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PRIMARY CARE Making Vision a Reality! November 23–26 2014 Edmonton, Alberta Hosted by: In collaboration with: 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