using facilitated audit & feedback to support choosing ... apcc/59...using facilitated audit...

Sampson Law, Ashi Mehta, Eileen Patterson, June Cooper, John Lester, Anthony Train, Shawn Dowling, Katrina Nicholson, Kelly Burak

Using Facilitated Audit & Feedback

to Support Choosing Wisely Initiatives

in Primary Care Networks

GoalsSupport individual physicians & Primary Care Networks to evaluate the appropriateness of their screening & ordering of tests related to three Choosing Wisely topics:

● Pap smear testing● Bone mineral density scans● Lumbar spine imaging

1. Collaboration

Primary Care Networks

PhysicianLearningProgram

Audit & feedback

Data reports

Facilitated multi-disciplinary sessions

Physician champions

PCN engagement

ChoosingWiselyAlberta

Planning, facilitation

Change plans

Implementation

TowardOptimizedPractice

PCN-level aggregatedata

Physician patientpanel reports

Health QualityCouncil ofAlberta

Subject matter experts

Screening and othersupport programs

AlbertaHealthServices

Identify barriers & enablers to best practice.

2. Interactive Learning Workshop

Primary Care Networks selected the Choosing Wisely topic(s) that were relevant & important to their physician members.Several provincial healthcare improvement agencies/initiatives co-developed a unique, multi-faceted educational workshop for primary care phycians & their teams.

Participants consented to receive their own confidential practice data reports from PLP or HQCA, then attended a 2.5 hour workshop.

Didactic Lecture45 min session from subject matter expert● updates to guidelines● evidence-based best practices● use case examples

Individualized Practice ReportsPhysicians received reports with individualdata & peer comparators showing their:● pap smear testing rates ● # of repeat DEXA scans ordered● # of CT scans and MRIs ordered on the

lower back

Facilitated Group Discussions● disuss the data ● identify opportunities for improvement● identify barriers & enablers to

achieving best practice

Action PlansParticipants developed change plans at individual, clinic, & PCN level, then made personal committments to change their practice

Participant Satisfaction5 PCNs participated in 7 events

4. Results

would recommend theevent to a colleague95.9%

felt the event was valuable90.0%

felt the event supported PCN improvement87.8%

said it helped set & evaluate personal goals90.2%

physicians participants207

allied health professionals, QI staff, and administrator participants60

data reports delivered by the HQCAwith metrics on CW topics2500

individualized data reports delivered182

felt the data taught them something about their practice88.7%

3. Data

NUMBER OF LUMBAR SPINE CT & MRIs ORDEREDAlberta

Don’t screen women with Pap smears if under 21 years of age or over 69 years of age

Don’t repeat DEXA scans more oftenthan every 2 years

Don’t do imaging for lower-back painunless red flags are present

Cervical Cancer Screening Osteoporosis Screening - DEXA Scans Lumbar Spine Imaging

70+ years15-20 years

Alberta16.9%

Alberta14.6%

North

South South9.4%13.6%

North14.0%20.8%

Edmonton Edmonton22.3%14.7%

Central Central13.6%16.3%

Calgary Calgary15.9%11.8%

25%

0%

3-YEAR CERVICAL CANCER SCREENING RATES (2012-2014)Shows over-screening in women under 21 & over 69

REPEAT DEXA SCANSAlberta 2015

REPEAT DEXA SCANSby zone

Alberta20.9%

South20.4%

North14.0%

Edmonton21.3%

Central15.7%

Calgary19.3%

25%

0%

20.9%65,922

79.1%249,288

< 2 years > 2 years

5. Participant Benefits● learning credits, workshops are CFPC Mainpro+ certified

(5 certified group learning credits)

● participants can claim additional self-learningcredits from CFPC:

● opportunity for self-reflection

● goal setting & action plan● ongoing implementation support

Participants receive on-going support from the PCNs Improvement Facilitators & other program partners

● physicians work with their teams to develop improvement plans

Linking Learning to Assessment(6 certified credits)

Linking Learning to Practice(5 certified credits)

Support development of change action plansfor improvement

1

2

3Contact plp@ucalgary.ca to sign your PCN up for the initiative

40000

30000

2011 2012 2013

# of

sca

ns o

rder

ed

Year2014 2015 2016

20000

10000

0%

CTMRI

18219

20354

6403

2011222321 22171 20162

51944576

24793

59775960