primary health care system level indicators - pcnpmo.ca · confidential – content not for...

Primary Health Care

System Level Indicators

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Presentation

March 2015

Confidential – Content not for distribution.

Presentation Outline

• Background

– Alberta's Primary Health Care Strategy

– Evaluation Framework and Logic Model

– Measurement and Evaluation Working Group

• Progress to Date

• PHC System Level Indicators

• Challenges

• Timing

• Supports

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Faculty/Presenter Disclosure

• Faculty

−Allison Larsen

• Relationships with commercial interests

−No relationships with commercial interests

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Disclosure of Commercial Support

− This program has received no financial support or in-

kind funding from commercial organizations

Potential for conflict(s) of interest:

– None

Mitigating Potential Bias:

− As the program received no commercial support or in-

kind funding, there are no sources of bias to mitigate

− Sessions were planned based on input from a planning

committee that included physicians

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Background

Alberta’s Primary Health Care Strategy

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• Released in May 2013, Alberta’s Primary Health

Care Strategy sets the direction for the long-term

primary health care (PHC) transformation and

reinforces the vision for “a PHC system that

supports Albertans to be as healthy as they can be”.

• The Strategy was informed by an Advisory

Committee with representatives from AH, AMA,

AHS, Professional Colleges & Associations,

academics and the primary care alliance.

Contributors:

Physicians

Interdisciplinary

National

Provincial

Operations


Background

Alberta’s Primary Health Care Strategy

• The Strategy involves 14 goals based on three strategic directions:

enhancing the delivery of care, bringing about cultural change and

establishing building blocks for change.

• Three strategic directions will result in six key outcomes:

– Attachment – all Albertans have a health home and are attached to a physician;

– Access – Albertans have timely access to a primary health care team;

– Quality – clinical and social supports come together to promote wellness

– Self Management – Albertans are involved in their care

– Improvements in Health Status and Care Experience – Albertans have better

health overall and report positive experiences

– Provider Engagement and Satisfaction – providers are satisfied and happy with

their work lives and able to provide quality care.

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Background

PHC Evaluation Framework

• The PHC Evaluation Framework will guide evaluation activities and

performance reporting of Alberta’s PHC system and address

concerns put forth by Alberta’s Office of the Auditor General in their

2012 Report.

• The Framework includes goals from the PHC Strategy that highlight

the Department’s approach to performance measurement.

• The Measurement and Evaluation Working Group (MEWG) was

established to support the implementation of the Primary Health Care

Evaluation Framework by providing recommendations and advice

relating to performance measurement and evaluation activities that

focus on improving quality and outcomes.

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Background: PHC Evaluation Framework

Logic Model

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Background : System Level Indicators

• There is a need for standardized indicators to measure the impact of

ongoing innovation on patient and population health outcomes..

• These System level indicators will inform Albertans of the progress

being made in primary health care.

• The indicators flow from the Primary Health Care Evaluation

Frameworkalign and align with the outcomes listed in the Primary

Health Care Strategy.

• Selected indicators are useful in quality improvement initiatives at the

PCN and provider level.

• PHC System Level Indicators were confirmed by the MEWG in

September 2014.

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Progress to Date

• Eight indicators included in the requirements of PCN funding

agreements in October 2014.

• Guideline prepared to explain the indicators and provide a summary

of expectations.

• Focus groups held for further input on acceptability, clarity of

instructions and implementation challenges.

• Measurement and Evaluation Working Group to work toward an

implementation package for each indicator.

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PHC System Level Indicators

• The indicators furthest along in readiness for implementation:

1. Time to third next available appointment with a provider for the fiscal

year

2. Percent of recommended screens that the clinic has offered to paneled

patients

3. Percentage of patients answering satisfied or very satisfied to the

question – Overall, how satisfied are you with the care you get from the

clinic?

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PHC System Level Indicators

Continued . . .

4. Percent of patients who are returning to the same provider at the clinic

for a subsequent visit

5. The percentage of identified team members responding to a team

effectiveness survey

6. Percent of paneled patients with a chronic disease who were offered

self-management supports during the fiscal year

7. Percent of paneled patients with a chronic disease who report

maintaining or improving quality of life as measured by the EQ-5D tool

during the fiscal year

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1. Time to third next available appointment

with a provider for the fiscal year

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Rationale

A measure of access to primary health care services.

The most common measure of access in Alberta.

Can be used, along with related information, to identify system

constraints such as:

availability of providers;

information on where patients ultimately go for services when

there is limited access; and

need for workflow improvements in a PCN.


1. Time to third next available continued…

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Calculation

The number of providers:

Reporting an average of 0 to .99 (same day access) ____________

Reporting an average of 1.00 to 4.99 ____________

Reporting an average of 5.00 to 8 .99 ____________

Reporting an average of 9.00 to 21.99 ____________

Reporting an average of 22+ ____________

Total number of providers reporting ____________


2. Percent of recommended screens that

the clinic has offered to paneled patients

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Rationale

Appropriate screening identifies health risks earlier so that action

can be taken to improve health outcomes.

Measurement encourages standardized screening across the

province.

ASaP has determined which screens are appropriate based on

evidence.

Tracking screening compliance provides information that can be

analysed along with related information to identify:

the long-term impact on health outcomes

need for workflow improvements in a PCN


2. Percent of recommended screens

continued…

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Calculation (for each maneuver)

Numerator – total number of paneled patients meeting the screening

criteria that were offered a screen (inferred screen may be counted where

offers are not documented)

Denominator – total number of paneled patients meeting the screening

criteria

Other considerations

The guideline proposes that providers can select the maneuvers to be

measured (minimum of four).


