action communicate actionengagement evidence looking at ... · o level of demand for health care...
TRANSCRIPT
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Looking at the Future of Clinical Health Care Services
Robyn Tamblyn, BScN, MSc, PhD Scientific Director, CIHR Institute of Health Services and Policy Research
Professor, Department of Medicine & Department of Epidemiology, Biostatistics and Occupational Health
Linkage
Evidence
Interact
Learn Knowledge
Polic
y
Engagement Action Evidence Communicate
Learn Collaborate
Renewal Healthcare Share
Action
Share Healthcare
Renewal Policy
Change
Inte
ract
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The Context Chronic disease and the aging population Health care spending Cost drivers and optimizing return on investment (ROI)
Clinical Program Redesign Examples of high impact redesign The Secret Sauce – Mobilizing key assets
Towards a Learning Health System Emerging models The Canadian approach
Overview
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Population Health Challenges
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Squires D, The US Health System in Perspective: A Comparison of Twelve Industrialized Nations, Issues in International Health Policy, 2011
Ho
spit
al a
dm
issi
on
s p
er 1
00
,00
0 p
op
.
Comparison of Hospitalization Rates for Ambulatory Sensitive Conditions, 2007
0
50
100
150
200
250
300
350
400
450
500
Asthma Chronic obstructivepulmonary disease
Congestive heartfailure
Hypertension Diabetes
Canada
Sweden
Denmark
Netherlands
Norway
Switzerland
United Kingdom
United States
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0
1000
2000
3000
4000
5000
6000
7000
8000
9000
1980 1984 1988 1992 1996 2000 2004 2008
US ($8,233)
NOR ($5,388)
SWIZ ($5,270)
NETH ($5,056)
DEN ($4,464)
CAN ($4,445)
GER ($4,338)
FR ($3,974)
SWE ($3,758)
AUS ($3,670)*
UK ($3,433)
JPN ($3,035)*
NZ ($3,022)
Source: OECD Health Data 2012.
Do
llars
($
US)
THE COMMONWEALTH
FUND * 2009
Average Health Care Spending per Capita, 1980-2010
(Adjusted for Differences in Cost of Living)
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CIHI. 2011. Macro-Level Health Care Cost Drivers. January
2.8%
1.0%
0.8%
2.8%
0.0%
1.0%
2.0%
3.0%
4.0%
5.0%
6.0%
7.0%
8.0%
Other
Aging
Population Growth
General Inflation
7.4% New technologies
Broader coverage
Average Annual Growth Rate, Public Health Care Spending, Canada, 1998-2008
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The Top Cost Drivers in Sweden
Population Aging
o Older people account for a large proportion of health care spending
o Level of demand for health care will come to exceed the capacity of health systems to meet it
Innovation in Health Technology
o New innovations are costly
o New technologies, even if substituting for an older technology, are normally more expensive
o Increased use of technologies leads to higher cost
o If older people are the principal beneficiaries of these innovations, the cost problems is compounded
Thomson S et al., Financing Health Care in the European Union, Challenges and policy responses
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Provided $5/day daycare for a year for 14.6 million children
0
1000
2000
3000
4000
1980 1984 1988 1992 1996 2000 2004 2008
Canada
UK
Cumulative Difference in Health
Spending between Canada and the UK 1980-2010
$659 billion
Average Health Care Spending per Person
With $659 billion we could have:
Sent 23.5 million students to university for 4 years
Built 9,171 Trans-Canada highways
Health Spending & Opportunity Costs
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Innovation in the Health System
Interventions
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Interventions
Health Policies
Programs
Innovation in the Health System
Health Technology Assessment
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New Technologies When Not Used as Planned Off-label Prescribing & Adverse Drug Events
Eguale T et al., Arch Intern Med, 2012
No. of Prescriptions Off-label Use, No. (%)
Central nervous system 58 914 15 491 (26.3)
Anti-infective 21 000 3599 (17.1)
Ear-nose-throat 10 622 1613 (15.2)
Gastrointestinal 14 237 1770 (12.4)
Antineoplastic 234 28 (12)
Distribution of Off-label Use by Therapeutic Class
Cumulative Hazards of Adverse Drug Events According to On-label and Off-label Use
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Diagnostic Imaging Utilization: MRI
Chung M et al., Emerging MRI Technologies for Imaging Musculoskeletal Disorders Under Loading Stress, 2011
20
40
60
80
100
MR
I sca
n p
er
10
00
po
pu
lati
on
1995 2000 2005 2010 Year
USA
Belgium Luxemburg
France
Canada
Denmark
Australia
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Choosing Wisely
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Clinical Care Redesign
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High Impact Clinical Redesign
4 Case Studies:
• Organized stroke care
• Pre-hospital emergency care
• Pre-term birth (elective labour)
• Hip and knee surgery
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Annual Number of Strokes, Sweden
0
5000
10000
15000
20000
25000
30000
1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Strokes Registered in Sweden by the Riks-Stroke Registry
Riks-Stroke Registry website, 2013
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Re-organizing the Care of Acute Strikes: Stroke Units
Five year follow up of a randomized controlled trial of a stroke rehabilitation unit. Lincoln et al., 2000.
