Integrated People-Centred Care in Canada - Policies, Standards, and Implementation Tools to Improve Outcomes.

INTRODUCTION: Despite the national and international policy commitment to implement integrated health systems, there is an absence of national standards that support evidence-based design, implementation, and monitoring for improvement. Health Standards Organization (HSO)'s CAN/HSO 76000:2021 - Integrated People-Centred Health Systems (IPCHS) National Standard of Canada (NSC) has been developed to help close this gap. This manuscript outlines the policy context and the process taken to develop the IPCHS standard. DESCRIPTION: The IPCHS standard is built around 10 design principles with detailed, action-oriented criteria and guidance for policy makers and health system partners. The IPCHS standard was co-designed with a technical committee that included balanced representation of policy makers, health system decision-makers, Indigenous leaders, providers, patients, caregivers, and academics. Additional feedback was received from a diverse audience during two public review periods and targeted consultation via interviews. This qualitative feedback, combined with the evidence reviews completed by the technical committee, informed the final content of the IPCHS standard. DISCUSSION: The IPCHS standard was developed through a co-design process and complements existing frameworks by providing 66 detailed, action-oriented criteria, with specific guidance. The co-design process and consultations resulted in increased awareness and capacity among policy makers and health system partners. Supplementary tools are also in development to facilitate implementation and monitoring of progress and outcomes. This manuscript was developed in collaboration with technical committee members and HSO staff who led the targeted consultation and adoption of the IPCHS standard in six integrated care networks. CONCLUSION: Implementing integration strategies requires that we create and sustain a culture of continuous improvement and learning. Key lessons from the development process focused on the importance of co-design, embedding people-centred practices throughout the standard, formal yet iterative methodology inclusive of broad consultation, clear accountability for both policy makers and system partners, tools that support action and can be adapted to local context and level of integrated system maturity.

Patient Relations Measurement and Reporting to Improve Quality and Safety: Lessons from a Pilot Project.

BACKGROUND: Effective patient relations can improve the patient experience and the safe delivery of care. Recent Ontario policy and legislative changes have increased accountabilities for healthcare organizations and expanded Health Quality Ontario's mandate to measure and report on patient relations. The purpose of this pilot project was to support improved care by validating standardized measures, data submission processes and prototype reporting of patient relations indicators for the hospital, home and community care and long-term care sectors across Ontario. METHODS: Health Quality Ontario identified potential indicators and best practices by performing a comprehensive environmental scan and consulting with experts, including patients and caregivers. It shortlisted indicators based on alignment to best practices and Ontario legislative requirements. A provincial advisory group then used a modified Delphi process to prioritize and recommend five patient relations indicators for province-wide measurement and comparative public reporting. Through the pilot project, these indicators were validated using facility-level data for fiscal year (FY) 2015-2016 from 29 hospitals, home and community care organizations and long-term care homes across Ontario. RESULTS: In June 2016, Health Quality Ontario recruited 34 organizations for the pilot project. Twenty-nine sites successfully submitted summary-level data on patient relations indicators. More than 90% of the required data were retrieved from existing papers or electronic systems. All sites mapped facility-level "complaint" and "action taken" categories to the provincial standardized categories. Across the three health sectors, "care and treatment" was the top complaint category in FY 2015-2016. CONCLUSIONS: This pilot project reinforced the value of measuring patient relations and reporting feedback to support facility- and system-level improvement. The pilot sites and provincial advisory group recommended phased implementation. This would permit healthcare organizations to standardize data collection and align with provincial indicators and categories. The next step would be voluntary data submission to Health Quality Ontario in advance of any reporting. To facilitate voluntary implementation, Health Quality Ontario included one indicator, "complaints acknowledged," in the annual Quality Improvement Plans beginning in FY 2018-2019. This will allow organizations to monitor and report on the percentage of complaints acknowledged within 2, 5 and 10 days. Implementation will evolve based on input from patients, health sector organizations, Local Health Integration Networks and the Patient Ombudsman.

Listening to Improve: Transforming Patient Relations Measurement and Reporting in Ontario.

Effective patient relations are important to improve patient experience and deliver better care. Policy and legislative changes in Ontario have increased accountabilities for patient relations and expanded Health Quality Ontario (HQO)'s mandate. In response, HQO collaborated with patients, health sector organizations, associations and the Ministry of Health and Long-Term Care to co-design a patient relations measurement and reporting approach. Informed by an environmental scan, broad consultations, a multi-sector survey and a provincial advisory group, the approach includes standardized patient relations indicators to support measurement and public reporting across the hospital, home and long-term care sectors. Pilot testing with 29 sites across three sectors will inform province-wide implementation.

Stepping Up to the Plate: An Agenda for Research and Policy Action on Electronic Medical Records in Canadian Primary Healthcare.

Building on a previous study, which identified gaps in primary healthcare electronic medical record (emr) research and knowledge, a one-day conference was held to facilitate a strategic discussion of these issues. This paper offers a multi-faceted research agenda and suggestions for policy actions as a way forward in bridging the gaps. one facet focuses on the need for research. The second facet focuses on harnessing the knowledge of primary healthcare emr stakeholders. finally, the third facet focuses on policy actions. this paper offers consensus-based suggestions with a view to improving the overall primary healthcare emr landscape in canada.

Opportunities to improve diabetes prevention and care in Canada.

