Practical tools for practices to improve quality

Patient experience measurement

In the summer of 2020, the Quality & Innovation Program launched a common patient experience survey across DFCM core teaching sites to better understand patient experience in primary care practice during COVID-19. The 13 participating sites are using a common core set of survey questions as well as a common survey distribution process. Questions relate to modes of access, timeliness and continuity of care, patient-centredness, privacy and security, and more. Results will directly inform site operations and will also provide a more general picture of patient experience of the changes in care during COVID-19.

We are sharing our survey questions and would love to support other primary care practices who are engaging in similar work.

For more details, contact Dr. Payal Agarwal.

View the survey:

Practical tools for your QI project

We have developed/adapted some practical tools to support your journey to improve quality.

Under construction. 

Accessing data for your practice

HQO MyPractice Report

https://www.hqontario.ca/quality-improvement/practice-reports/primary-care

Learn even more about your practice by signing up for a confidential report that includes personalized data, along with suggestions to support you in improving care for your patients.

 

Screening Activity Report (SAR)

https://www.cancercareontario.ca/en/guidelines-advice/treatment-modality/primary-care/screening-activity-report

The SAR is an online tool available to primary care physicians who practice as part of a patient enrolment model, It provides screening data for breast, cervical and colorectal cancers to help physicians improve their cancer screening rates and appropriate follow-up. The report platform is interactive, allowing physicians to quickly find specific cancer screening information for each patient.

 

OntarioMD Dashboard

https://www.ontariomd.ca/products-and-services/insights4care/i4c-dashboard

OntarioMD has developed an EMR-integrated, actionable population health management tool that gives clinicians real-time visual representation of their EMR data using widely recognized primary care indicators each representing different preventive care and chronic disease management focus points (diabetes test results, smoking status, etc). The dashboard enables clinicians to drill down to patient-level data for each indicator and take immediate proactive steps to improve patient care. Email support@ontariomd.com to find out how to start using the dashboard in your practice

 

UTOPIAN - DFCM

https://www.dfcm.utoronto.ca/about-utopian

UTOPIAN can provide practices with de-identified patient data from the practice Electronic Medical Record, summarizing practice demographics and information on quality of care.

Ethics, privacy and consent

We do not need formal ethics review for local QI work that will not be published but regardless, we should always consider issues related to ethics, privacy, and consent.

 

Ethics

We engage in QI work to improve care for patients but sometimes our actions can have unintended harm or risk. Some of the potential harms that we think about related to efforts to improve quality include:

  • Privacy breaches
  • Opportunity costs
  • Patient distress resulting from interviews about a sensitive issue
  • Staff distress resulting from disclosure of poor performance

When designing your QI initiative, consider how to minimize potential harms and risks to patients and providers.

 

Privacy

When conducting your quality improvement initiative, it is important to follow strict procedures to protect patient and staff privacy including:

  • Storing hard copies of data in a secure location and shredding when no longer needed
  • Storing soft copies of data on secured drives with limited access
  • Limiting the amount of information collected or stored together
  • De-identifying data for presentations or reports (e.g. not presenting identifiable information in quotes, suppressing cell size where n<6)

 

Informed consent

When interviewing staff or patients for an improvement initiative, ensure they are informed about:

  • Why you are doing the interview
  • How you will use their data
  • Steps you are taking to protect their privacy
  • Opportunities to learn about how their data and your project impacted care

Disseminating your QI work

We can think creatively about ways to disseminate our results with others – from a blog, to commentaries, to presentations, to a QI report, to a more traditional peer-reviewed publication. Here are some avenues to consider.

 

Blogs

  • Share your improvement experiences with other colleagues engaged in improvement work via Quorum (hosted by Ontario Health)
  • Share your experience with patients through HealthyDebate 
  • Many medical journals have associated blogs that would be good venues to share reflections

 

Presentations

The following conferences offer great opportunities to present primary care QI work:

 

Peer-reviewed publications

Full research papers can be published in a number of reputable journals. If a full research paper seems out of reach, here are some other options to consider:

QI Professional Development

Maintaining knowledge and skills to improve quality is required to nurture a culture of curiosity and desire for ‘better’. There are many opportunities to continue your education in this regard:

 

Certificate programs:

Centre for Quality Improvement & Patient Safety https://www.cquips.ca

Institute for Health Care Improvement  - Improvement Advisor http://www.ihi.org/education/InPersonTraining/improvement-advisor/Pages/default.aspx

 

Degree programs:

Institute for Health Care Improvement (IHI) Open School

http://www.ihi.org/education/Pages/default.aspx

University of Toronto’s Institute of Health Policy, Management and Evaluation (IHPME) Master of Science in Quality Improvement & Patient Safety

https://ihpme.utoronto.ca/academics/rd/qips-msc/

Queen’s University - Master of Science in Healthcare Quality

https://healthsci.queensu.ca/hqprograms/programs/master-science-healthcare-quality

Queen’s University - Doctor of Philosophy in Quality

https://healthsci.queensu.ca/hqprograms/programs/doctor-philosophy-health-quality

 

Fellowships:

VA Quality Scholars: https://www.deptmedicine.utoronto.ca/veteran-affairs-quality-scholars-vaqs

Resources for faculty

QI Publication Funding

Purpose

To help support DFCM faculty who have had peer-reviewed articles focused on improving quality accepted for publication.

Award

The DFCM will award 50% of a publication acceptance fee up to a maximum of $1,000 CAD per publication. An applicant must demonstrate availability of matching funds. Awards are based on availability of funds.

Eligibility

All faculty in the Department of Family and Community Medicine are eligible to apply. Preference will be given to Quality and Innovation Program Directors. The faculty member must be either first author or senior responsible author. Publications should relate to improving quality in primary care and summarize results of an original intervention. A maximum of one award will be granted per person per calendar year (January 1 - December 31).

Requirements

Completion of the online form.

Helpful websites

Center for Excellence in Primary Care

https://cepc.ucsf.edu/

 

Institute for Healthcare Improvement (sign up via email address & password to access white papers and resources)

http://www.ihi.org

 

machealth  - Quality in Family Practice

https://machealth.ca/programs/quality/

 

Ontario Health - Patient Partnering

https://www.hqontario.ca/Patient-Partnering/Patient-Partnering-Tools-and-Resources

 

Ontario Health - Quality Improvement in Primary Care

https://www.hqontario.ca/Quality-Improvement/Quality-Improvement-in-Action/quality-improvement-in-primary-care

 

Canadian Patient Safety Institute

https://www.patientsafetyinstitute.ca/en/toolsresources/Pages/default.aspx