At 5 years: 45% of patients on stroke unit had died compared to 55% in conventional unit
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Reduction in Mortality/Disability with Stroke Programs vs tPA
Systematic Review tPA: Cochrane, 2010
0 0
0
BETT
Stroke Units vs. Usual Care tPA vs. Usual Care
15.8%
New Protocol for Stroke Mortality,
Disability. Gandey, A. (2011). Lancet.
4.9%
Absolute Reduction in
Mortality/ Disability
WORSE BETTER WORSE BETTER
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Re-Designing Pre-Hospital Emergency Care
• “The Golden Hour”
• Improved survival in trauma cases
• Trained healthcare professionals to work specifically in emergency medical situations
– Ex: Paramedics
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Impact of Re-Designing Pre-Hospital Care in Trauma Cases
The importance of pre-trauma centre treatment of life-threatening events on the mortality of patients transferred with severe trauma. Gomes et al., 2010.
Patients were more likely to survive when their life-threatening events were managed in the pre-hospital phase.
0
0.2
0.4
0.6
0.8
Cu
m S
urv
ival
0 100 200 300 Length of stay
1.0
400
Pre-hospital
First Hospital
Trauma Center
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1%
42%
5%
64%
10%
76%
50%
97%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Ontario Population Health Expenditure
$6,397
$1,848
$998
$106
Expenditure
Threshold (2007
Dollars)
Wodchis et al, ICES, 2012 CAHSPR Conference
Within different age groups, the concentration of health care costs is highest for children (aged 0-17 years), with the top 1% of the population accounting for 42% of spending in this
age group.
Pre-Term Birth & Downstream High System Use in Children
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Intermountain Healthcare: Elective Labour
Target for improvement: induction of early labour 32,000 deliveries each year Nurse required to fill out form to determine if
elective induction is appropriate If not, the chair of the department has to give
consent
James BC. Health Affairs, 2011
Results: Elective inductions that did
not meet clinical standards dropped from 28% to 2%
Collective length of time in labour dropped by 31 days
1,500 additional deliveries each year (without any additional beds or nurses)
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The New Care Path for Hip and Knee Replacements
Alberta Hip& Knee Joint Replacement Projects, Evaluation Report
Primary Care & Referral
-Referral template
-Surgeon access
-Benchmark/monitor
Surgery Post-surgery
-Standard treatment
-Dedicated OR team
-Benchmark/monitor
-Standardize rehab
-Monitor outcomes
Pre-surgery
-Centralize intake
-Case manager
-Patient buddies
WAIT TIMES COST POST SURGICAL QUALITY OF LIFE
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0
100
200
300
400
500
New Care Path Control
Wait Time
95
100
105
110
115
120
125
New Care Path Control
Time in the Operating Room
0
5
10
15
20
New Care Path Control
Institutional Stay
33
34
35
36
37
38
New Care Path Control
Quality of Life
Alberta Hip& Knee Joint Replacement Projects, Evaluation Report Gooch KL et al., Osteoarthritis Cartilage, 2012
Nu
mb
er o
f D
ays
Nu
mb
er o
f D
ays
Nu
mb
er o
f M
inu
tes
Ch
ange
in W
OM
AC
A
rth
riti
s In
dex
Improved Outcomes Using the New Care Path
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Reduced Cost Using the New Care Path
0
50000
100000
150000
200000
250000
300000
350000
400000
450000
Do
llars
(in
10
00
)
Total cost
Over 21 million saved in a year!
