Download Abstract - PCN PMO

PRIMARY CARE
Making Vision a Reality!
November 23–26
2014
Edmonton, Alberta
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Edmonton, Alber ta — Nov. 24 – 25 — A B S T R A C T S — 2 0 1 4 Accelerating Primar y Care Conference
Abstract Table of Contents
Full abstracts will be available online at www.pcnpmo.ca after the conference.
1
Dr. Allan L. Bailey, MD, CCFP, Westview Primary Care Network
Panel Management, Performance Measurement And Reporting (PM2R):
The Evolving Story Of Quality Improvement
ORAL ABSTRACT PRESENTATION
2
Dr. Allan L. Bailey, MD, CCFP, Westview Primary Care Network
Quality Improvement In Family Medicine: Is Formal Accreditation The Way
To Go?
POSTER ABSTRACT PRESENTATION
3
Dr. Jacqueline Bakker, MD, FRCPC, Neurologist, Medical Director - Multiple Sclerosis Clinic, Red Deer
Primary/Specialty Care Collaboration To Enhance Care For MS Patients
With Recurrent Urinary Tract Infections: A Case Study
POSTER ABSTRACT PRESENTATION
4
Alison Bidie, Bachelor Health Information Management, Grad. Dip Applied Information Systems, Canadian Institute for Health Information
Clinician Friendly Pick-Lists In Electronic Medical Records:
Supporting Quality Improvement At The Practice Level And Beyond
POSTER ABSTRACT PRESENTATION
5
Omenaa Boakye, MSc, PMP, Alberta Health Services
Practical Implications Of Existing Policies On Team-Based Care Primary
Health Care: Lessons From Three Provinces
POSTER ABSTRACT PRESENTATION
6
Gregory Boughen, MD, CCFP
Patient Experience: What Does It Mean To The Clinician And How To
Measure For System Improvement?
POSTER ABSTRACT PRESENTATION
7
Rebecca Carter, MA, Calgary Rural Primary Care Network
“Pedal To The Metal”: Calgary Rural PCN’s Journey To Accelerate Progress
And Strengthen Medical Homes
POSTER ABSTRACT PRESENTATION
8
Steven Clelland, MA, AIM Alberta
Evolving AIM: Changing Tack In A Time Of Change
POSTER ABSTRACT PRESENTATION
9
Dr. Lisa Cook, PhD, Chinook Primary Care Network
The Addition Of Outcome Date To Cancer Screening
POSTER ABSTRACT PRESENTATION
10
Dr. Lisa Cook, PhD, Chinook Primary Care Network
What Does Patient Attachment Lead To?
POSTER ABSTRACT PRESENTATION
11
Dr. Lisa Cook, PhD, Chinook Primary Care Network
Why Are AIM Measures Important At The PCN Level?
POSTER ABSTRACT PRESENTATION
12
Shelby Corley, MA, CE, Evaluation Services, Alberta Health Services
Incorporating Evaluation Throughout Development, Implementation
And Improvement Of A Weight Management Program
POSTER ABSTRACT PRESENTATION
Edmonton, Alber ta — Nov. 24 – 25 — A B S T R A C T S — 2 0 1 4 Accelerating Primar y Care Conference
13
Agnes Dallison, MSc, CE, University of Calgary, Department of Family Medicine
Implementation of QI Projects For Post‑Graduate Clinical Learners
In Non‑Academic Clinics: Aleas And Caveats
POSTER ABSTRACT PRESENTATION
14
Nikki Davis, BSc (PhysEd), CSEP-CEP, Alberta Heartland Primary Care Network
Evaluation Of Community-Based Cardiac Rehabilitation Program
In The Alberta Heartland Region
POSTER ABSTRACT PRESENTATION
15
Laurie deBoer, Clinical Process Advisor, RN, BN, Toward Optimized Practice
Building Capacity In Primary Care Networks
POSTER ABSTRACT PRESENTATION
16
Lana deBoon, Executive Director, RN, Peace River PCN
From Chaos To Control: How Peace River PCN Got Smart With Panel
POSTER ABSTRACT PRESENTATION
17
Crystal Degenhardt, BSW, RSW, Edmonton Southside Primary Care Network
Improving Quality Of Life Through Managing Emotions Group
POSTER ABSTRACT PRESENTATION
18
Karin Dixon, BNSc, MN-NP, NP, Copeman Healthcare
Comprehensive Travel Health Care In Primary Care
POSTER ABSTRACT PRESENTATION
19
Amra Dizdarevic, MN-NP, BSN, BSc, Copeman Healthcare Centre
Enhanced Well Child Visits In Primary Care
POSTER ABSTRACT PRESENTATION
20
Ron Garnett, MD, CCFP(EM), FCFP, DipSportMed, University of Calgary Department of Family Medicine
Accu-Meds: An Approach To Medication Reconciliation
In A Family Practice Setting
POSTER ABSTRACT PRESENTATION
21
Ron Garnett, MD, CCFP(EM), FCFP, DipSportMed, University of Calgary Department of Family Medicine
The Patient And Citizen Innovation Council In Family Practice
POSTER ABSTRACT PRESENTATION
22
Lee A. Green, MD, MPH
Use Of Cognitive Task Analysis To Support Change Management
POSTER ABSTRACT PRESENTATION
23
Debbie Greenbank, Panel Manager, LPN, Sylvan Lake Medical Clinic, Wolf Creek PCN
Improvement Processes In Action: The Sylvan Lake Medical Clinic Example
POSTER ABSTRACT PRESENTATION
24
Hamilton Hall, MD, FRCSC, CBI Health Group
Stratified Back Care: From Mechanical To Psychosocial
POSTER ABSTRACT PRESENTATION
25
Jessica Hein, BSc Kin, MScPT, Alberta Health Services
Whitecourt Healthy Living Program: Bridging The Gap
POSTER ABSTRACT PRESENTATION
26
William Hnydyk, MD, Alberta Medical Association
Choosing Wisely Canada: Leadership And Implementation In Alberta
POSTER ABSTRACT PRESENTATION
Edmonton, Alber ta — Nov. 24 – 25 — A B S T R A C T S — 2 0 1 4 Accelerating Primar y Care Conference
27
Rhiannon Jacek, Exercise Specialist, Edmonton Southside Primary Care Network
Successes Of A Supervised Exercise Program In Primary Care:
Moving For Health
POSTER ABSTRACT PRESENTATION
28
Max Jajszczok, RN, BN, PMP, Director, Palliative & End of Life Care Practice and Development, Alberta
Health Services
Provincial Palliative And End Of Life Care Program Initiatives
POSTER ABSTRACT PRESENTATION
29
Monica Joly, RN, BScN, Lakeland Primary Care Network
Panel Identification And Preventative Screening
POSTER ABSTRACT PRESENTATION
30
Holly Kennedy-Symonds, RN, BSc (Hon Psych), MHSc, Copeman Healthcare
Clinical Service Excellence Integration
POSTER ABSTRACT PRESENTATION
31
Sarjiwan Khullar, MRCS, LRCP, MBBs, FRCS, EdFRCS, Devon Medical Clinic
Quality Improvement Initiatives To Improve Diabetes Care At Devon
Medical Clinic
POSTER ABSTRACT PRESENTATION
32
Sara Mallinson, PhD, Alberta Health Services
Advancing Team-Based Primary Health Care: Policy Imperatives
POSTER ABSTRACT PRESENTATION
33
Dr. Donna Manca, MD, FCFP, MClSc, Department of Family Medicine University of Alberta
Utilizing Electronic Medical Record Data To Inform Clinical Practice
POSTER ABSTRACT PRESENTATION
34
Carol Maskowitz, RN, Program Manager, Red Deer Primary Care Network
Family Nurses Play A Key Role In Health Homes: Transforming Primary
Health Care In Alberta
ORAL ABSTRACT PRESENTATION
35
Barbra McCaffrey, BSc, DipEd, EMR KT Lead, Toward Optimized Practice
Case Studies In Building Electronic Medical Record (EMR) Capacity For
Medical Home
POSTER ABSTRACT PRESENTATION
36
Shera McConnell, LPN, Aspen PCN
Healthy Lifestyle Youth Project
POSTER ABSTRACT PRESENTATION
37
Dr. Diane McNeil, PhD, Alberta Health Services
Assisting Primary Care Health Care Professionals In Earlier Detection Of
Mental Health Disorders In Community-Dwelling Seniors: An EvidenceBased Toolkit
POSTER ABSTRACT PRESENTATION
38
Dr. David G. Moores, MD, MSc, CCFP, FCFP, Dept. of Family Medicine, University of Alberta
Quality And Safety In Primary Care: Family Medicine Residency Education
And Training At The University Of Alberta
POSTER ABSTRACT PRESENTATION
39
Lorna Milkovich, RN, BN, MBA, Executive Director, Red Deer Primary Care Network
Red Deer Primary Care Network Case Study: Adapting The Toyota
Management Model To Primary Health Care: Facilitating Optimized
Collaboration
POSTER ABSTRACT PRESENTATION
Edmonton, Alber ta — Nov. 24 – 25 — A B S T R A C T S — 2 0 1 4 Accelerating Primar y Care Conference
40
Grace C. Moe, BPT, MSc, PCMH-CCE, Westview Physician Collaborative/Westview PCN
Primary Care Evolution: A Family Practice Readiness Assessment—
“Medical Homeness” And Performance Measures Capability
POSTER ABSTRACT PRESENTATION
41
Tony Mottershead, MSc, AIM Alberta
For The Good Of The Team: Can Physician Participation In A Core QI Team
Improve Access Outcomes?
POSTER ABSTRACT PRESENTATION
42
Micheline Nimmock, RN, BScN, MBA, Highland Primary Care Network
Medical Home Tactical Plan And Change Management Approach In The
Highland PCN
POSTER ABSTRACT PRESENTATION
43
Dolores Paul, BEd, Edmonton Southside Primary Care Network
Engaging Primary Care Providers In Quality Improvement
ORAL ABSTRACT PRESENTATION
44
Kelsey Pruden, LPN, Symphony Medical Clinic, WestView PCN
Alberta Screening And Prevention Initiative: A Clinic Journey
POSTER ABSTRACT PRESENTATION
45
Maya Rathnavalu, BScN, RN, Smith Clinic & Camrose PCN
Your EMR: Getting To The Heart Of Improving Patient Care
POSTER ABSTRACT PRESENTATION
46
Darlene Rowe, BSc(Pharm), Aspen PCN
Healthy Lung Clinic-Rural Breathe Easy Program
POSTER ABSTRACT PRESENTATION
47
Peter Rymkiewicz, Bcomm, MSc (Candidate), Highland Primary Care Network
Interdisciplinary Care: Driving Quality Improvement Through Data
Collection And Use Of Information
POSTER ABSTRACT PRESENTATION
48
Peter Rymkiewicz, Bcomm MSc(Candidate), Highland Primary Care Network
Primary Care Network Quality Improvement Initiative Using Proactive
Patient Encounters To Effect Patient Screening Rates
POSTER ABSTRACT PRESENTATION
49
Peter Rymkiewicz, Bcomm MSc(Candidate), Highland Primary Care Network
Using EMR Data Extraction To Support Improvements In
Patient Screening Rates
POSTER ABSTRACT PRESENTATION
50
Dr. Ginetta Salvalaggio, MD, MSc, CCFP, University of Alberta Department of Family Medicine
Developing A Preventative Alcohol Screening Tool For Use In
Multidisciplinary Primary Care Team Practices
POSTER ABSTRACT PRESENTATION
51
Dr. Ginetta Salvalaggio, MD, MSc, CCFP, University of Alberta Department of Family Medicine
Addiction Recovery And Community Health (ARCH): Introduction
Of A Targeted, Multidisciplinary Acute Care Team To Enhance Primary Care
Delivery For A High Risk Urban Population
POSTER ABSTRACT PRESENTATION
52
Elisabeth M.S. Sherman, Copeman Healthcare Centre, University of Calgary
Brain Health And Psychological Health Awareness And Monitoring
In A Primary Care Setting
POSTER ABSTRACT PRESENTATION
Edmonton, Alber ta — Nov. 24 – 25 — A B S T R A C T S — 2 0 1 4 Accelerating Primar y Care Conference
53
Nicolette Sopcak, PhD, Department of Family Medicine, University of Alberta
How Can We Do BETTER? Contrasting Perspectives On A New Approach
To Chronic Disease Prevention And Screening (CDPS) In Newfoundland
And Labrador
POSTER ABSTRACT PRESENTATION
54
Donna Thompson, BASc RD Program Evaluator, Red Deer Primary Care Network
How Can We Better Support The Primary Health Care Team?
Adapting And Piloting A Health Team Effectiveness Tool
ORAL ABSTRACT PRESENTATION
55
Dr. Eric Wasylenko, MD, BSc, MHSc (bioethics), Provincial Medical Advisor, Alberta Health Services
Adopting Advance Care Planning/Goals Of Care Designations Within
Community Practice
POSTER ABSTRACT PRESENTATION
56
Dr. Linda Watson, RN, PhD(c), CON(c), Alberta Health Services
Making Cancer Patient Navigation A Reality: Sharing Results
From A Provincial Quality Improvement Initiative
ORAL ABSTRACT PRESENTATION
57
Denise Watt, CCFP(EM), AHS
Patient Care Handouts: Standardized Patient Teaching Tools
For Clinical Practice www.myhealth.alberta.ca
POSTER ABSTRACT PRESENTATION
58
Mark Watt, Program Development Lead, RN, BN, Toward Optimized Practice (TOP)
Don’t Let Panel Myths Stop You From Taking The Panel Plunge!
POSTER ABSTRACT PRESENTATION
59
Amanda Weiss, RN, BScN, BA, AHS Foothills Emergency Department
ED - PCN Referral Process
POSTER ABSTRACT PRESENTATION
60
Lisa Wozniak, MA, ACHORD, University of Alberta
Impact Of Organizational Stability On Adoption Of Quality-Improvement
Interventions For Diabetes In Primary Care Settings
POSTER ABSTRACT PRESENTATION
61
Alvin Yapp, BSc (Psychology), MEd, Edmonton Oliver Primary Care Network
Best Practice: Bringing In Evidence-Based Pharmacology Studies
POSTER ABSTRACT PRESENTATION
62
Alvin Yapp, BSc (Psychology), MEd, Edmonton Oliver Primary Care Network
Group Therapy As A Viable Alternative To Individual Counseling
To Address High Volumes Of Referrals In Primary Care Settings
POSTER ABSTRACT PRESENTATION
63
Alvin Yapp, BSc (Psychology), MEd, Edmonton Oliver Primary Care Network
Mom Care Docs: Maternity Care Practice By Family Physicians?
POSTER ABSTRACT PRESENTATION
64
Alvin Yapp, BSc (Psych), MEd, Edmonton Oliver Primary Care Network
No Change Can Be Good Change: Tracking BMI
POSTER ABSTRACT PRESENTATION
65
Alvin Yapp, BSc (Psychology), MEd, Edmonton Oliver Primary Care Network
The Impact Of Attrition On Panel Management
POSTER ABSTRACT PRESENTATION
Edmonton, Alber ta — Nov. 24 – 25 — A B S T R A C T S — 2 0 1 4 Accelerating Primar y Care Conference
Abstract
1)
Panel Management, Performance
Measurement And Reporting (PM2R):
The Evolving Story Of Quality Improvement
Dr. Allan L. Bailey, MD, CCFP, Westview Primary Care Network
Grace Moe, MSc, PCMH-CCE
Context
Results
Primary Care Network (PCN) Evolution and
Alberta’s “Primary Health Care Strategy” emphasize
evaluation as a priority for family physicians.
No system framework has been proposed, nor
is there an inventory of necessary resources to
enable evaluation, performance measurement or
reporting.
Two antecedent elements are necessary for
evaluation to be executed:
1) an information management infrastructure
including clear and transparent data
governance;
2) a quality improvement framework identifying
Electronic Medical Record (EMR) accessible
data from the “current state” but expanding
universe of process and outcome indicators
and primary care performance indicators.
Objectives
1) To identify some of the essential elements
required when performing any practice-based
evaluation.
2) The effectiveness of the POET role/intervention
in screening and prevention as an element of
panel management is evaluated by the study
hypothesis: “The implementation of the POET
role improves screening performance as defined
by the Towards Optimized Practice (TOP) ASaP
indicators”.
Methods
Both a technical solution and adherence to
data stewardship principles were required
in the development of the information
management infrastructure and this PM2R system.
A retrospective analysis using the developed
information management infrastructure examined
the success of screening manoeuvers in three
phases: baseline standard of care pre-POET; in the
early POET implementation phase; and the “mature”
phase of POET-facilitated panel management.
An Information Sharing Agreement (ISA) was
developed between the physicians’ Non-Profit
Corporation (Westview Physician Collaborative)
and all member physicians of the Westview PCN.
Combined with an approved Privacy Impact
Assessment (PIA), data stewardship was ensured.
A “menu” of 26 primary health care indicators
was developed that includes the ASaP data set.
Evaluation of the performance of screening
manoeuvers shows a statistically significant
improvement post-POET for the sample physician
panel used.
Conclusion
With appropriate infrastructure support, and a
clear framework of relevant indicators, evaluation
of panel management, performance measures and
reporting is achievable in EMR-enabled practices.
Edmonton, Alber ta — Nov. 24 – 25 — A B S T R A C T S — 2 0 1 4 Accelerating Primar y Care Conference
Abstract
2)
Quality Improvement In Family Medicine:
Is Formal Accreditation The Way To Go?
Dr. Allan L. Bailey, MD, CCFP, Westview Primary Care Network
Grace Moe, MSc, PCMH-CCE
Keith McNicol, MD, CCFP
Context
Results
Continuous quality improvement in family practice
clinics is deemed to enhance care and improve
outcomes. Accreditation is a formal process by
which a family practice is assessed against predetermined and published standards. To date,
there is no evidence that formal accreditation is an
optimal means to achieving family practice quality
objectives. In this study, five Westview Primary Care
Network (PCN) clinics were the first communitybased, fee-for-service family practices in Canada to
voluntarily pursue accreditation.
All five clinics received the Primer Accreditation
award. There is evidence of increased adherence
to national standards in safety, medication
management, infection control, emergency
preparedness, HR work life, leadership and quality
of service delivery. Clinic staff cited benefits from
clinic implemented quality improvement activities,
but were uncertain if “accreditation” added value.
Costs were estimated and proven onerous by
the FP clinics. Over 90% of patient respondents
to surveys in 2013 and 2014 continued to rate
“Satisfaction with FP providers” as “Excellent/Very
Good” and reported improvements in perceived
access, care quality and self-care. There is no
evidence however those improvements were direct
outcomes of accreditation.
Objectives
To determine the resource requirements for, and
the utility, impact and sustainability of formal
accreditation in family medicine.
Methods
A qualitative study to examine the formative and
summative experiences of participating clinics was
performed using:
• Pre- and post clinic self-assessment and quality
roadmaps
• Primer Survey Report by Accreditation Canada
Conclusion
Formal accreditation is one approach to quality
improvement in family medicine; its primary utility
is validation and recognition of “gaps”. The cost
burden upon standalone fee-for-service family
practice clinics is onerous. Commitment of system
resources is needed for sustainable and accessible
quality improvement infrastructure.
• Retrospective survey of clinic personnel
• Pre- and post patient survey The accreditation
program was evaluated retrospectively using
a logic model approach to examine the cost,
outcomes and impact.
