CIHR Institute of Health Services and Policy Research UBC CHSPR - PowerPoint PPT Presentation

The Science of Performance Measurement: Next Frontiers in Research Robyn Tamblyn Scientific Director CIHR Institute of Health Services and Policy Research UBC CHSPR Conference: Performance Anxiety February 25, 2014

2 Society’s Expectations Contribution Of Health Research Optimal Course Health Status Possible for Condition X, Y Effect of Health care Adverse effects of treatment Natural Course Time

3 Best Case Scenario: Optimal Course with Low Variability in Outcomes for Equivalent Resources Optimal Course Possible Health Status High performing system Natural Course Time

4 Poorly Performing System: High Variability in Expected Output for Equivalent Resources Optimal Course Possible Health Status Great, Good, No Impact, Unsafe Natural Course Time

5 Moving the Dial on Health: Early Wins Focus on Common Problems with Big Intervention Effects Targets for Biomedical/ Social/ Targets for Health System/ Epigenetic Discovery Provider Performance Optimal Course Health Status Effect of Health Status Health care Optimal Course Adverse effects Adverse effects , of treatment of treatment Natural Natural Course Course Time Time

What’s In the Secret Sauce to 6 Op Optimi timize ze Sy Syst stem em Per erforma ormance nce Measurement, Feedback, Incentives Effective Organization of Interventions People, Programs, Policies to Deliver Effective Interventions

7 Towards Evidence-Based Policies, Programs, & Interventions Health Policies Programs Interventions

8 Non-Evidence-Based Quality Process Measures Can Cause Harm Health Policies Programs Infant Positioning  SIDS Hormone Replacement  MI/Stroke O2 for Premies  Retrolental Fibroplasia Interventions

9 Towards Evidence-Based Policies & Programs Health Policies Weak Links Programs Interventions

10 Impr proving ing Acce cess ss to P Pri rimary mary Care re Case study: Primary health care reform in Ontario • ~$1B/year for patient rostering, interdisciplinary care teams, blended payment models, bonus payments and incentives (for screening, prevention, etc.) • penalty for utilization outside the group practice • The result? Glazier et al. All the Right Intentions but Few of the Desired Results: Lessons on Access to Primary Care from Ontario's Patient Enrolment Models. Healthcare Quarterly 2012; 15(3)

No Change ge In Access ss to Primary mary Care or ED Use 11 Are there Missin ssing g Ingred edients? ients? Are these se Process ess Measu sures res Approp opriate riate? “Many patients continue to be without timely access to care, and the use of walk-in clinics and emergency departments remains high… the details of how incentives are structured matters .” Glazier et al. All the Right Intentions but Few of the Desired Results: Lessons on Access to Primary Care from Ontario's Patient Enrolment Models. Healthcare Quarterly 2012; 15(3)

12 Restructuring the Care Team: Reduction in Mortality/Disability with Stroke Programs vs tPA 0 0 Absolute Reduction in Mortality/ Disability 0 BETT WORSE BETTER WORSE BETTER 15.8% 4.9% tPA vs. Usual Care Stroke Units vs. Usual Care New Protocol for Stroke Mortality, Systematic Review tPA: Cochrane, 2010 Disability. Gandey, A. (2011). Lancet.

Re-Designing Pre-Hospital Emergency 13 Care • “The Golden Hour” • Improved survival in trauma cases • Trained healthcare professionals to work specifically in emergency medical situations – Ex: Paramedics 13

14 Impact of Re-Designing Pre-Hospital Care in Trauma Cases Patients were more likely to survive when their life-threatening events were managed in the pre-hospital phase. The importance of pre-trauma centre treatment of life-threatening events on the mortality of patients transferred with severe trauma. Gomes et al., 2010. 14

15 Re-engineering the Continuum of Care for Hip and Knee Replacement Primary Care Pre-surgery Surgery Post-surgery & Referral -Referral template -Centralize intake -Standard treatment -Surgeon access -Standardize rehab -Dedicated OR team -Case manager - -Monitor outcomes -Benchmark/monitor Benchmark/monitor -Patient buddies 38 Change in WOMAC Arthritis Index 37.5 37 36.5 36 35.5 35 34.5 34 33.5 33 Intervention Control The Alberta hip and knee replacement project: Comparative effectiveness of clinical pathways. Gooch, K.L. et al. (2009).

