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Insights into Quality Improvement: New Sector-Wide QIP Reports Published

With the release of our latest reports on the quality improvement efforts of Ontario’s health system, here’s a closer look at how progress unfolds in health care.

Ontario’s health system leads in many facets of the quality agenda. One of the most significant has been the steady adoption of quality improvement plans (QIPs). Initially only hospitals completed QIPs. By the end of next year more than 1,000 health care organizations will select priority areas for focus, establish goals, set targets and document their progress. These organizations span acute, primary, long-term care and community sectors.

Healthy Quality Ontario helps set priority areas for focus, provides infrastructure for documenting and tracking activity, and then analyzes QIPs for common themes and learning.

We recently launched next year’s QIP process. To help organizations look ahead we also released the first of several reports summarizing last year’s QIPs. Our Quality Improvement Reports, known as Insights Into Quality Improvement, share lessons learned and highlight what works (or doesn’t quite work) in each sector. It is our hope that providers will leverage what we’ve learned through our analyses of this year’s QIPs to better support their quality goals and initiatives in the year ahead.

Some of our findings include:

Hospitals (PDF, 262KB)

  • Hospitals are committed to reducing Clostridium difficile infection (CDI) rates. Four out of five hospitals focused on this priority, and nearly half met or exceeded their self-set targets for improvement.
  • Medication reconciliation is now extending beyond admission into transfer and discharge as a priority among hospitals.
  • There is still a wide regional variation in the hours patients spend in the emergency department before being admitted, however more hospitals (90%) are electing to focus on improving these stats, with 41% meeting or exceeding their targets and 60% improving (but not necessarily meeting) their targets.

Community Care Access Centres (PDF, 1MB)

  • CCACs are changing the way they communicate and coordinate within, and beyond, their sector.
    • One-quarter of CCACs are utilizing information technology to coordinate care across sectors. They have planned to expand and improve the process by which CCACs are notified when CCAC patients are seen in a hospital emergency department.
    • More CCACs are using the Ontario Telemedicine Network (OTN) and e-shifts (a smartphone-based application which allows personal support workers to provide care in a home setting with the support of an off-site nurse) to provide clinical expertise to caregivers in home settings.
  • Seventy percent of CCACs described the importance of strengthening their relationships with primary care practices. Several CCACs plan to place care coordinators in the primary care setting.
  • Over half of Ontario’s CCACs are fine-tuning the Rapid Response Nursing program to improve the quality of care provided during the transition from acute care to home care.

Primary Care Organizations (PDF, 1,3MB)

  • Primary care organizations are strengthening their relationships with other sectors in the health care system
    • Compared to last year, there was a 91% increase in the number of references to collaborating with CCACs to deliver continuous, high quality care to their patients. There was a 50% increase in the number of references to working in partnership with Health Links or drawing upon Community Support Services to provide better care for their patients.
  • Primary care organizations are benefiting from greater access to data and evidence to support quality improvement work.
    • Over 260 family physicians are participating in HQO’s Primary Care Practice Report initiative, which uses administrative health databases to give physicians customized data about their practices. Having access to practice-level information allows providers to compare performance to other practices, and to better identify strengths and opportunities for improvement.
  • Primary care organizations are using electronic medical records (EMRs) to identify and support patient needs.
    • Approximately 38% of primary care organizations described using EMRs to identify specific disease conditions.

Long-Term Care Homes (PDF, 1MB)

  • Long-term care homes are focusing on improving access and patient flow across the regional system.
    • 83% of LTC homes indicated they would achieve these improvements by strengthening relationships between primary, specialty, community and acute care partners in an effort to integrate patient care and improve transitions across the care continuum
  • Many LTC homes noted that they are struggling with the following challenges: recruitment and retention of staff, increasingly complex levels of care, budget restraints, after hours and weekend coverage for nurse practitioners and physicians, and issues associated with quality improvement.
    • These homes identified the following ways to mitigate these challenges: incorporating quality improvement into staff’s everyday routine; eliminating waste; partnering with other agencies to increase quality improvement capacity; educating staff and engaging staff, residents, and families in quality improvement planning.

While different sectors have focused on different priorities, there is one factor that unites them all. It is clear that every health sector is committed to improving the quality of care they deliver.

It is with that sentiment that I hope you’ll read the reports, appreciate the efforts already underway to continuously improve care, and get as excited as me about the future of our health system. As we continue to move toward more patient-centred care, it is my hope that these reports will stimulate new ways of thinking about quality among board members, senior leaders, individual clinical leaders and teams.

Change takes time, and progress is rarely without setbacks, but I’m optimistic that by emphasizing our commitment to quality it will rub off on everything we do.

I’d love to hear your thoughts on our latest reports. Please join the discussion on Twitter by following @HQOntario or myself @DrJoshuaTepper.

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