Edmonton, Alber ta — Nov. 24 – 25 — A B S T R A C T S — 2 0 1 4 Accelerating Primar y Care Conference
Abstract
3)
Primary/Specialty Care Collaboration To
Enhance Care For MS Patients With Recurrent
Urinary Tract Infections: A Case Study
Dr. Jacqueline Bakker, MD, FRCPC, Neurologist, Medical Director - Multiple Sclerosis Clinic, Red Deer
Dr. Robert Warren, JD, MD, CCFP
Dr. Michelle Warren, MD, CCFP
Bonnie Blain, RN, MScN
Mark Watt, RN, BN
Marion Relf, RN, MHSA
Context
Multiple Sclerosis (MS) is a chronic, debilitating
disease with no known cure and is a challenge
to manage for both doctors and patients. Many
patients have bladder dysfunction causing
frequent urinary tract infections (UTI) which
are difficult to identify and treat early. These
individuals can progress from mild, non-specific
complaints to becoming very ill very quickly and
may encounter barriers to accessing primary care
in a timely fashion. Early diagnosis and treatment
of UTIs should reduce emergency visits and
hospitalizations.
Objectives
I) Identify best practices in the treatment of MS;
2) Support process improvement opportunities;
3) Support care coordination between primary/
specialty care and patients. The project involved
developing a guideline and working with
specialty and primary care to successfully
implement the guideline and support patients
in managing their own health.
resources, which would fully utilize primary care
team members to support early identification
and management and optimize patient selfmanagement. Based on the success of the early
trials, the processes were spread to others. A
patient resource, My Bladder Management Action
Plan, was also piloted and distributed to patients.
What we have learned from the pilots has allowed
further opportunities to spread improvements
through the effective use of improvement
facilitators.
Results
1) Focusing on process improvements allowed
teams to achieve success;
2) Physician to physician communication and
leadership supported engagement in change.
Visible and engaged leadership supports
success of improvement activities;
3) Patients are willing to engage in an
improvement processes and provide feedback;
4) Collaborative processes for development and
refining materials reduced likelihood of sites
rejecting tools/resources.
Methods
Conclusion
A clinical guideline on the management of UTIs
was developed along with a summary, tools and
patient resources. A facilitator worked with some
primary care practices to trial new processes and
Effective linkages between specialty and
primary care may be attained through
assistance of improvement facilitators to
enhance care provided by health professionals.
Edmonton, Alber ta — Nov. 24 – 25 — A B S T R A C T S — 2 0 1 4 Accelerating Primar y Care Conference
Abstract
4)
Clinician Friendly Pick-Lists In Electronic
Medical Records:
Supporting Quality Improvement At The
Practice Level And Beyond
Alison Bidie, Bachelor Health Information Management, Grad. Dip Applied Information Systems, Canadian Institute
for Health Information
Mary Byrnes
Caroline Heick
Context
Methods
The Canadian Institute for Health Information
(CIHI) has been leading an initiative to improve
primary health care (PHC) data and information
across Canada. Currently, most Electronic Medical
Record (EMR) data is unstructured which makes the
extraction, analysis and comparison of the data to
be labour intensive and unsustainable. In response
to stakeholder concerns, CIHI has developed the
Primary Health Care EMR Content Standard and
Clinician Friendly Pick Lists (CFPL). The Content
Standard is a Pan-Canadian solution to facilitate
the capture of structured EMR data at the point of
care. The CFPLs are a key tool; they consist of eight
constrained lists of clinically validated terms, which
have been mapped to underlying codes systems.
The focused scope of the CFPLs supports priority
PHC information needs and the calculation of
many PHC indicators. For PHC clinicians, this means
better EMR data about their patient populations,
which will inform improvements to the quality of
care, patient safety and efficiency of their practice.
The development of the Content Standard,
including the CFPLs, was a collaborative effort
which engaged PHC clinicians, decision support
specialists, jurisdictional representatives and
Canada Health Infoway. In May 2014, the updated
CFPLs and a plan to map them to relevant code
systems were reviewed and supported by the
Jurisdictional Advisory Group. This Advisory Group
provides strategic direction and oversight to the
PHC EMR CS and consists of representatives from
all provincial, territorial and federal constituencies,
including Alberta.
Objectives
To accelerate adoption of the EMR Content
Standard across Canada and to enable the
collection of structured EMR data at the point
of care.
Results
Improved availability of structured, comparable
EMR data will better inform PHC clinicians efforts
to study and improve the quality of care, patient
safety and efficiency of their practice. At the health
system level, better EMR data will support better
monitoring of chronic disease prevention and
management, health outcomes and quality of care.
Conclusion
When implemented at the point of care, it is
anticipated that the EMR Content Standard, and
associated CFPLs, will increase the availability
of structured, comparable EMR data to support
priority information needs at the practice level
and beyond.
Edmonton, Alber ta — Nov. 24 – 25 — A B S T R A C T S — 2 0 1 4 Accelerating Primar y Care Conference
Abstract
5)
Practical Implications Of Existing Policies
On Team-Based Care Primary Health Care:
Lessons From Three Provinces
Omenaa Boakye, MSc, PMP, Alberta Health Services
Sara Mallinson
Esther Suter
Renee Misfeldt
Amanda Wilhelm
Context
Results
Much has been reported on the challenges,
successes and current state of team based
approaches in primary health care. However, since
overall policy development and implementation
is provincial jurisdiction, each province has
different ways to conceptualize and operationalize
primary health care team based service delivery.
Our objective was to understand how existing
policies guide team-based primary health care in
British Columbia, Alberta and Saskatchewan. We
also sought to identify what has been particularly
helpful in moving team based care forward and the
barriers currently hindering uptake and spread.
Strategic policy guidance at the provincial level
was often said to enable team based care, but
participants said that there is little operational
guidance on how to implement teams. Providers
and managers are often left to “learn” and
“experience” as they build teams and this has led
to variability in structure, organization and extent
to which teams work collaboratively. Challenges
linked to payment of different staff on interprofessional teams were noted as well as wider
resource issues such as creating appropriate
infrastructure for team-based care. Lack of clarity
around regulatory frameworks and legislation,
particularly with respect to professional liability
and privacy, was felt to impede shared care.
Initiatives that were regarded as supportive
of team-based care include increased use of
technology and provision of team facilitators/
mentors to embed collaborative practice.
Objectives
Our research team conducted in-depth qualitative
interviews with key informants from three
provinces to understand the practical implications
of existing policies on team-based care primary
health care.
Methods
Twenty nine key informants from three provinces
participated in qualitative interviews. Participants
included representatives from provincial ministries
of health, regional health authorities, primary
health care organizations, professional colleges
and associations. Interviews were transcribed and
thematically analyzed.
Conclusion
Overarching policies are important in terms of the
principles and approaches that need to be taken,
however they must be flexible to account for team
and local needs. Funding for teams extends beyond
salary and should take into account change
management, space redesign, professional
development and benefits. Providers need
support to understand the concepts and
theories of collaborative practice in order to
adopt them.
Edmonton, Alber ta — Nov. 24 – 25 — A B S T R A C T S — 2 0 1 4 Accelerating Primar y Care Conference
Abstract
6)
Patient Experience:
What Does It Mean To The Clinician And How
To Measure For System Improvement?
Gregory Boughen, MD, CCFP
Keith McNicol, MD, CCFP
Allan L. Bailey, MD, CCFP
Grace Moe, MSc, PCMH-CCE
Context
Results
Striving for positive doctor-patient relationship’s is
the fundamental culture and value of the physician.
The Westview Primary Care Network (WPCN)
envisions expanding this traditional paradigm to
include multi-perspective relationships within and
external to the family practice (FP) clinic, across
systems and through care levels.
I. The Beryl Institute 2014 Definition of “Patient
Experience” was found to be supportive of the
WPCN vision.
Objectives
The Westview Primary Care Network Quality
Initiative Program (WPCN-QIP) Patient Experience
(“PE”) Initiative is designed to create a multiperspective positive patient experience within
the Medical Home and across the “Medical
Neighborhood”. Specific objectives include:
1) Define and operationalize “PE” goals; and
2) Measure patient experience to identify and
monitor key elements to PE-enhancing
practice changes.
Methods
The WPCN’s “PE” initiative includes:
1) PCN-wide forums to review results of a “PE”
literature research and build consensus on an
operational definition;
2) Measures of “PE” using in part Starfield’s
PCAT tool via multi-year surveys of the WPCN
catchment population (telephone) and
family practice (FP) clinic patients (self-report
questionnaire) 2007/2010/2013; and
3) Develop practice-based PDSA improvement
action plans and PCN-wide strategic
initiatives.
II. WPCN Service Population demonstrated
a strong affiliation and continuity with
their family physician (scoring 3.9 and 3.8
respectively on a PCAT scale of 1-4). Using
Haggerty’s threshold acceptable performance
level of a PCAT score of “>3”, Ongoing Care,
Coordination, Family Centeredness, Community
Orientation and Cultural Competence scored
above the acceptable threshold; while Access,
Comprehensiveness and CoordinationInformation scored below. In 2013, 91% of
surveyed population were “Very Satisfied/
Satisfied” with their family physician, and 96%
with the FP nurse clinical associates. There is
a statistically significant correlation’s between
Patient Satisfaction and the Length of Affiliation
(p=.000).
III.Patient Experience is dependent on multiperspective relationships across three levels:
1) Patient-Provider/Team Relationships;
2) Intra-clinic Person-to-Person Relationships;
3) Extra-clinic Relationships.
Positive intra-clinic relationships are foundational
to and positive clinic-external relationships
influential to the patient’s overall experience.
Conclusion
To further family practice Patient Experience
goals and targets, WPCN efforts are underway to
study cost-efficient resources allocation to “PE”
oriented initiatives; as well as the development of
a potential “Incentive-associated Evaluation” of FP
clinic performance on “PE” measures.
Edmonton, Alber ta — Nov. 24 – 25 — A B S T R A C T S — 2 0 1 4 Accelerating Primar y Care Conference
Abstract
7)
“Pedal To The Metal”:
Calgary Rural PCN’s Journey To Accelerate
Progress And Strengthen Medical Homes
Rebecca Carter, MA, Calgary Rural Primary Care Network
Joe MacGillivray, Executive Director, CRPCN
Context
Results
In 2012, the Calgary Rural Primary Care Network
(CRPCN) initiated the Clinical Innovation Strategy
(CIS). The strategy aims to develop the following
key dimensions: medical homes with sustainable
business models; panel management through
interprofessional care teams that collaborate to
ensure patients receive appropriate screening
and comprehensive care for potential or actual
chronic conditions; and excellence in informational
continuity practices. This work is rooted in our
understanding that “relational continuity” is the
most important factor in quality of primary care
Nearly all CRPCN physicians are participating in
the CIS (N = 135), and data for approximately
50,000 participating patients have been collected
to date. Results demonstrate a significant increase
in screening and treatment outcomes for patients
participating in the program. Additionally,
qualitative feedback have underscored the
profoundly positive impact of the service delivery
model on the quality of life for patients and
providers.
Objectives
The Clinical Innovation Strategy is an evidencebased service delivery model for the practical
implementation of the medical home. However,
our PCN has found that CIS development cannot
be optimized without careful attention to other
variables in the family practice setting. These
include the practice’s business model, partnership
agreements, and accounting and payroll
mechanisms. We also recognized the necessity of
funding each participating clinic with the clerical
and nursing resources required to move forward.
The CIS was designed to address the myriad
challenges faced by family physicians in
implementing the principles of the medical home
model. The PCN’s infusion of business practice
support, co-located interprofessional team
members, and in-house expertise to optimize the
use of electronic medical records (EMRs) provide
the necessary infrastructure to implement the
medical home model forward at a practice level.
Methods
CRPCN’s team, in collaboration with TOP, developed
a “Panel Management Manual” to give physicians
an opportunity to wed their strong commitment
to each patient with knowledge that they are
providing high quality comprehensive care for all
of their patients.
Conclusion
These variables play a critical foundational role
in readiness and ability to implement practice
changes. As such, we recommend that PCNs aiming
to implement the tenets of PCN Evolution develop
strategic plans that emphasize comprehensive
support of member physicians’ offices, which
consider both the clinical and business
dimensions of a practice.
The manual is rooted in a framework of continuous
quality improvement and includes instructions
on how to optimize the use of major EMRs,
incorporates ASaP guidelines, and will be a
continually improving resource for panel managers.
Edmonton, Alber ta — Nov. 24 – 25 — A B S T R A C T S — 2 0 1 4 Accelerating Primar y Care Conference
Abstract
8)
Evolving Aim:
Changing Tack In A Time Of Change
Steven Clelland, MA, AIM Alberta
Emma Mcgeachy
Tony Mottershead
Marc Robichaud
Context
Results
After seven years of operation and 21 improvement
collaboratives, involving primary and specialty
clinics from across Alberta, minor changes in
collaborative delivery have been tested and
implemented. Over the years the curriculum has
been adjusted and improvements have been
made in response to stakeholder suggestions
and evaluation recommendations. The current
collaborative model includes five learning session
model over ten months. The evolution of primary
care delivery in Alberta necessitates the need for
further refinement of program delivery.
Since 2007, 126 family physician clinics (including
608 family physicians) and 105 specialty care
programs (453 specialist physicians) have
participated in the AIM initiative. Learning session
data indicated there were a number of areas for
improvement, specifically around the development
of unique primary care and specialty care curricula,
reduced time out of clinic, and more self-directed
learning. In addition, stakeholder feedback
indicated a significant investment in practice
facilitation, measurement and evaluation to
support quality improvement, is essential.
Objectives
Conclusion
To utilize program evaluation information and
stakeholder feedback to support the identification
and development of a new collaborative model
and enhanced quality improvement curriculum.
In response to the findings, AIM is developing a
revised curriculum and delivery model to enable
physicians and improvement teams to undertake
access focused quality improvement successfully.
Methods
Alberta Access, Improvement, Measures (AIM) is
a collaborative-based health care delivery quality
improvement program based on the Institute for
Healthcare Improvement Breakthrough Series to
teach a set of core principles that help health care
delivery (improvement) teams make and sustain
improvements to access, efficiency and clinical
care. Using evaluation data from learning session
surveys, pre- and post-collaborative improvement
team surveys and stakeholder engagement, AIM
sought to identify opportunities for program
improvement to best meet stakeholder needs.
Edmonton, Alber ta — Nov. 24 – 25 — A B S T R A C T S — 2 0 1 4 Accelerating Primar y Care Conference
Abstract
9)
The Addition Of Outcome Date To Cancer
Screening
Lisa L Cook, PhD, Chinook Primary Care Network
Rebecca Albrecht
Dr. Charles M. Cook
Context
Results
Evaluations of preventative cancer screening
typically focuses on the physician/multidisciplinary
team performance. The logical next step is to
determine the impact the screening has on the end
diagnoses, such as the number of patients where
cancer was identified and the resulting outcome of
that identification.
There was a direct relationship between the
percentage of screening and number of cancers
detected. The longitudinal analysis showed the
cancers were detected in a younger end of the
screening guidelines for breast and colorectal (ages
50-55 years) and that those cancers were of stage
I or II. The results of the cervical cancer screening
were not as straightforward and will be discussed
in further detail.
Objectives
The Chinook Primary Care Network (CPCN) has
been measuring screening performance for breast,
cervical, and colorectal cancer on all participating
primary care physicians since 2007. The result
of the screening was added to the evaluation to
determine which patients were diagnosed with
cancer, the age of diagnosis, and the staging of
the disease, and whether this was associated with
screening.
Methods
The CPCN partnered with Alberta Health Services
(AHS) to acquire cancer outcomes of their panelled
patients. AHS provided a file that contained the
date of cancer diagnosis, and the stage of the
cancer. This file was matched to the screening
data acquired by the physicians’ electronic
medical record, Radiology Associates, Meditech,
and Calgary Laboratory. This allowed the direct
comparison as to whether the patient diagnosed
had a screening procedure performed prior to
diagnosis.
Conclusion
Proactive preventative cancer screening is a sign
of a high functioning primary care system, as it is
stems from panel identification and management.
The addition of outcome data associated with
the screening is an important variable as it
quantifies the purpose behind the procedure. This
reinforces the importance of implementing quality
improvement measures that focus on clinical
access, efficiency and outcomes with the end
goal of providing patient centred care within the
medical home. This type of analysis could not be
accomplished without the collaboration between
AHS and the CPCN.
Edmonton, Alber ta — Nov. 24 – 25 — A B S T R A C T S — 2 0 1 4 Accelerating Primar y Care Conference
Abstract
10) What Does Patient Attachment Lead To?
Dr. Lisa Cook, PhD, Chinook Primary Care Network
Dr. Tobias Gelber
Context
Results
Patient attachment has been identified as a
foundational element for PCN 2.0 Evolution. Once
attachment is achieved, the panel can be used to
provide pertinent population level reports.
The web-based central data repository allows
physicians to receive information that is normally
not readily available on their patient population.
The website is extremely user friendly and provides
the participating primary care physicians with
immediate data for quality improvement purposes
and also allows for comparisons with colleagues
within their own medical home and with
colleagues throughout the PCN.
Objectives
The Chinook Primary Care Network (CPCN) has
established a patient attachment initiative, PAIR
(Patient Attachment for Improved Relationships),
with the overall objective to attach each patient to
one physician panel and provide timely, detailed,
patient-identifiable activity reports based on those
panels.
Methods
The CPCN has developed a web-based central
data repository that is used to assist physicians
with panel attachment, chronic disease registries,
and preventative screening. The source of the
data on the website is derived from the physician’s
electronic medical record and is matched to
other population level data sources that pertain
to the panelled patients. This matched data of
each patient panelled to a physician is available
in various formats (itemized tables, graphs, or
geographical information system (GIS) formatting)
all of which are interchangeable with a touch of
an icon (table to GIS, GIS to graph, etc), and is
exportable in a customizable format. This website is
compliant with current privacy legislation.
Conclusion
In 2003, Barbara Starfield stated the main challenge
for primary care in the 21st century is transitioning
from patient-centred care to a population-based
care. This web-based central data repository
containing population level data matched to EMR
data allows Chinook PCN physicians to amalgamate
primary care with population health.
Edmonton, Alber ta — Nov. 24 – 25 — A B S T R A C T S — 2 0 1 4 Accelerating Primar y Care Conference
Abstract
11) Why Are Aim Measures Important At The PCN
Level?
Dr. Lisa Cook, PhD, Chinook Primary Care Network
Dr. Tobias Gelber
Dr. Rob Wedel
Rachel Hardcastle
Nicole Boras
Dr. Charles Cook
Context
Results
The provincial program AIM (Access Improvement
Measures) provides an excellent foundation for
clinics to establish processes to improve their
access and efficiency. Although these metrics are
extremely important, the collection of these data
points at the Primary Care Network (PCN) level
can allow for further detailed analysis and enable
specific quality improvement strategies.
Various patterns emerged depending on whether
the independent variable was a specific physician
or medical home and whether the clinic was
located in a rural or urban setting. Detailed
examples will be provided during the presentation.
Objectives
To correlate population level data with clinic/
physician level AIM access and efficiency measures.
Methods
Conclusion
AIM access and efficiency measures are critically
important to make improvements at the clinic and
physician level. When these metrics are collected at
the PCN level and combined with different sources
of data, such as number of clinic and ER visits,
distinct groups can be detected which can enhance
resource planning and allocation.
The Chinook PCN (CPCN) has been collecting
time-to-third-next-available appointments weekly
since 2006 across the 26 clinics participating in the
PCN. The attached patients, which were identified
by the physician in the electronic medical record,
were matched to the Alberta Health billing data in
order to compile the number of clinic visits they
made each week to their primary care physician,
the medical home, and to other medical homes
participating in our PCN. The attached patients
were also matched to the AHS ER Utilization data
to determine the number of Emergency Room
(ER) visits these patients made for Family Practice
Sensitive Conditions (FPSC) and Ambulatory Care
Sensitive Conditions (ACSC) each week. All of these
data points were combined from 2010 through
2013 and a time-series analysis was performed.
