Date post: | 15-Apr-2017 |
Category: |
Health & Medicine |
Upload: | cachc |
View: | 600 times |
Download: | 0 times |
Making data work – Untangling input, output and reporting
Jennifer RaynerCanadian Association of CHCs September 17, 2015
Objectives and problems to discussData measurement, data management,
clinical decision making, reporting and analytics – power of data
Administrative data, EMR data, evaluation data – what is important to collect
EMR data (or how to collect data without an EMR)
How do we measure the impact of team-based care (when most EMRs are built for individual practitioners)
What is meaningful? Discussion – core data for national
reporting
Data RequirementsFunding requirements/reporting Financial reportingHR reportingEvidence based decision makingQuality Improvement/
benchmarking/target settingPlanning Population healthProgram evaluationPrediction (projections) analysesResearch
Electronic Medical Records (EMR)
Often built for physicians (not team-based)
Prescriptive (individuals have little input in how system is designed)
Providers use EMRs as electronic charts – free text, no data standards, etc
Users cannot get data out at all or in a meaningful way
Often data rich but information poor
Next Steps/Gaps Identified in survey
• 64% indicated they have data on primary care clients (54% for non community governed)
• 36% said they collect data on heath promotion and outreach (28% for non community governed)
• 49% have data on gender
• What can we do about this?
• Is it important?
What makes you unique?
When is it important to standardize?
US/Ontario StoryCommitment to working collaboratively
at the national, regional/state, and local levels to make the case with available data
Commitment to “Tell Our Story”Recognition of the importance of
research and data in “Telling Our Story”Recognition that the “right”
partnerships with academia and other community partners is key to success
Ontario Evaluability Assessment
Do we have enough in common to see ourselves as a ‘program’ – late 1990’sAccessibilityWellness and PreventionCoordination and IntegrationHolistic, client centred
(comprehensive)Community ownership
54 CHCs operational Tested and refined in 2000 – all CHCs
have common data elements (only use system for electronic, administrative data, scheduling and client roster
2003 – transition to EMR 3 EMRs common EMR
Results Based Logic Model
Evaluation
Questions and
Indicators
Data Elements
CHC Evaluation Framework
Original logic modelAccessible Services
·Accessible location·Convenient hours of operation·Services available in different languages·Culturally relevant programs and services·Outreach
·Communities/individuals identify their own needs·Community involvement in running centres/programs/activities·Community development programs/activities·Health education/promotion
·Health education/promotion activities with individuals/groups (clinical and community focus)
·Use of multi-disciplinary teams and assessments of all aspects of lives·Multi-disciplinary interventions and appropriate referrals
·Team approach·Internal referral systems, meetings, case conferences·Fostering external linkages
Empowering individuals and communities
Focus on Wellness and Prevention
Holistic approach to provision of Health Care
Provision of Coordinated services/programs
Reach and serve groups who would not access relevant services elsewhere
Community participation (in decision-making/ leadership)
Change in health care
·Awareness·Attitudes·BehaviourProvision of relevant services
Presence on community boardsEstablishment of coordinating groups/ projects¨Joint program planning
Impact on determinants of health of individuals and communities
Improve health status of individuals and communities
CHC Program Evaluation System
Broad Organization•Main Intended Populations•Broad Issues Addressed
Client Demographics
Individual Service Events
Personal Development Groups
Community Initiatives
Original standardized data elementsAccessibility (individual client characteristics, hours of operation,
language of service, issues addressed location of encounter, etc)
Interprofessional Teams – provider roles, referrals, consultations, etc
Focus on Wellness and Prevention – types of services, PDGs, health education, health promotion activities, issues addressed
Coordinated Services – referrals, care coordination, system navigation
Individual and Community Ownership – Community development activities, involvement in care, etc
Model of health and well-being
Supports on-going assessment and evaluation of our programs and services – common starting point
Includes a series of discrete componentsResults based logic modelEvaluation questions
Process evaluation questions (nature of people served, extent to which the program has been implemented as expected
Outcome/impact questions (attendance caused a positive outcome)
Indicators (measures)Data sourcesData entry manual (also produced)
Revised Ontario Evaluation Framework
Commitment to health through the lens of social determinants, community vitality belonging, health equity & social justice
Increased community capacity-building
Reduced risk, incidence, duration and effects of acute
& episodic conditions
Increased civic
engagement and social
capital
Improved level and distribution of population health and wellness
Improved capacity of communities to be involved in decision-making about their health
Increased seamless delivery of services, appropriateness
of time, place and inter-professional team through
integration and coordination
Improved functioning, health, resilience & wellbeing of Individuals, families & communities Improved Health Equity across Sectors
Reduced risk, incidence and
effects of chronic through HP
Increased access for people who experience the
greatest barriers
Resources - Financial, Material and Human
Community Knowledge Synthesis - Community and client input, Needs assessments, Environmental scans
Client & community driven health care programs, services and initiatives with particular focus on those who face barriers to health
Highest Quality, People and Community Centred Health and Wellbeing
H
Improved equity in access to CENTRE services by eliminating barriers and advocating for healthy public policy
Reduced negative impact of SDOH on health and wellbeing of clients
How Many?(Volumes, clients,
etc)
What services do we deliver?
