Leadership. Knowledge. Community.1

Improving the Quality of Care

Blair J. O’Neill MD FRCPC

Chair, Quality Collaborative, Specialist Forum CMA

Senior Medical Director

Cardiovascular Health and Stroke Strategic Clinical Network

Alberta Health Services

Past President and Chair of DDQI Initiative,

Canadian Cardiovascular Society

Leadership. Knowledge. Community.2

O Canada…..

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Objectives

• To discuss the opportunity of quality

improvement

• To discuss an initiative by one National

Specialty Society to improve quality

• To describe progress to date of the

National Quality Collaborative

(CMA/Specialist Forum)

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The Intermountain Healthcare Way

• Apply the rigorous measurement tools

developed for clinical research to

routinely measure clinical variation in

routine care performance

• Examine quality, utilization and efficiency

• Learning Approach; not a judgmental

approach

• Focus on the process; not on the persons

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The Opportunity

• Care often falls short of its theoretical potential

• Well documented massive variation in practices

• High rates of inappropriate care

• Unacceptable rates of preventable care-related patient injury

and death

• A striking inability to do “what we know works”

• Huge amounts of waste leading to spiraling costs that limits

access to care – 50% of resource expenditures in hospitals is

quality-associated “waste”

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Higher Quality usually comes at

lower cost

• 30-50% of all resource expenditures in

hospitals is quality-associated waste:

• Recovering from preventable foul-ups

• Building unusable products

• Providing unnecessary treatments

• Simple inefficiency

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Intermountain Health care

approach to protocols

• Build evidence-based best practice protocols

• Incorporate them into clinical workflow

• Embed data systems to track protocol variations

and short- and long- term results (memory-based

medicine gets it right 50% of the time!)

• Demand that clinicians vary care based upon

patient need

• Feed the data back in a “Learning Loop”

• Consistently update and improve protocols

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Summary: Leading with Quality

• Measure success in lives

• Higher quality drives lower costs

• Better Care is the least expensive care

• Intermountain Goal limit annual rate increases

to 1% of CPI to reduce burden of cost on

communities

• Focus on those work processes (<10%)

that drive 95% of costs

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Intermountain

philosophy

Better has no limit….

Old Yiddish Proverb

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CCS Quality Project

Cardiovascular Data Definitions and Quality Indicators – A BRIDGE to better manage care

Benchmarking, Research, Innovation and Data Generate Excellence

http://bridge.ccs.ca/index.php/en/

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Introduction

Canadian Heart Health Strategy and Action Plan

(2009): Build the infrastructure to enable better

cardiovascular health care.

Public Health Agency of Canada grant: To establish:

Cardiovascular Data Definitions (A): The establishment of pan-

Canadian Data Dictionary to reflect national consensus on definition

within three spheres of cardiovascular disease treatment.

Cardiovascular Quality Indicators (B): Establish a national e-

catalogue/repository of quality indicators both existing and new, that

would be embedded within the CCS clinical practice guidelines

process.

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Measuring Quality of Care:

How are we doing?

Measurement plays an important part in

improvement and helps to promote change Campbell et al.

Qual Saf Health Care 2002;11:358-364

Variation Standardisation

ALL

Clinical and Administrative Registries

INTEREST GROUPS

Research, Subspecialty Areas, Clinical Programs/Institutions

Health SystemPerformanceReporting

Provincial/Federal Govt., CCS andSubspecialty groups/organizations

CCS National Data Dictionary and Quality Indicators

Targets (scorecards) are in the middle

Clinical Practice

Guidelines

Specialized = expanded set of recommended data element to be used for more in-depth data collection and analysis.Essential = minimum recommended data element to be used as a standard to enable reporting of key quality indicators and to allow cross-comparison with other centres using these common data elements.

Scorecard

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QI Development Measurement

Reporting

Action

Updating

New

CPGs

New

Data

CCS Quality Project:

From development to measurement and reporting

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Working with quality partners

1. Provinces

Cardiovascular Registries

Quality Councils

2. CCS Affiliates

3. CIHI, Statistics Canada

4. Public Health Agency of Canada

5. Conference Board of Canada

Project mangement

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Next phase of the project 1. Field testing – good start. Admin databases had some of the

indicators but still need to work with other means of obtaining

“granular” data

2. There are links to other CCS projects

a) Choosing Wisely Canada

b) Clinical Practice Guidelines

3. Next phase will develop better links with the provinces and other

national organizations to better obtain the data from which QI’s are

developed, and better integrate CV quality indicators into reporting

and health care system management.

4. Report card on TAVI – a demonstration project.

Leadership. Knowledge. Community.17 08/02/15 HealthPolicyWORKs Inc 17

Summary

Progress Made

a. Expanded the number of cardiovascular quality

indicators (39) based on demand from the provinces.

b. Expanded the number of collaborators (provinces,

Quality Councils, Canada Health Infoway) to ensure

that the quality indicators result in real, measurable

change.

Goal: not to measure variation, but to incentivize

change – through reporting – in clinical practice.

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Quality Collaborative

Update

Specialist Forum, Jan. 30, 2015

Dr. Blair O’Neill

Quality Collaborative Chair

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2014 QC Re-cap

• Winter 2014 - Support from SPF and CMA Board

• Ad hoc Steering Committee confirmed direction

• Summer - Discovery Conversations to inform QC

options/partnerships

• SK HQC, HQC AB, BCPSQC, HQO, ON’s IDEAS,

Cancer Care Ontario, Canada Health Infoway, RCPSC,

CMPA, Accreditation Canada, CFHI, CPSI, CPAC, CIHI

• Fall – Advisory Committee and CFHI ramping up

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General Themes From

Discovery Calls

• All around support

• Niche: physicians as leaders of change, peer-to-peer

champions

• NSS involvement - core asset

• Spreading and scaling crucial

• Physician-level and synoptic (template-style) reporting

• Role of education, IT & KT

• Early patient involvement

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Jan. 29th

QC Workshop

• Clinical and Cost Variation at University Health Network –Dr. Timothy Jackson

• Intermountain Healthcare – Lucy Savitz• Quality Improvement: Why, Where, and How

• Identifying Expected/Experienced Barriers to QI in Practice (Exercise)

• QI Tools & Strategies for Making Change in the Real World

• Implementation in the Real World (Exercise)

• Taking Improvement to Scale

• Discussant – Steven Lewis

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Next Steps

• What comes next depends on:

• What role CMA wants to play in the Quality

Agenda

• Whether CFHI gets funding in Federal Budget,

allowing for a learning Collaborative

• Most importantly, each of our organizations

committing to advance work in this area

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Role of Participating

NSS/Physicians if CFHI gets

Federal Funds

• Identify physicians to lead CFHI applications

• Operationalizing the QI Collaborative

- Designing improvement plans

- Creating indicators

- Developing stakeholder engagement strategy

- Implementation

- Evaluation and measurement

- Preparing for spread

• Need for supportive participating institution

• Team members attend face-to-face learning sessions & webinars

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Regardless of CFHI funding, we

propose that all QC organizations

• Identify 1-3 CPV areas

• Why is it a patient care issue?

• Encourage min. 1 MD-level CPV report

• Base priorities on member input

• Follow-up phase - creation of action plans

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Conclusions

• Quality is key element of physician

leadership in the Healthcare System

• National Specialty Societies have a major

role to play in improving quality

• Advocate for tools

• Education/culture change of all members in

quality improvement, identification and

intervention in key areas of CPV