Alberta Hip& Knee Joint Replacement Projects, Evaluation Report Gooch KL et al., Osteoarthritis Cartilage, 2012
Cost per case
$9447
$9976
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eHealth solutions
Healthcare professionals
Data
Patients Policies and
systems
Transforming Clinical Programs Capitalizing on the Assets
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Educational attainment for workers 25 years and older by detailed occupation, Bureau of Labor Statistics
Frontline Healthcare Professionals Have the Highest Education Level
Year
s o
f Ed
uca
tio
n
Health care professionals Banking professionals Police Force
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Training Professionals for Practice-based Learning and Improvement Systems
Core competencies of physician leaders
• Leadership
• Strategic planning
• “Systems thinking”
• Change management
• Persuasive communication – Including negotiation and
conflict resolution
• Team building Partnership: CNA-CMA-CCHL-QC Consortium
See: www.cfhi-fcass.ca Denis JL et al., Physician Engagement and Leadership for Health System
Improvement, CIHR webinar
The EXTRA Program
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Data Assets and Analytics
REAL-TIME MONITORING, ANALYTICS, AND FEEDBACK
ELECTRONIC HEALTH
RECORDS
Social Networks
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Beneficiary Demographics
Name, age, sex, residence [income, education], death
Medical Services
Prescriptions
Date, Provider Location (e.g. ER), Diagnosis (icd9)
Procedure (hip fx repair)
Date, Provider Drug
Quantity Duration
Unique ID
Unique ID
Using Administrative Medical Service and Prescribing Claims Data to Monitor Care Delivery
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Weekend Visit Family Medicine
UTI Long Term Care
Hospital admission
and hip fracture repair
ER Visit for Hip
Fracture
Dilantin dispensed 800
mg /day
Hospital admission
Hemorrhagic Stroke
ER Visit Hemiplegia
Consult Visit Rheumatologist Osteoarthritis
Followup Visit
Internal Medicine Diabetes
Coumadin Diltiazam Digoxin
Glyburide Ciprofloxacin
Celebrex 400 mg/day
Female
Age: 71 yrs.
Creating Longitudinal Health Histories with Administrative Data
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1.3
1.4
1.5
1.6
1.7
1.8
1.9
2.0
2.1
Janvier-94 Juillet-96 Juillet-97 Juillet-97
Phase I Phase II Phase III
Ancien régime Nouveau régime
Médicaments essentiels
Observée
Prédite
5% 10%12%
Nom
bre
de
méd
icam
ents
par
jou
r
1.3
1.4
1.5
1.6
1.7
1.8
1.9
2.0
2.1
Janvier-94 Juillet-96 Juillet-97 Juillet-97
Phase I Phase II Phase III
Ancien régime Nouveau régime
Médicaments essentiels
Observée
Prédite
5% 10%12%
Nom
bre
de
méd
icam
ents
par
jou
r
Tamblyn R et al., JAMA, 2001
Assessing Drug Policy: User Fees Reduce the Use of Essential Drugs in the Elderly
Evaluation of the Quebec income-indexed user co-insurance plan for prescription drugs in a random sample of 120,000 elderly
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Creating regional data platforms: The ICES Effect
74
175
59
119
0
20
40
60
80
100
120
140
160
180
200
2006/07 2012/13
Nu
mb
er
of
Scie
nti
sts
an
d
Researc
h S
taff
Fiscal Year
Scientists
Research Staff
Research Capacity: Growth in ICES Scientists and Research Staff (2006/07-2012/13)
0
50
100
150
200
250
300
350
400
0
50
100
150
200
250
300
350
400
FY 2008/09 FY 2009/10 FY 2010/11 FY 2011/12 FY 2012/13
New
Pro
jects
(d
ash
ed
lin
e)
Nu
mb
er
of
Peer-
Rev
iew
ed
P
ub
licati
on
s (
bars
)
Publication Year The quality, quantity, research capacity building
and impact of ICES work, 2013
ICES Publications and New Projects (2008/09-2012/13)
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SN Murphy http://researchit.uchc.edu/resources/ResearchRepository.pdf
Partners Clinical Research & Performance Monitoring Warehouse
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Partners Clinical Research & Performance Monitoring Warehouse
Murphy SN et al., AMIA Annu Symp Proc, 2003
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The Clinical Case Registry Model
EMR EMR EMR EMR
CCR: Nightly Screens for ICD9, lab values, drugs=clinical case definition(s)
Clinical Case transmission to
Central
Local Reports
Text Parsing and Data Cleaning
National and Comparative Data Analysis and Quality Reports
Backus et al., JAMIA, 2009
Example: HIV and HCV Care
New Advances in using Distributed Electronic Medical Records: U.S. Veteran`s Affairs
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Jick H et al., Br J Gen Pract, 2004
Monitoring the Incidence and Prevalence of Attention Deficit Disorder using the GPRD EMR
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Provide person-specific decision support to reduce morbidity.