Edmonton, Alber ta — Nov. 24 – 25 — A B S T R A C T S — 2 0 1 4 Accelerating Primar y Care Conference
Abstract
12) Incorporating Evaluation Throughout
Development, Implementation And
Improvement Of A Weight Management
Program
Shelby Corley, MA, CE, Evaluation Services, Alberta Health Services
Michele Mitchell
Laura Ewatski
Annita Doherty
Kevin Thomson
Context
Results
Edmonton West Primary Care Network (EWPCN)
has worked with Evaluation Services, AHS, to
include evaluation at all stages of planning and
implementing a weight management program.
As measured by the EQ-5D and 12-Item Short
Form Health Survey (SF-12), patients’ health related
quality of life improved over the duration of the
program. For each of the following clinical markers,
improvement was seen between the beginning
and end of the program: blood pressure, LDL,
triglycerides, total cholesterol, weight and waist
circumference. Most patients either maintained
or improved their Body Mass Index (BMI). Focus
groups provided clients a method to communicate
their experiences in the program; clinical staff used
these findings to adjust the program.
Objectives
EWPCN wanted to develop a weight management
program to serve the needs of its clients, member
physicians, and multidisciplinary (MDT) staff. They
were motivated to include evaluation at all stages
to create an evidence-based, responsive and
effective program.
Methods
Multiple data collection methods have been
employed throughout this project. Physician/
MDT staff needs assessments and patient focus
groups were used to inform program planning
and initial development. Evaluation Services
facilitated development of a program logic model
that incorporated targets for process and outcome
indicators. The clinical and evaluation teams
collaborated to review and select appropriate
measurement tools and clinical markers to be
tracked and analyzed throughout the program.
Qualitative data collection included interviews and
focus groups. The clinical team used those findings
to modify the program, in an attempt to deliver an
effective program responsive to client needs.
Conclusion
This collaboration between Evaluation Services
and EWPCN enabled the development of a
program that has helped clients to improve their
physical and mental health, and produce reliable
evidence of program impact. Additionally, clinical
staff enhanced their own understanding of and
capacity to undertake evaluation. This collaborative
model of developmental evaluation is now being
practiced with other programs within the EWPCN,
and would be applicable for other groups working
in primary care.
Edmonton, Alber ta — Nov. 24 – 25 — A B S T R A C T S — 2 0 1 4 Accelerating Primar y Care Conference
Abstract
13) Implementation of QI Projects For
Post‑Graduate Clinical Learners In
Non‑Academic Clinics: Aleas And Caveats
Ms. Agnes Dallison, MSc, CE, University of Calgary, Department of Family Medicine
Dr. Turin Chowdhury
Dr. Steven Mintsioulis
Kristi Rosko
Context
Results
Quality Improvement (QI) has changed healthcare
dramatically and is the foundation of success for
health care clinics around the world. In Alberta,
influence from bodies such as the Alberta College
of Family Physicians, Alberta Medical Association,
Primary Care Networks, and the health ministry
have resulted in a concerted effort to improve
core metrics. Within the University of Calgary’s
Department of Family Medicine (DFM), there has
been a growing emphasis upon implementing QI
programs, as well as training residents in QI. This
training includes he compulsory completion of
a post-graduate year one (PGY-1) project at the
residents’ academic or non-academic sites.
It is anticipated that the barriers and facilitators
to residents undertaking successful QI projects in
non-academic clinics will be discussed, as well as
the limitations of the current system for teaching
QI at the post-graduate level in a non-academic
setting, and the changes we have made to
overcome identified gaps and shortcomings.
Objectives
Conclusion
The DFM has established plans for additional
development of QI teaching to residents. We
expect that this project will be useful to any clinic
or department that is planning to implement a
comprehensive QI program, particularly for those
emphasizing teaching the process and building
capacity within learners.
We aimed to evaluate residents’ experiences of
completing the PGY-1 QI project at the DFM’s nonacademic clinical sites. We choseto focus on these
non-academic sites because we the non-academic
clinics carry a different set of needs than the
academic sites and the QI curriculum is not always
in the forefront.
Methods
We invited a sample of PGY-2 residents from the
DFM’s 27 non-academic clinics to participate
in interviews. Because they completed the
compulsory PGY-1 project in their first year, these
residents could comment on the barriers and
facilitators to running QI projects in non-academic
clinics. In addition, we interviewed key-informants
including faculty and staff who are integral to
resident teaching and project development. Lastly,
we examined elements of supporting resources
such as the Residents’ Handbook and orientation
sessions that were part of the curriculum.
Edmonton, Alber ta — Nov. 24 – 25 — A B S T R A C T S — 2 0 1 4 Accelerating Primar y Care Conference
Abstract
14) Evaluation of community-based Cardiac
Rehabilitation program in the Alberta
Heartland region
Nikki Davis, BSc (PhysEd), CSEP-CEP, Alberta Heartland Primary Care Network
Stephanie Olechow, BA, RN
Context
Results
Northern Alberta Cardiac Rehabilitation Program
(NACRP) provides a Cardiac Rehabilitation (CR)
program which is available at the Mazankowski
Alberta Heart Institute and at the Glenrose
Rehabilitation Hospital in Edmonton, Alberta. The
Alberta Heartland Primary Care Network Cardiac
Rehabilitation (AHPCN CR) program was set up to
increase accessibility for residents of the Alberta
Heartland region to provide services that would
contribute to secondary prevention of heart
disease. CR has been well demonstrated to slow or
reduce total mortality and morbidity and have a
positive influence on participants’ quality of life.
The AHPCN CR program consists of 12 weeks of
supervised exercise, facilitated by an Exercise
Specialist and Registered Nurse, as well as, seven
education classes taught by various members
of the multidisciplinary team. In addition to the
Registered Nurse and Exercise Specialist, the
MDT consists of Registered Dieticians, Registered
Psychologists, a Pharmacist, Occupational Therapist
and Social Worker. Over the last 2 years, the
program has expanded from a capacity for 12
participants weekly to 21 participants weekly.
Objectives
Data provided by the NACRP in 2012 indicated that
from 2006-2010, 48% of all cardiac event patients
treated at either the Mazankowski Heart Institute
or Royal Alexandra Hospital live in rural areas.
Only three percent of these patients attended a
CR program in Edmonton. The main barriers to
participation include cost, time and distance.
Methods
Evaluation of the AHPCN CR program includes
referral numbers and number of participants since
initiation of the program. A comparison of AHPCN
program enrolment will be made to the NACRP
data.
Current plans are in place to expand capacity
to 30 participants weekly, to meet demand.
Partnerships: Community partnerships include the
Dow Centennial Centre, PCN Physicians, ongoing
connection and support from the Glenrose
Rehabilitation Hospital.
Recently a relationship has been developed with
a Cardiologist offering services and consultation
locally. A partnership with a respiratory health
company also increased access to respiratory and
sleep apnea screening. Participation: Referrals
are accepted from acute cardiac care centers, the
NACRP, cardiologists and PCN physicians. The
AHPCN CR program is also included on the formal
Cardiac Rehabilitation referral forms for Alberta
Health Services and Covenant Health.
Conclusion
Availability of community-based Cardiac
Rehabilitation programs improves access and
program participation for rural residents.
Edmonton, Alber ta — Nov. 24 – 25 — A B S T R A C T S — 2 0 1 4 Accelerating Primar y Care Conference
Abstract
15) Building Capacity In Primary Care Networks
Laurie deBoer, Clinical Process Advisor, RN, BN, Toward Optimized Practice
Mark Watt, RN, BN
Context
Methods
According to the ancient Chinese proverb, if you
give a man a fish, you feed him for a day; teach a
man to fish and you feed him for a lifetime. Alberta’s
Primary Care Strategy outlines the need for Primary
Care Networks (PCNs) to strive towards the Medical
Home in providing patient care.
ASaP provides training for IFs and panel managers
as well as ongoing support through mentoring and
webinars. Data is captured throughout the ASaP
project, as well as anecdotal evidence from PCNs
on the impact of capacity building for QI.
Quality improvement (QI) is one step toward the
Medical Home, and Toward Optimized Practice,
along with their partners in capacity building, such
as AIM, assist PCNs in moving in this direction. It is
anticipated that providing training and support for
internal expertise in PCNs will lead to sustainable
improvement.
Objectives
Using the Model for Improvement and QI tools,
Improvement Facilitators (IFs) are change agents
in primary care settings. Primary care practices
working with an IF have demonstrated measurable
success. PCNs have found unique ways to draw
upon the skills of IFs and put the learnings from
provincial programs, such as Alberta Screening and
Prevention (ASaP), into practice. These experiences
will be highlighted, and ideas for PCNs on getting
started or on leveraging QI processes to reach their
goals will be discussed.
Results
To date, well over 100 individuals from 26 PCNs
have been trained in improvement facilitation and/
or panel management. They have been actively
working with physicians and clinic teams to foster
a culture of continuous quality improvement,
starting with panel identification and with an
ultimate goal of the Medical Home. Each PCN is
unique in how they have made changes through
the optimization of processes, particularly through
the enhanced use of team and the Electronic
Medical Record (EMR).
Conclusion
Through development of internal resources,
PCNs are taking positive steps toward achieving
Medical Home goals. They are finding ways to
utilize the training and support for improvement
facilitation and panel management as foundations
for sustainable change and continuous quality
improvement.
Edmonton, Alber ta — Nov. 24 – 25 — A B S T R A C T S — 2 0 1 4 Accelerating Primar y Care Conference
Abstract
16) From Chaos To Control: How Peace River PCN
Got Smart With Panel
Lana deBoon, Executive Director, RN, Peace River PCN
Context
Results
As a participating clinic in the Alberta Screening
and Prevention (ASaP) initiative, we needed to
ensure that our physicians’ panels accurately
reflected the patients whose care they were
responsible for, in order to design reliable and
efficient processes for preventive screening.
As a result of our clean-up process, we were able to
bring the clinic panel list down to approximately
10,000 active patients. Now, when we generate
panel reports of patients due for particular
screening maneuvers, or set up the EMR to provide
reminders for screening at any appointment, we
know that we can trust the results.
Objectives
When we generated a list of the clinic’s panel,
66,000 names appeared. Our town, Peace River, has
only 7,500 citizens. We decided to actively “clean
up” our patient panels. According to the evidence,
this would not only aid in achieving our screening
goals, but would also enhance continuity of care,
improve access, and help us to better understand
the clinical needs of our patient population.
Methods
Conclusion
Prior to the work we did on our panel, we did
not have the ability to manage patient care in a
truly proactive manner. Now, we feel much more
confident that our patients are being offered
appropriate screening, even when they don’t come
in for a screening appointment (i.e. the “annual
physical”). As a next step, we intend to expand our
use of panel to enhance other areas of patient care,
such as chronic disease management.
Using the Electronic Medical Record (EMR), we were
able to change documented statuses from “active”
to “inactive” or “temporary” for patients who:
• had not been to the clinic for many years
• had visited the clinic for walk-in encounters only,
or
• had been a patient at the clinic temporarily for
specialty care
We also devised a process for monitoring and
updating the status when patients pass away.
Edmonton, Alber ta — Nov. 24 – 25 — A B S T R A C T S — 2 0 1 4 Accelerating Primar y Care Conference
Abstract
17) Improving Quality Of Life Through Managing
Emotions Group
Crystal Degenhardt, BSW, RSW, Edmonton Southside Primary Care Network
Shelina Merali-Tate, MSW, RSW
Luc Therrien, MN, RN
Context
Results
Managing Emotions is a psycho-educational
group that was developed in collaboration with
the Edmonton Southside Primary Care Network
(ESSPCN) and Edmonton Mental Health in 2013
following an increased presentation of emotional
challenges by those seen within the Primary
Care setting. This program was piloted in 2013 to
patients of the PCN, and is now integrated to the
regular rotation of group offerings. This four week
psycho-educational group Is available to any PCN
patient, targeting our emotional health and how
to better cope with our emotions by incorporating
a mindfulness based component in de- escalating
those challenging emotions.
Compared to the general population, Managing
Emotions participants have average physical health
overall, with a lower score for general health.
However, participants have much worse emotional
health compared to the general population at a
level of major clinical importance. 82% fall below
the general population norm for emotional health.
These participants were at much greater risk for
depression at the start of the session than the
general population norms (72% versus 20%).
Objectives
Many of our ESSPCN groups focus on distorted
thinking patterns as well as behavior changes.
Managing Emotions teaches patients how to
connect with their emotions and identify them to
prevent further deterioration of their mental and
physical health. The group improves ones quality
of life by understanding one’s emotions, where
they stem from, and how to effectively manage
these emotions in order to engage in healthy
relationships.
Conclusion
Our results indicate we are seeing the right patients
and despite having much worse emotional health
compared to the general population and being
at a much greater risk for depression, we clinically
see important changes in emotional health from
the first class to the last class for participants
completing managing emotions group. Those with
chronic and complex medical conditions scored
lower on physical and emotional health scores
compared to those without medical conditions. The
target is to make positive changes at levels that are
considered of clinical importance.
Methods
ESSPCN uses the 12-Item Short Form Health Survey
(SF-12) questionnaire for Managing Emotions
group to help determine quality of Life scores pre
and post group. This survey can help facilitate
communication with patients and can reveal
issues and help support them in a patient centred
approach to care. The questionnaire offered eight
scales that are further summarized into physical
health and emotional health component summary
scores. 44 initial surveys were delivered during the
time period of December 1, 2012 and December
31, 2013 for Managing emotions group.
Edmonton, Alber ta — Nov. 24 – 25 — A B S T R A C T S — 2 0 1 4 Accelerating Primar y Care Conference
Abstract
18) Comprehensive Travel Health Care In
Primary Care
Karin Dixon, BNSc, MN-NP, NP, Copeman Healthcare
Amra Dizdarevic
Holly Kennedy-Symonds
Context
Results
Each year, more and more Canadians are travelling
abroad for work, education, and pleasure. This
international traveler has a distinctly increased
risk of becoming ill or injured while abroad,
which often they are often not prepared for.
Unfortunately, many primary care providers find
it difficult to stay up to date on the constantly
changing world of travel medicine and may
recommend their clients go to travel clinics.
However, due to additional cost or lack of access to
travel health advisors, some clients do not follow
that recommendation and remain unprepared for a
multitude of health and safety risks while abroad.
The travel health program was launched in
Vancouver in 2012 by a Nurse Practitioner lead,
and multiple registered nurses (RNs). Due to
success of the program, this was expanded to the
Calgary and West Vancouver offices in 2014. Each
office was required to have a Nurse Practitioner
travel health lead, who was responsible for Public
Health Agency of Canada (PHAC) Yellow Fever
designation, training the RN staff, and providing
comprehensive individual risk based assessments
and recommendations. More complex cases
involved collaboration with the primary care
provider and community pharmacists.
Objectives
As a result of incorporating travel services into
primary care, patients who attended pre-travel risk
assessment, completed recommended vaccines
and prophylactic regimes, and engaged in travel
health education had reduced post travel health
concerns. Clients (rather than case examples)
reported decreased anxiety with travelling,
increased travel health knowledge and in control of
their own health while abroad.
To provide high quality, individually focused,
comprehensive travel health risk assessments,
evidence based recommendation on vaccines,
prophylactic medications and treatment regimes,
and anticipatory guidance for all travelers. Utilize
a multidisciplinary team of Nurse Practitioners
and nurses in coordination with the primary care
providers and community pharmacists across three
centers in Alberta and BC. This would in turn reduce
the prevalence and severity of illness and injury
obtained by travelers while abroad.
Methods
Centre of Disease Control
• Yellow Fever online module
• Health information for the international traveller
Public Health Agency of Canada
Structured Educational sessions for care providers
• General travel risk assessment
In house physician referrals also increased during
this time, as many physicians noted inexperience or
lack of up to date knowledge in travel health due to
the constant dynamic nature of the field.
Conclusion
The provision of comprehensive and
multidisciplinary travel health services on a
PRN basis to Canadian travelers at primary care
clinics increased traveler health and wellness,
knowledge, satisfaction and patient continuity
of care.
• Vaccine overview
• Antimalarial decision making tool
• Monthly and pro re nata (PRN) updates on
epidemics
Edmonton, Alber ta — Nov. 24 – 25 — A B S T R A C T S — 2 0 1 4 Accelerating Primar y Care Conference
Abstract
19) Enhanced Well Child Visits In Primary Care
Amra Dizdarevic, MN-NP, BSN, BSc, Copeman Healthcare Centre
Karin Dixon, MN-NP, BSN
Holly Kennedy-Symonds, MHSc
Context
Results
Primary care providers have a tremendous
potential to positively affect outcomes through
regular contact with children and families, not
only in the early years, but throughout childhood.
However, there are no regularly scheduled well
child visits between 18 month and preschool years
and none after school entry – this creates a gap in
care.
For the past two years, nurse practitioners in
collaboration with family physicians at our
clinic have been providing regularly scheduled,
enhanced well child visits for children up to age
18. Each well child visit is structured to include
a physician-prompt health supervision guide
(the Rourke for those below six years of age
and the Greig for those above six). Additionally,
development is assessed regularly, and children
are screened for autism spectrum disorders at 18
and 24 months. Older children and adolescents
are screened for anxiety, depression, Attention
Deficit Disorder, behavioural or developmental
issues, bullying, substance use, etc. Anticipatory
guidance and health education is provided at every
visit. Children and families demonstrate increased
knowledge and change in their health behaviours
when they are contacted for follow-up or at their
next health visit.
Objectives
Primary care providers promote a wide variety of
positive behaviours (such as breastfeeding, healthy
nutrition, quality parenting, injury prevention,
minimizing screen time), using anticipatory
guidance and connecting children and their
families to local community resources. For these
interventions to be effective, the literature supports
using a physician-prompt health supervision
guide, having found that clinical judgment alone is
not enough. Recently, Canadian Pediatric Society
recommended offering enhanced well child visits
at 18 months of age. Our objective was to take this
recommendation even further and offer an annual
enhanced well child visits to every child up to
age 18.
Conclusion
The provision of regularly scheduled, enhanced
well child visits annually to all children up to age 18
results in improved health behaviours of children
and families and higher satisfaction with care.
Methods
Physician-prompt health supervision guides:
Rourke Baby Record (age 0-5), Greig Health
Record (age 6-17); Ages and Stages Questionnaire;
Modified checklist for autism in toddlers; Strengths
and Difficulties Questionnaire
Edmonton, Alber ta — Nov. 24 – 25 — A B S T R A C T S — 2 0 1 4 Accelerating Primar y Care Conference
Abstract
20) Accu-Meds: An Approach To Medication
Reconciliation In A Family Practice Setting
Ron Garnett, MD, CCFP(EM), FCFP, DipSportMed, University of Calgary Department of Family Medicine
Joe Tabler
Jane Bowman
Context
Results
Maintaining an accurate and current medication
list is necessary for safe patient care. The literature
however indicates office-based medication profiles
are inaccurate; one study cited 88.5% of charts with
discrepancies (reduced to 49.1% after intervention).
AHS Medication Reconciliation initiatives have
had limited applicability in the Family Practice
office; the facility-based workflow trigger is usually
patient transition between physical settings, rather
than an ongoing routine process.
Interim results show 60% of consultant reports
indicated some change to medications. A teaching
point and office routine, leading to routine
translation of consultant-initiated changes, should
decrease the risk for errors. Ongoing evaluation of
ACCU-Med interventions will include measurement
of time involved in documenting the intervention
(initial study suggests documentation time
entails 90 seconds). ACCU-Med interventions
should increase patient safety also from patientdriven changes to the regimen as an additional
component of this initiative has staff members
routinely prompting the patient during visits to
report on any interaction with other healthcare
providers.
Objectives
The goal of the initiative is to improve the
translation of medication change initiated
elsewhere to the office Electronic Medical
Record (EMR) medication list. Suspected
contributing factors to discrepancies include
multiple prescribers (non-clinic), multiple fill
sites, variable patient adherence to instructions,
non-standardized medication reporting in consult
notes, and inadequate office routines to update
medication records between visits. Reviews
identified discharge summaries and incoming
consult reports from Gastroenterology (GI),
Cardiology, Internal Medicine, and Emergency as
highest probability for medication change.
