2015 quality forum, hyatt regency vancouver a4 opening doors to primary care serving north...
TRANSCRIPT
2015 Quality Forum, Hyatt Regency Vancouver
A4 Opening Doors to Primary Care
Serving North Vancouver’s High-Needs, Unattached
Patients through an Innovative Model of
Primary Care: HealthConnection Clinic
Authors: Sarte, A., Edelman, S., Brown, D., Turris, S., Macnutt, J., Simpson, D.
Presenter: Sandra Edelman, ManagerPublic Health, Population Health & Chronic Disease Services
Vancouver Coastal Health, North Shore
Disclosure Statement
I am unable to identify any actual or potential conflict of interest and have nothing to disclose
in relation to this presentation.
Background
individuals on the North Shore do not have regular access to primary care (i.e.,
“unattached”) and are deemed to have “high-needs”
3,0003,000
True Collaboration
Vancouver Coastal Health
Division of Family
Practice
Community Partners
Practice Support Program
Practice Support
Program – Technology
Group
To improve the health & wellness of vulnerable pop’ns
To provide better care coordination & health care utilization
To increase attachment to family physicians
To improve patients & providers experience
To plan for sustain-ability
HealthConnection Clinic Goals
Clinic Operations
Open 9AM to 12NoonMonday to Friday
Location: 148 E. 15th Street (close to Lions Gate Hospital)
• Staffed by GP, NP, Case Manager (SW), CDN, MOA
• Community Partners regularly scheduled to sit in clinic: – Hollyburn Family Services– Lookout Society– Canadian Mental Health
Association
Unique Features of the Clinic• Partnership between Division of Family
Practice & Vancouver Coastal Health• Engagement of community partners• Built on Triple Aim Evaluation Model• Use of a Patient Complexity Assessment
Tool (attachment, medical, mental health & addictions & social determinants of health)
• Training opportunities for medical students, residents (e.g., social work, psychiatry, family medicine, nurse practitioners)
Evaluation Approach
• Ongoing evaluation to determine the feasibility and value of the clinic and to idenitfy successes, challenges, and lessons learned
• Guiding principles of evaluation: 1. Participatory2. Utilization-focused3. Synergistic4. Developmental
18-month evaluation results
Data current to December 15, 2014
Who are we seeing?
Client Gender
38.2% 61.8%
Client Age
Average age of client
Client ages range from 2-92 yearsMedian age is 50.5 years
49.5years
49.5years
Client Housing
of clients have an unstable housing situation (i.e., homeless, staying in shelter, with a friend, or in a
collective dwelling)
39.7%39.7%
Aboriginal/First Nations
of clients are Aboriginal/First Nations
18.3%18.3%
Referral Sources
Total visits since clinic opened
2010Total Visits
350 were new visits(17.4%)
1661 were follow up visits
(82.6%)
As of December 15, 2014
Average Number of Visits per Day since Clinic opened
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 53 55 57 59 61 63 65 67 69 71 73 75 770
1
2
3
4
5
6
7
8
9
10
11
Average number of clients per day by week Target number of visits per day Median number of visits per day
Year 2 Begins
Profile of Attached Clients
Average number of visits 8
Minimum number of visits 2
Maximum number of visits 55
Based on 184 who have had two visits or more, i.e. ‘attached’
What services are our clients using?Health Utilization Data
Important Considerations
• ONLY clients with 2 visits or more have been included in the analysis (89 clients)
• ALL clients have been a part of the clinic for a FULL 12 months
• Analyzed by 12 months before first clinic visit, and the time since that visit
• Data is current to January 7th, 2015• Most conservative way to analyze our data
Summary of Health Utilization
22.0%
39.2%
2.6%
Decrease in Hospital Admissions
Slight increase in Emergency Department Visits*
Decrease in Hospital Admissions from the ED
*85% of ED visits occurred when the clinic was closed. Time spent in ED has decreased (7.7 hrs to 4.6 hrs)
Percentage of Alternative Level of Care Days
22
8.8% 5.8%
12 months before 1st clinic visit 12 months after 1st clinic visit*
*see notes section of slide
Increasing Primary Care Capacity
Acute costs
23
Increasing Capacity in Acute
24
What are our clients saying?
Client Interview Results
“It’s very good. It seems to provide a service for those who struggle to fit
in the mainstream system which requires you to advocate strongly for
yourself.”
- Client
“This has been excellent. I’ve had more medical care here than I care
to shake a stick at. It’s been one thing after another. Some small
things, and some big issues with me too. It’s been great. [The NP] is
extremely knowledgeable and right on top of things.”
- Client
27
What are our providers saying?
Memorable Case Studies
“A homeless gentleman with stage 4 cancer was met at the clinic by Outreach. When
discovered that he did not have a place to stay, he was secured a bed at the Lookout shelter. Outreach continues to support this gentleman with getting to the clinic regularly and chemo
treatments at LGH.”- Survey Respondent
“A client was referred by a community agency. He was a low income and isolated senior. He
was reluctant to go to the clinic but had experienced several falls. After meeting the
healthcare professional, he became increasingly comfortable and now sees the
clinic regularly.”
- Survey Respondent
“One of our first patients is a physically disabled man hugely addicted but wanting to get off
meds. Over the course of time, we have developed a trusting working relationship with
him, he is doing much better, and it is very gratifying. “
- Survey Respondent
Learnings | Next Steps• Value of a collaborative approach• Importance of identifying & addressing medical and
social needs (e.g., housing, poverty) of clients to improve health outcomes over long-term
• Ongoing evaluation is key to early success & helps to clarify priorities & identify opportunities for improvement
• Sustainability & clinic growth– Division of Family Practice’s A GP for Me Strategy – Home visiting component to support frail elderly & other
vulnerable groups unable to access services at the clinic– Implementation of EMR
Contact Information
Sandra Edelmane. [email protected]
p. 604 904-6453f. 604 904-6470
www.healthconnectbc.ca