The prevalence of diabetes in Canada is expected to more than double by 2030. Additionally, the costs associated with diabetes have nearly doubled between 2000 and 2010 and will continue to rise unless improvements are made. Fortunately, more effective policies and programs can reduce both the prevalence of diabetes and the complications associated with the disease. We used responses from the Canadian Community Health Survey to assess whether Canadians with diabetes report (1) receiving from healthcare professionals the recommended tests to screen for complications, (2) performing sufficient self-care for their diabetes and, (3) for those in lower-income households, receiving less recommended care. The results show that only one in three (32%) Canadian adults with diabetes reported having received all four recommended tests during the previous year. Lower-income Canadians were more likely to report having diabetes and less likely to report receiving the four diabetes care tests. Only half of adults with diabetes reported checking their blood sugar levels daily, and only two in five reported checking their feet for injuries and ulcers. Improvements to adherence to diabetes care guidelines are needed to reduce the likelihood that Canadians, especially lower-income Canadians, will develop complications from diabetes. Bending the cost curve downward is possible through more effective policies and programs that prevent diabetes in the first place and that ensure Canadians with diabetes get both recommended care from their healthcare providers and enough support for effective self-care.

Data that makes a difference in quality improvements in primary health care: approaches through a pan-Canadian voluntary electronic medical record source.

Primary Health Care (PHC) is the most common health care experienced by Canadians and is an important source of chronic disease prevention and management; however, PHC providers say they have little information about their patient populations, especially groups of patients with multiple conditions. The Canadian Institute for Health Information in collaboration with 50 PHC providers examined the ability to extract and use a subset of PHC EMR data from four disparate environments in an agreed and privacy sensitive manner. Findings describing the feasibility of clinician engagement, EMR data extraction, EMR content standards and data utility gaps, information system requirements, and systemic enablers and barriers are described in this paper. Ability to collect and use discrete and standardized clinical and administrative information is fundamental to improving practice efficiency, optimal use of information, and patient quality of care. Improving quality of EMR data captured at the point of service will considerably enable our ability to measure and understand PHC across Canada; promote dialogue to identify priority information needs; and support health system information uses for clinical program and health system management, research, and population surveillance.

Development of a draft pan-Canadian primary health care electronic medical record content standard.

In collaboration with a broad range of stakeholders, the Canadian Institute for Health Information (CIHI) led the development of the draft pan-Canadian primary health care (PHC) electronic medical record (EMR) content standard to be used in EMR applications across the country to support PHC data capture and information use and improved health system management. To achieve this goal, CIHI initiated the following activities: stakeholder engagement, information requirements gathering and adoption and implementation promotion of the common content standard for wide-spread use. The resulting pan-Canadian standardized data set will allow consistent data capture that will improve understanding and ability to report on PHC utilization and access, chronic disease prevention and management, health promotion, medication usage, patient safety, quality of care including patient safety and outcomes. The standard will improve patient care information by providing the structured comparable information needed to care for patients over time and across the continuum of care. Standards support clinical practice reminders and alerts, improvements in operating efficiencies, onscreen feedback reports to PHC providers and the ability to look at clinical trends over time. This standard will improve the flow of information by providing standardized information to providers at points on the continuum of care leading to better coordination of care and a reduction of repeat tests. Lastly, a common content standard will improve the health system use of data; by enabling aggregation and analysis of comparable standardized health information, clinicians, jurisdictions, and regions can benefit from using this data for more effective planning and policy decisions. The jurisdictions and clinicians, supported by CIHI and Canada Health Infoway will continue to work together with other key stakeholders, such as vendors to support the adoption and implementation of this standard into future jurisdictional EMR vendor specifications.

Capturing pan-Canadian Primary Health Care indicator data using multiple approaches for data collection.

The Canadian Institute for Health Information (CIHI), in collaboration with diverse stakeholders, led the development of pan-Canadian indicators to measure primary health care. In 2006, CIHI released a set of 105 pan-Canadian Primary Health Care (PHC) indicators that were developed with the assistance of national, provincial and territorial representatives, clinicians and researchers. Additionally, data gaps were identified in a series of reports. In 2006 and 2007, CIHI assessed options for closing the data gaps so that the indicators could be measured and reported. CIHI then began a program to build the data infrastructure needed for the PHC indicators. The program included the development of content standards for electronic medical records, a prototype of a voluntary reporting system, enhancements to surveys, and the development of reports. In 2006, fewer than 10% of the 105 indicators could be calculated with existing data sources. Now, four projects have begun and over 50% of the indicators are being captured. Important relationships have been established with key collaborators. These relationships will lead to the development of a reporting system prototype and to the refinement of PHC indicators and electronic medical record (EMR) content standards. The project for pan-Canadian PHC indicators has encouraged consultation and synergy. It has motivated CIHI to establish an information program to fill data gaps and to make PHC indicators available.

Development of electronic medical record content standards to collect pan-Canadian Primary Health Care indicator data.

In 2006 the Canadian Institute for Health Information (CIHI) released a set of 105 pan-Canadian Primary Health Care (PHC) indicators. This was followed by an assessment of data gaps, which prevented the calculation of the indicators, and the data collection options available to close the gaps. A quality review of Electronic Medical Record (EMR) data indicated a requirement for content standards. In order to assist the provinces as they developed requests for proposal for PHC-based EMRs, the EMR content standards project was born. Considerable effort was made to identify standards for the Electronic Health Record (EHR) including existing national and international EHR content. As well, CIHI attempted to align the content standards with those of other projects such as the Physician Office System Requirements (POSR). The outcome of this project was a set of EMR content standards for 12 pan-Canadian PHC indicators. The standards will be used to develop a prototype of a PHC reporting system that collects and analyzes data to generate clinical quality indicators for regional and longitudinal comparisons. In late 2008, CIHI will release the pan-Canadian PHC Core Reporting Data Set. This project has developed EMR content standards to better understand PHC in Canada.