Advancing Access to Team-Based Care Executive Leadership Network Meeting – Oct. 29, 2019 Jennifer Rayner Walter Wodchis Elana Commisso Jennifer Im
Agenda 1. Introductions 2. Research Team Presentation 3. Participating Sites’ Presentation 4. Open Discussion / Q + A 2
Overview 1. Provincial and Regional Context 2. Overview of TeamCare 3. AATBC Research & Evaluation Framework 4. Preliminary Results 5. Early Lessons 6. Next Steps 3
Provincial Context Interprofessional New Team Proposals Implementation Existing Sites (SPiN, (expansion of sites with facilitator PCO, PINOT, etc) team-based care) (4 LHINs currently) 17/18, 18/19) Advancing Access to Team-Based Care 4
Local Design & Adaptation • Engage local stakeholders and end-users, including clients and providers, in defining, and planning for, change • Build on, and enhance, existing local competencies and capacity to support ongoing collaboration, integration and improvement • Co-design and test new operational practices and procedures that support meaningful collaboration • Use data to inform locally-defined change and improvement goals • Support alignment with existing initiatives at regional and sub-regional levels • Foster the development of local change champions, and communities of practice to support continued learning, communication and partnerships 5
Facilitation • Supporting change and bridging cultures • Facilitation helps build cross-boundary teams & communities of practice • Facilitation creates greater integration by bridging organizational cultures not changing them 6
TeamCare Process Population Health Patient Experience Provider Experience Costs 7
Access to Team-Based Care (w/o PCO) 2017 2018 2019 Total # of 8 20 27 27 participating sites Total # of new 465 5,004 15,240 20,709 clients Total # of 2,358 12,935 47,059 62,352 visits # of - - - 1,153 participating PCPs and NPs 8
Access to Team Care TeamCare Growth 2017-2019 50000 40000 30000 20000 10000 0 2017 2018 2019 (Q2) # of New Clients # of Visits 9
Access to Team-Based Care (w/ PCO) 2017 2018 2019 Total # of 13 24 29 29 participating sites Total # of new 1,713 5,315 15,371 20,709 clients Total # of 30,937 21,843 51,819 104,590 visits # of - - - 1,323 participating PCPs and NPs 10
Access to Team Care Access to TeamCare (including PCO sites) 120000 100000 80000 60000 40000 20000 0 2017 2018 2019(Q2) total # of New Clients # of Visits 11
Research & Evaluation 12
AATBC Research & Evaluation Program • Purpose : to evaluate new locally-designed models of care collaboration/team-based care in diverse regional and sub-regional contexts across Ontario • Local context matters : • Each model is adapted to its context, capabilities of sites, primary care collaborators, and patient needs • Early results : • Provider Readiness, Team Climate • Patient Experience 13
Research and Evaluation Context 14
Quadruple Aim Framework 1) Patient Experience 2) Provider Experience 3) Population Health 4) Cost of Care TeamCare Service Access to Care Team Climate Utilization Primary & specialist Coordination Knowledge Management care Primary Care and Communication Leadership ED Use specialist visits Continuity Motivation Hospitalizations ED visits Post-Acute Care Quality of Life Relational Coordination Inpatient hospitalizations SDOH Normalization Post-Acute Care Total cost of care 15
Preliminary Results 16
Advancing Access to Team-Based Care 2017 2018 2019 Total # of 1 4 5 5 participating sites Total # of new 265 1560 3374 5199 clients Total # of 1178 4189 14709 20076 visits # of - - - 464 participating PCPs and NPs 17
Advancing Access to Team-Based Care AATBC Growth 2017 - 2019 16000 14000 12000 10000 8000 6000 4000 2000 0 2017 2018 2019 (Q2) Acess to TeamCare in AATBC # of New Clients # of Visits 18
Overview of Findings Type of Data Number of Participants Patient Experience • Surveys 2 sites; n = 38 • Interviews 1 site; n = 6 IP Team Provider Experience • Baseline Surveys 5 sites; n = 74 • Follow-up Surveys 2 sites; n = 22 • Focus groups / interviews 5 sites; n = 77 Primary Care Provider Experience • Baseline surveys 3 sites; n = 24 19
Primary Care Provider Motivation to Participate Motivation 100% 90% 80% 70% Strongly Disagree 60% Disagree 50% 40% Slightly Disagree 30% Neither Agree nor Disagree 20% Slightly Agree 10% Agree 0% Strongly Agree 1. Team-based 2. Team-based 3. Team-based 4. Team-based care fits well care helps us care is timely care fits well with other meet the needs given the needs with the culture programs in the of the patients. of the patients. and values of practice. the patients. 20