• Fully integrated patient monitoring solution
• Continuous real-time vital sign and motion information
• Timely alerts for early detection
New Technologies and Predictive Models are Being Used to Detect Deterioration in Health Status
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Tamblyn R et al., J Am Med Inform Assoc., 2012
Tamblyn R et al., J Am Med Inform Assoc., 2012
Designing New Smart Alerts that Provide Person-Specific Risk Assessment
nmhazardnmrisk baseline _^11*100_100
lw*0.0023- ci*0.287
gb*0.123 female *0.047 age_65*0.038_ EXPnmhazard
class_23*0.07 class_18*0.147
class_17*0.047 class_16*0.099
class_15*0.106 class_13*0.008
class_11*0.056 class_9*0.225
class_7*0.088 class_6*0.088
class_5*0.105 class_4*0.253
class_3*0.035 class_2*0.304
*__ EXPnmhazardtotalhazard
totalhazardtotalrisk baseline _^11*100_100
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Providing Immediate Feedback on the Consequences of a Change in Medication
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epidemic curve
Potential of Digital Disease Detection
SMS Messaging
Micro Blogging
Emailing
Internet Searching
Social Networking
Internet Chatting
Blogging
Online News Reporting
Video/Radio Reporting
Health Expert Reporting
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0
50
100
150
200
1996 2000 2004 2008
Number of days from outbreak start to outbreak discovery
Year of Outbreak Start
Tim
e in
Day
s
20 in 2010
days
167 in 1996
days
Chan et al. 2010. Proceedings of the National Academy of Sciences.
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HealthMap identified a new pattern of respiratory illness in Mexico in
2009 well before public-health officials realized a new influenza
pandemic was emerging
Real-Time Population Monitoring
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Tracking Obesity with Facebook
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Patients and Families Experience-based co-design
King’s Fund (UK) – 2013: Experience-based co-design toolkit Working with patients to improve health care This toolkit outlines a powerful and proven way of improving patients' experience of services, and helps you to understand how it can help you meet your aims. A 2013 global survey discovered that EBCD projects had either been implemented, or were being planned in more than 60 health care organisations, in countries including Australia, Canada, England, the Netherlands, New Zealand, Sweden, and the United States.
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Healthtalkonline (UK)
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Healthexperiences.ca
XDataData
Caregiving module: 35-50 in-depth semi-structured interviews Maximum variation sample; at home or place of convenience
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Experiential evidence for system change
http://healthexperiences.ca/en/
http://www.youtube.com/watch?feature=player_embedded&v=RGb8AhDpb1w
Drew – on experiences with the healthcare system caring for his mother (since he was 5 yrs old).
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The Result? Representative timeline of a patient’s ex p eriences
in the U.S. health care system Representative timeline of a patient’s experience in the health care system
Source: Best care at lower cost: the path to continuously learning health care in America. Institute of Medicine, 2012
Analytics
Evidence – on – the - Go
A Continuously Learning Health Care System
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Greene SM et al., Ann Intern Med, 2012
Implementing the Learning Healthcare System: Group Health Cooperative
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International Learning System: Variations in NICU Outcomes
Richardson DK et al., J Pediatr, 2001
Canadian Network
Kaiser Permanente
New England
No. died/No. total 418/10 819 (3.9%) 117/5 530 (2.1%) 231/3 492 (6.6%)
Birth weight
˂750 g 387 (3.6%) 85 (1.5%) 321 (9.2%)
750-999 g 501 (4.6%) 138 (2.5%) 372 (10.7%)
1000-1499 g 1267 (11.7%) 373 (6.7%) 898 (25.7%)
1500-2499 g 3755 (34.7%) 1712 (31%) 963 (27.6%)
≥2500 g 4909 (45.4%) 3222 (53.3%) 938 (26.9%)
Characteristics of Birth Weight and Mortality in Participating NICU Networks
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-National Strategy, Provincial
Execution
-Cancer Services uniquely organized
in Most provinces (special envelope)
-Conservative technology/drug
approval
-Modest Spending Growth
-100% Physician/Hospital Coverage
Variable Drug + Community Services
-Ontario: 13.5 million; 1.1 million sq.
