Primary Health Care Delivery
Optimizing Quality, Access, Integration and Equity in Ontario Primary Care
Much of what we know about models of primary care reform in Ontario dates from the early 2000's when the Primary Health Care Transition Funds were used in Ontario to provide knowledge about models current at that time. Current research suggests that PC models have somewhat different socio-demographic profiles but their geographic distribution and reach in relation to population needs has not been previously examined. Therefore, our studies will address the current issues in primary care reform: attributes of reform; quality of chronic disease care; economic impact; access, integration and equity and disparities.
The studies outlined below will make use of secondary data sources housed at the Institute for Clinical Evaluative Sciences (ICES). The project team are all ICES appointed scientists and have access to the data sets at their institutions through local access sites. Data sets that will be utilized will include well established data sets such as OHIP Billing Data, ODB prescribing information, provider information, hospital and ER utilization (DAD and NACRS), census data and the CCHS, as well as newly available and soon to be available data such as Family Health Team specific reporting data, homecare data, the Patient Care Survey and the QUALICOPC survey.
Objective 1: Primary Care Reform and Quality of Care
This project is focussed on the provision of primary preventive and health promotion services which reduce the risk of developing chronic conditions as well as the management of chronic conditions once they have developed. We will capture three broad categories of outcomes:
Each of the four groups of measures will contain indicators of several chronic conditions, including diabetes, congestive heart failure, chronic obstructive pulmonary disease, and depression from which a composite score will be derived.
Objective 2: Access to Care
For this objective, we will use time series analysis to evaluate how PC access has changed between 2003-2013 as reform and quality improvement initiatives were implemented, using the Primary Care Access Survey (PCAS) data (housed at ICES), the upcoming Primary Care Survey (PCS) and data from the QUALICOPC Study to understand Ontarians' experience of access over time. Billing data will be used to assess changes in the pattern of PC use (e.g. after-hours clinics, usual provider continuity) and use of other resources (ER visits, Ambulatory Care Sensitive Admissions, Specialist Visits). Using available data we will explore which PC structures are associated with enhanced access. Potential explanatory factors include PCmodel, participation in Quality Improvement initiatives, use of advanced access scheduling and human resources factors.
Objective 3: Integration
We will examine primary care structures over time in relation to changes in referrals to homecare, timely receipt of homecare after referral, non-urgent ED visits, ambulatory care sensitive hospital admissions, hospital readmissions within 30 days and follow up in primary care within 7 days after hospital discharge. The structural elements of most interest for integration include the type of governance model, the presence and composition of the inter-professional teams, use of telephone consultation codes, use of specialist sessional fees, and participation in Health Links.
Objective 4: Keeping Ontarians Healthy Through Alignment of Care with Population Needs Research Questions
What attributes of primary care use and availability are related to health status outcomes across the spectrum of socio-demographic characteristics of Ontarians? Is Ontario's PC aligned with population need? What have been the unintended consequences of the reform strategies for equity? We will consider whether PC is equitable, and responsive and aligned to needs for practice patients and for local communities.
For more information, please contact Dr. Michael Green (Co-Lead), or visit the PHC Research Network web site
Using Population-Level Data to Inform Policy and Practice
FORGE AHEAD: Community-driven Innovations and Strategic Scale-up Toolkits
In Canada, significant disparities between the health status of Indigenous peoples and the general population exist, particularly for chronic diseases such as diabetes. There is a pressing need to shift the present episodic care focus common to most First Nations communities, to one that integrates prevention and management of chronic disease care.
The overarching goal of the TransFORmation of IndiGEnous PrimAry HEAlthcare Delivery (FORGE AHEAD) research program is to develop and evaluate community-driven primary healthcare delivery models that enhance chronic disease management with appropriate access to available services in First Nations communities. The program will use a participatory research approach that honors and reflects the communities' involvement as full partners. Type 2 diabetes mellitus will be the chronic disease targeted.
The activities in FORGE AHEAD are linked to the Expanded Chronic Care Model which describes the inter-relationships of individual, community, population and health system factors in chronic disease prevention and care. The projects within FORGE AHEAD include measuring community and healthcare provider readiness to change, supporting and integrating prevention activities within the community, developing community capacity for quality improvement activities and evaluating community-driven strategies to improve the quality of diabetes care. The program will produce a tool-kit of tested strategies that can be successfully implemented, sustained and used for other chronic diseases in First Nations communities in Canada.
For more information, please contact Dr. Michael Green (Co-Investigator)
In Canada, approximately 5% of the population incurs 66% of the total healthcare costs. These “high-cost” users tend to be elderly patients with multiple chronic conditions and low sociodemographic status, who experience fragmented care and system inefficiencies. Numerous jurisdictions, including Canada, have implemented Coordinated Care Plans (CCPs) to support “high cost” users with healthcare system navigation and to influence social determinants of health. CCPs provide patients with early assistance in transitioning between care providers (hospitals, rehabilitation centres, primary care providers) and follow-up care and may improve system level performance by reducing service gaps for complex patients, reducing hospital admissions/ readmissions, increasing communication within and between patients and providers, and increasing patient and provider satisfaction.
The recent overhaul of the regional health agencies system makes it a critical time to evaluation what has been working well for the community and what gaps persist, in order to inform policy decision-making.
For more information, please contact Dr. Ana Johnson (Co-Investigator)
Disability Policy, Models of Care, and Knowledge Translation Supporting Canada's Vulnerable Populations
Dr. Heather Stuart Re-Appointed to Second Five-Year Term
On January 24, 2017, Bell Let's Talk announced a $1 million gift to Queen’s to renew the Bell Canada Mental Health and Anti-Stigma Research Chair; Dr. Heather Stuart has been reappointed to the position for another five-year term.
“I am extremely grateful for the support of Bell Let’s Talk and Queen’s and I look forward to continuing my work with partner organizations to develop and evaluate mental health best practices,” Dr. Stuart says.
More Information: Queen's, Bell Let's Talk renew commitment to mental health research
Bell Let's Talk Establishes Mental Health Research Initiative
at Queen's University
Dr. Heather Stuart is a Senior Consultant for the Mental Health Commission of Canada (MHCC) Opening Minds Anti-Stigma Initiative.
"Opening minds is the largest systematic effort in Canadian history focused on reducing stigma related to mental illness. Established by the MHCC in 2009, it seeks to change Canadians’ behaviours and attitudes toward people living with mental illness to ensure they are treated fairly and as full citizens with opportunities to contribute to society like anyone else."
Capacity Building in Health Services and Policy Research
Dr. Ana Johnson is leading a prospective observational cohort study of patients presenting warfarin or NOAC-related bleeds at four tertiary referral entres in Ontario between 2010 and 2015, using electronic medical records, hospital blood bank registries and linked administrative databases.
The study’s uniqueness lies in its outcomes – while there are many studies looking at factors that predispose individuals to risk of anticoagulation associated bleeding, few have evaluated predictors of outcome once patients are presented at hospital with a bleed. There is a dearth of resource utilisation and cost information related to treatment of anticoagulant-associated bleeding in the real-world setting, though expensive blood products are advocated for treatment of these haemorrhages.