www.HQOntario.ca

Health Quality Ontario The provincial advisor on the quality of health care in Ontario

B7 Data For Outcomes – Moving Past the Numbers June 8 11:00 pm – 12:00 pm

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The provincial advisor on the quality

of health care in Ontario

www.HQOntario.ca

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Welcome

From AOHC facilitating today’s workshop:

Mark Mycyk – Business Intelligence Report Tool

From HQO facilitating today’s workshop:

Maria Krahn – Clinical Adoption team

Marg Millward – Quality Improvement Plan team

Dave Zago - Clinical Adoption team

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Presenter Disclosures

• No relationship with commercial interests

• No financial support

• No in-kind support

• No known conflict of interest

• No plan to mitigate potential bias as none are known

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Learning Objectives

After active engagement in this workshop, participants will be better

able to:

• Describe three key sources of information to assist with care

system improvement at their organization

• Demonstrate use of these sources to support improvement on

one of three areas:

– Improved outcomes for prevention and screening (Cancer)

– Improved outcomes for people living with chronic illness (Diabetes)

– Follow up or care coordination with hospital care

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Some Information Sources for Practice Reflection

• Business Intelligence Reporting

• Practice Reports

• QIP Query

• Business Intelligence Reporting

• Practice Reports

• Clinical Record

Clients – one at a time - CHC helps

care for over time

Groups of clients CHC

helps care for over time

Groups of clients CHC

helps care for over time

compared to similar groups

What other CHCs are

doing & what other

organizations are doing

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Data for Improvement:

HQO Online Reporting

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Provincial

LHIN

Organization

Group

Physician

Client/Patient

Primary Care Sector Performance

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Data for Improvement:

HQO Navigator QIP Query

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Provincial

LHIN

Organization- self reported

Group

Physician

Client/Patient

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Quality Improvement Plans

A QIP is…

• a commitment that a health care organization makes to its

patients, staff, and community and to the Ontario public as a

whole to improve quality through focused targets and

actions.

• a way to focus organizations, sectors and the system as a

whole on key priorities and to collectively address system-

wide needs and priorities through cross-cutting metrics

• a way of harmonizing dialogue and encouraging peer-to-

peer sharing and benchmarking

• one means to help entrench quality improvement culture

as a system-wide standard

Health Quality Branch 10

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Transparency: All QIPs are publicly

accessible & searchable

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Data for Improvement: CHC system

BIRT

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Provincial

LHIN

Organization

Group

All Clinicians – by type and name

Client/Patient

Purpose of BIRT

• Sector’s single comparative reporting source

• Combine Purkinje and Nightingale EMR data sources including all History, fully auditable and verified

• Consistent for all CHCs and soon AHACs

• Consistently applied definitions for Accountability Reporting for

• MSAA and soon OHRS

• Ad Hoc capabilities

• High level summary & specific client/encounter/provider specific analysis

• Shareable among all CHCs

• Full Business Intelligence capability

• Designed for future expansion and enhancement

BIRT – NORA Strategy 3-D “Discover Demonstrate Deliver ”

• EMR data from 73 CHCs • EMR data from Purkinje Dossier and Nightingale On Demand • All Historical PHI Content for up to 25 years

– Client Demographics – Inter-professional Provider details – Individual Client Interactions/Encounters – Diagnosis (ENCODE-FM, ICPC, ICD10-CA) – Procedures – Immunizations – Referral activities – Group activities

MSAA Dashboard

Using the Ad Hoc Report Capabilities – Advanced Business Author

• A package has been created that enables ad hoc analysis capabilities

• Click drag and explore your CHCs data

• Profile Clients and examine Clinical Staff’s practice patterns

• Analyze by diagnosis, procedures and services

The Goals are Discovery, Gaining Knowledge

and Sharing Wisdom for the Benefit of All

Shared Environment – Shared Wisdom

Sharing the knowledge and Experience for all users As little and as much shared data as the CHCs choose

Variable Description Data Source Newcomer Status RPDB Income Quintiles Stats Canada (2006) Age Groups Percentage of clients by age group RPDB Adjusted Diagnostic Groups (ADGs) Measure of comorbidity CHC data, OHIP, NACRS, DAD

Resource Utilization Bands (RUBs) Measure of overall morbidity and expected resource utilization (presented as a quintile)

CHC data, OHIP, NACRS, DAD

Standardized ACG Morbidity Index (SAMI) Measure of expected resource utilization (average Ontarian =1) CHC data, OHIP, NACRS, DAD

Emergency Department (ED) Visits Rate per population of total ED visits NACRS

CTAS levels ED visits with a triage score (CTAS) of 1-3 (urgent) or 4-5 (less urgent) NACRS

ED visits best managed elsewhere (BME) Proportion of clients who were seen in the ED for conditions that could have been better managed than the ED (conjunctivitis, otitis media, and upper respiratory infection)

NACRS

Ambulatory Care Sensitive Conditions (ACSC)/Avoidable hospitalizations

The conditions included in this definition are asthma, COPD, congestive heart failure (CHF) and Diabetes Mellitus (DM). Total ACSC may be reported (due to small cell counts)

