Strengthening Primary Care in Oxford Sub-Region

Dr. Jitin Sondhi H.BSc, MD, CCFP (PC)

Sub-Region Clinical Lead

October 26, 2017

Who?

South West LHIN Senior Leadership Team

Donna LadouceurVP, Home and Community Care

CEO Co-Chair

Kelly GillisVP, Strategy, System Design

and Integration CEO Co-Chair

Mark BrintnellVP, Quality, Performance

and Accountability

Maureen BedekVP, Human Resources

Hilary AndersonVP, Corporate Services

Cathy FauldsChief Clinical Lead

Sub-Regions• Part of the vision of seamless, consistent

high-quality care

• The focal point for integrated service planning and delivery—part of the “how” we get there.

• The South West LHIN has five sub-regions

• With sub-regions formalized, our goal will be to create shared responsibility to improve how we work together.

Oxford Sub-region Team

Dr. Jitin SondhiSub-Region Clinical

Lead

Lynn HindsSub-Region

Administrative Lead

Anita ColeDirector, HCC

Access/ Short Stay, Placement

Christina JansonHealth System Planner

Lisa RiggExecutive Assistant

Why?

Background and Context

• High performing health care systems require high quality integrated Primary Care (Ross Baker et al 2008).

• Input from primary care providers gathered through engagement sessions and provider surveys identified that primary care needs to coordinate itself to:

• Work together as a cohesive sector; and

• Integrated 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;

• Fully participate in the important health system transformation described in Patients First; and

• Be better positioned to identify and act on sector-specific and cross-sector issues, challenges and opportunities .

Primary Care Alliance

Sub-Region Primary Care Alliances

• Proposing the establishment of a “Sub-region” Primary care Alliance (PCA) for each sub-region

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

• Members represent the broader primary care sector in the sub-region• Number and mix of representatives may differ from sub-region to sub-

region based on the unique primary care landscape of the sub-region• Each PCA would be supported by 2 co-chairs

• The South West LHIN Sub-region Clinical Lead• A representative elected from the sub-region PCA by the members

• The elected co-chair will be accountable to the local primary care sector to represent their identified needs, interests and opinions

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 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)

Cohesive Primary Care Sector

Primary Care Alliance

Primary Care Alliance Co-Chairs

Relationship Between Primary Care Sector and PCA

• 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

• ensure the flow of information between the SRIT, the PCA and the broader primary care sector

Relationship Between Primary Care Sector and PCA

Oxford Primary Care Alliance Co-Chair Position

• Upon review of information look for nominees at first Oxford PCA meeting

• Submit nominations and bios of interested parties by October 27th, 2017

• Voting begins (via SurveyMonkey Anonymous service) October 30th to November 1st

• Voting will require entering your name however your vote will not be linked to your name. Collection of identity is strictly to review who has voted so reminders are not sent to members who have voted.

• November 2nd 2017 we will release the name of our elected member.

Sub-Region Integration Table

Oxford Sub-region Integration Table MembersLynn Hinds Sub-region Lead

Dr. Jitin Sondhi Sub-region Clinical Lead

Christina Janson Health System Planner

Karen Devolin Patient, Family, Caregiver Partner

Anna Pearson Patient, Family, Caregiver Partner

Jim Jones Patient, Family, Caregiver Partner

Deborah Wettlaufer Long-Term Care Partner

Suzanne Mezenberg Community Support Services Partner

Anita Cole Home and Community Care Partner

Mike McMahon Mental Health and Addictions Partner

Lynn Beath Public Health Partner

Natasa Veljovic Hospital Partner

Randy Peltz Primary Care Partner

Sub-region PCA Co-Chair Primary Care Partner

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.

Sub-Region Integration Table 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

• Initially, the chair will be appointed by the LHIN from the table’s membership. Over time, the position will be elected by the members

• The tables will meet monthly

Relationship Between Sub-Region Integration Tables and Other Patients First Elements

Projects

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 Coordianted 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

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 such

• 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

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

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

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

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

MRI- What’s New!

• New Single SW LHIN wide MRI Requisition Form

• ONE FORM TO RULE THEM ALL!

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.

MRI- What’s New!

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

_________________________ ________________

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.

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______________________ _______________

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

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

Community Based Palliative Care

• Support for patients who require community based palliative care

• Number of palliative patients within the LHIN is increasing year over year

• Goal is for individuals to die in their place of choice

• Palliative Care Outreach Teams in place in Elgin, Oxford, Huron perthand Grey Bruce that have palliative care focus practice physicians and Family physicians. London Middlesex will be getting two new teams in Fall of 2018.

• HQO quality standards for the delivery of palliative care

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 a 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

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 (all available 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)

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)

Future Projects

IT/Digital Strategy

• SW LHIN wide strategy on e-referral in progress

• Clinical connect with CHRIS and Digital drug repository