faculty/presenter disclosure faculty: harry jones program: 51 st annual scientific assembly...
TRANSCRIPT
Faculty/Presenter DisclosureFaculty/Presenter Disclosure
• Faculty: Harry Jones• Program: 51st Annual Scientific Assembly
• Relationships with commercial interests:– Grants/Research Support: No– Speakers Bureau/Honoraria: No.– Consulting Fees: I provide consulting services to physicians– Other: Employee of Clarence-Rockland FHT
Mitigating Potential BiasMitigating Potential Bias
• Presentation was reviewed by Dr. Lori Teeple, Dr. Steve Pelletier and Dr. Kendall Noel
Presentation Outline
• Where are we?
• Why measure?
• What should you measure?
• Our experience
• Things to keep in mind
• Excellent Care for All Act
• Health Quality Ontario
• CIHI
• Preventative care bonuses
• www.rateyourmd.com
• Accountable Care Organization (US)
• etc. etc.
It’s already here
Why measure?
• Influence the agenda
3,000 Hospital Admissions
2,000 CT/MRI Scans50Hip and knee replacements
137,000General practitioner/family physician visits
12,000EmergencyDepartmentVisits
54,000Specialist visits
41,000X-rays taken
In 2010-11 46% of every program dollar went to healthcare. If the rate of growth is not slowed, it is projected to rise to 70% in 12 years.
Why measure?
• Set a baseline
• Support quality improvement initiatives
• Force change
• Shift corporate culture
• Enable comparisons
Operations
• Wait time on the phone < 3 minutes
• Time in the waiting room < 15 minutes
• Scanning in the EMR < 24 hours
• Consultations requested < 48 hours
Human resources
• FTE staff / FTE doctor
• Patients / staff
• Turnover
• Clinical vs. non-clinical staff
Access
• Time to get an appointment (i.e. 3rd next)
• Access bonus retention
• % of patients seeing their own physician
• % of visits diverted through a phone call by physician
Outcomes
• Hypertensive patient’s BP < 140/90
• Diabetic patient’s HbA1c < .07
• Preventative care bonuses
• # of patients who remain non-smoking after 6 months
• Survey after group session indicates patients have a better understanding
PM & QI Committee
• Improve the care provided at the clinic
• Identify and measure appropriate performance indicators
• Share the results outside the clinic
Progress to date
• Agreed which ICD9 codes to use
• Updated coding on all rostered patients
• Agreed what performance measures to track and publish – first report June 2011
• Converted to ICD10
• Completed second patient survey
• Added critical incidents to committee
Challenges
• Nomenclature – 12+ written terms for diabetes (e.g. diabetes mellitus / DM / diabète)
• Agreeing on codes
• Finding comparators (e.g. actual 3rd next)
Next steps
• Verify patient coding
• Identify additional useful measures
• Simplify the process to generate measures
• Continue using data to deal with issues (e.g. immunisation)
Measure what you can control
• Patient survey – “are the exam rooms large enough?”
• Clinical – HbA1c
• System – 30 day readmission rate