Enable, enhance and champion collaboration between

patients, providers and other system stakeholders

• Establish sub-region priorities for improvement in line with Patients First and the Integrated Health Service Plan

• Ensure local priorities include consideration of Francophone and Indigenous people in the sub-region

• Ensure local alignment with LHIN-wide programs

• Work together to reduce duplication and integrate services

• Foster an environment of shared responsibility

• Leverage current communication and reporting structures to share information

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Relationship between Primary Care Sector and Sub–region Integration Table

The role of the co-chairs as primary care representatives on the SRIT is to:• actively contribute to achieving the overall aim of the

SRIT;• work with the SRIT members to collectively improve

the health care system; and• ensure the flow of information between the SRIT, the

PCA and the broader primary care sector.

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Supporting Patients First

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Grey Bruce Sub-region Integration Table Members

Tolleen Parkin Sub-region Lead

Dr. Keith Dyke Sub-region Clinical Lead

Rose Peacock Health System Planner

Barbara West Bartley Patient, Family, Caregiver Partner

Annemarie Fleer Patient, Family, Caregiver Partner

To be recruited Patient, Family, Caregiver Partner

Vanessa Ambtman-Smith Indigenous Collaborative Leadership Partner

PCA Co- Chair Primary Care Partner

Megan Garland Long-Term Care Partner

Andy Underwood Community Support Services Partner

Ian Reich Home and Community Care Partner

Claude Anderson Mental Health and Addictions Partner

Dr. Lynn/ Arra Public Health Partner

Paul Rosbush Hospital Partner

Gerry Glover Primary Care Partner/FHT ED

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Grey Bruce PCA -Co-Chair Election Process

• Candidates have expressed interest in running for the Co-Chair position. Deadline for additional names and Bio is Friday Nov 10

• Short bio from each candidate with link to vote will be emailed out by Nov 13

• Vote using survey monkey from Nov 13 to 15. Successful Candidate revealed on Nov 16

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South West PCA – Web Site• www.swpca.ca

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Opioid Strategy• Ontario is implementing a strategy to prevent

addiction and overdose through:– Modernizing opioid prescribing and monitoring;– Improving the treatment of pain; and– Enhancing addiction supports and harm reduction

• HQO has convened stakeholders to develop an approach to support clinicians – plan is to start with supports for PC clinicians, then move to other prescribing groups

• Effort is to improve pain management through a coordinated approach that will support clinicians and patients in the best possible management of pain and improved connections to services and supports to enhance decision making

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Opioid Strategy Continued• Supports that are available now• Medical Mentoring for Addictions and Pain (available through the Ontario

College of Family Physicians)

• Digital tools like eConsult and EMR dashboard for optimizing the use of your EMR and the data in it to understand current patterns of care. Expert users of these tools are also available to help you through a Peer Leader Program (allavailable through OntarioMD)

• Safer Opioid Prescribing webinars and workshops (available through the University of Toronto Faculty of Medicine, Continuing Professional Development)

• Quality Improvement Decision Support Specialists (QIDSS) and analytic support for Family Health Teams (available through the Association of Family Health Teams of Ontario)

• Ontario’s Narcotics Strategy, stemming from the National Narcotics Monitoring Network, lets you see whether a patient is obtaining drugs from multiple providers (available through the Ministry of Health and Long-Term Care)

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Opioid Strategy Continued• Supports that are coming• A confidential report (My Practice: Primary Care) lets you see your

own opioid prescribing patterns compared with the provincial average (available through Health Quality Ontario)

• Quality Standards outlining what quality care looks like for people with acute or chronic pain considering opioid therapy, and people with opioid use disorder (available through Health Quality Ontario; grounded in the 2017 Canadian Guideline for Opioids for Chronic Pain)

• One-on-one educational outreach visits (Academic Detailing) and access to clinical tools and supports focused on delivering providers with objective, balanced, evidence-informed information on best practice (available through the Centre for Effective Practice)

• Outreach to increase awareness of available supports and programs, and investments to increase access to addiction services (coordinated through the Local Health Integration Networks)

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SW LHIN Medical Imaging Integrated Care Project

• More than ~30% of diagnostic imaging scans are inappropriate/ or potentially avoidable

• The project(s) aim to discover, plan and implement efficiencies to current processes and distribution services for patients

• This first project/phase will address the regional improvement needs above by focusing on MRI.

