pooled referrals for better patient care
TRANSCRIPT
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Pooled Referral Systems Lisa Gaede
Bruce Povah & Diane Edlund
Jennifer Telford
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Dr. Lisa Gaede
Dr. Bruce Povah & Diane Edlund
Dr. Jennifer Telford
Introductions
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Financial Disclosures
(past 24 months)
Name: Dr. Lisa Gaede
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No discussion of commercial products
Managing potential bias
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Financial Disclosures
(past 24 months)
Name: Dr. Bruce Povah
Speaker Advisory Research Consultant
Interior Health √ √
BC Ministry of
Health √
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Financial Disclosures
(past 24 months)
Name: Diane Edlund, B.Sc., CPHIT
Speaker Advisory Research Consultant
Interior Health √
Doctors of BC √
Ministry of Health √
COACH √
BCHIMPS √
McMaster
University √ √
BCCA √
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No financial interest in commercial products discussed
Managing potential bias
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Financial Disclosures
(past 24 months)
Speaker Advisory Research Consultant
Boston Scientific √
Ferring √
Pendopharm √ √
AbVie √
BC Cancer
Agency √
BC Ministry of
Health √
Name: Dr. Jennifer Telford
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No discussion of commercial products
Managing potential bias
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Benefits of Pooled Referral System
Challenges of Pooled Referral System
Objectives
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Where do we Start?
Independent Silo’s of Practice
Separate Referrals
Separate Variable Waitlists
Inconsistency of Processes
Inconsistency of Workflow
Independent Pockets of Best Practices!
rebalance
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What challenges do you see in referring patients for specialist care?
Why a Pooled Referral System?
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Constant Flow of Referrals
Gate Open
Under
utilized
Not Happy
Constant Flow
Some
Chaos Low Output
Gate Partly Open
Gate Open
Happy HAPPY
Gate Closed
Chaos
Constantly Changing Capacity
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Long wait-times
Who has the shortest wait list?
Referral to the wrong specialist
Who is the most appropriate specialist for an indication?
Specialists declining referrals
Who is accepting patients?
What types of patients?
Why a Pooled Referral System?
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First Available and Appropriate Specialist
Triage Patients based on:
Urgency of Indication
Time on wait-list
Who referral was made by? (Specialist higher priority?)
Other?
Advantages of a Pooled Referral System
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Which stakeholders should be considered when developing a pooled referral system?
How to engage?
How to develop a pooled referral system
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Faxed Over the Wall
Family Physician Engagement
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How did we engage family physicians?
Early engagement to ensure process makes sense
PDSA
Challenges can include users with different EMRs
Family Physician Engagement
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What kinds of challenges do you envision for developing and using a pooled referral system?
Challenges of a Pooled Referral System
People
Process
Technology
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Our experience
1) Engagement of specialists
2) Engagement of Family Physicians
3) Importance of triage
4) ? Disruptive to pre-existing relationships between physicians and/or for patients?
Challenges of a Pooled Referral System
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8 Otolaryngologists
Central & South Okanagan
Multiple Offices
Multiple Subspecialties
iWaitLESS Project
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Identified Areas of Resistance
Pride in Long Waitlists
Advantages of Long Waitlists
Poker Game
No Financial Advantage?
Specialist Engagement
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Current State
Liability in Long Waitlists
Disadvantages of Long Waitlists
Poker Game
Burns Up Time
Financial disadvantage
Bringing Specialists On Side
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Current State Assessment
Collaboratively Create a Future State Vision
Gap Analysis
Involve MOAs
Communicate Communicate Communicate
Strategic Approach
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Create Common Goals
Specialist Engagement
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Create a Brand
www.entegrity.ca
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Do we have the right technology to support these changes?
Does the technology drive the workflow or does the workflow drive the technology?
How can we partner to create the right tools?
Electronic Medical Records
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Same / Increasing Number of Referrals
Same Number of Practitioners
How do we lower the waitlist after we pool the referrals?
Efficiency to Meet Demand
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Patients Contribute to Health Records
Intake Assessments > Encounter Notes > Dictation > Auto-Population of Medical Questionnaires
E-Booking – Waiting List Priority > Invitations to Book
Automated Appointment Confirmations
Website – Educating Patients and Referring Providers
Less Time Lost to Unproductive Encounters
Improve How We Work
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How will we know we are successful?
We will measure the results!
PROMS & PREMS
Data Analysis / Reporting
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Patient Engagement
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Patient engagement in health care choices
Patient engagement in health care (re)design and quality improvement
Patient Engagement
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What is gained through patient involvement?
Patient Engagement
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Current benchmarks for gastroenterology wait-times based on physician consensus
Physician bias
Patient-centered care requires patient input
Patient Engagement
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Partnered with a decision scientist
Measure how patients value health
Patient decision aids to elicit preferences
Wait-time for symptom type and severity
Wait-times for functional impairment due to symptoms
Patient Preferences
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1. Prioritized based on the severity of their symptoms. 100% agreement
2. Patients with similar symptoms are prioritized based on time waiting on the list. 95% agreement
3. Patients requiring urgent care are to be seen within 2 weeks, semi-urgent care are to be seen within 2 months, patients requiring non-urgent care are to be seen within 6 months and no patient is to wait more than 1 year. 50% agreement
4. Patients are able to find out where they are on the waitlist. 100% agreement
5. Patients requiring non urgent care are supported more by their family doctor with help from the gastroenterologists group. 95% agreement
6. Able to see the gastroenterologist with expertise. 100% agreement
7. Patients from Vancouver have priority over patients from outside Vancouver. 15% agreement
Patient Opinions on Physician Goals
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Agreement in 5 of 7 goals
Goal 3 Patients felt all of the benchmark wait-times were too
long
Goal 7 Patients did not think physicians should limit referrals by
geography
Expressed concerns re: availability of physicians in different jurisdictions
Patient Opinions on Physician Goals
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Surveyed 200 patients attending our office
Further explore the 2 goals in question
Patient decision aid to elicit triage preferences
trade-offs of prioritization
Inputs on alternative models of care
Group sessions
Involvement of dieticians
General recommendations to PCP prior to or in lieu of GI consultation
Patient Engagement
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Decision Aid
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Functional status plays a role
Of 2 patients with the same symptoms, the one with greater functional impairment should be prioritized
Availability of specialists in other jurisdictions should be considered when declining referrals
Time on the wait list should be considered
Patients Opinions on Triage
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Patient-centered care requires patient input at every level
Summary
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Thank you – Questions?