Health Quality Ontario: Health System PerformanceNew Zealand Master Class March 25, 2014

2

Monitoring & Reporting on the Quality of Ontario's Health Care System

• Ontarians want a sustainable public health care system that helps people stay healthy and delivers excellent quality care when they need it

• Monitoring and public reporting on quality helps define excellence and provides a clear standard with which to articulate what high-quality care is and what success looks like

• HQO supports transparency and accountability through objective monitoring and reporting on health system performance

www.HQOntario.ca

3

Excellent Care for All: HQO’s Mandate• Within the domain of monitoring and reporting, the

Excellent Care for All Act, 2010, identifies four areas of focus:1. Access to publicly funded health services2. Health human resources in publicly funded health services 3. Consumer and population health status4. Health system outcomes

www.HQOntario.ca

4

Presentation Overview

• HQO’s suite of performance monitoring and reporting tools

• Stakeholder engagement in HQO’s development and reporting activities

• Questions and discussion

www.HQOntario.ca

5

Performance Monitoring and Reporting• Public Facing Reporting

– Common Quality Agenda/ Yearly Report– Online reporting– Theme reports (Planned)

• Confidential Tools and Reports– Primary Care Practice Report– Quality improvement monitoring

• Indicator Development– Primary Care Performance Measurement Framework– Patient Experience

• Aggregate-level data only

www.HQOntario.ca

6

Public Facing: Common Quality AgendaA system-wide initiative informed by three goals:

1. Focus the health care system on a small number of priority areas for quality improvement

2. Leverage performance reporting as a mechanism for improvement

3. Improve quality through partnership

• Linked to HQO’s quality improvement and evidence functions

• Provincial- regional- and over time, facility-level, named reporting

• Trending data (10 year historical, as available)• Development of indicator benchmarks (as appropriate)

www.HQOntario.ca

7www.HQOntario.ca

Common Quality Agenda

8

Public Facing: Online ReportingWeb-based reporting for three sectors:• Home care: 11 indicators

– Provincial- regional- and service provider-levels (named) (personal care worker, home care nurses)

– Data refreshed annually• Hospital care (currently Patient Safety): nine indicators

– Provincial- facility-levels (named)– Data refreshed monthly, quarterly, annually

• Long-term care: 12 indicators– Provincial- regional- and facility-levels– Data refreshed annually

• Facility-level searches by topic, facility name, or location

www.HQOntario.ca

9

Long-Term Care Public Reporting

www.HQOntario.ca

10

Long-Term Care Public Reporting

www.HQOntario.ca

11

Public Facing: Theme ReportsNew for 2014 and ongoing:• Multiple reports per year focusing on key issues

related to the health care system• Topic selection and report development in partnership

with provincial health organizations. For example:– Cardiac Care Network – Public Health Ontario– Community Care Access Centres

• Descriptive and in-depth, theme reports may also be positioned as “quick response” reports, responding to critical emerging issues

www.HQOntario.ca

12

Confidential Tools and ReportsHQO provides customized tools and reports to health system providers:• Primary Care Practice Report

– Administrative data including:• Practice demographics (e.g., age, gender, rurality, case mix) • Health service use (e.g., Emergency Department visits,

admissions, specialist visits), and • Chronic disease prevention and management (e.g., diabetes

management, cancer)– Practice, group, region, and province performance comparisons

• Quality improvement initiative monitoring tool– Standardized and custom quality improvement indicators – Free web-based platform for run charts, control charts, tables

www.HQOntario.ca

13

Confidential Tools and Reports: Quality Improvement Reporting &

Analysis Platform (QI RAP)

www.HQOntario.ca

14

Indicator Development: Primary Care Performance Measurement

• Partnership model to develop a comprehensive primary care performance measurement framework

• Designed to meet the information needs of patients, the public, health providers and policymakers

• Developed to address system- and practice-level data requirements:– System-level: Drive short-term improvement, support longer

term goals and track the impact of policy changes and investments

– Practice-level: Inform planning, performance monitoring and quality improvement

www.HQOntario.ca

15

The Primary Care Performance Measurement Framework

www.HQOntario.ca

*

*

*

*

*

*

*

*

*

**

*

*

*

*

Moving Forward

16

Agreement on performance

measures

EHR/EMR data

Driving improvement

1. Better care 2. Better health

3. Better value

Survey data

Administrative data

www.HQOntario.ca

17

Indicator Development: Patient ExperienceTo identify/develop a practice-level patient experience survey and implementation guide:

• Suitable for use with different models of primary care• To support/inform quality improvement at the practice-

level• Leverages/aligns with subsets of items from existing

instruments• Based on a rigorous development methodology• Stakeholders and partners engagement throughout the

development and testing process• Aligned HQO – Primary Care Association strategy for

communication and dissemination of materials

www.HQOntario.ca

18

Indicator Development: Patient ExperiencePhase 1: Survey & implementation strategy development• Advisory Committee with broad practice model,

association, ministry psychometric and patient advocacy group representation

• Collection, review and crosswalk of existing instruments, domains and survey items

• Key stakeholder interviews • Cognitive and psychometric survey testing

Phase 2: Implementation testing and refinement• Expanded survey and implementation testing • Revisions and dissemination

www.HQOntario.ca

19

External Stakeholder Engagement• Health System Performance Strategic Plan

– Stakeholder feedback on the overarching direction of HQO’s performance monitoring and reporting strategy

• Provincial Measurement and Reporting Committee– Service provider, association, patient, academic, ministry and

data providers contribute to the identification of measurement priorities, alignment opportunities and measurement advocacy

• Sector-specific Advisory Committees– Sector specific committees for discussion of measurement

alignment, capacity building, strategies and issues • Technical Working Groups

– Indicator and data expertise to guide indicator technical specifications, benchmark and target development, measurement and data advocacy

19

Thank you and

conversation