Conclusion
ACCU-Med interventions will provide enhanced
patient safety, act as a practical practice and
teaching tool for family practice residents, and
allow providers to have more accurate information
available when making decisions. It would also
be extrapolated that clarification calls from
community pharmacists should decrease if the
information at point of contact is more accurate.
Methods
Between patient visits, automated EMR triggers
were implemented for an ACCU-Med intervention
on receipt of these reports. Reports are triaged to
nursing/pharmacy for review, including assessment
by multidisciplinary team members, with changes
recorded by pharmacy or preceptors/residents.
EMR documentation of the intervention ensured
subsequent provider awareness, and included
reason for the change.
Edmonton, Alber ta — Nov. 24 – 25 — A B S T R A C T S — 2 0 1 4 Accelerating Primar y Care Conference
Abstract
21) The Patient And Citizen Innovation Council In
Family Practice
Ron Garnett, MD, CCFP(EM), FCFP, DipSportMed, University of Calgary Department of Family Medicine
Joanne Ganton
Jane Bowman
Context
Results
Patient engagement is integral to the Patient
Medical Home. Patient-centred is more than what
happens in the examination room – initiative
prioritization includes patient perspective.
A committee of five volunteers (two clinic patients,
two CAT members, one community member), one
PFCC staff member, and 2 AFM members resulted.
A minimum five evening meetings per year was
planned. Since May 2014 the group has: adopted
terms of reference; delivered a presentation to
incoming family medicine residents on role of
PCIC; advised on methodology for collection and
representation for broad patient perspective,
including input to operations management and
quality improvement committees; considered
quality of the patient experience from a “customer
service” focus.
Objectives
The Academic Family Medicine (AFM) clinic at
Calgary South Health Campus (SHC) identified
a need for patient advisory expertise regarding
clinic initiatives and quality improvement. The
council’s purpose is to engage patients/citizens
in meaningful ways to drive innovation while
improving care experiences.
Methods
The clinic partnered with the SHC Patient and
Family Centred Care (PFCC) staff to create a
dedicated family medicine patient and community
council, based on the success of the SHC Citizen
Advisory Team (CAT). A draft terms of reference,
and promotional brochures/poster and expression
of interest process were created. A patient advisor
role description defined attributes, expectations
and responsibilities for the volunteers. Clinic
physicians were asked to nominate from their
known patients. Applicant screening, interviews
and security checks followed, with intent to recruit
members having broad “advisory” focus, customer
service expertise, record of successful committee
work.
Conclusion
Volunteer comments: Success in my contribution
to this group will be: “focus on “new” family doctors
as another key tool in the PFCC toolbox using the
SHC success to expand across city and region”;
“enhance the patient service experience focussing
on both the provision of care and the engagement
of patients in that care”; “guide the leading edge of
best practice in moving patient-centered care from
ideas to action”; “disrupt and innovate our patient
care model to become a best-in-class example for
exceeding patient’s and staff’s expectations”.
Edmonton, Alber ta — Nov. 24 – 25 — A B S T R A C T S — 2 0 1 4 Accelerating Primar y Care Conference
Abstract
22) Use Of Cognitive Task Analysis To Support
Change Management
Lee A. Green, MD, MPH
Rob Wedel, MD, CCFP
Leaders and staff from Chinook PCN practices
Context
Results
Three practices in the Chinook Primary Care
Network (PCN).
This work is in process now. The participants
will present their experience going through the
process, and their views on the positives and
negatives of the CTA process and reports as aids
to their change management efforts. Actual CTA
findings will remain confidential to the practices,
however.
Objectives
Determine whether a formal consulting
methodology (Cognitive Task Analysis, CTA)
used in other knowledge work industries can
help Family Medicine practices with change
management efforts such as implementing the TOP
ASaP measures, AIM program, or similar practice
improvement initiatives.
Methods
Conclusion
The practices will share their conclusions about
the value of this formal methodology to PCNs and
practices.
CTA is a family of tools developed to understand
the work of teams of experts, and to help
teams implement new knowledge or skills.
It is based on understanding and improving
“macrocognition”, the skills that teams use
in real-world time-pressured settings. These
skills include coordination, problem detection
and monitoring, sensemaking, planning and
replanning, and managing uncertainty. CTA has
been widely successful in aviation, the nuclear
industry, intensive care units, and the military. A
family physician who pioneered its use in primary
care (LAG) and a PhD organizational psychologist
trained TOP facilitators in the method. The
facilitators then visited each practice in teams
of two, for two days per practice, interviewing
physicians and staff and making observations.
The teams met regularly for several weeks
analyzing the data and preparing CTA reports with
recommendations for each practice.
Edmonton, Alber ta — Nov. 24 – 25 — A B S T R A C T S — 2 0 1 4 Accelerating Primar y Care Conference
Abstract
23) Improvement Processes In Action:
The Sylvan Lake Medical Clinic Example
Debbie Greenbank, Panel Manager, LPN, Sylvan Lake Medical Clinic, Wolf Creek PCN
Context
Results
The Sylvan Lake Medical Clinic was a participant
in the Alberta Screening and Prevention (ASaP)
initiative to ensure that they had processes in place
to identify the most responsible physician and
ensure patients of those physicians were screened
appropriately.
The trained Improvement Facilitator worked
with an improvement team using the Model for
Improvement to create an aim and make process
changes. Offers of screening, both opportunistically
and through outreach, increased from 50.43% of
patients prior to making process changes, to 70.65
% following implementation.
Objectives
The objective was to improve the rate in which
paneled patients were screened and to utilize a
team approach to screening and prevention.
Methods
Training an Improvement Facilitator to address:
• Current process for paneling patients as well as
screening and prevention
• Empower the team to make process changes
that address panel identification, screening and
prevention
• Screen patients who arrived at the clinic
for appointments other that screening
appointments (opportunistically)
• Development of an outreach process
for screening patients due/overdue for
mammography
Conclusion
Patients were only offered screening at complete
physicals prior to Sylvan Lake Medical Clinic’s
involvement in ASaP. Staff members were not
aware of the number of patients that did not
actually follow up screening appointments. They
are now confident that their patients are being
offered screening more consistently. They are
also aware that using an Improvement Facilitator
allowed a process to be developed that worked
for their clinic and involved team members doing
the work of screening. This meant that physicians’
time was not negatively impacted. Physicians were
able to spend more time with their patients during
appointments, and had more opportunity to see
those with urgent needs.
Edmonton, Alber ta — Nov. 24 – 25 — A B S T R A C T S — 2 0 1 4 Accelerating Primar y Care Conference
Abstract
24) Stratified Back Care:
From Mechanical To Psychosocial
Hamilton Hall, MD, FRCSC, CBI Health Group
Context
Results
Back pain is one of the most common complaints
seen in primary care. A goal of low back pain
assessment should be to perform a structured
history that provides the necessary elements and
techniques for completing a concordant physical
examination.
Odds ratio for the Classification Group ranged
from 2 to 10 times the odds of the Comparison
Group for the outcomes: pain relief (p<0.05),
no medication use (p<0.01), and functional
improvement (p<0.01). The Generic Group had
the highest number of treatment days, statistically
significantly greter than for each syndrome within
the Classification Group. A syndrome approach
classifies mechanical back pain and offers a distinct
treatment strategy for each Pattern; classification
clarifies the role of psychosocial issues in chronic
back pain and indentifies the relevant clinical
markers.
Objectives
To describe how to conduct a thorough history
and physical examination that leads to the
identification of distinct, reliable syndromes of
mechanical low back pain. To compare clinical
outcomes between patients assessed and treated
based on a syndrome approach to those managed
under the rubric on non-specific low back pain.
Methods
Two groups of patients were studied in a
prospective double cohort study:
1) Classification Group (n=1356); clinicians were
trained to use a syndrome approach that
categorized patients into one of five distinct
classifications, each dictating a separate
treatment approach.
Conclusion
Low Back Pain is a heterogenous condition and
treatment results may significantly improve
when clinically relevant syndromes are initially
determined to guide treamtent. In a primary care
setting, the syndrome approach provides the basis
for: conducting a thorough history and physical
examination, identification of the red flags, rational
for spinal imaging, recognition and management
of psychosocial factors and specialist referral.
2) Generic Group (n=754); patients received
generic, traditional, therapy including modalities
and exercise with an emphasis on reassurance of
likely recovery, encouragement to remain active
and avoidance of bed rest.
Edmonton, Alber ta — Nov. 24 – 25 — A B S T R A C T S — 2 0 1 4 Accelerating Primar y Care Conference
Abstract
25) Whitecourt Healthy Living Program:
Bridging The Gap
Jessica Hein, BSc Kin, MScPT, Alberta Health Services
Lyndsay Perkins
Gail Bablitz
Context
Results
The purpose of the Whitecourt Healthy Living
Program is to develop a team approach using
partnerships in the community to establish an
exercise/education program which will prevent,
postpone or manage the onset of chronic disease
through exercise and education.
The program was well received by all participants.
Participants improved in subjective and objective
measurements including balance, cardiovascular
fitness, and strength. Most importantly, participants
are continuing to exercise independently in
the community following completion of the
Whitecourt Healthy Living Program.
Objectives
Currently, a gap exists for persons with chronic
conditions to participate in exercise programs in
many communities. Strong evidence has been
shown that low levels of physical activity are linked
with:
1) Morbidity and mortality in adults, particularly
the risk of chronic disease such as type II
diabetes, heart disease, osteoporosis, and
certain types of cancer and
2) The risk of overweight and obesity.
(Childhood overweight and obesity: Evidence
from the Cost of Obesity in Alberta for 2005
Report )
Methods
A partnership was formed between Alberta Health
Services, McLeod River Primary Care Network,
Whitecourt Cancer and Wellness Group, Woodlands
County, and the Town of Whitecourt (Allan and
Jean Millar Center) to develop the Whitecourt
Healthy Living Program: an education and exercise
program for persons living with chronic conditions.
The supervised exercise component incorporated
all aspects of the Allan and Jean Millar Centre:
weighted machines, portable exercise equipment
(theraband, exercise balls), pool, and fitness
classes (Zumba, TRX, yoga). The education sessions
were developed to cover a variety of health
related topics (blood pressure, nutrition, stress
management, medication) and were presented by
health care professionals.
Conclusion
This project bridged the gap for persons living with
chronic conditions to transition into community
fitness facilities to complete independent exercise
programs. The desired outcomes of this project
were achieved by:
1) developing partnerships in the community
which integrate care teams
2) participants improving in subjective and
objective measurements
3) Participants continuing to complete exercise
programs at the community fitness facility
4) reaching maximum enrollment for the past
five years
5) having over 200 graduates
6) expanding the program to meet the ongoing
needs of the community.
Edmonton, Alber ta — Nov. 24 – 25 — A B S T R A C T S — 2 0 1 4 Accelerating Primar y Care Conference
Abstract
26) Choosing Wisely Canada:
Leadership And Implementation In Alberta
William Hnydyk, MD, Alberta Medical Association
Eileen Patterson
Context
Results
The physician led Choosing Wisely Canada (CWC)
campaign promotes opportunistic patientcentredness and optimal use of tests, treatments
and procedures—where strong evidence suggests
they are unnecessary, have no added value and/or
may cause harm.
Alberta CWC implementation leverages physicianled initiatives and uses practical approaches to
help physicians provide the right care. Patients are
included in the planning and implementation. The
Alberta Medical Association (AMA) communicates
with members, partners with Strategic Clinical
Networks to embed CWC in related projects,
promotes feedback audits through the Physician
Learning Program, and provides improvement
supports as needed. Web-based support and
social media are a significant component
of implementation. An example of a CWC
recommendation is to avoid ordering diagnostic
imaging for lower back pain when pain is less than
six weeks duration and no red flags. Patients will
receive information on recommended testing and
symptom management.
Objectives
Choosing Wisely Canada encourages physicians
to be evidence-informed, and apply current best
practices and educates patients that “more care is
NOT better care”.
Methods
In 2014, national organizations identified 40 items
(selected tests, treatments and procedures) with
strong evidence of overuse, waste, or potential
to harm. These items are available in a format for
patient use and are being implemented in Alberta.
A comprehensive evaluation strategy will be
implemented to determine use of the guidelines
and impact on patients, primary care physicians
and specialists.
AMA, Alberta Health, Alberta Health Services,
Institute for Health Economics, Alberta Innovates
— Health Solutions, Alberta Society of Radiologists,
Primary Care Networks, academic groups, and
patient representatives are partners for the CWC
Alberta implementation.
Conclusion
Physicians in Alberta and across Canada are
selecting tests, treatments and procedures
to “choose wisely” in their practices. Alberta
physicians are the drivers. Primary and specialty
care are linking and processes are being developed
to address priorities. Of the 40 Choosing Wisely
topics, 27 are directly associated with primary
care. New tools and resources will support
informed patient-physician dialogue and
decision-making on these topics.
Edmonton, Alber ta — Nov. 24 – 25 — A B S T R A C T S — 2 0 1 4 Accelerating Primar y Care Conference
Abstract
27) Successes Of A Supervised Exercise Program In
Primary Care:
Moving For Health
Rhiannon Jacek, Exercise Specialist, Edmonton Southside Primary Care Network
Laura Miller
Jessica Schaub
Crystal Sun
Context
Results
To determine the success of a supervised exercise
program run in the primary care setting on
patient’s health indicators and functional capacity.
We will present data that describes our patient
population and our results of using standardized
tests to examine changes for those participants
completing the program i.e. quality of life using
the 12-Item Short Form Health Survey (SF-12),
functional capacity (6MWT), lower body strength
and function (30 second sit to stand).
Objectives
Moving for Health is an eight week supervised
exercise program run by a Certified Exercise
Physiologist and Registered Nurse. Pre and post
functional fitness tests are completed by all
participants. The group is comprised of a two
hour program, one hour of which is an interactive
educational session, and the other is supervised
exercise adapted to each patient’s needs.
Conclusion
With the standardized tests we chose,
improvements in these areas are known to show
an increase in quality of life, overall health and
functional capacity.
Methods
Patient population and health history data
was collected prior to the start of the program.
Functional fitness using the Six Minute Walk Test
and 30 Second Sit to Stand Test and quality of
life using the 12-Item Short Form Health Survey
(SF-12) were measured at the start and end of the
program.
Edmonton, Alber ta — Nov. 24 – 25 — A B S T R A C T S — 2 0 1 4 Accelerating Primar y Care Conference
Abstract
28) Provincial Palliative And End Of Life Care
Program Initiatives
Max Jajszczok, RN, BN, PMP, Director, Palliative & End of Life Care Practice and Development, Alberta Health Services
Michelle Peterson Fraser
Context
To provide a standardized approach that will direct
the development of integrated and accessible care
for the dying in our province.
Objectives
While there are some exceptional service delivery
models and programs across Alberta, they are not
available within all geographies, creating inequity
of services for Albertans. This has resulted in the
inability to meet patient and family care wishes of
being treated within the community. The objective
of the Provincial Palliative and End of Life Care
(PEOLC) team is to address these inequities and
increase care within the community regardless of
geography.
Methods
In order to address the objective, initiatives were
developed through a collaborative approach from
PEOLC stakeholders including administration,
clinicians, and patients and families.
Results
Through the collaborative approach, 36 initiatives
were identified to address PEOLC inequity concerns
and six have begun development:
1. Advance Care Planning / Goals of Care
Designation Level 1 Policy Review and Year 1
Implementation Evaluation
• Standardized provincial processes for advance
care planning and the determination of
goals of care with patients across the care
continuum.
2. PEOLC Website Development and Launch
• One stop information portal for patients,
families and clinicians.
3. 24/7 Palliative Physician on-call across Alberta
for both Pediatrics and Adult PEOLC patients
• Centralized access point for physicians to
access Palliative Specialist consult.
4. Best Practice Guidelines and Pathways Strategy
Development
• A pan SCN plan outlining in detail a structure
to how and when guidelines and pathways
will be created and integrated into care
treatment.
5. PEOLC Indicators Dashboard
• Gather and publish PEOLC performance data.
6. EMS Assess, Treat and Refer
• Provincial development, standardization, and
implementation of a PEOLC EMS program(s) in
the community settings within all Zones.
Working groups have been established for each
initiative to help assist in the development and
implementation. Lastly, Program & Project Charters
outlining the six initiatives have been approved
by senior executives and endorsed by Clinical
Operations Executive Committee.
Conclusion
These proposed initiatives will improve community
based medicine, alleviating strain on the acute
care systems and align with patient and family care
wishes.
Edmonton, Alber ta — Nov. 24 – 25 — A B S T R A C T S — 2 0 1 4 Accelerating Primar y Care Conference
Abstract
29) Panel Identification And Preventative
Screening
Monica Joly, RN, BScN, Lakeland Primary Care Network
Context
Results
When Lakeland Primary Care Network Executive
Director Robb Foote heard about the Alberta
Screening and Prevention initiative (ASaP) he
knew this was a program Lakeland Primary Care
Network (LPCN) should embrace. The key to the
success of this program was hiring Monica Joly, a
full-time Clinical Facilitator and Registered Nurse.
After being introduced to the clinics, Monica began
working with them to facilitate improved processes
for screening, prevention and defining patient
panels.
With 16 out of 33 physicians actively participating
in ASaP, program results look promising. One
physician had a baseline score of 57.5% of patients
who were appropriately offered screening during
their visits. After introducing new tools and
enhancing patient processes to ensure screening
questions are asked, the same physician’s follow-up
chart review showed that 95.1% of patients were
offered appropriate screening. Subsequently, five
clinics have completed follow-up chart reviews
and the results are impressive. With another
physician scoring a 33.5% baseline screening
and after four months of process improvement,
the physician scored 71.5% resulting in a 38%
screening increase. By operationalizing paneling
and screening methods, clinics soon realized it is
easy to incorporate small changes into everyday
work processes. These successes lead to more
changes which lead to better screening awareness
and patient outcomes.
Objectives
ASaP is designed to increase the number of
patients offered screening by their primary care
physician. We achieve this through a customized
intervention that supports current clinic
practices. Surprisingly, about 30% of patients
don’t book periodic health exams therefore,
we opportunistically target those patients for
screening.
Methods
Work started with panel identification and
observing patient information management
processes. After finishing these initial steps, we
started planning outreach activities and enhancing
strategies / opportunities to screen scheduled
patients. The goal is to bundle screening processes
and educate patients about preventative care.
This benefits patients since it improves rates of
screening and early detection of significant health
issues.
Conclusion
Success requires leadership and involving a clinic
team lead and clinical facilitator for support
and guidance. Physicians now understand the
importance of panel identification and how
preventative screening of patients moves us
toward more responsible care.
Edmonton, Alber ta — Nov. 24 – 25 — A B S T R A C T S — 2 0 1 4 Accelerating Primar y Care Conference
Abstract
30) Clinical Service Excellence Integration
Holly Kennedy-Symonds, RN, BSc (Hon Psych), MHSc, Copeman Healthcare
Context
Intentionally planning & achieving excellence in
the delivery of quality health care hasn’t been a
major focus in Canada; even though the patient
experience is pivotal to quality care.
Objectives
The objective is to describe the impact of planning
and delivering quality healthcare with a focus on
the patient experience.
Methods
Descriptive design and survey methodology.
Results
In Canada, quality has been framed in the context
of patient outcomes and with less focus on the
patient experience, yet designing health care
delivery for this purpose helps patients work in
partnership with providers, overcome anxiety,
lessens discomfort and optimizes healing.
Ultimately designing delivery of services with the
patient’s experience forefront, is integral to overall
quality care.
Health care can be framed as a guest service. Our
patients are guests of the service we provide.
Embedding service excellence as a strategic
priority in everything we do is integral to quality.