KMs; 14 regional cancer programs
Organizational Context & Performance Initiatives in Cancer Services in Canada
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54
Ministry of Health and Long-term Care
Cancer Care Ontario
Regional Cancer
Centre
LHIN 1
Regional Cancer
Centre
LHIN 2
Regional
Cancer Centre
LHIN 3….
Regional
Cancer Centre
LHIN 14
Cancer
Quality
Council of
Ontario
Other regional cancer
providers
Other regional cancer
providers
Other regional cancer
providers
Other regional cancer
providers
Annual jurisdiction wide
performance
measurement &
monitoring and public
reporting: CSQI
~ 30% of
expenditures
~ 70% of
expenditures
Mission: To improve the performance of the cancer system by driving
quality, accountability and innovation in all cancer-related services
Cancer Care Ontario: Delivery at a Glance
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55
Program in
Evidence-Based
Care Breast DSG
More DSGs
Lung DSG
Clinical Council
Pre
ven
tion
Scre
en
ing
Rad
iatio
n
Pallia
tive C
are
Mo
re P
rog
ram
s
Clinical Accountability Structures (cont.)
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1. Data/Information
• Incidence, mortality, survival
• Analysis
• Indicator development
• Expert input
2. Knowledge
• Research production
• Evidence-based guidelines
• Policy analysis
• Planning
3.Transfer
• Publications
• Practice leaders engaged
• Policy advice
• Public reporting
• Technology tools
• Process innovation
4. Performance Management
• Institutional agreements
• Quarterly review
• Quality–linked funding
• Clinical accountability
Horizon-scanning
and championing
innovation
Identifying quality
improvement opportunities
Standardizing
development
and guidelines
Developing and
implementing
improvement
strategies
Monitoring
performance
Clinicians Engaged in All Components of Performance Improvement Cycle
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The Patient Journey IM Tools Instrument the Disease Journey
Symptom Management
Robust data systems
Recovery/
Survivorship
Structured care plans
In Screen
Integrated
Cancer Screening
Diagnostic
Assessment
Programs
Wait Times
Computerized
Physician Order
Entry
Multi-disciplinary
Case Conferences
Stage Capture
Quality Indicators
Risk factor
surveillance
2010 Annual General Meeting 57
Supported by IM/IT
Disease Pathway Management
Cancer System Quality Index
Regional/Corporate Scorecard
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Cancer Quality Council of Ontario
Overall CSQI 2012 Summary
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CSQI results by quality dimension: Effective
11/26/2
013 Cancer Quality Council of Ontario
5
9
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Cancer survival in Ontario ranks among best in the world
December 21, 2010 Megan Ogilvie Toronto Star
Cancer survival in Australia, Canada, Denmark, Norway, Sweden, and
the UK, 1995–2007 (the International Cancer Benchmarking
Partnership): an analysis of population-based cancer registry data
Coleman et al The Lancet - 8 January 2011 ( Vol. 377, Issue 9760, Pages
127-138
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Häkkinen U et al., Health Policy, 2013
Sweden
Scotland
Norway
Netherlands
Hungary
Finland
International Learning System: Comparing Health System Performance Across Europe
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The Result? Representative timeline of a patient’s ex p eriences
in the U.S. health care system Representative timeline of a patient’s experience in the health care system
Source: Best care at lower cost: the path to continuously learning health care in America. Institute of Medicine, 2012
Analytics
Evidence – on – the - Go
Policy
LEADERSHIP CITIZEN ENGAGEMENT
A Continuously Learning Health Care System
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63
Provincial Learning Networks
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Alberta Specialty Clinic Networks
Obesity,
Diabetes &
Nutrition
SCN
Bone & Joint
SCN
Surgery
OCN
Emergency
OCN
Addiction &
Mental Health
SCN
Cardiovascular
Health and
Stroke
SCN
Insulin
Pump
criteria
Rural Stroke
Program
Vascular
Risk
Reduction
C-CHANGE
Enhancing
recovery after
surgery
ART
E-referral
Fragility &
Stability -
Hip Fracture
Rx and
prevention
Inappropriate
use of
antipsychotic
Cancer
SCN
Critical Care
OCN
Seniors’
Health
SCN
Depression
Pathway
Safe
Surgery
Checklist
aCATS
TBD TBD
Hip & Knee
5 year Plan
Lung
Cancer
Elder Friendly
Care*
Select Priorities for Improvement
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The Launch of Canada’s National Learning Networks: The Strategy for Patient-Oriented Research
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Network of Networks in Primary and Integrated Health Care Innovations
AB
Network
SK
Network MB
Network
ON
Network QC
Network Maritimes
Data
Platform
Newfoundland
and Labrador
Data Platform BC
Data
Platform
Network of Networks in Primary and Integrated Health Care Innovations
BC
Network
AB Data
Platform
SK Data
Platform MB
Data
Platform
