Making data work – Untangling input, output and reporting

Jennifer RaynerCanadian Association of CHCs September 17, 2015

Objectives and problems to discussData measurement, data management,

clinical decision making, reporting and analytics – power of data

Administrative data, EMR data, evaluation data – what is important to collect

EMR data (or how to collect data without an EMR)

How do we measure the impact of team-based care (when most EMRs are built for individual practitioners)

What is meaningful? Discussion – core data for national

reporting

Data RequirementsFunding requirements/reporting Financial reportingHR reportingEvidence based decision makingQuality Improvement/

benchmarking/target settingPlanning Population healthProgram evaluationPrediction (projections) analysesResearch

Electronic Medical Records (EMR)

Often built for physicians (not team-based)

Prescriptive (individuals have little input in how system is designed)

Providers use EMRs as electronic charts – free text, no data standards, etc

Users cannot get data out at all or in a meaningful way

Often data rich but information poor

Next Steps/Gaps Identified in survey

• 64% indicated they have data on primary care clients (54% for non community governed)

• 36% said they collect data on heath promotion and outreach (28% for non community governed)

• 49% have data on gender

• What can we do about this?

• Is it important?

What makes you unique?

When is it important to standardize?

US/Ontario StoryCommitment to working collaboratively

at the national, regional/state, and local levels to make the case with available data

Commitment to “Tell Our Story”Recognition of the importance of

research and data in “Telling Our Story”Recognition that the “right”

partnerships with academia and other community partners is key to success

Ontario Evaluability Assessment

Do we have enough in common to see ourselves as a ‘program’ – late 1990’sAccessibilityWellness and PreventionCoordination and IntegrationHolistic, client centred

(comprehensive)Community ownership

54 CHCs operational Tested and refined in 2000 – all CHCs

have common data elements (only use system for electronic, administrative data, scheduling and client roster

2003 – transition to EMR 3 EMRs common EMR

Results Based Logic Model

Evaluation

Questions and

Indicators

Data Elements

CHC Evaluation Framework

Original logic modelAccessible Services

·Accessible location·Convenient hours of operation·Services available in different languages·Culturally relevant programs and services·Outreach

·Communities/individuals identify their own needs·Community involvement in running centres/programs/activities·Community development programs/activities·Health education/promotion

·Health education/promotion activities with individuals/groups (clinical and community focus)

·Use of multi-disciplinary teams and assessments of all aspects of lives·Multi-disciplinary interventions and appropriate referrals

·Team approach·Internal referral systems, meetings, case conferences·Fostering external linkages

Empowering individuals and communities

Focus on Wellness and Prevention

Holistic approach to provision of Health Care

Provision of Coordinated services/programs

Reach and serve groups who would not access relevant services elsewhere

Community participation (in decision-making/ leadership)

Change in health care

·Awareness·Attitudes·BehaviourProvision of relevant services

Presence on community boardsEstablishment of coordinating groups/ projects¨Joint program planning

Impact on determinants of health of individuals and communities

Improve health status of individuals and communities

CHC Program Evaluation System

Broad Organization•Main Intended Populations•Broad Issues Addressed

Client Demographics

Individual Service Events

Personal Development Groups

Community Initiatives

Original standardized data elementsAccessibility (individual client characteristics, hours of operation,

language of service, issues addressed location of encounter, etc)

Interprofessional Teams – provider roles, referrals, consultations, etc

Focus on Wellness and Prevention – types of services, PDGs, health education, health promotion activities, issues addressed

Coordinated Services – referrals, care coordination, system navigation

Individual and Community Ownership – Community development activities, involvement in care, etc

Model of health and well-being

Supports on-going assessment and evaluation of our programs and services – common starting point

Includes a series of discrete componentsResults based logic modelEvaluation questions

Process evaluation questions (nature of people served, extent to which the program has been implemented as expected

Outcome/impact questions (attendance caused a positive outcome)

Indicators (measures)Data sourcesData entry manual (also produced)

Revised Ontario Evaluation Framework

Commitment to health through the lens of social determinants, community vitality belonging, health equity & social justice

Increased community capacity-building

Reduced risk, incidence, duration and effects of acute

& episodic conditions

Increased civic

engagement and social

capital

Improved level and distribution of population health and wellness

Improved capacity of communities to be involved in decision-making about their health