Normalization of Team-Based Care for PCPs 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 5. Staff at this primary care practice have a shared understanding of the purpose of the [program]. 6. I understand how the [program] affects the nature of my own work. 8. There are key people who drive the [program] forward and get others involved. 9. I believe that participating in the [program] is a legitimate part of my role. 15. Sufficient training is provided to enable staff to implement the [program]. 16. Sufficient resources are available to support the [program]. Strongly disagree Disagree Slightly agree Moderately agree Agree Strongly agree I Don’t Know 21
Interprofessional Team Readiness Team Climate (N=70) 100% Strongly 90% disagree 80% Disagree 70% 60% 50% Slightly agree 40% 30% 20% Moderately 10% agree 0% Strongly 1. We have a 'we 2. People keep each 3. People feel 4. There are real agree are in it together' other informed understood and attempts to share attitude. about work-related accepted by each information issues in the team. other. throughout the team. 22
Communication Q: Do [IP team members / PCPs] Q: How frequently do [IP team members communicate with you in a timely way / PCPs) communicate with you about about patients in the [program]? patients in team-care? 12 20 10 15 8 10 6 5 4 0 2 Much Too Too Often Just the Not Not Nearly 0 Often Right enough Enough Always Often Sometimes Rarely Never Amount Primary Care Providers Interprofession Team Primary Care Providers Interprofession Team 23
Patient Demographics Bachelor's Education Employment Status degree Other Graduate / 14% 6% Professional Patients n=38 14% Age Less than Unable to Retired high school work • Under 25 5 19% 5% 25% High School • 45-64 1 17% Unemployed 8% • 25-45 8 Employed College 42% • 65 and over 7 50% • Did not answer 3 Out-of-pocket spending on care in the Annual Household Income past 3 months Sex 3% • Female 14 0 50K + 13% Under 20K 35% 1-100 • Male 21 33% 35% 101-200 • Did not answer 3 19% 201-500 500+ 20-50K 32% 30% 24
Patient Demographics - SDoH 0 5 10 15 20 25 30 35 40 15. How often do you feel isolated from others? 16. How often do you feel left out? 17. How often do you feel that you lack companionship? 18. Do you ever worry about losing your home or place to live? 19. After paying your monthly bills, do you typically have enough money left for food each month? 20. Do you ever have difficulty making ends meet / paying your bills at the end of the month? Never Sometimes Usually Always 25
Being Heard Meeting Client’s Goals and Priorities (n=38) 100% 90% 80% 70% 60% 50% Totally 40% Mostly 30% 20% A little 10% No, not at all 0% 13. In the past 6 months, did 14. If yes, in the last 6 your health care team talk months, did the care you with you about your goals or received from your health priorities for your health? care team help you meet your goals or priorities? 26
Focus Group Findings 27
Team-Based Care: Wins “…we’re always working towards the best client- “… a phrase that [leader] uses all the time is culture by design … a big centered care , so no matter what debate or piece of that is who you're bringing in to be a part of your conversation we’re having it always comes back to organization , making sure they share those values and beliefs … the how do we – is this the best choice for the client , for “… a lot of freedom to try it on your own . Like “You think organization tries to provide a lot of opportunity for growth and when I the patient coming in and no matter what’s going on. this might work, this might be helpful? Go try it. Okay, what do say that I mean by like challenging peoples’ internalized beliefs already. We try to adapt our situation to fit what they need." you need from us?” That’s something you hear all the time is Like at our all-staff days we'll have presentations on trauma-informed “You like that idea? How can I support you in making that care or [IP team provider] will give some talks about how do you as a happen? Try it and then we’ll touch base and see how it’s caregiver or somebody in the caring profession care for yourself. So going.” So there’s a lot of openness around that kind of stuff.” there’s a lot of – there’s a drive here for continual betterment .”
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