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Medical Imaging Integrated Care (MRI)

- There are 6 MRIs in the SWLHIN (Owen Sound, Stratford, LHSC-VC, LHSC-UH, SJHC, Woodstock)

– Each booking office has their own requisition form and had their own protocols

– There is no coordination of bookings across the LHIN

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SW LHIN Medical Imaging Integrated Care Project - MRI

• Optimize Access to (MRI) services for patients: effective utilization of services & capabilities, so the right patient can access the right service within acceptable timeframe.

• Standardization of Quality: every patient has access to the same quality services and quality experience no matter where they receive (MRI) services in the LHIN.

• Enhanced Appropriateness: referral and scheduling that supports greater appropriateness, urgency and prudent prioritization for all patients and all modalities

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MRI- What’s New!

• New Single SW LHIN wide MRI Requisition Form

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MRI REQUISITION (Check one site)

□ Grey Bruce Health Services – Owen Sound F: 519-376-3952 □ London Health Sciences Centre – Vic/Children’s F: 519-667-6826

F: 519-646-6025 □ Huron Perth Healthcare Alliance – Stratford F: 519-272-8247 □ St. Joseph’s Health Care London

□ London Health Sciences Centre - UH F: 519-663-3544 □ Woodstock Hospital F: 519-421-4238

PATIENT INFORMATION:

Surname: _______________________________ First Name: ________________________________ Middle Initial:_____

Gender: ________ Date of Birth (YYYYM DD): _________________ Height: _________ cm Weight: _________ kg

Street Address: _________________ Apartment: ____ City: ______________ Province:___ Postal Code: _____

Telephone (Day): ___________________ (Evening): _____________________ (Cell): _______________________

Long Term Care Inpatient Isolation Precautions: ______________________________

MRN: ________________ Insurance: Province: __ No.: _________________ Research or 3rd

Party No.:__________

WSIB: N WSIB No.: __________________ Date of Injury (YYYYMM DD): _____________________

Mobility: mbulatory eelchair etcher echanical Lift Preferred Language: EN FR _____________ Other

Considerations: laustrophobia Mild Sedation (not provided) General Anaesthesia

Surgery in exam area

Y N Timed: _____________ Requested Date

Relevant rep orts attached

EXAMINATION REQUESTED: _________________________________________________

Working Diagnosis: _______________________________________________________

Clinical Information:________________________________________

_________________

Y N Please check the Y N Contrast Risk Factors following, if applicable

HypertensionBreast feeding

History of cancer Impaired renal function

Medication patch (Foil) MRI contrast reaction

Y N Possible MRI Contraindications

Piercings (Remove On dialysis

prior to exam)

Pregnant ____ wks. Contrast Patient ≥ 60 yrs.:

Shrapnel or bullets Recent serum creatinine result:

Surgery in last 6 wks. ____________________

Sample date: Tattoos ____________________

YYYYMM DD

History of Metal In Eye (X-ray may be required)

Aneurysm surgery*

Cardiac pacemaker or defibrillator*

Cochlear or Ocular Implants*

Coils, filters, grafts, stents *

Electronic devices, implanted or not implanted*

Heart valve*

Implanted stimulators, electrodes or pumps*

Shunts: Programmable* Non-Programmable*

Other ___________________________

* Please forward surgical report and specify the:

Make/Model: _______________________ Date: _________

Institution of surgery: ________________________________

REFERRING PHYSICIAN:

