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Primary Care to Specialist Care

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34

Patients usually don’t mind waiting…..• If they are confident that it is safe to wait• If they are confident that they haven’t been forgotten• If they have confidence in the integrity of the triage• If there is good communication and good concurrent

care during the wait

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AUS CAN FRA GER NETH NZ NOR SWE SWIZ UK US

OVERALL RANKING 2 9 10 8 3 4 4 6 6 1 11

Care Process 2 6 9 8 4 3 10 11 7 1 5

Access 4 10 9 2 1 7 5 6 8 3 11

Administrative Efficiency 1 6 11 6 9 2 4 5 8 3 10

Equity 7 9 10 6 2 8 5 3 4 1 11

Health Care Outcomes 1 9 5 8 6 7 3 2 4 10 11

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w w w . H Q O n t a r i o . c a

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39

What is the problem?

w w w . H Q O n t a r i o . c a

0

100

200

300

400

500

600

700

800

900

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itoul

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rey

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ry /

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Source: CIHI Portal NACRS

Example 1: ED visits for schizophrenia per age standardized 100,000 residents, by Ontario census area

40

0

50

100

150

200

250

300

350

400

North East Erie St. Clair WaterlooWellington

South East NorthSimcoe

Muskoka

South West Champlain North West HamiltonNiagara

HaldimandBrant

Central East CentralWest

Central MississaugaHalton

TorontoCentral

w w w . H Q O n t a r i o . c a

What is the problem?Example 2: Hysterectomies per age standardized 100,000 women residents, by LHIN

Source: CIHI Portal DAD & NACRS

w w w . H Q O n t a r i o . c a

What is the problem?

Source: Looking For Balance: Antipsychotic Medication Use in Ontario Long-Term Care Homes, Health Quality Ontario (2015)

Example 3:

w w w . H Q O n t a r i o . c a

While some of these variations reflect differences in patient needs and/or preferences, others do not. Instead, they are due to other factors, such as variations in medical practice styles or unequal access to health care services.

This variation raises concern about the quality of healthcare, especially the equity and the efficiency of health systems

Geographic variations in health care: What do we know and what can be done to

improve health system performance?OECD (2014)

Why are these problems?

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Venous and Mixed Venous/Arterial Leg Ulcers Care for Patients in All Settings

www.HQOntario.ca

INFORMATION AND DATA BRIEF: WHY THIS QUALITY STANDARD IS NEEDED

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45

4 things we need to amplify• Common wait lists• Wait list management, consult and referral e-tools• Appropriateness and quality guidelines (Choosing

Wisely, HQO quality standards, etc)• Public reporting / wait time benchmarks / robust triage

46

Patients who need to wait• Communication, communication, communication

– respectful

– personalized

• Formal and informal touchpoints• Transparency, honesty and authenticity

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