3. Percentage of patients answering satisfied or very

satisfied to the question – Overall, how satisfied

are you with the care you get from the clinic?

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Rationale

A measure of the Patient Experience

Satisfied patients tend to take a more active role in their own

treatment.

Regular measurement of patients’ experience, including

satisfaction, will help PHC organizations make appropriate,

evidence based changes to processes to improve patient

experience and, ultimately, health outcomes.


3. Percentage of patients answering satisfied or very

satisfied continued…

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Calculation

Numerator – total number of patients answering satisfied or very satisfied

to the survey question.

Denominator – total number of patients answering the survey question.


The single patient satisfaction results will be the information flowing to AH.

The expectation is that this will be part of a broader patient experience

survey.

The specific survey has not been identified.

Consultation with PCNs will be a very important part of the survey

selection process.


4. Percent of patients returning to the same

provider at the clinic for a subsequent visit

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Rationale

Evidence shows that individuals who have a continuous relationship

with a primary care provider or team:

Receive higher rates of preventive care;

Make fewer visits to the emergency department;

Have lower hospitalization rates;

Experience better management of acute and chronic illness; and

Tend to report increased satisfaction with their care.

This indicator will provide information on the extent of patient

continuity.

Can be analyzed along with the underlying data sets to support

improved panel management leading to better health outcomes.


4. Percent of patients returning to the same

provider at the clinic continued…

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Calculation

Numerator –total number of visits by the providers panel to the provider

Denominator – total number of visits by the providers panel to any provider


The best approach to extracting, compiling and reporting continuity is to be

determined.


5. The percentage of identified team members

responding to a team effectiveness survey

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Rationale

A measure of progress toward enhancing the delivery of care

through the creation of health homes with teams of providers.

Surveying team effectiveness and acting on the results will help

PCNs make improvements over time.

Survey results at the local level can facilitate improved team

function leading to a more satisfying work experience for providers

and better health services for patients.


5. Team effectiveness survey continued...

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Calculation

Numerator – number of people responding to a team effectiveness survey

Denominator – number of people identified as working in a interdisciplinary

collaborative care team


6. Percent of paneled patients with a chronic

disease who were offered self-management

supports during the fiscal year

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Rationale

Self-management is:

one of the six outcomes identified in the Primary Health Care

Strategy.

consistent with the principle of person-centered care where

individuals partner with their health team to meet their health goals.

Self-management support is provided to help a patient physically,

socially and emotionally manage their chronic condition.

Can include programs, tools and policies

Can be undertaken by the patient, and/or provided by non-profit or non-

government groups, and their communities.

This indicator will help PHC organizations measure their progress

towards involving patients as partners in their care.


6. Chronic disease self-management supports

continued…

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Calculation

Numerator – number of paneled patients with a chronic disease who were

offered self-management supports

Denominator – number of paneled patients with a chronic disease


7. Percent of paneled patients with a chronic disease

who report maintaining or improving quality of life as

measured by the EQ-5D tool during the fiscal year

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Rationale

Measuring outcomes from a patient’s perspective is an important

aspect of determining the success of the health system.

Self-reported health status is a broad multidimensional concept

that includes subjective evaluations of both positive and negative

aspects of life.

Measurement of self-reported health status over time, particularly

before, during, and after participation in a program, can inform

whether health status has been maintained and/or improved in a

patient-centred way.

Information relating to changes over time can support program

evaluation and quality improvement.


7. Chronic disease and EQ-5D continued

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Calculation (for each maneuver)

Numerator – number of paneled patients with a chronic disease who

completed an EQ-5D survey (or equivalent) that indicated maintaining or

improving functional health status

Denominator – number of paneled patients with a chronic disease who

completed an EQ-5D survey (or equivalent


Summary of Opportunities and

Challenges

Efficient indicator reporting requires standardized definitions, consistent

measurement methodology and common reporting protocols.

– Goal is high quality information on a timely basis to support clinical

practices;

– Will be supported by:

• utilization of EMRs;

• automated data extracts and data sharing; and

• collaboration on how to best use existing EMRs.

Challenges

– Variability across PCNs in EMR implementation;

– Several different EMRs are in place; and

– Variability in measurement and reporting process across PCNs

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Summary of Opportunities and

Challenges - Continued . . .

Changes and improvements in service delivery will facilitate

achievement of positive outcomes including:

– Better health outcomes

– Value for money

– Improved patient and provider experience

Challenges

– Setting appropriate targets and expectations

– Support for change at the provider level including new work

processes and other enablers

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Supports

• Measurement and Evaluation Working Group will:

– Be a conduit for feedback from all parts of the system

– Suggest practical solutions to implementation challenges

– Direct the changes in indicators as they evolve

• Toolkit

– Toolkits providing more information to support implementation will

be developed for each indicator

• Support for indicator reporting by PCNs will be provided by the PCN

Program Management Office

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Timing for Reporting

• Guideline

– Feedback from focus groups and other stakeholders will be

addressed in an updated guideline

– The new version is expected to go to the Measurement and

Evaluation Working Group in April 2015

• Toolkit

– Work on the first toolkit for Time to Third Next Available

Appointment is underway

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Timing for Reporting - Continued . . .

• Annual Report - Results

– Template for reporting will be Included in the current year Annual

Report template for information only

– PCNs will be able to report indicator results to the extent they

have reliable results in 2015/16

• Report on Progress

– First report due June 30, 2016

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Questions?

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