Last Name: _________________________

Address: __________________________

Telephone:_________________________

First Name: ___________________ Signature: _______________________

City: ________________________ Province: ______ Postal Code: ________

Fax: ________________________ Billing No.: _______________________

COPY TO:

Last Name: _________________________

Address: __________________________

First Name: ___________________ Fax: ____________________________

City: ________________________ Province: ______ Postal Code: ________

Appointment Date and Time: ___________________________

OFFICE USE ONLY

Pro tocol:

□ 1 □ □ □ □ med

Contrast X-rays required: □ N □ Staff Initials: ______

NOTE: This requisition may be booked at an alternate site in the South West LHIN to improve patient access.

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MRI- What’s New!

• MRI Spine and MRI Knee – Check List –endorsed by Choosing Wisely Canada

Page 30: Strengthening Primary Care in Grey Bruceswpca.ca/Uploads/ContentDocuments/GB PCA... · Grey Bruce Primary Care Alliance Agenda Item Time Topic or Subject Presenter 1. 4:45 (5 minutes)

_________________________ ________________

MRI KNEE APPROPRIATENESS CHECKLIST

This checklist is required for all outpatient MRI knee referrals. Please include with MRI requisition.

Referring Physician Name: ______________________

CHECK ANY/ALL THAT APPLY:

Patient label placed here, or minimum information below required

Patient Name:

Date:

Date of Birth (YYYYMMDD):

Gender:

MRN:

A. Recent Knee X-rays Recommended For All Patients B. Other Knee Imaging

Required for: Patients > 55 years oldWhat: ______________________________________

Suspected osteoarthritis (weight bearing views) When: ______________________________________

History of trauma Where: ______________________________________

C. MRI is recommended for:

Locked knee/Mechanical symptoms (unable to fully extend knee with relaxed muscles)

Suspected ligamentous injury

Which ligament(s):

Persistent swelling/effusion despite conservative therapy for 4-6 weeks

Suspected soft tissue or bone tumour

D. MRI is NOT recommended if there is:

Moderate or severe osteoarthritis without locking or extension block

MRI is unlikely to alter patient management

E. Consider MRI if all of the following are present:

Absent or mild osteoarthritis

Persistent unexplained pain > 3 months

Failed conservative therapy (physiotherapy and anti-inflammatories)

Patient is surgical/arthroscopy candidate

F. Additional Clinical Information

Please provide any additional information relevant to this request.

Include arthroscopic and surgical reports.

Referring Physician Signature Date Version 12.0, June 28, 2017

This checklist is based on the Choosing Wisely criteria and the CORE Back Tool. It is required for all adult (18+) outpatient MRI spine referrals. Please include with MRI requisition . Referring Physician Name:

MRI SPINE APPROPRIATENESS CHECKLIST

A. Red Flags requiring Emergent Management (immediate MRI and consultation to Surgery)(consider sending patient to Emergency Department)

Severe/Progressive Neurologic Deficit Cord Compression or Cauda Equina Syndrome

B. Red Flags requiring Urgent MRI

Suspected Cancer Suspected Spinal Infection Suspected Epidural Abscess or Hematoma

Suspected Fracture (recommend X-ray or CT first)

C. Mechanical Spine Pain Syndrome with no Red Flags requiring Non-Urgent MRI(Check all that apply – there MUST be a check in sections 1, 2, and 3 below to meet imaging criteria)

1. Unbearable Arm (and/or)

or Leg Dominant Pain

Disabling Neurogenic (and/ or)

Claudication

Functionally Significant Neurologic

Deficit

2. Failure to Respond after 6 weeks of conservative care 3. Considering Surgery

D. Suspected or Known Conditions (Check all that apply)

Cancer (please specify) Intradural Tumour Bone Tumour or Metastases

Congenital Spine Anomaly Scoliosis Spinal Radiation

Demyelination or MS Inflammatory Disease Assessment for Vertebroplasty

Prior Spine Surgery (date) Arachnoiditis Post-operative Collections

Follow-up for a Known Condition (please specify)

Condition Not Listed (please specify)

Prior CT or MRI Spine Imaging

When: ____________________________ Where: ________________________________________

Additional Clinical Information

Please provide any additional information below.