(e.g., PHC, CD, etc
How do we deliver services?(i.e., 8 MoHWB Attributes)
With Whom? (priority populations )
Increased community
partnerships
AccessibleIP, integrated & coordinated
Community governed
Based upon the SDOH
Culturally Safe
Accountable and Efficient
Community Development
Approach
Population and Needs-
based
Current standardized dataIndividual client data and
sociodemographic information
Encounter data – All individual encounters and personal development groups (specific data fields)
Community development initiatives
Financial data – MIS compliant
Client experienceQuality Improvement Plans MSAAs – Accountability
Agreements
Continue to demonstrate our impact and success...
Collective evidence to continue telling our story, improve & demonstrate our effectiveness
Tools and DataBIRT, Organizational
Survey, QIPs, MSAA, CI Tool, PCPM, Practice Profile, CI Tool, Activity Based Costing data
Importance of standard data – a few examples
Data linkage with health databases
Comparison of primary care models
Health equity analysesCosting comparisons Population planning &
prevalence dataAccountable care organizationsRisk adjustmentHaving our clients included in
population health studies
CHC FHG FHN FHO FHT Other NON0
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
1.8
2
1.84
1.26
1.07 1.11 1.04
1.22
0.950000000000001
Standardized ACG Morbidity In-dex (SAMI) by primary care model
Primary Care Models - ALL
At Risk
Urban
Urban G
eogra
phy
Rural G
eogra
phy
Franco
phon
e
Newcom
erOthe
r
Ontario
CHCs
Ontario
Total
0102030405060708090
Cancer Screening
MammographyColorectal ScreeningCervical Screening%
CHC DashboardQuality information driver
for better careClinical team have
undertaken a review of QBT and PCPM and prioritized a subset of measures to benchmark and QI
Provide an active performance monitoring tool for clinical engagement, operational effectiveness, clinical outcomes & patient experience
Example – Economic/Costing Analyses
Outcomes overshadowed by unsubstantiated statement that `model is expensive`
Tricky to allocate costs and potential benefits
Primary health care, community development, health promotion all under one roof
Creating an activity based costing methodology
Lessons learnedImportance of having key people on
hand for on-going training Super-users (clinicians included)Use the data for more than just
accountability – use the data in-house
Ensure that standardized data is going to be used (clinician time) + force queries to do some of the work
Data quality an on-going issue Importance of working together as a
sector to tell our storyImportance of using data
throughout the organization
Types of Services at CHCs• 100% of CHCs provide primary care
services• 82% provide self-management
programs• 62% provide primary care through
home visits• 33% provide primary care through
street outreach or within a mobile unit
• 73% offer harm reduction programs• 69% offer mental health counseling
Canadian CHCs: whom does this include?1.Publicly-funded, not-for-profit or government
agency;2.Principally offers primary health, social,
rehabilitation and other non-institutional services;
3.Health promotion, health education and community health and development programs;
4.Inter-professional teams from various disciplines, & volunteers;
5.Serves an identifiable community6.Governed by locally representative board of
directors (BOD); or a BOD of a broader health network/region having an advisory committee made up of locally representative directors;
7.Remunerates the majority of human resources by funding arrangements such as salary, sessional fees or capitation rather than fee-for-service.
Questions to considerWhat data do we all
collect now?What questions do we
need to answer? What data is important to
collect across all CHCs to demonstrate our collective impact? Is this possible?
Other questions that we need to consider?