At Copeman Healthcare, we test this out by
surveying patients on their experience at regular
intervals and use their feedback to trigger regular
quality review and develop improvements. As
a result, patients are happier and the team is
happier. Surveys are completed annually as well as
following an assessment. The results are presented
below. (These will be inserted). Integration of
clinical service excellence into everything we do
takes an intentional focus, plan and accountability
at the individual, team and organization level.
The key to system integration is multi-level;
organizations are wise to set service excellence as
a key organizational priority; recruiters may need
prompts to ask new hires about their training and
experience in service excellence, service excellence
integrated in the on-boarding and performance
review of new staff and physicians; team meetings
and quality review rounds to monitor & reset
standards for service excellence and review on a
regular basis; hosting patient feedback sessions
and inviting feedback. Finally managing the patient
experience with understanding expectations and
managing those expectations well at the start
of their healthcare journey with frequent checkin to assess whether the patient’s expectations
are being met and whether they feel valued and
important. The sum of these integrated activities
and surveillance across the organization, system,
team and individual creates a culture of learning,
appreciation and continuous quality improvement
for the patients we serve, the individual providers,
the teams we lead and the organization as a whole.
Conclusion
Clinical service excellence in the delivery of
healthcare, is essential to quality care.
Edmonton, Alber ta — Nov. 24 – 25 — A B S T R A C T S — 2 0 1 4 Accelerating Primar y Care Conference
Abstract
31) Quality Improvement Initiatives To Improve
Diabetes Care At Devon Medical Clinic
Sarjiwan Khullar, MRCS, LRCP, MBBs, FRCS, EdFRCS, Devon Medical Clinic
Kim Babiy
Context
Results
Since 2011, Devon Medical Clinic has been
collaborating with the private sector in quality
improvement initiatives to help improve diabetes
process and outcome measures. Collaboration
with Merck Care Elements started to help improve
patient outcomes in Chronic Diseases specifically
with the Diabetic population.
Our 2011 baseline measures revealed that 47%
of our Type 2 patients had Hemoglobin A1C
(HgbA1C) at target. A goal was set for a ten percent
improvement. By April 2012 we had 59% of
patients at target HgbA1C. Reanalysis in February
2013 showed further improvement at 72%. There
was also a three percent increase in LDL at target
and BP remained stable with 71% at target.
Objectives
Devon Medical Clinic is a community based clinic
consisting of six family doctors with a diabetic
panel of approximately 800 patients. We are a
part of the Leduc Beaumont Devon Primary Care
Network (PCN). Recognizing the challenges that
the diabetic population faces.
Methods
1. Established performance measures/ clinical
goals
2. Generated patient registry & determine baseline
values
Conclusion
Devon Medical Clinic has been collaborating with
the private sector to improve diabetic care and
outcomes measures through quality improvement
initiatives such as EMR optimization, panel
management and process enhancement.
And upon assessing the diabetes registry clear
gaps were identified. A needs assessment revealed
inconsistency in data input and tracking of diabetic
patients and lack of a proactive patient recall
mechanism.
3. Conduct self-evaluation and needs assessment
to help identify clinical care gaps
4. Implement interventions/solutions — including
standardization of Electronic Medical Record
(EMR) data entry, patient recall
5. Monitor effects of interventions — by doing reevaluations within the EMR system.
Edmonton, Alber ta — Nov. 24 – 25 — A B S T R A C T S — 2 0 1 4 Accelerating Primar y Care Conference
Abstract
32) Advancing Team-Based Primary Health Care:
Policy Imperatives
Sara Mallinson, PhD, Alberta Health Services
Omenaa Boakye
Renee Misfeldt
Esther Suter
Amanda Wilhelm
Context
Results
Although team-based care and collaborative
practice is regarded as a key element of primary
health care evolution, relatively little is known
about the policies being used to drive change at a
strategic or operational level across Canada. Each
province has responsibility for developing primary
health care services to meet the needs of their
population and, because there is little in the way
of a national framework for primary health care,
provincial approaches to primary health care teams
may differ.
The comparative policy analysis and stakeholder
interviews generated a list of 15 priorities, which
were then refined to a short-list of four policy
imperatives.
Objectives
Our CIHR funded study aimed to:
• Compare how policies in 3 provinces define and
support team-based primary health care
• Identify a set of priorities for policy development
to move team-based primary health care
forward
Methods
We used narrative synthesis tools to systematically
compare the content of primary health
care policies on team-based care in Alberta,
Saskatchewan and British Columbia. We then
conducted qualitative interviews with 29 provincial
stakeholders to explore their views on policies
to support the development of team-based care.
Information from the policy analysis and interviews
was used to generate a list of policy imperatives.
The list was refined and ranked by an expert panel
of knowledge users before being debated at a
roundtable event involving senior health system
stakeholders from three provinces.
1) Align health system goals, policies, workforce
and structures to optimize team-based primary
health care.
2) Develop appropriate and sustainable
compensation models to support team-based
primary health care.
3) Invest adequate resources to support system
change and a team-based primary health care
model.
4) Integrate collaborative practice metrics in
primary health care monitoring and evaluation.
Conclusion
Policy makers should focus on system alignment,
compensation models, resources to support
change, and metrics to monitor collaborative
practice models to move team-based forward. The
roundtable participants argued strongly that the
imperatives are interdependent and ‘cherry-picking’
a single imperative was inappropriate.
Edmonton, Alber ta — Nov. 24 – 25 — A B S T R A C T S — 2 0 1 4 Accelerating Primar y Care Conference
Abstract
33) Utilizing Electronic Medical Record Data To
Inform Clinical Practice
Dr. Donna Manca, MD, FCFP, MClSc, Department of Family Medicine University of Alberta
Brian Forst
Allan Bailey
Grace Moe
Kimberly Duerksen
Context
Methods
There is a need for good primary care data to
inform clinical practice and health care policy.
Unfortunately due to lack of interconnectivity
and a user-friendly software interface, and poor
data “hygiene” the information captured in the
Electronic Medical Records (EMRs) is not readily
available for those purposes to clinicians or other
stakeholders. The Canadian Primary Care Sentinel
Surveillance Network (CPCSSN) has developed
expertise in extracting, cleaning and structuring
information from 12 different EMRs across Canada
to develop an anonymized longitudinal multidisease EMR data repository. Data is collected from
EMRs at regular intervals for the purpose of chronic
disease surveillance, research, and practice quality
improvement. The system provides standardized
feedback reports for participating practitioners
about their practice in comparison to others
regionally, provincially, and nationally.
Working together NAPCReN, Westgrove Clinic,
the WestView PCN, and Telin have developed and
tested a data migration algorithm from Mediplan
to the CPCSSN core data set.
Results
In Alberta three EMR systems now have the ability
to interface with CPCSSN: Wolf, Med Access and
most recently, Telin Systems “Mediplan”.
Conclusion
Practices using Telin Systems “Mediplan” EMR can
now be included with those using Wolf and Med
Access and can participate in the CPCSSN. With
adequate support from EMR vendors it is possible
to develop approaches to include their EMR data in
the CPCSSN extractions.
Objectives
Primary Care Networks (PCNs) and/or Family Care
Clinics (FCCs) that participate in CPCSSN have
the ability to capture point of care data for the
purpose of quality improvement, evaluation and
measurement activities. In Alberta, the Northern
Alberta Primary Care Research Network (NAPCReN)
and the Southern Alberta Primary Care Research
Network (SAPCReN) are participating in the
CPCSSN. These networks have developed expertise
in extracting data from Wolf and Med Access EMR
systems. Unfortunately, practices in participating
PCNs and FCCs that do not use either Wolf or Med
Access EMR products are unable to participate in
the CPCSSN. The WestView PCN includes member
practices that use the Mediplan EMR by Telin
Systems of Calgary. We explored how to extract
data from the Mediplan EMR for inclusion in the
CPCSSN data repository.
Edmonton, Alber ta — Nov. 24 – 25 — A B S T R A C T S — 2 0 1 4 Accelerating Primar y Care Conference
Abstract
34) Family Nurses Play A Key Role In Health Homes:
Transforming Primary Health Care In Alberta
Carol Maskowitz, RN, Program Manager, Red Deer Primary Care Network
Context
Results
With the release of Alberta’s Primary Health Care
Strategy (AB Health, 2014), strategic directions
and goals are specified in enhancing the future
delivery of primary health care. A goal speaks to all
Albertans having a “health home”.
In 2013-14, 2100 patients were referred to RDPCN
Family Nurses: over 40% complex care patients
were navigated to PCN and community resources.
Patient feedback acknowledged attributes of
self-managed care i.e. involvement in action/care
planning (>90%), confidence in improving health
(88%) and awareness that Family Nurses were
collaborating in their care (94%). Health indicators
e.g. glycated hemoglobin (HbA1c), Body Mass
Index (BMI) and blood pressure were improved
six months after initial visit. Health team survey
findings indicated a positive correlation between
health team functioning and work satisfaction.
Objectives
To validate the role of Family Nurses working to full
scope of practice in Red Deer Primary Care Network
(RDPCN) as leaders within the health home team.
Methods
Patients are connected to inter-professional
practice teams (Physician, Family Nurse, Mental
Health Counselor, Pharmacist) co-located in
physician offices. These teams ensure easy
access, core services and attachment resulting in
collaboration, patient continuity and coordination
— essential components of the health home.
Family nurses provide leadership and direct patient
care in managing chronic disease conditions,
coaching smoking cessation programs, assessing
patients for dementia, and offering an Insulin Start
program — all utilizing a patient centred approach.
Family nurses connect patients to community/
health resources for income support, dementia
care, housing etc. Patients are linked to PCN
programs i.e. Health Basics, a lifestyle management
program; mental health groups; falls prevention,
sleep and recreation therapy programs. Along with
treatment, Family Nurses emphasize prevention
and wellness for both patient and family. Patient
surveys and on-line survey of PCN health team
members in selected clinics were conducted to
assess patient and provider experience.
Conclusion
The health home offers patients team-based
primary health services, provides support and
connects them with other services. Evidence shows
that comprehensive primary health care results
in fewer visits to the Emergency Department,
hospitalizations and increased patient satisfaction.
Family Nurses are proud to be a key member of the
health home team!
Edmonton, Alber ta — Nov. 24 – 25 — A B S T R A C T S — 2 0 1 4 Accelerating Primar y Care Conference
Abstract
35) Case Studies In Building Electronic Medical
Record (EMR) Capacity For Medical Home
Barbra McCaffrey, BSc, DipEd, EMR KT Lead, Toward Optimized Practice
Doug Stich, BSc, Director, Toward Optimized Practice
Context
Results
The Alberta Screening and Prevention (ASaP)
initiative is focused on supporting physicians
and nurse practitioners to offer a screening and
prevention bundle to all their patients through
enhanced opportunistic and planned outreach
methods, targeting patients who do not present for
screening care.
Final evaluation is in progress, overall screening has
shown significant improvement over the course of
the initiative. These results are being achieved with
process redesign including new EMR processes.
Successful clinics had all initiated panel processes
that involved attaching active patients to the
primary care provider and managing patient status
to discern active from inactive, lapsed, transient,
specialty service and deceased patients.
Throughout the initiative, cases were identified
where Electronic Medical Records (EMRs) were
optimized to support panel identification and
screening processes. While panel is foundational
for the medical home, improved screening is one
example of changing care delivery.
Objectives
Share leading practices in using EMR for panel
identification and preventative screening through
case studies.
Methods
With supports such as coaching, mentoring,
instructive documentation and relaying of
resources many clinics identified features and
capabilities of their EMR beyond what they
were already using and developed processes for
improved screening.
Case studies will be shared to illustrate how the
following EMR practices contribute to success:
• Documenting offers of screening in a template
that can be customized to provider needs
• Use of a prompt to identify when a patient is
due for screening either:
- Within the documenting template
- Or outside the template within the EMR; these
took various forms and provided providers
with choice of workflow.
• Use reports to generate a list of patients due for
screening; this may be by maneuver or a list of
patients overdue for several or many maneuvers.
• Successful clinics disseminated EMR knowledge
through the clinic amongst teams of users.
Clinics achieved these successes with support
from their EMR vendor, another user, their trained
Improvement Facilitator, Primary Care Network
(PCN) EMR resource or the TOP resources.
Conclusion
With appropriate support, clinic users can
adopt features of their EMR that facilitate panel
identification and improved preventative
care screening. The ASaP initiative has proven an
excellent framework for EMR optimization.
Edmonton, Alber ta — Nov. 24 – 25 — A B S T R A C T S — 2 0 1 4 Accelerating Primar y Care Conference
Abstract
36) Healthy Lifestyle Youth Project
Shera McConnell, LPN, Aspen PCN
Krystin Minns, LPN
Context
Results
There is an increased prevalence of adolescents
who have been diagnosed with Type 2 Diabetes
(T2DM) over the past 30 years. This may, in part,
be due to a lack of education regarding healthy
lifestyle choices and the risks associated with living
a sedentary lifestyle.
The immediate result was awareness, while still in
the school, PCN staff were approached by several
individuals to discuss current health problems and
concerns; the key messages of the sessions were
being heard. The surveys provided suggestions for
future presentations. 68% of students had a better
understanding of how to prevent chronic disease
and 73% have considered making changes to their
lifestyle since attending the sessions.
Objectives
There are healthy eating programs in place in the
primary and secondary schools in this community,
however, the high school does not offer the same
program. There are currently no programs in place
geared toward this demographic in the community.
Our objective was to encourage young adults to
start living a healthier lifestyle and educate them
on specific components of a healthy lifestyle. We
also wanted to raise awareness to the implications
of an unhealthy lifestyle such as, T2DM, metabolic
syndrome, dyslipidemia, Hypertension (HTN), and
cardiac risk.
Conclusion
The Aspen Primary Care Network plans to formalize
this program and to continue delivering and
building relationships with all high schools within
the PCN this fall.
Methods
Our targeted demographic was 13-18 year olds.
To reach out to this demographic we approached
the local high school, specifically the physical
education department. The program is designed
around four topics of interest plus an introductory
presentation to discuss the reasons living a healthy
lifestyle are so important. The four topics are:
Smoking cessation and prevention; Canada Food
Guide and portion sizes; sugary beverages and
energy drinks; and physical activity and SMART
goals. The presentations were given over three
sessions with four stations; each hosted by a
Primary Care Network (PCN) nurse or social worker.
There were 111 participants in total. Surveys were
completed by the students for feedback at the end
of the last session.
Edmonton, Alber ta — Nov. 24 – 25 — A B S T R A C T S — 2 0 1 4 Accelerating Primar y Care Conference
Abstract
37) Assisting Primary Care Health Care
Professionals In Earlier Detection Of Mental
Health Disorders In Community-Dwelling
Seniors: An Evidence-Based Toolkit
Dr. Diane McNeil, PhD, Alberta Health Services
Dr. Bonnie Dobbs
Anita Saini, MC
Context
The research that led to the development of an
evidence-based Toolkit for the Early Identification
of Mental Health Disorders in Seniors was based
on the recognition that common mental health
disorders (e.g., dementia, depression, anxiety,
alcohol abuse) in community-dwelling seniors
often go undetected in the primary care setting.
Failure to detect these disorders often results in
reductions in everyday functioning for the patient;
decreases in quality of life for the patient and
caregivers; and increases in use of health care
services. Earlier detection has the potential to lead
to improved patient (and caregiver) outcomes and
reductions in cost to the health care system.
Objectives
The objective of our research was to develop an
evidence-based, standardized, user-friendly Toolkit
for health care professionals in the primary care
setting for early identification of the four most
common mental health disorders (dementia,
depression, anxiety, and alcohol abuse) in
community dwelling seniors.
Methods
A series of systematic literature reviews (one
for each mental health disorder) assessing the
accuracy of ‘screening’ tools for identification of
dementia, depression, anxiety, and alcohol abuse
in community-dwelling seniors were done. In
addition to accuracy, criteria for tool selection
included ease of administration and scoring, short
time requirements for administration and scoring;
and tools that were available at no cost. Following
the systematic reviews, an Expert Panel provided
validation of the selected tools for inclusion
in the Toolkit. Finally, primary care health care
professionals in both rural and urban settings in
Alberta provided input on the feasibility of use
of the selected tools for use in the primary care
setting.
Results
In total, eight tools are included in the Toolkit
(two for dementia, three for depression, one for
anxiety, and two for alcohol abuse). To assist with
the uptake of the Toolkit, we have developed
paper-based, web-based versions, as well as a USB
version, of the Toolkit. All are available to health
care professionals at no cost. Resources to support
patients and their caregivers also are included in
the Toolkit.
Conclusion
The Toolkit for the Early Identification of Mental
Health Disorders in Seniors was developed to
assist health care professionals in primary care in
earlier detection of dementia, depression, anxiety
disorders, and alcohol abuse in communitydwelling seniors. These disorders often go
undiagnosed in the primary care setting, with
negative outcomes for patients and families,
and result in increased costs to the health care
system. The availability of user-friendly tools
(to patients and health care professionals) that
are available at no cost, represents a significant
step in earlier detection of these commonly
occurring mental health disorders in communitydwelling seniors.
Edmonton, Alber ta — Nov. 24 – 25 — A B S T R A C T S — 2 0 1 4 Accelerating Primar y Care Conference
Abstract
38) Quality And Safety In Primary Care:
Family Medicine Residency Education And
Training At The University Of Alberta
Dr. David G. Moores, MD, MSc, CCFP, FCFP, Dept. of Family Medicine, University of Alberta
Mirella Chiodo
David Ross
Lindsey Campbell
Context
Methods
Much of the quality and safety research and
activity in health services reflects the acute care/
institutional care setting. Significantly more
frequent health service interactions occur at
the primary care/community care level, often
encompassing hospital and continuing care
activities. Incorporating formal education and
training in quality and safety specific to primary
care and concomitant documenting and engaging
in significant event analysis is a prerequisite to
making quality and safety integral to all activities in
primary care.
This is a descriptive study of a new educational
and training initiative developed and adopted in
2013/2014. It is an ongoing and core component
of the Residency Program at the University of
Alberta. A two part seminar series and collection
of significant event data and subsequent analysis
formed the basis of the intervention.
Objectives
Undergraduate medical education in Canada,
in general, pays insufficient attention to quality
and safety skills development particularly as it
relates to whole system health service integration.
Postgraduate education programs in Family
Medicine are governed/guided by the “Red Book”,
a compilation of educational objectives (“musts
and shoulds”) around which accreditation status is
determined. Currently there are too few initiatives
to address the emerging field of quality and safety
in primary care.
Results
Pre-test and post-test measures were applied
and an educational certificate documenting
the successful completion of the program was
provided. Quality and safety learnings (significant
events) were collected from participating practices/
individuals, shared and formed the discussion at
the final workshop. Greater awareness of common
mistakes and misadventures in primary care
and new skills in approaches to significant event
analysis were the most highlighted outcomes.
Conclusion
Significant Event Analysis (SEA) in Primary Care is
more encompassing of quality and safety issues
when compared to Critical Incident Analysis. SEA
is essential to advancing the understanding of
issues in primary care quality and safety and the
implications for health system performance.
Edmonton, Alber ta — Nov. 24 – 25 — A B S T R A C T S — 2 0 1 4 Accelerating Primar y Care Conference
Abstract
39) Red Deer Primary Care Network Case Study:
Adapting The Toyota Management Model To
Primary Health Care: Facilitating Optimized
Collaboration
Lorna Milkovich, RN, BN, MBA, Executive Director, Red Deer Primary Care Network
Context
Results
Alberta has built a strong primary care delivery
system and in this evolving field there is always
room for continuous improvement, collaboration,
innovation and accountability (Alberta’s Primary
Health Care Strategy, 2014).