ON Data
Platform QC Data
Platform NS
Network
Atlantic
Network
Network Leadership Council
(Clinical, Science & Policy
Leads)
Network Coordinating Centre
(KT, Communications, Training) NWT
Network
Nunavut
Network
Yukon
Network
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1%
34%
5%
66%
10%
79%
50%
99%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Ontario Population Health Expenditure
Health Care Cost Concentration: Distribution of Health expenditure for ON, 2007
$33,335
$6,21
$3,04
$181
Expenditure
Threshold
(2007 Dollars)
On average, health care spending is highly concentrated, with
the top 5% of the population (ranked by cost) accounting for
66% of expenditure Source: Wodchis et al, ICES, 2012 CAHSPR Conference
High System Users
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68
Network Objectives
1
• Create cross-jurisdictional opportunities to conduct research on the comparative efficiency, cost-effectiveness and scalability of innovative and integrated models of care that build on the foundations of CBPHC and facilitate transitions into and along the care continuum.
2
• Accelerate the timely investigation of new interventions and approaches in primary and integrated care across multiple jurisdictions and sectors.
3
• Catalyze research on and scale-up of cost-effective and innovative approaches to primary and integrated health care delivery.
4
• Support capacity building among researchers, clinicians, decision-makers and citizens/patients/families for timely generation and use of primary and integrated health care knowledge.
5
• Foster the exchange of information and evidence on successful and unsuccessful interventions and innovative models of primary and integrated health care across jurisdictions to inform policy development.
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Network Membership Requirements
1 • Tri-partite leadership (science, policy, clinical)
2
• Strategic scope: (1) individuals with complex care needs across the life course, showing capacity to evolve the network's scope over time to include age groups from children to older adults; and (2) multi-sector integration of upstream prevention strategies and care delivery models
3
• Engagement of Key Stakeholders across the care continuum in primary and integrated care re-design
4 • Citizen/patient/family engagement
5
• Capacity for rapid monitoring, evaluation, feedback (linkages with SUPPORT Units)
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6
• University partnerships to develop primary and integrated health care research capacity
7
• Capacity to implement and evaluate e-Health solutions that could improve the cost-effectiveness of care delivery
8 • Geographic scope: Coverage of practices and patients
9 • Linkage to CBPHC Innovation Teams
10
• Partnership funding (1:1 for infrastructure award and research priorities)
Network Membership Requirements
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Network Funders’ Consortium
Network Leadership Council
Member network: A
Member network: B
Member network: C
Co-investment and cross-jurisdictional collaboration: Member networks A, B and C collaborate. A invests $400K to lead comparative cost-effectiveness of the different interventions; B invests $350K to examine transitions in care and avoidable hospitalizations; C invests $250K to examine patient experience and patient-reported outcomes.
Peer review and funding: Network management office coordinates assessment of research protocol. Upon approval, CIHR matches funding on 1:1 basis with member networks ($1M) for a total overall budget of $2M
Network: Entire Network (including all member networks) benefits from findings shared through Leadership Council interactions, Coordinating Centre, and annual Network forums
Priority setting: for example: •New models of home care for older adults (assessing the comparative cost-effectiveness of the different models for managing older adults with multiple chronic conditions to reduce nursing home placement and avoidable hospitalizations and foster transitions across care )
Fostering Cross-jurisdictional Priority-setting and Research
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In Summary…
• The key challenges in future health systems are to: • transform health care to prevent and manage chronic conditions • prudently incorporate and use new technologies
• There are no magic bullets
• Health systems that produce meaningful improvements in costs and outcomes: • Engage front line clinicians and patients in all parts of the process • Establish information systems that provide real-time monitoring of process
and outcome targets • Align strategic, organizational and clinical goals for ‘systems thinking’ • Optimize enablers and tackle policy-level barriers • Provide comparative performance data and support learning networks for
exchange
• Canada is experimenting with research/ health system partnering programs to engage producers and users of evidence in new ways for health care transformation