Please also clearly indicate the affected area on the image to the right.

Image ©

Alila

07 | D

ream

stim

e.c

om

Vers

ion 10

.0 J

une 9

, 2017

______________________ _______________

Referring Physician Signature Date (YYYY-MM-DD)

Patient Name:

Date (YYYY-MM-DD):

Date of Birth (YYYY-MM-DD):

Gender:

MRN:

Patient label placed here, or minimum information below required MRI SPINE APPROPRIATENESS CHECKLIST

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MRI- What’s New!

• All forms will be available in the following formats:

– Hand written

– Fillable PDF

– EMR compatible for Accuro, PS Suite, Oscar and NOD (Downloadable from the SW PCA website).

• Youtube Video’s being produced

Page 32: Strengthening Primary Care in Grey Bruceswpca.ca/Uploads/ContentDocuments/GB PCA... · Grey Bruce Primary Care Alliance Agenda Item Time Topic or Subject Presenter 1. 4:45 (5 minutes)

Other tools and resources

• Health Links-CCP

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What is Coordinated Care Planning?

• About bringing multiple providers together with the individual and their informal supports to understand the goals of the individual

• Develop a care plan to support the person

Who benefits from Coordinated Care Planning?

• Those people who would be best supported by the coordinated efforts of multiple health and social service providers

• Those with high are needs who would be best supported with a team approach

Health Link CCP Video

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What is ClinicalConnect?

– Securely aggregates essential electronic patient care data in real-time from Hospitals, LHIN Home and Community Care (formerly CCACs) & Oncology Centres in Southwest Ontario, OLIS, SWODIN, DHDR, DI-CS

– Accessible on desktop computers, tablets or mobile devices

– Physicians in some LHINs have the option to electronically download hospital data into their EMRs

– Single Sign-On and direct launch from select HISs capabilities

How will it benefit me and my patients?

– Reduces duplication of documentation, tests and procedures, saving time, discomfort and cost

– Improves the transfer and coordination of care between healthcare providers and organizations

– Increases patient safety and the quality of care

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Videos !!

• https://www.youtube.com/watch?v=DXpqmVuu6fg

• https://www.youtube.com/watch?v=FvMshuVADhU

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Health Quality Ontario

http://www.hqontario.ca/Quality-Improvement/Guides-Tools-and-Practice-Reports/primary-care

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What’s Coming!• Next Month’s PCA meeting will include

speaker and additional info on OntarioMDe-consult

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IT/Digital Strategy

• SW LHIN wide strategy on e-referral

• Central referral/notification system

• Clinical connect with CHRIS and Digital drug repository (DDR)

• More integration between CHRIS/CC/DDR with Accuro/PS/Nightingale

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Transforming Musculoskeletal (MSK) Care in Ontario

• The 2017 budget committed $17M for expanding MSK intake and assessments across all LHINs

• Funds will be provided for– Clinical operations i.e. new assessors, admin support, office equipment

etc.– Change management and implementation support i.e. LHIN-based project

managers, hip/knee and spine teams, provincial clinical champion stipend

• In 2017/18– The South West LHIN is working to build capacity for MSK intake and

assessment in all LHINs and to implement a Central Intake and Assessment Centre starting with hip and knee replacement referrals

– Add ISAEC referrals when there is a readiness– Test beta sites for MSK intake

• In 2018/19– Test shared care models for other surgical and non-surgical MSK conditions

(e.g. rheumatology)– Develop and test bundled models for additional MSK QBPs

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Transforming MSK Care in Ontario Continued

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Grey Bruce PCA• Questions?

• Comments?

• Feedback?

• Next Steps?