The following are examples from RDPCN In
successful application of this management model:
support from 82 physicians in community health
promotion through diverse partnerships such
as City of Red Deer in disc golf and the RCMP in
PACT, a mental health crisis intervention program;
group-based programs focused primarily on
creating opportunities, motivating participants and
building skills sprinkled with practical messages
(AMSO model, O’Donnell, 2009) - participants are
empowered to make healthy choices the “simple
and easy choices “; celebrating Real People ,
Real Successes for patients who have achieved
personal health goals; facilitating team building
in 17 medical clinics and programs designed
and developed by staff; piloting and evaluating
programs such as an on-line sleep module
to ensure resources are effectively allocated;
supporting and stimluating over 40 staff in
profressioanl and personal development; listening
and responding to physicians, staff and patients in
improving program access and content.
Objectives
To meet present and future demands, both internal
and external, Red Deer Primary Care Network
(RDPCN) has adapted the Toyota Management
Model which is predicated on a set of principles in
two key areas:
1) continuous improvement and
2) respect for people.
Methods
The Toyota model incorporates the following
principles: Continuous improvement: establishing
a long-term vision, working on challenges,
continual innovation ; Tools for building respect
and teamwork into your practice; Management
with a long term view: establishing goals and
motivating practitioners; Belief in the right process
will produce the right Results.
Examples of evidence based, pilot projects with
evaluation results, stakeholder involvement,
best practice use of tools for communication ;
Building of continuing professional development
into practice and Solving root problems to drive
organizational learning: how we continue to move
forward.
Conclusion
Principles from the Toyota Management model
apply not only to the RDPCN in advancing primary
health care, but are also transferrable to other
primary health care settings in Alberta.
Edmonton, Alber ta — Nov. 24 – 25 — A B S T R A C T S — 2 0 1 4 Accelerating Primar y Care Conference
Abstract
40) Primary Care Evolution: A Family Practice
Readiness Assessment—“Medical Homeness”
And Performance Measures Capability
Grace C. Moe, BPT, MSc, PCMH-CCE, Westview Physician Collaborative/Westview PCN
Keith McNicol, MD, CCFP
Allan L. Bailey, MD, CCFP
Context
Results
Transforming family practices (FP) into the Medical
Home model is fundamental to Westview Primary
Care Network’s (WPCN) Primary Care (PC) Evolution
strategy. Integral to the Medical Home model
is a standardized and sustainable performance
measurement system that provides meaningful
feedback for improvement at the practice and
policy levels.
On status of “Medical Homeness”, WPCN-FP clinics
achieved an overall PCMH-A score of 8.8 out of
12 (Level B+). Scores of all eight PCMH-A change
concepts fell within the “B” implementation
level: Leadership, Quality Improvement (QI),
Empanelment, Continuous Team-based
Relationships and Evidence-based Care scored
9.0-9.7 (Level B+/A-); Patient-centered Interactions,
Enhanced Access and Care Coordination scored
8.0-8.2 (Level B).
Objectives
Development and implementation of a Family
Practice Readiness Assessment Strategy to educate
and prepare member clinics for the WPCN PCEvolution journey, using two self-assessments.
Methods
The United States Safety Net Medical Home
Initiative (US-SNMHI) developed Patient-Centered
Medical Home Assessment (PCMH-A) and a WPCN
designed PHC Indicator Inventory Check-list
were included in a survey package distributed
to 11 WPCN-FP Clinics. Survey responses were
summarized for discussions at a PCN-Membership
Forum. Forum feedbacks were triangulated with
survey-generated scores and responses.
Conclusion
WPCN family practices have implemented the
basic elements of key changes toward achieving
“Medical Homeness”. Commitment to performance
evaluation is solid. A “PHC-Meaningful Use-EMR
Data Management/Measurement/Reporting”
system has been developed. Further resources and
infrastructure support for efficient practice-based
data collection and utility shall further realization of
this PC-Evolution goal.
Edmonton, Alber ta — Nov. 24 – 25 — A B S T R A C T S — 2 0 1 4 Accelerating Primar y Care Conference
Abstract
41) For The Good Of The Team:
Can Physician Participation In A Core QI Team
Improve Access Outcomes?
Tony Mottershead, MSc, AIM Alberta
Richard Golonka
Steven Clelland
Context
Results
Despite the growth of Quality Improvement
(QI) initiatives in healthcare, little is known
about how to consistently improve care across a
variety of settings. Successful implementation of
healthcare-based quality improvement initiatives is
dependent on a myriad of factors. The variation in
outcomes associated with QI success may be due
to contextual differences at the clinic or program
level.
Since 2007, 126 family physician clinics (including
608 family physicians) and 105 specialty care
programs (453 specialist physicians) have
participated in the AIM initiative. For every week
of measurement, short and long appointments
experienced 0.07d (p<0.001)and 0.2d (p<0.001)
improvements in access respectively. Physicians
on improvement teams saw a significantly greater
improvement in access for short (-0.027 vs 0.031
days) and long appointments (-0.249 vs 0.054
days) compared to physicians not on improvement
teams.
Physician involvement in QI teams is not frequently
examined but has been shown to have consistent
associations with success, especially where
physicians engage in a leadership role.
Objectives
To determine whether physician participation on
an improvement team improves outcomes related
to patient access and office efficiency.
Methods
Conclusion
Having a physician on an improvement team
appears to have enhanced benefits for improving
access to primary care services. This may enable
QI programs and their teams to maximize the
likelihood of success in achieving their respective
improvement goals.
Alberta Access, Improvement, Measures (AIM) is
a collaborative-based health care delivery quality
improvement program based on the Institute for
Healthcare Improvement Breakthrough Series to
teach a set of core principles that help health care
delivery (improvement) teams make and sustain
improvements to access, efficiency and clinical
care. Physician participation on improvement
teams is voluntary provided the core team is
multidisciplinary and representative of the clinic
environment. To identify the effect of physician
involvement compared to non-involvement on an
improvement team, linear regression analysis of
aggregated data over multiple collaboratives was
be undertaken.
Edmonton, Alber ta — Nov. 24 – 25 — A B S T R A C T S — 2 0 1 4 Accelerating Primar y Care Conference
Abstract
42) Medical Home Tactical Plan And Change
Management Approach In The Highland PCN
Micheline Nimmock, RN, BScN, MBA, Highland Primary Care Network
Dr. Tammy Paulgaard McNight
Dr. Ema Gye
Regan Paddington
Peter Rymkiewicz
Context
Results
The Primary Care Network (PCN) leadership team
and Board identified the need set objectives and
key tactics to support physicians and their teams
in the implementation of the Medical Home in
their offices. The tactical plan provides the teams
which resources, structures and tools to support
the clinics.
The Tactical Plan is being implemented and results
and being collected in each of the tactical areas.
Some preliminary results will form the basis of the
presentation/poster. The plan is being rolled out in
14 of 15 clinics to date in our PCN.
Objectives
This abstract will provide a practical approach for
the implementation of the Medical Home Model by
a Primary Care Network.
The objective of the tactical plan of is to support
the clinics to provide comprensive care and
continuity of care for their panels of patients and
to to engage physicians in the implementation of
medical home objectives
Conclusion
Methods
The College of Physicians and Surgeons of Alberta
(CPSA) medical home document was utilized to
develop key objectives and tactics that can be
implemented in our PCN. Six key objectives were
selected with specific tactics attached to the
objectives. Physicians and their teams work on
meeting objectives that best meet their needs.
The six areas of work (objectives) include: panel
identification, access strategies, teams, enhanced
screening, enhanced use of the electronic medical
record (EMR), Linkages to the rest of the system.
Measurement strategies have been developed for
each tactic.
Edmonton, Alber ta — Nov. 24 – 25 — A B S T R A C T S — 2 0 1 4 Accelerating Primar y Care Conference
Abstract
43) Engaging Primary Care Providers In Quality
Improvement
Mrs. Dolores Paul, BEd, Edmonton Southside Primary Care Network
Sandra Pelchat, BSc Kin, CSEP-CEP
Robin Anderson, BSc RD
Context
Results
Our initiative to engage clinic teams in
improvemetn efforts has required multi-pronged
appraoches to build understanding, gain support,
and forge relationships with key players.
Engagement grew slowly, but now 20 clinic
teams, representing 38% of PCN membership,
have significant awareness of what supports are
available for improvement work. Nine of these
teams, including 26 physicians, have shown
interest or have begun structured improvement
work. The improvement projects are varied and
include: enhancing patient screening processes
(Alberta Screening and Prevention maneuver
implementation, Peripheral artery disease
screenign in diabetic patients, chorinic obstructive
pulmonary disease screening in smokers); clarifying
interdisciplinary team roles; streamlining clinic
processes; panel identification and management;
bridging clinical need with innovative
technological solutions.
Objectives
The Edmonton Southside Primary Care Network
(PCN) identified a need to spearhead improvement
strategies and support clinic teams to enhance
patient outcomes and increase staff activity in
quality improvement. Improvement facilitators
were hired to provide structure and support
for change at the system or individual provider
level. The facilitators have employed the Model
For Improvement and related facilitation tools to
support team progress towards PCN 2.0 Evolution
and the Medical Home Initiative.
Methods
A detailed communication strategy provided
the framework towards the goal of engaging ten
percent of the PCN physicians and clinic teams
in improvement work within year one. Relentless
communication strategies included: direct mail
and e-newsletter correspondence identifying
facilitated projects; in-person meeting with
physicians and clinic teams to better understand
their operating values, beliefs, and clinic needs;
group presentations to PCN managers and
interdisciplinary staff; consistently addressing
inquiries and providing consult and resources
for implementation of projects. Attending to the
unique needs of these teams has built the trust
needed to sustain and grow the improvement
work.
Conclusion
With thoughtful and methodical communication,
the improvement facilitators have been able to
broaden their reach through support from PCN
staff and the work of the early clinical adopters.
These successful strategies will benefit other
clinical teams working on similar projects or
expanding their panel management processes in
support of PCN 2.0.
Edmonton, Alber ta — Nov. 24 – 25 — A B S T R A C T S — 2 0 1 4 Accelerating Primar y Care Conference
Abstract
44) Alberta Screening And Prevention Initiative:
A Clinic Journey
Kelsey Pruden, LPN, Symphony Medical Clinic, WestView PCN
Dr. Sunil Datar, Symphony Medical Clinic
Barbra McCaffrey, EMR KT Lead, Toward Optimized Practice
Context
Results
Moving a family practice to a new location that also
offers walk-in care was an opportunity to develop
panel identification and preventative screening
processes with new clinic staff.
• Panel processes were refined and will always be
ongoing; reception is part of the process team
and leads the front office
Objectives
To improve preventative screening processes for
the general adult population in Dr. Datar’s family
practice at the Symphony Medical Practice. Longterm goal is to reach a screening rate of 80%.
Methods
The LPN acted as the clinic improvement facilitator
and the following activities took place:
1) Panel:
• Front reception were key in patient validation
and verifying which patients were family
practice and which were walk-in
• LPN ran panel reports in electronic medical
record (EMR)
- Long-term care patients were given their
own tag
- Panel reviews determined which patients
are due for screening
• Regular panel reports are run from EMR; large
family practice for Dr. Datar means panel
management is key
• Outreach by letters, containing requisitions,
being sent to patients over 50 years due for
screening; few patients decline offers
• Nursing team created new in-reach processes
• Chart reviews showed that there was an
overall 20 % increase in screening over the
improvement period.
Conclusion
New panel processes allowed the clinic to identify
the panel for the family practice and validate
which patients were seeking walk-in care. The new
screening processes, developed with the help of
an improvement facilitator, resulted in improved
screening rates.
) New Screening Processes
2
• Outreach screening process development
involving PDSA cycles
• Trials of telephone and letter outreach took
place
• In reach processes for screening outside of
physical appointments
Edmonton, Alber ta — Nov. 24 – 25 — A B S T R A C T S — 2 0 1 4 Accelerating Primar y Care Conference
Abstract
45) Your EMR:
Getting To The Heart Of Improving Patient Care
Maya Rathnavalu, BScN, RN, Smith Clinic & Camrose PCN
Dr. Chris Nichol
Heidi Marcin
Colleen McKinstry
Eryn Petiot
Barbra McCaffrey
Context
• One doctor starting and completing small test
cycles (PDSA’s) to assess current practice
The Smith Clinic, a member of the Camrose Primary
Care Network (PCN), is participating in the Alberta
Screening and Prevention Initiative with the goal
of paneling and improving offers of preventive
screening to adults.
• Implementing changes to streamline the patient
paneling process and ensure accurate patient
attachment
Objectives
The objective is to maximize effective use of the
Med Access electronic medical record (EMR) to
optimize the physician visit, support paneling and
improve preventive screening processes.
Methods
The ASaP program uses the Model for
Improvement (PDSA – plan, do, study, act) which
includes assessing and mapping current paneling
and screening practices, conducting baseline
and ongoing chart reviews, identifying areas
for improvement, implementing small changes
and evaluating those changes. Resources were
allocated (i.e. staff, time) to support this initiative.
As a result, a team consisting of physician,
registered nurse (RN), medical office assistant
(MOA) and administration championed the
activities at the Smith Clinic by piloting the project.
Within six months, seven physicians are actively
engaged with a total of nine physicians enrolled.
Results
Preliminary data analysis suggests screening rates
are improving. Factors leading to this success:
• Standardizing the visit template to ensure
more consistent measurement and monitoring,
and to reflect current practice guidelines.
Customization is used to better reflect physician
preference/individuality
• Templates were expanded to include:
• Applicable referrals & resources
• Regular reminder triggers marking overdue
screening maneuvers
• Efficiencies were implemented – tablets are used
to enter data into the EMR at time of collection
prior to physician visit
Conclusion
Using the EMR to record patient information in an
interactive way that can be measured is critical for
improved patient care.
Preliminary data analysis has shown an
improvement in preventive screening processes
when patients are panelled, and EMR screening
templates are developed and used during regular
patient visits. Improvement can be successful if
the approach involves adapting the EMR and
clinic processes to meet the needs of physicians
and their patient panel. Once a group adopts
this mindset, it often opens the door to other
improvement opportunities.
• MOA involvement, engagement and
commitment, asking pertinent questions to
provide opportunistic screening to improve the
regular office visit
Edmonton, Alber ta — Nov. 24 – 25 — A B S T R A C T S — 2 0 1 4 Accelerating Primar y Care Conference
Abstract
46) Healthy Lung Clinic-Rural Breathe Easy
Program
Darlene Rowe, BSc(Pharm), Aspen PCN
Context
Results
The Healthy Lung Clinic provides multidisciplinary
approach to education and assessment services to
individuals suffering from a chronic lung condition.
Through collaboration with AHS, the Centre for
Lung Health in Edmonton and the PCN September
brings the addition of the eight week Breathe Easy
program to Athabasca and Westlock. Participants
in the Healthy Lung Clinics learn about: the
indications and use for medications, coping with
fear, anxiety and stress, choosing healthy foods,
the importance of exercise, smoking cessation.
Since incorporating lung health as a priority in
the community in January 2013 Break Free has
been offered 15 times with a 24% success rate.
Participation in the Healthy Lung Clinics since the
fall of 2013 is 41 clients.
Objectives
To assist individuals with chronic lung disease to
achieve the highest possible functional capacity
and quality of life through respiratory programs
including exercise, education and support; while
remaining in community. AHS reports that in 2010
the incidence of chronic obstructive pulmonary
disease (COPD) in the area of Westlock was 2.8/100
with the provicial average of 1.8 for the same time.
The age of the population and the farming industry
in the area would affect the difference in these stats
however, it is also an indicator for the need for this
type of service in the area.
Methods
The initial COPD team concept was started in the
local healthcare centre in 2011. The Primary Care
Network (PCN) initiated a smoking education
program (Break Free) in early 2013 and later in 2013
the Healthy Lung program which was comprised
of the RTs from Athabasca and Westlock as well
as PCN registered nurses and AHS dieticians from
both communities. In early 2014 a pharmacist
with CRE was contracted by the PCN to lead
the development of the program. The concept
continues to grow both in facility and in the
community.
Conclusion
Through collaboration of many organizations lung
health is improving within the PCN. The next step
will bring access to pulmonologists to the area so
that people do not have to travel for pulmonology
services. The ultimate goal is to reduce hospital
admissions, improve quality of life and general
health for individuals suffering from a chronic lung
condition.
Edmonton, Alber ta — Nov. 24 – 25 — A B S T R A C T S — 2 0 1 4 Accelerating Primar y Care Conference
Abstract
47) Interdisciplinary Care: Driving Quality
Improvement Through Data Collection And
Use Of Information
Peter Rymkiewicz, Bcomm, MSc (Candidate), Highland Primary Care Network
Micheline Nimmock, MBA, RN, BScN
Tammy McKnight, MD
Regan Paddington, RN, BScN
Context
Results
The implementation of the Medical Home model
is one of the Goals of Primary Care Network (PCN)
Evolution. Adoption and use of interdisciplinary
teams to support physicians to drive improvements
in quality patient care has been increasing in
Alberta. Currently little information is gathered
to help PCNs support their physicians in
understanding how their Interdisciplinary teams
are being adopted across various clinical settings.
Highland Primary Care Network has the capability
and understanding to do primary data collection,
measurement and internal reporting to support
business decisions driving improvements in quality
of services and efficient allocation of resources.
This initiative positions HPCN for robust future
evaluation of Health Management Team patient
interventions and will support the development of
activity based cost for the Highland PCN Chronic
Disease Management (CDM) program. Comparative
measures will include: visits per clinical hour,
patient time as a percent of time available in
clinic, visit volumes, direct and indirect patient
time, reasons for referral and all issues discussed
with patients. The program also allows us to
better understand our staff efficiency by looking
measures such as patient time (direct and indirect)
as a percent of time the providers is available to see
patients in a clinical day.
Objectives
To discuss and present the development of the
Highland Primary Care Network (HPCN) Health
Management Team Information strategy and
to show the interactive Health Management
Team Reporting dashboard. The dashboard
supports improvements and understanding of
interdisciplinary team adoption.
Methods
Data is systematically gathered by the Highland
PCN Health Management Team and centrally
transcribed into a relational database and
subsequently reported out using an interactive
reporting dashboard. A variety of tools are used to
facilitate the internal data collection and reporting
processes.
Development of these and similar measures will
allow us to understand how our staff members are
being utilized within different clinic setting.
Conclusion
Ongoing reporting of PCN resources in member
clinics has served to close the information cycle
by informing the HPCN Board, administrative
staff and providers on program activities and
has been a valuable resource to ensuring that
the PCN is meeting the objectives as set out in
out Business Plan and serving the needs of our
patient panels.
Edmonton, Alber ta — Nov. 24 – 25 — A B S T R A C T S — 2 0 1 4 Accelerating Primar y Care Conference
Abstract
48) Primary Care Network Quality Improvement
Initiative Using Proactive Patient Encounters To
Effect Patient Screening Rates
Peter Rymkiewicz, Bcomm MSc(Candidate), Highland Primary Care Network
Micheline Nimmock, MBA, RN, BScN
Tanvir C Turin, MD, PhD
Tammy McKnight, MD
Regan Paddington, RN, BScN
Context
Traditionally Primary Care has had few resources
to support family physicians to improve Electronic
Medical Record (EMR) data standards in an effort
to proactively identify patients due for screening.
The Highland Primary Care Network (HPCN) is
sequentially implementing the Clinic Innovation
(CI) Strategy to a network of 15 PCN clinics. The
goal of the strategy is to support family physicians
and their clinical staff to improve patient screening
rates using dedicated clinic resources (Proactive
Office Encounter Technician - POET).
Objectives
Our goal is to share the results of the HPCN
program evaluation. This includes the development
of the proactive patient management evaluation
methodology and the associated outcomes. In
addition, this includes how the conclusions of the
evaluation support program expansion and further
adoption across HPCN.
Methods
The HPCN clinic innovation information I don’t
understand the use of the word information here
strategy has four distinct component steps; each
step being an integral part and a foundation for the
next.