DAD

Hospital readmissions within 30 days (total) and one year (total)

Rate of readmissions per admission DAD

Specialist visits Any and specific specialist visit (respirology, cardiology, endocrinology, general internal medicine, and psychiatry). Total specialist visits may be reported (due to small cell counts)

OHIP, NACRS, & DAD

7-day primary care visit after discharge 7 for specific health issues (stroke, COPD, pneumonia, CHF, diabetes, cardiac conditions and gastrointestinal disorders)

CHC EMR, DAD

Colorectal Screening % who have had a FOBT within the past two years OR a colonoscopy within the past 5 years (age 50-74)

OHIP, RPDB, DAD, & (OCR)

Cervical Screening % who have had a pap smear within the past three years (age 20-69) OHIP, RPDB, DAD, OCR

Breast Screening % who have had a mammogram within the past two years (age 50-69) OHIP, RPDB, DAD, OCR

Overlapping Clients % of clients who are enrolled or have seen physicians elsewhere CAPE & OHIP

CHC data is exported annually from BIRT and compiled at ICES with other data sources for CHC Practice Profile - Below are the Profile variable descriptions

Data for Improvement: HQO Primary Care Practice Reports – CHC Group

Reports

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Provincial

LHIN

Organization

Group

Physician

Client/Patient

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Overview of the PCP Reports

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• The Primary Care Practice Report provides cross-sectional and longitudinal data on practice

demographics and case mix, patterns of service use, chronic disease prevention and management,

and the health status of the practice population.

• CHC reports provide information at the CHC, CHC comparison of rural or urban and provincial levels.

Reports are generated annually, and include data up to March 31 of the previous year.

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List of Indicators in Group level CHC Practice Report

• Cancer Screening

– Cervical, Mammogram, Colorectal

• Health Service Utilization

– ED: total visits, urgent visits, less urgent visits, BME

– Readmissions: within 30 days, within 1 year

– ACSC: total, asthma, CHF, COPD, diabetes

• Client Demographics – Recent OHIP registrants, age, gender, income quintile, rurality index

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Additional Indicators in Appendix

(not graphed in report)

• Health Service Utilization

– Specialist visits

• Cardiologists

• Endocrinologists

• Internal medicine

• Psychiatrist

• Respirologist

– Resource Utilization Band

– Adjusted Clinical Groups (ACG), Morbidity Index (SAMI)

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Sign-up for PCP Reports

www.HQOntario.ca

http://www.hqontario.ca/quality-improvement/practice-reports/primary-care

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Using Information Sources to Inform Improvement

Questions:

1) How can we improve illness prevention and early detection

for our clients?

2) How can we improve how well our clients are living with

their chronic illness?

3) How can we improve how well our clients are transitioning

between our local hospitals and our health centre?

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How would my CHC start to answer these questions?

Try answering some basic questions:

1. What does current practice look like at my CHC?

2. What does practice look like at other similar CHCs?

3. Is anyone doing anything different to improve their

support to their clients and their outcomes?

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How would my CHC start to answer these questions?

Table Exercise - Case Study

Step 1: Pick one of the following questions to think about:

1) How can we improve illness prevention and early detection for

our clients? (Consider cancer screening)

2) How can we improve how well our clients are living with their

chronic illness? (Consider diabetes)

3) How can we improve how well our clients are transitioning

between our local hospitals and our health centre? (Consider

hospital readmissions)

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How would I start to answer these questions?

Step 2: Using the information in the handouts on your table labelled:

1. Sample Primary Care Practice Group Report

2. Sample BIRT Dashboard Report – MSSA Trend

3. Sample BIRT Report - # of Clients with Diabetes

4. Table Exercise – Case Study

Try answering some basic questions:

What does my current (Maple Leaf) CHC look like?

What do other CHCs look like?

Take 15 minutes to review the samples and jot down some points on

the Table Exercise template.

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Exercise Recap

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QIP Query

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How would I start to answer these questions?

Step 3: Using the information in the handouts on your table labelled:

Sample QIP Query Output – Cancer Screening

Sample QIP Query Output – Diabetes

Sample QIP Query Output – Hospital Admissions

Try answering a basic question:

Is anyone doing anything different to improve their support to their

clients and their outcomes for:

– illness prevention and early detection (cancer screening)

– chronic illness management (diabetes)

– transitions between chc and hospital (readmissions)

Take 20 minutes to review the samples and jot down some

points on the Table Exercise template.

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Exercise Recap

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• Is anyone doing anything different on…cancer

screening…diabetes care…hospital admissions…?

• Are any of those ideas something to consider testing at

my (Maple Leaf) CHC?

• Jot those ideas down on the exercise template

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Debrief

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• What went well….even better if….

• Any ideas for us to try that would support you using

this information to help improve quality?

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Additional Quality Improvement Resources

• http://qualitycompass.hqontario.ca/portal/getting-started

• http://www.ideasontario.ca/

• IHI Open School: http://www.hqontario.ca/Quality-Improvement/Health-

Links/Learning-Opportunities

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