Louise Nasmith University of British Columbia
1
Acknowledgements/Disclaimer
• Focus on Canadians with chronic health conditions d h C di A d f H l h • Based on the Canadian Academy of Health Sciences’ panel assessment “Transforming Care for Canadians with Chronic Health Conditions: Put People First, Expect the Best, Manage for Results” 2The Expert Panel
Co‐Chairs: Louise Nasmith & Penny Ballem
• Raymond Baxter ‐ Kaiser Permanante, USA • Howard Bergman ‐ Fonds de la recherche en santé du Québec • David Colin Thomẻ ‐ Department of • Dale McMurchy ‐ Dale McMurchy Consulting • Pamela Ratner ‐ University of British Columbia • Peter Rosenbaum ‐ McMaster Health, United Kingdom • Carol Herbert ‐ University of Western Ontario • Nora Keating – University of Alberta • Richard Lessard ‐ Agence de la santé et des services sociaux de Montréal • Renee Lyons ‐ Bridgepoint Health and
University of Toronto
University
• Robyn Tamblyn – McGill University • Ed Wagner ‐ MacColl Institute for
Healthcare Innovation, USA • Brenda Zimmerman – York University
Context: The Canadian Health System & Chronic Disease • The basic premise: that the health system needs transformation to better meet the needs of the millions of Canadians who have one or more chronic diseases. –Morbidity: 16M Cdns live with chronic disease –Health of Communities and Quality of Life: especially for Q y p y poorest Canadians –Inefficiencies: 60% of hospitalizations are due to chronic disease.
–Access to Care: 76% of people with breast cancer, versus 45% of
people with diabetes receive the recommended care –Economic Impact: if trend continues, ON Ministry of Health expenditures could make up 80% of total government program spending by 2030 Tensions: Canadian Health Care System • Half of physicians work in primary care, where most visits relate to CD • Regionalization of health services in most parts of the country, enabling population need based
Resources of system focused on acute care and disease-focused
Health system primarily reactive to patient crisis not g p p planning • Universal access to health services =shared value • Innovations in primary care are underway in a number of jurisdictions across Canada.
reactive to patient crisis, not proactive to population needs. People in poor communities have higher CD and lower life expectancy
No universal EHR to support integration. Tensions: Canadian Health Care System • Multiple statutory roles with responsibility for quality of care and protecting public interest • Canada internationally recognized as a leader in tobacco control and
Weak accountability for health outcomes of patients living with chronic illness.
Rate of daily tobacco smoking among aboriginal populations as a leader in tobacco control and
other health promotion initiatives.
• Increasing move to collaborative practice and inter‐professional education
among aboriginal populations is more than double that of the general population. .
Health system largely siloed– health disciplines and single diseases/organs .
Canada: Current Status
• 15% of Canadians do not have a family physician
• High utilization rates of ER by patients with chronic health conditions
chronic health conditions • Long wait times to access specialty care • Predominant FFS payment method for physicians • Lowest rate of training in QI among primary care physicians 7
Canada: Current Status
• Pharmaceutical management processes vary widely across jurisdictions • Canada has EHR infrastructure for 50% of Canadians but only ~40% of physicians use an Canadians but only ~40% of physicians use an EMR • Less than 50% of the population have access to primary care teams • Little investment in patient self‐management • Focus on diseases not patients 8What would success look like?
“If we were building a health care system today from scratch, it would be structured much differently from the one we now have and might be less expensive. The system would rely less on hospitals and doctors and ld id b d f it b d would provide a broader range of community‐based services, delivered by multidisciplinary teams with a much stronger emphasis on prevention. We would also have much better information linking interventions and health outcomes.“ (National Forum on Health, 1997)“Islands of Innovation” ?
Inter and Intraprofessional Models
• Primary Care Networks (PCNs) • Family Health Teams in Ontario • RACE in BC • Expanded scope of practice for pharmacists 10“Islands of Innovation” ?