Increased seamless delivery of services, appropriateness

of time, place and inter-professional team through

integration and coordination

Improved functioning, health, resilience & wellbeing of Individuals, families & communities Improved Health Equity across Sectors

Reduced risk, incidence and

effects of chronic through HP

Increased access for people who experience the

greatest barriers

Resources - Financial, Material and Human

Community Knowledge Synthesis - Community and client input, Needs assessments, Environmental scans

Client & community driven health care programs, services and initiatives with particular focus on those who face barriers to health

Highest Quality, People and Community Centred Health and Wellbeing

H

Improved equity in access to CENTRE services by eliminating barriers and advocating for healthy public policy

Reduced negative impact of SDOH on health and wellbeing of clients

How Many?(Volumes, clients,

etc)

What services do we deliver?

(e.g., PHC, CD, etc

How do we deliver services?(i.e., 8 MoHWB Attributes)

With Whom? (priority populations )

Increased community

partnerships

AccessibleIP, integrated & coordinated

Community governed

Based upon the SDOH

Culturally Safe

Accountable and Efficient

Community Development

Approach

Population and Needs-

based

Current standardized dataIndividual client data and

sociodemographic information

Encounter data – All individual encounters and personal development groups (specific data fields)

Community development initiatives

Financial data – MIS compliant

Client experienceQuality Improvement Plans MSAAs – Accountability

Agreements

Continue to demonstrate our impact and success...

Collective evidence to continue telling our story, improve & demonstrate our effectiveness

Tools and DataBIRT, Organizational

Survey, QIPs, MSAA, CI Tool, PCPM, Practice Profile, CI Tool, Activity Based Costing data

Importance of standard data – a few examples

Data linkage with health databases

Comparison of primary care models

Health equity analysesCosting comparisons Population planning &

prevalence dataAccountable care organizationsRisk adjustmentHaving our clients included in

population health studies

CHC FHG FHN FHO FHT Other NON0

0.2

0.4

0.6

0.8

1

1.2

1.4

1.6

1.8

2

1.84

1.26

1.07 1.11 1.04

1.22

0.950000000000001

Standardized ACG Morbidity In-dex (SAMI) by primary care model

Primary Care Models - ALL

At Risk

Urban

Urban G

eogra

phy

Rural G

eogra

phy

Franco

phon

e

Newcom

erOthe

r

Ontario

CHCs

Ontario

Total

0102030405060708090

Cancer Screening

MammographyColorectal ScreeningCervical Screening%

CHC DashboardQuality information driver

for better careClinical team have

undertaken a review of QBT and PCPM and prioritized a subset of measures to benchmark and QI

Provide an active performance monitoring tool for clinical engagement, operational effectiveness, clinical outcomes & patient experience

Example – Economic/Costing Analyses

Outcomes overshadowed by unsubstantiated statement that `model is expensive`

Tricky to allocate costs and potential benefits

Primary health care, community development, health promotion all under one roof

Creating an activity based costing methodology

Lessons learnedImportance of having key people on

hand for on-going training Super-users (clinicians included)Use the data for more than just

accountability – use the data in-house

Ensure that standardized data is going to be used (clinician time) + force queries to do some of the work

Data quality an on-going issue Importance of working together as a

sector to tell our storyImportance of using data

throughout the organization

Types of Services at CHCs• 100% of CHCs provide primary care

services• 82% provide self-management

programs• 62% provide primary care through

home visits• 33% provide primary care through

street outreach or within a mobile unit

• 73% offer harm reduction programs• 69% offer mental health counseling

Canadian CHCs: whom does this include?1.Publicly-funded, not-for-profit or government

agency;2.Principally offers primary health, social,

rehabilitation and other non-institutional services;

3.Health promotion, health education and community health and development programs;

4.Inter-professional teams from various disciplines, & volunteers;

5.Serves an identifiable community6.Governed by locally representative board of

directors (BOD); or a BOD of a broader health network/region having an advisory committee made up of locally representative directors;

7.Remunerates the majority of human resources by funding arrangements such as salary, sessional fees or capitation rather than fee-for-service.

Questions to considerWhat data do we all

collect now?What questions do we

need to answer? What data is important to

collect across all CHCs to demonstrate our collective impact? Is this possible?

Other questions that we need to consider?