16 Raising ising the Bar: r: Ne New Ge Gener eration ation Learning rning Health lth Care re Sy System em The Learning Health System Optimal Course Health Status Possible for Condition X, Y Effect of Health care Adverse effects of treatment Natural Course Time

17 The he Lear arning ning Heal alth th Sys ystem: tem: Tac ackli ling ng the he Tou ough gh Pop opulations lations ’ Representative timeline of a patient’s experience in the health care system Policy LEADERSHIP CITIZEN ENGAGEMENT International Evidence – on – the - comparisons Go Analytics Source: Best care at lower cost: the path to continuously learning health care in America. Institute of Medicine, 2012

18 Changing the Health Systems Research Paradigm by Building the Living Laboratory: PCORI Clinical Data Research Networks (CDRNs) : system- based networks that originate in healthcare systems, such as hospitals, health plans, or practice-based networks, and securely collect health information during the routine course of patient care Patient-Powered Research Networks (PPRNs): networks operated and governed by groups of patients and their partners and are focused on a particular condition and interested in sharing health information and participating in research

19 LEGEND The Canadian Audas Liddy Innovation Teams in Grunfeld Ploeg Community-Based Harris Stewart Kaczorowski Wodchis Primary Care Katz Wong Haggerty Young Accessing child/youth mental health services Transforming PHC Community-based PHC for in First Nations & approaches for persons living rural/remote older adults and with HIV/AIDs communities their caregivers Community- Chronic disease based cancer awareness & Transforming care along the management Indigenous continuum PHC delivery Patient-centred Organisational Performance innovations for innovations to improve measurement persons with access to PHC for & reporting multimorbidity vulnerable groups Transforming Improving PHC for PHC in the older adults with remote North complex care needs

20 Spotlight otlight: Tran ansform sforming ing Comm mmunity nity-Based Based Prim imary ary Car are deli live very ry thr hrough ough performance formance meas asur urement ement We will help make Canada a leader Canadian NPI : Sabrina Wong in evaluating the effectiveness of (University of British Columbia) CBPHC innovations. Funding Partners : CIHR & MSFHR The challenge : A comprehensive performance portrait of primary health care in Canada is lacking, and comparisons across jurisdictions are challenging. The goal : Demonstrate the feasibility and usefulness of comparative and comprehensive CBPHC performance measurement and reporting in three provinces as a foundation to inform innovation in the delivery and organization of the Canadian CBPHC system.

21 Underst rstanding nding Attribut butes es of Contex ext, , Organiz nizatio tion n & Researc search h In Invest estment ment wi with th a C Commo mmon n Set t of In Indicators ators CBPHC Innovation Teams are working together to identify and report on a common set of context and outcome indicators (in domain areas like access, health outcomes, equity, cost). Why: • To understand the impact of different models of CBPHC on (1) access to care for vulnerable populations and (2) chronic disease prevention and management • To understand how structures (e.g., governance, financing) and context influence the success of PHC models of care How: • Working group chaired by Dr. Sabrina Wong. Each team earmarked $50K annually to support the common set of indicators.

SPOR OR Net etwo work rk of N f Net etwo works rks in in Pr Prim imary ary 22 and an d In Inte tegrated ated He Heal alth th Ca Care e In Inno novations ations Yukon Support NWT Unit Support Unit Network Network Yukon Coordinating Leadership Council NWT Network Centre Network Nunavut Network Nunavut BC Support Newfoundland Network Unit SK AB and Labrador Network Network Support Unit MB BC Network Newfoundland Support SK NB and Labrador AB Unit Support Network ON Network Support MB QC Unit Network Unit Support Network Maritimes PEI Unit Support Network ON QC Unit Support Support Unit NS Unit Network Network of Networks in Primary and Integrated Health Care Innovations

23 Thank ank you ou Robyn Tamblyn Scientific Director CIHR Institute of Health Services and Policy Research rtamblyn.ihspr@mcgill.ca