1) Primary data collection and EMR data
extraction – This includes EMR data extraction
capturing patient screening rates and along
with PCN program intervention data.
2) Analytics and Business Intelligence – This
includes the PCN’s secure data environment
along with Business Intelligence and
Reporting based on clinical definitions and
program guidelines.
3) Reporting and information strategy –
A quarterly Information cycle is used to
support our member physicians with ongoing
information.
4) Evaluation –The statistical evaluation linking
quarterly reporting to evidence of program
effectiveness.
Results
Positive evaluation results showed that patients
were more likely to be screened during the current
visit or within 30 days if their family physician clinic
used the services of a POET. Patients were 8.86
(5.22-15.06) times more likely to have their blood
pressure taken during a physician visit or within
30 days, if the visits were accompanied by a POET
intervention. Odds ratios for the remaining screens,
height, weight, HbA1c and Lipid screens, were also
very positive.
Conclusion
The PCN Clinic Innovation Strategy supports
physicians and clinics with dedicated resources
focused on proactive patient management. In
conjunctions with a robust information and
evaluation strategy has generated excitement
and has shown to be very effective in
improving the odds patients being screened to
guidelines
Edmonton, Alber ta — Nov. 24 – 25 — A B S T R A C T S — 2 0 1 4 Accelerating Primar y Care Conference
Abstract
49) Using EMR Data Extraction To Support
Improvements In Patient Screening Rates
Peter Rymkiewicz, Bcomm MSc(Candidate), Highland Primary Care Network
Micheline Nimmock, MBA, RN, BScN
Tammy McKnight, MD
Regan Paddington, RN, BScN
Context
Results
Use and availability of clinic Electronic Medical
Records (EMRs) information is limited. This
data source can be leveraged by Primary Care
Networks (PCNs) to support improvements in
clinical care and to evaluate effectiveness or
program improvements in primary care settings.
The Highland PCN has developed an interactive
scalable reporting methodology to extract and
present screening and control data from EMRs.
The Highland PCN has developed a scalable
interactive reporting dashboard that enables
feedback and reporting to support five clinics,
initially. Anonymous PCN, clinic and physician level
reports are presented on a quarterly basis showing
changes in patient screening rates. A subsequent
evaluation has been completed showing a
statistically significant association between the
HPCN proactive patient management program and
the improvements in screening rates seen in the
interactive dashboard.
Objectives
To share the Highland Primary Care Network
Interactive Screening Dashboard as well as the
process for EMR data extraction, information
synthesis and presentation of patient screening
rates. This includes an outline of the process for
EMR data extraction, information synthesis and a
presentation of anonymized provider and clinic
level information supporting PCN physicians and
staff.
Conclusion
The use of EMR data has allowed HPCN to support
PCN physician with strategic information showing
timely improvements in clinical patient care.
Methods
The components of the project to be presented
include areas supporting the use of EMR data
and PCN implementation. The presentation will
address steps taken by Highland PCN to address
information privacy facilitated by the PCN Privacy
Impact Assessment (PIA), data sharing agreements
with physicians, along with the establishment of
a secure data environment. Next steps include
analysis and Information synthesis with a goal of
showcasing a reporting method that is reactive to
changes in screening practice within PCN physician
clinics.
Edmonton, Alber ta — Nov. 24 – 25 — A B S T R A C T S — 2 0 1 4 Accelerating Primar y Care Conference
Abstract
50) Developing A Preventative Alcohol Screening
Tool For Use In Multidisciplinary Primary Care
Team Practices
Dr. Ginetta Salvalaggio, MD, MSc, CCFP, University of Alberta Department of Family Medicine
Kolotyluk T
Chiodo M
Lukasewich M
Torti J
Aguilar C
Duerksen K
Yan A
Manca D
Context
Methods
Presently there are no specific recommendations
on entering alcohol consumption information
in patients’ electronic medical records (EMRs).
A review of Alberta family physicians’ EMR data
participating in the Canadian Primary Care Sentinel
Surveillance Network (CPCSSN) demonstrated that
alcohol consumption was inconsistently and poorly
documented. In addition, alcohol screening tools
focus on alcohol use disorders, not chronic disease
risk reduction. Regrettably, Canadians informed by
these guidelines may consume unhealthy amounts
of alcohol from a chronic disease prevention
perspective.
The ADKAR (Awareness, Desire, Knowledge, Ability
and Reinforcement) model for change will inform
implementation. Potential participants include
primary care practices within the Northern Alberta
Primary Care Research Network (NAPCReN) who
are contributing data to CPCSSN. Family physicians
and other key team members will be invited to
participate in clinic-level workshops on alcohol
screening, with introduction to the EMR-based
tool. NAPCReN will collect descriptive data on EMR
alcohol documentation over the study period.
Individual interviews and/or focus groups will
further assess alcohol screening behaviours prior to
preventative screening tool implementation and at
three month intervals.
Objectives
An EMR tool that captures alcohol intake and
facilitates discussions about alcohol consumption
with patients has been developed with input from
end-users. The project aims to:
1) Assess the feasibility of a chronic disease
prevention-oriented alcohol screening tool
applied in family practice settings, including
perceptions and uptake of the tool;
2) Work with participants to adapt the tool and
develop a process to use the tool in their
settings;
3) Evaluate and refine a framework of
implementation, and;
4) Compare alcohol documentation of those
practices using the screening tool to those not
using the screening tool.
Results
The EMR tool is being introduced via facilitated
workshops in four NAPCReN practices. The study
team has engaged with physicians, learners, and
staff responsible for quality improvement in each
practice and identified champions within each
site. Preliminary findings from baseline data
collection will be presented.
Conclusion
This project will facilitate implementation of
maneuvers and processes at the physician and
practice level that shift from a disease focus
(alcohol use disorders) to a chronic disease
prevention focus (unhealthy alcohol consumption).
Edmonton, Alber ta — Nov. 24 – 25 — A B S T R A C T S — 2 0 1 4 Accelerating Primar y Care Conference
Abstract
51) Addiction Recovery And Community
Health (ARCH): Introduction Of A Targeted,
Multidisciplinary Acute Care Team To Enhance
Primary Care Delivery For A High Risk Urban
Population
Dr. Ginetta Salvalaggio, MD, MSc, CCFP, University of Alberta Department of Family Medicine
Hyshka E
Budgell J
Dong K
McCabe C
Rosychuk R
Surood S
Wild TC
Context
The Royal Alexandra Hospital (RAH) is a primary
point of care for Edmonton’s inner city population,
a group characterized by medical and social
complexity, low uptake of chronic disease
prevention and screening (CDPS), and low primary
care attachment. Case management and patientcentered medical home models have limited reach
in acute care settings. Acute care visits present an
opportunity to respond to unmet health and social
needs and facilitate the transition between acute
and primary care.
Objectives
RAH’s Addiction Recovery and Community
Health (ARCH) team provides a multidisciplinary
consultation service including
1) in-hospital addiction stabilization and CDPS ;
2) brokered access to primary care and social
services; and
3) population-specific care coordination and
discharge planning. We hypothesize that this
acute care intervention will be associated with
increased primary care attachment, increased
CDPS, and reduced emergency department (ED)
use.
Methods
The ARCH program evaluation employs a pre-post
quasi-experimental design. ARCH patients will
be asked to provide informed consent allowing
for collection of primary survey data, secondary
administrative data, and data linkage. Surveys
will be administered at baseline, six months, and
12 months; administrative data will be retrieved
for the months prior to and 12 months after
enrolment.
Outcome measures include 1) attachment
to a primary care provider; 2) total ED use; 3)
ambulatory care sensitive condition presentations
to the ED; 4) stabilization or reduction of tobacco
/ drug / alcohol intake; and 5) uptake of CDPS
(e.g. STI screening, contraception, vaccinations).
Descriptive analyses and appropriate inferential
statistical tests adjusted for covariates will be
performed on all outcome measures.
Results
ARCH launched its service in July 2014 and
conducts approximately 19 patient consults
weekly. Early program data suggest that ARCH
recipients have low CDPS uptake pre-intervention
and a high demand for primary care linkage.
Study enrollment has commenced, and we will
present preliminary baseline characteristics of
our sample.
Conclusion
ARCH addresses a disconnect between acute
and primary care, and is designed to improve
CDPS uptake and primary care attachment for a
socially vulnerable population. Comprehensive
characterization will help primary care teams adapt
their services to the needs of this population.
Edmonton, Alber ta — Nov. 24 – 25 — A B S T R A C T S — 2 0 1 4 Accelerating Primar y Care Conference
Abstract
52) Brain Health And Psychological Health
Awareness And Monitoring In A Primary Care
Setting
Elisabeth M.S. Sherman1,2
Shawnda Lanting1
Shauna Thompson1
Holly Kennedy-Symonds1
Rick Tiedemann1
Chris Nedelmann1
Don Copeman1
1 Copeman Healthcare Centre, 2 University of Calgary
Context
Results
Family physicians are often the first point of care
for patients concerned about their brain health or
psychological health. Early access to preventative
services benefits conditions affecting brain health
and psychological health, including helping
patients implement lifestyle changes that can
mitigate or improve problems. Despite the family
physician’s unique potential to improve brain
health and psychological health outcomes, few
models of care incorporate dedicated brain health
and psychological health services within the
primary care setting.
The Brain Health and Psychological Health service
initially began as a referral-based assessment
and therapy service to help with differential
diagnosis of conditions affecting brain health and
psychological health. The assumption was that
most referrals would be from physicians, and that
these would be for severe conditions (e.g., stroke,
dementia) or for long-term psychological support
for specific psychiatric conditions (i.e., depression,
substance abuse). However, as the clinic evolved,
it became apparent that there was a high need
for prevention-based monitoring of cognitive
and psychological health in healthy patients,
and that many patients benefited from a brief,
problemfocused visit about general topics such
as sleep, stress, exercise, brain-healthy eating, and
normal agerelated cognitive changes. The service
was then broadened to all regular patients. Patient
satisfaction with the service is very high.
Objectives
We describe a brain health and psychological
health program created for primary care that
focuses on evidence-based tools, information
technology, collaborative care, and patient
education.
Methods
Copeman Healthcare Centre is a family
practice aimed at prevention and collaborative
multidisciplinary health care. This abstract
describes its Brain Health and Psychological Health
Consult service. During the consult visit, each
patient completes an on-line, iPad or paper version
of the PROMIS-29 (Patient Reported Outcome
Measurement Information System), a health
screening questionnaire, and meets with a member
of the psychology or neuropsychology staff to
review goals and concerns. Results, educational
materials, and referrals are provided to patients,
and graphical results are placed on the electronic
chart for follow-up by the primary care physician
and multidisciplinary team.
Conclusion
Brain health and psychological health monitoring
services are a model of care that show promise in
serving patients and advancing education and
prevention in the primary care clinic.
Edmonton, Alber ta — Nov. 24 – 25 — A B S T R A C T S — 2 0 1 4 Accelerating Primar y Care Conference
Abstract
53) How Can We Do BETTER? Contrasting
Perspectives On A New Approach To Chronic
Disease Prevention And Screening (CDPS) In
Newfoundland And Labrador
Nicolette Sopcak, PhD, Department of Family Medicine, University of Alberta
Donna Manca
Carolina Aguilar
Mary Ann O’Brien
Kris Aubrey-Bassler
Richard Cullen
Melanie Heatherington
Eva Grunfeld
Context
Results
Chronic disease prevention and screening (CDPS)
has been identified as a top priority in primary
care. The BETTER2 (Building on Existing Tools To
Improve Chronic Disease Prevention and Screening
in Primary Care) program involves a patient-level
intervention that introduces a new provider
role to primary care settings: the prevention
practitioner (PP). PPs are health care professionals
who are trained to meet with patients to develop
personalized ‘prevention prescriptions’ through
motivational interviewing and shared decisionmaking. Based on the findings from the BETTER
trial, the BETTER2 program aims to transform
practice in urban, rural, and remote populations.
Although BETTER2 was well received overall by
managers, clinic staff, nurses, and patients some
physicians were more critical of having a PP in
their practice. Some physicians perceived the PPs’
prevention visits a duplication and interfering
with their own practice. Physicians’ views differed
from the patients’ perspectives who saw the PP as
providing a very different approach regarding
1) time (significant more time with a PP as
compared to a physician),
2) format of communication (having someone
listen to them and explaining tests and lab
values in a comprehensive and meaningful
way) and
3) empowerment (being motivated to set goals
to improve their health and lifestyles). PPs
and other clinic staff perceived the prevention
visits as a useful and important addition that
should complement not replace physicians’
practice of CDPS.
Objectives
To explore perspectives on the implementation of
the BETTER2 program, specifically the perceptions
of patients and healthcare providers on having a PP
as part of a primary care team.
Methods
We conducted five focus groups and 20
key informant interviews with managers,
researchers, physicians and other health care
providers (including PPs) who took part in the
implementation of BETTER2 in Newfoundland
and Labrador. We also received written feedback
from 44 patients. We analyzed these data and
additional field notes and memos using qualitative
description.
Conclusion
Our findings suggest that while the
involvement of prevention practitioners
(PPs) in primary care settings was well
received overall, some health care providers
may experience role confusion and uncertainty.
Expectations and potential role overlap should
be addressed beforehand to facilitate uptake and
implementation of a new CDPS approach.
Edmonton, Alber ta — Nov. 24 – 25 — A B S T R A C T S — 2 0 1 4 Accelerating Primar y Care Conference
Abstract
54) How Can We Better Support The Primary
Health Care Team? Adapting And Piloting
A Health Team Effectiveness Tool
Donna Thompson, BASc RD Program Evaluator, Red Deer Primary Care Network
Context
Results
Effective team care is identified as a critical element
in creating a Health Home in PCN Evolution in
Alberta (2013) and the Alberta Primary Health Care
Strategy (2014). Red Deer Primary Care Network
(RDPCN) assigns a co-located inter-professional
team to 17 family physician clinics. Individuals
attached to a primary health team receive
comprehensive care with better outcomes and are
more satisfied with their care (Health Council of
Canada, 2009).
Four clinics with 50 staff participated with
a response rate of 50%. Sample comprised
physicians, mental health counselors, family nurses,
medical office assistants (MOAs), and pharmacists.
Findings reflected satisfaction specific to clinics
and service provider groups. Those with overall
greater work satisfaction had higher health team
effectiveness scores (r (25) = .72, p=.000), and as
satisfaction with team function increased so did
HTE scores (r (25) = .79, p=.000). Positive correlation
between work satisfaction and team function
was strongest among physicians (r=.65), mental
health counselors (r = .57) and MOAs (r =.39). Team
functions with high satisfaction ratings included
decision-making, vison and leadership, role clarity.
Lower satisfaction rating was identified with
communication including team meetings and team
building opportunities. Work satisfaction scores
were over 90% in facilitating patient relationships,
IT, safety and administrative support. Structured
time for collaborative case management was rated
lower. Tool proved reliable with Cronbach’s Score,
α = .96.
Objectives
As part of the Alberta PCN Measurement Capacity
Initiative, RDPCN piloted an on-line tool and
assessed health team effectiveness and work
satisfaction of the Primary Health Care Team.
Methods
In collaboration with RDC and a student research
project, a self-administered on-line Health Team
Effectiveness (HTE) survey was adapted to satisfy
RDPCN context. The survey consisted of 45
questions addressing team function domains –
decision making, vison and leadership, structure,
communication in addition to work satisfaction
domains – patient care, IT support, safety and skill
utilization. RDPCN appointed a team facilitator to
coordinate survey administration with clinic teams.
Conclusion
Health team effectiveness survey tool was easy to
administer, generated reliable results and utilized
to inform priorities for action in strengthening
RDPCN primary care teams. Tool is transferrable to
other primary care settings.
Edmonton, Alber ta — Nov. 24 – 25 — A B S T R A C T S — 2 0 1 4 Accelerating Primar y Care Conference
Abstract
55) Adopting Advance Care Planning/Goals Of
Care Designations Within Community Practice
Dr. Eric Wasylenko, MD, BSc, MHSc (bioethics), Provincial Medical Advisor, Alberta Health Services
Claire Neeland
Context
Results
Advance Care Planning/Goals of Care Designation
(ACP/GCD) is a way to help Albertans think about
and document their wishes for healthcare, together
with their health care providers.
Ipsos Reid data from Canadian family physicians
reveal that more than three quarters of physicians
are seeking support to engage in Advance Care
Planning discussions with their patients (2014). In
line with national findings, provincial evaluation
results from round one of two provincial Zone
chart audits and patient and family satisfaction
telephone surveys have generated key
recommendations for advancing the uptake of
Advance Care Planning and improving patient care:
Objectives
Use of ACP/GCD is a function of all team members,
within facilities, clinics, pre-hospital and in
community care. It is believed that widespread
implementation of this fundamental clinical
practice will improve communication and decisionmaking regarding patient care, is respectful of
patient’s preferences as well as clinician expertise,
and better supports clinicians in their efforts to
provide high quality and safe health care in all
settings, especially during transitions.
Methods
The provincial ACP/GCD Policy and Procedure
went live province-wide April 1, 2014 after earlier
adoption in some Zones.
Educational material for patients, the public
and health care providers are available through
a variety of mechanisms. National surveys and
provincial audits reveal the uptake, barriers and
facilitators for adoption.
• Develop Public Awareness Strategies and;
• Develop strategies to help Health Care Providers
better adopt ACP/GCD Procedures, including:
(a) providing inter-professional learning
opportunities to help care teams clarify roles
and collaborate with patients and families in
ACP/GCD discussions and documentation,
and;
(b) ensure documents are available to health care
providers in all care settings.
Conclusion
Sustained operational support for ACP/GCD across
all Zones and care settings is critical for improving
patient care. Increased focus and support for
community practitioners is required. This session
will describe mechanisms to assist the adoption of
ACP and GCD within community practice.
Edmonton, Alber ta — Nov. 24 – 25 — A B S T R A C T S — 2 0 1 4 Accelerating Primar y Care Conference
Abstract
56) Making Cancer Patient Navigation A Reality:
Sharing Results From A Provincial Quality
Improvement Initiative
Dr. Linda Watson, RN, PhD(c), CON(c), Alberta Health Services
Sarah Champ, RN, BScN, CON(C)
Jennifer Anderson, RN, MN, CON(C)
Context
Results
Challenges related to access, coordination of care,
and integration of services are well documented
within healthcare. Cancer Patient Navigators
have been identified as a meaningful strategy to
improve timely access to information, enhance
access to supports and services, improve continuity
and coordination of care, and improve system
efficiency.
The evaluation of the program focused on the
patient and family experience, the navigator
role, teamwork and engagement, and the impact
on the health system. Numerous sources of
data including focus groups, patient and staff
surveys, workload measures, and health system
data were collected. The examination of data
collected suggests that the introduction of the
navigator role had numerous positive effects on
the patient experience including reduced hospital
and emergency room visits, improved support for
emotional and practical concerns, and improved
care coordination. Additionally, patients appeared
to be very satisfied with their experience with
the navigator as a whole, and indicated that they
felt that the navigator provided them valuable
continuity, information, and supports in a personcentred manner.
Objectives
From 2012 to 2014, the provincial Cancer Patient
Navigation program was developed and navigators
were implemented in all 15 Community Oncology
sites. In addition to the introduction of navigators,
a standardized orientation was developed, a
Community of Practice was established, and
partnerships with community agencies were
formed. The program objectives were to improve
rural Albertan access to psychological, physical and
supportive care, enhance the quality of cancer care
across their disease trajectory, and improve system
efficiencies.
Methods
The program was designed as a Quality
Improvement initiative with three fundamental
questions:
Conclusion
The navigator role improved timely access to
information, enhanced access to supports and
services, improve continuity and coordination
of care, and improve system efficiency. As a
result of the compelling evaluation results, the
Cancer Patient Navigation program has been
operationalized.