Quality Improvement
• Canadian Working Group for Primary Care I (CHS ) Improvement (CHSRF) • Saskatchewan Health Quality Council • Quality Improvement and Innovation Partnership (QIP) in Ontario 11“Islands of Innovation” ?
Education
• IPE initiatives across the country • “Patient’s Voice” project at UBC • AIPHE • FMEC ‐ UG & PG“Islands of Innovation” ?
Self‐Management
• MyOscar and PHR • Chronic Diseases Self‐Management Program 13“Islands of Innovation” ?
Health Information
• Drug Information Systems • Sault Ste. Marie Group Health Centre • Alberta – provincial system 14“Islands of Innovation” ?
Research
• Bridgepoint Collaboratory for Research and
I i i C l Ch i i
Innovation in Complex Chronic Disease • Canadian Strategy on Patient Oriented
Now What?
We know where we are still lagging behind……. We have good models to build on……… How can we make these “mainstream”? 16Overarching Recommendation
What needs to happen? Enable all people with chronic health conditions to have access to a system of care with a specific clinician or team of clinicians with a specific clinician or team of clinicians who are responsible for providing their primary care and for coordinating care with acute, specialty, and community services throughout their life spans 17Enabling Recommendations
• Aligning system funding and provider remuneration with desired health outcomes; • Ensuring that quality drives system performance; • Creating a culture of lifelong education and learning for healthcare providers;g p ; • Supporting self‐management as part of everyone’s care; • Using health information effectively and efficiently; • Conducting research that supports optimal care and improved outcomes.Strategy for Transforming Care for Canadians with Chronic Health Conditions 19
Core Principles
• Focus on patients not diseases • Ensure equitable access • Use population health data • Create a culture of CQI 20Critical Investment in…….
Interprofessional Primary Care Teams:• linked by functioning EHR to other sectors • linked by functioning EHR to other sectors • have access to data; used for CQI • are patient not disease‐focused • serve as educational hubs
Critical Investment in…….
Interprofessional Primary Care Teams:
• Linked by functioning EHR to other sectors • Linked by functioning EHR to other sectors ‐invest in implementation of EMRs ‐across community and acute care sectors ‐access to population health data 22
Critical Investment in…….
Interprofessional Primary Care Teams:• Have access to data; used for CQI • Have access to data; used for CQI ‐link family physicians and consultant specialists into regional structures (accountability) ‐create CQI programs that are population outcomes‐based and feedback to practice performance 23
Critical Investment in…….
Interprofessional Primary Care Teams:• Are patient not disease focused • Are patient not disease‐focused
‐remuneration for primary care providers linked to “whole patient” indicators
‐consultants paid to be available and on‐site ‐flexible payment models for other team members
Critical Investment in…….
Interprofessional Primary Care Teams:
• Serve as educational hubs • Serve as educational hubs ‐new pedagogic models to teach interprofessionally ‐new payment schemes for teaching ‐explicit teaching about IPC, CQI and patient vs disease‐focused care 25
Critical Investment in…….
Interprofessional Primary Care Teams:• Serve as research hubs for “complex” patients • Serve as research hubs for “complex” patients, “complex” care (multimorbidity) ‐build research capacity at the “coal face” ‐CIHR funding for “multimorbidity” good models of care 26
Who is responsible?
Strategy for Transforming Care for Canadians with Chronic Health Conditions 28
Core direction for healthcare system
transformation in Canada
Put people first –We need system‐wide changes to focus on and to further engage people and their family or friend caregivers who want and need to be partners in their care. Clinicians need to be involved in changing and continuously improving the system. Expect the bestExpect the best –We know what is needed. Many examples of innovative services and systems already exist. We need to learn from and, where possible, to build on these pockets of excellence so that all areas in Canada can expect the best health services. Manage for results –We need to consistently monitor what we are doing so that we know what to change. We need to learn from our mistakes and near misses as well as from our successes. 29