1) What are we trying to accomplish?
2)What changes would result in an improvement?
3) How will we know that the change resulted in an
improvement?
Best evidence regarding navigation program
implementation, care coordination, community
engagement, and role implementation were
utilized to inform the development of the program.
Edmonton, Alber ta — Nov. 24 – 25 — A B S T R A C T S — 2 0 1 4 Accelerating Primar y Care Conference
Abstract
57) Patient Care Handouts: Standardized Patient
Teaching Tools For Clinical Practice
www.myhealth.alberta.ca
Denise Watt, CCFP(EM), AHS
Sue Cumming
Context
Results
Previously, there was a lack of standardized,
maintained, locally reviewed teaching tools easily
accessible to Alberta clinicians. Patient Care
Handouts (PCH) are available online, evidence
based, regularly reviewed teaching material that
covers a wide range of clinical topics. Using these
tools will improve patients’ experience and may
avoid unnecessary visits.
Calgary ED providers were surveyed about their
awareness and use of PCH. Patients discharged
from the ED were given a PCH to read, followed by
a brief satisfaction survey. Among ED providers,
there was a high level of awareness of the
handouts (99%), but low utilization (40%). ED
providers were satisfied with the content of the
handouts (93%). Barriers to utilization included
time spent finding and printing the handouts and
resistance to change workflow. Patients were very
satisfied with the readability (94%) and helpfulness
of the handouts (91%).
Objectives
Providing patients with written teaching material
following a clinical encounter has been shown to
improve patient recall, compliance with follow‐up
instructions and decrease unnecessary visits. An
online source of standardized teaching material
will decrease duplication of resources and make it
easier for clinicians to use.
Methods
MyHealth.Alberta.ca is a website containing trusted
health information and resources for the public and
healthcare providers funded by Alberta Health and
operated by AHS. The site has recently acquired
over 2700 PCH from Healthwise®. The content is
evidence‐based, written in plain language and
has been reviewed by subject matter experts in
Alberta. PCH were introduced into the Calgary
Emergency Departments (ED) in January 2014. A
Quality Improvement (QI) study evaluated staff
utilization and patient and staff satisfaction.
Conclusion
Patient Care Handouts are available on MyHealth.
Alberta.ca. User satisfaction with the content
is high. PCHs can help patients manage their
health issues more effectively at home. Future
work includes integrating the PCH with electronic
medical records and introducing the PCHs to
Primary Care Networks (PCNs), and other clinical
groups.
Edmonton, Alber ta — Nov. 24 – 25 — A B S T R A C T S — 2 0 1 4 Accelerating Primar y Care Conference
Abstract
58) Don’t Let Panel Myths Stop You From Taking
The Panel Plunge!
Mark Watt, Program Development Lead, RN, BN, Toward Optimized Practice (TOP)
Sandee Foss, RN, Clinical Process Advisor
Margo Schmitt-Boshnick, BA, MEd Evaluation Specialist
Context
Results
The Alberta Screening and Prevention (ASaP) is a
Quality Improvement (QI) initiative designed to
increase offers of screening within primary care
and build capacity for improvement. Nearly 400
physicians from 27 Primary Care Networks (PCNs)
are enrolled in the initiative, working with their
clinic teams and Improvement Facilitators to
enhance patient care.
ASaP Clinical Process Advisors (CPAs) train and
support PCN/Clinic Improvement Facilitators.
Questions and concerns with panel identification
and management were often raised and solved by
those involved in these roles. As the initiative rolled
out, CPAs noticed the emergence of common
myths about the panel process, such as the
requirements for lengthy time commitments by
physicians and their teams, and limited Electronic
Medical Record (EMR) capabilities. The TOP Ten
Panel Myths will be outlined and dispelled in this
presentation, which is appropriate for anyone
about to take the panel plunge!
Objectives
Quality Improvement work is based on an
understanding of the composition of a physician’s
patient panel. As such, the first step in any QI
endeavour is to confirm that panel identification
has occurred, or if not, to complete this step. This
presentation will discuss the ASaP experience
of undertaking this first step and some of the
concerns raised by clinic staff and physicians.
Methods
Conclusion
PCNs and clinics, armed with the collective wisdom
of provincial experience, can avoid common
misunderstandings about the panel process and
move forward faster and more efficiently.
Anecdotal evidence was gathered by those
working in ASaP and used for improving the ASaP
program and communications.
Edmonton, Alber ta — Nov. 24 – 25 — A B S T R A C T S — 2 0 1 4 Accelerating Primar y Care Conference
Abstract
59) ED - PCN Referral Process
Amanda Weiss, RN, BScN, BA, AHS Foothills Emergency Department
Erin Bugbee, RN, BScN
Marilyn Howlett, RN
Context
Results
Establishing an ED (Emergency Department) to
PCN (Primary Care Network) referral process was
done to ensure patients would receive quality care,
at the right time, in the right place by the right
provider.
Between December 23, 2013, and July 31, 2014,
482 patients who were appropriate and agreed to
the process were referred to Access 365 Clinic. The
clinic staff contacted the patients to arrange an
appointment, 82% were seen in the clinic. Those
who were not seen included no shows (10%)and
other (8%) which included patients who the staff
were unable to contact, decided to go to their
family physicians and /or felt better and did not
require medical services.
Objectives
During the June 2013 disaster flooding in Alberta
the Calgary Foothills Primary Care Network
(CFPCN), now Access 365 Clinic, stepped forward to
foster a relationship between the ED and the PCN
to assist with disaster management of incoming
displaced patients. Between December 2013 and
January 2014 the ED again partnered with CFPCN
Access 365 and the Primary Care Team, to pilot
an unprecedented patient referral process. An
innovative new way to provide quality patient
care at the right time, in the right place, by the
right provider, the AHS ED-PCN Referral Process
has developed community relationships and
established ED to PCN referral as a viable process.
Conclusion
ED to PCN Referral has become a regular
operational practise in the FMC ED, with volumes of
greater than 90 patients per month being referred
to the PCN, and consequently receiving quality
care, at the right place, at the right time from the
right provider.
Methods
The protocol included assessment criteria
aimed at identifying the level of urgency and
appropriateness for referral, as well as a multifaceted patient tracking and booking system,
through which robust evaluation could be
completed.
Edmonton, Alber ta — Nov. 24 – 25 — A B S T R A C T S — 2 0 1 4 Accelerating Primar y Care Conference
Abstract
60) Impact Of Organizational Stability On Adoption
Of Quality-Improvement Interventions For
Diabetes In Primary Care Settings
Lisa Wozniak, MA, ACHORD, University of Alberta
Allison Soprovich, MPH
Sandra Rees, BScPharm
Len Frank, MPH
Steven T. Johnson, PhD
Sumit R. Majumdar, PhD
Jeffrey A. Johnson, PhD
Context
Results
While there have been advances in diabetes care,
there remain considerable challenges in translating
these into practice. Understanding successful
adoption of quality-improvement interventions
in primary care is important. To address this gap,
we prospectively examined organizational and
contextual characteristics related to the adoption
of two quality-improvement interventions in
partnership with four non-metropolitan primary
care networks (PCNs) in Alberta. One intervention
was directed at lifestyle and called Healthy Eating
and Active Living for Diabetes (HEALD) and the
other was a collaborative care intervention for
patients with diabetes and depression called
TeamCare.
A “Ready? Set? Go!” construct summarizes our
findings. Though the PCNs differed in many ways,
all were non-metro, served a sufficient number of
patients with T2D, and had programs and services
related to T2D, lifestyle management, or depression
(“ready”).
Objectives
Both HEALD and TeamCare were clinically effective
in Alberta’s primary care setting. Here we describe
the process of adoption at an organizational level
across the four PCNs.
Methods
We used the RE-AIM (Reach - Effectiveness Adoption - Implementation - Maintenance)
framework to evaluate adoption of the qualityimprovement interventions in the PCN setting. We
undertook semi-structured interviews with PCN
staff (n=24), systematic documentation (e.g., field
notes) and formal reflections by the research team
(n=4). Content analysis was used to interrogate the
data.
Respondents reported prioritization and optimism
to initiate the interventions based on identified
positive indicators (“set”), including alignment with
PCN priorities or programming and provision of
additional resources (i.e., effort-neutral). Regardless,
the continuous and dynamic interplay of leadership
support, existing physician culture and limited
engagement with PCNs, and the unique context
of each PCN (history and development) influenced
the overall degree of adoption of the interventions
across the PCNs (“go”).
Conclusion
We conceptualize the interplay between the
factors that influenced the adoption of the
interventions across the participating PCNs as
‘organizational stability’. Within this project, we
found that organizational stability was fluid and
non-linear; organizations can move between
stages, advancing or regressing over time. Our
findings suggest that alignment of priorities,
sustained support, and a culture of innovation
will facilitate adoption of quality improvement
interventions – particularly when the organization
itself is relatively stable.
Edmonton, Alber ta — Nov. 24 – 25 — A B S T R A C T S — 2 0 1 4 Accelerating Primar y Care Conference
Abstract
61) Best Practice:
Bringing In Evidence-Based Pharmacology
Studies
Alvin Yapp, BSc (Psychology), MEd, Edmonton Oliver Primary Care Network
Betsy Thomas
Sara Strang
Jamil Ramji
Context
Results
The Edmonton Oliver Primary Care Network
(EOPCN) has introduced a professional
development program wherein pharmacists will be
informed about the latest pharmacology literature
by an expert physician; this new evidence-based
best practice information was then disseminated
by the pharmacists to PCN-member family
physicians and other clinicians in order to inform
best practice. Each year, the topics are developed,
and the pharmacists are trained on the new
materials before presenting back to each clinic.
Results were positive throughout for each of the
scale questions (average rating > 4.8). Qualitative
feedback provided through comments were also
examined and taken into consideration for the
next sessions. Qualitative comments were also
very positive, with most praising the quality and
of the sessions. Other comments included insight
into complicating factors (e.g., U.S. vs Canadian
guidelines, patients’ wishes), topics for future
discussions, and suggestions for improvement of
the session (e.g., correct typos).
Objectives
Conclusion
Feedback was collected from attendees of these
sessions in order the evaluate the usefulness of
these sessions, as well as overall satisfaction of how
they were conducted in order to inform further
development of the program.
Satisfaction with the program has been high, not
only for the clinicians, but also the pharmacists
who are presenting the information. Anecdotal
evidence suggests that they value the allocated
time to keep their knowledge up-to-date, which
also helps with their daily activities. Comments
provided from session attendees indicate that they
find the sessions informative and useful. Further
study will be needed to examine if these sessions
result in a change in clinician practice; the feedback
forms will be updated to ask more specific
questions related to the topics being presented.
Methods
Feedback forms were collected from each session.
Attendees were asked to rate how much they
agreed with the following statements:
1) The session was relevant to family medicine.
2) The session was helpful and non-biased.
3) The speakers were clear and knowledgeable.
4) Overall satisfaction with the program.
Opportunity was provided for additional
comments.
Edmonton, Alber ta — Nov. 24 – 25 — A B S T R A C T S — 2 0 1 4 Accelerating Primar y Care Conference
Abstract
62) Group Therapy As A Viable Alternative To
Individual Counseling To Address High
Volumes Of Referrals In Primary Care Settings
Alvin Yapp, BSc (Psychology), MEd, Edmonton Oliver Primary Care Network
Sue Ludwig
Context
Methods
The Edmonton Oliver Primary Care Network began
offering a Cognitive Behavioural Therapy (CBT)based psycho-educational group in 2011 in an
effort to better manage an increasing volume of
mental health referrals.
Sessions were assessed with patient feedback
survey; patients were able to provide comments on
the session as well as rate how well they felt they
were respected, heard and understood, and if the
group content addressed their needs. Feedback
from each session is used to improve the upcoming
sessions.
Objectives
Group therapy also had some benefits that
individual therapy could not offer; these include
the eleven curative factors of group therapy
outlined by Yalom (2005). Patients were referred
to the group from physicians and members of
the multidisciplinary team of the PCN. The first
set of groups was help in 2011 with six 2 hour
psycho-educational CBT-based sessions; patients
were given the option of attending any number
of sessions they wished from those offered.
The sessions were designed to help patients
understand anxiety and depression, identify
unhelpful thinking styles, develop strategies to
help with worrying, communication skills, coping,
and relapse prevention. Later, a group on anger
management was added as a response to patient
feedback that this was an area of concern for them.
Group sessions have since been offered twice a
year starting in January 2012; once in the fall and
once in the winter.
Results
Patient satisfaction with the sessions are
consistently high across all sessions demonstrating
that patients felt they were respected, heard,
understood, and that the group met their needs.
Feedback was focused around logistical issues (e.g.,
parking, room size, etc.) which were mitigated as
much as possible in the future.
Conclusion
This demonstrates the efficacy of a group setting in
addressing an increasing number of mental health
referrals; in this environment, it may be difficult
to have timely one-on-one counseling sessions,
however, for some patients, a group session can be
as helpful, if not more helpful, than a one-on-one
session. Further tracking may be implemented
in the future to examine the effect of the group
classes on wait times.
Edmonton, Alber ta — Nov. 24 – 25 — A B S T R A C T S — 2 0 1 4 Accelerating Primar y Care Conference
Abstract
63) Mom Care Docs:
Maternity Care Practice By Family Physicians?
Alvin Yapp, BSc (Psychology), MEd, Edmonton Oliver Primary Care Network
Catherine Becker
Sudha Koppula
Context
Results
Since 2010, the Edmonton Oliver Primary Care
Network (EOPCN) has included the Mom Care
Docs, a prenatal care program run by primary care
physicians. Its aim is to provide pregnancy and
delivery care to low-risk maternity patients at the
Royal Alexandra Hospital. Patients are pre-screened
by a medical office assistant for the following highrisk criteria. Patients who are identified as high risk
at any point are referred to an obstetrician.
Chart Audit: Patients who were audited were
generally low-risk; few pregnancy complications
arising. Seven percent of patients smoked
cigarettes at some point during pregnancy, and
three percent drank alcohol. There was no recorded
use of recreational drugs during pregnancy.
95% of patients carried to term, with a mean
gestational age of 39 weeks. 75% of births were
by spontaneous vaginal delivery. The majority of
babies had an appropriate birth weight for their
gestational age. No relationship was found within
these patients between potential risk factors
and pregnancy outcomes, indicating that these
patients had low-risk pregnancies. Survey: 100% of
respondents felt that the Mom Care nurse/doctor
treated them with respect, listened, and explained
things in a way they could understand. 96.9%
thought they had enough involvement in decisions
about their health care.
Objectives
As part of ongoing program monitoring, a chart
audit was conducted to gauge the pregnancy risk
of patients who stay with the program through
delivery. The following questions guided the
variable and chart selection for the audit:
1) How many Mom Care patients present with
certain pregnancy risks?
2) How complex are Mom Care patients in the
terms of pregnancy risks?
Methods
The chart audit database included demographic
variables, patients’ weight and blood pressure
measurements at some visits and selected risk
factors of interest to Mom Care physicians . Out of
1,703 patients first seen by Mom Care in FY2013,
a systematic random sample of 100 patients was
selected. A patient experience survey was sent to
patients at the 30-week visit seen in May of 2013
(n=121)
Conclusion
Several studies have demonstrated lower
intervention rates for family physicians as
compared to obstetricians with comparable
low risk patients. The current study adds to this
evidence; low-risk patients are not more likely to
have complicated birth outcomes, and are wellmanaged. Low-risk pregnancies can be effectively
managed with high patient satisfaction by family
physicians.
Edmonton, Alber ta — Nov. 24 – 25 — A B S T R A C T S — 2 0 1 4 Accelerating Primar y Care Conference
Abstract
64) No Change Can Be Good Change:
Tracking BMI
Alvin Yapp, BSc (Psych), MEd, Edmonton Oliver Primary Care Network
Sharon Macklin
Context
Results
Weight management is an increasing issue; in the
2014 fiscal year, 66.5% of dietitian referrals were for
weight management. An in-depth look at patient
outcomes for these patients was done; change
in patients’ Body Mass Index (BMI) was examined
done for patients who were first seen between
January 2012 and September 2013.
More than 70% of patients managed to either
maintain, or decrease their BMI, which indicates
success in treatment. A clinically significant
decrease (more than 2 points decrease or 5-10%
decrease compared to the initial BMI was observed
in 12% of patients. Close to half of patients showed
some decrease, but not within clinical significant
range. The majority of patients in all co-morbidity
status groups (measured by their initial EOSS score)
were able to maintain or decrease their BMI.
Objectives
The guiding questions of the analysis were:
1) To what extent did obese patients change the
BMI during the course of treatment?
2) Was this change clinically and statistically
significant?
3) Was the BMI change linked to differences in
patients’ co-morbidity status at entry?
Methods
Conclusion
Demonstration of successfulness of dietitians in
helping to maintain or decrease patients’ BMI.
Anecdotally, patients were enthusiastic working
with the dietitians; further studies will examine the
patient experience further, focusing on qualitative
measures.
Data was tracked for 478 patients whose first
encounter with a dietitian was between January
2012 and September 2013 who were classified
“obese” (BMI ≥ 30). Change in BMI scores is reported
in two ways:
1) Difference in BMI scores between first and last
BMI value for each patient. This measure allows
gauging increase or decrease in weight through
increase or decrease in BMI.
2) Percent change in BMI between first and last
measure for each patient. Clinical significance
was defined as:
a) Decrease of more than 2 BMI points;
b) Decrease of 5-10% or more in percent change
units;
c) Stability of BMI, defined as no change in BMI,
or increase of no more than 2 BMI points
or 5% increase. Co-morbidity status group
is determined by the Edmonton Obesity
Staging Score (EOSS).
Edmonton, Alber ta — Nov. 24 – 25 — A B S T R A C T S — 2 0 1 4 Accelerating Primar y Care Conference
Abstract
65) The Impact Of Attrition On Panel Management
Alvin Yapp, BSc (Psychology), MEd, Edmonton Oliver Primary Care Network
Naomi Usman
Context
Methods
An effective and integrated Panel Management
program includes quality improvement reviews of
data and processes to ensure the consistency and
effectiveness of the Panel Management program
in terms of improving patient uptake, as well as
the standardized processes used to measure the
program.
A method to identify, clarify and classify suspected
inactive patients was developed and implemented,
leading to increased knowledge on how to correct
for attrition. The necessity of incorporating an
outreach aspect to any existing Panel Management
program was recognized and additional processes
were developed within the Panel Management
program to maintain a more accurate active patient
panel. Reports were regenerated after removal
of inactive patients and the results were again
analyzed and determined to be a more accurate
representation of average patient screening
completion rates.
Objectives
The Edmonton Oliver Primary Care Network
(PCN) has implemented a panel identification
and management program at the Allin Clinic
since 2008. Detailed statistics have been gathered
on effectiveness annually since the programs’
inception at the Allin Clinic. These statistics are
analyzed to ascertain opportunities for growth
and improvement within processes. By year four
of the program, physician and administrative were
confident that significant work in terms of panel
management of thousands of patients should
yield noticeable positive improvements in terms
of patient engagement and participation. The gap
between expected and measured results were
examined over several months with the objective
to narrow this gap, or to provide a tangible
explanation for this gap.
Results
Eight maneuvers were measured before and after
panels were updated evidencing an average
increase in completion rates of ten percent per
maneuver. Attrition management processes
were shared across the Edmonton Oliver PCN to
ensure that this important factor is considered
for measurement of mature, robust panel
management programs.
Conclusion
Management of attrition variables is a critical
consideration and requirement for mature,
ongoing panel management programs.
Edmonton, Alber ta — Nov. 24 – 25 — A B S T R A C T S — 2 0 1 4 Accelerating Primar y Care Conference
For More Information
http://www.pcnpmo.ca/NewsEvents/Events/APCC/APCC2014/Pages/default.aspx