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Dr. David Kaplan

Quality at the coalface: How front-line providers are upping their game

“It was not very common until recently for us (as physicians) to get any sort of true feedback about our performance after we exit training.”

                                                                  From accompanying podcast

Providing quality care should be the aim of all who work in the Ontario health care system.

However, in today’s high-pressure environment, physicians and other health care professionals practising primary care in the community or in hospitals are often challenged to find time to engage in quality improvement initiatives on top of providing the necessary care for their patients.

As Dr. Jeremy Grimshaw, Professor of Medicine at the University of Ottawa said in a recent commentary for physicians: “You want to provide the best care for your patients but often don’t have the time or energy to scan a dense and convoluted report that tells you how to do this, even if it is based on data from your own practice.”

A possible solution? When done properly, “audit and feedback” has been identified and validated as one of the most promising approaches to enhance quality care. Audit and feedback involves the independent assessment of a physician’s clinical practice against a set of indicators.

At an international summit held in Toronto last summer co-hosted by Health Quality Ontario, the audit and feedback MyPractice reports prepared by Health Quality Ontario were showcased. The reports use validated data about a family physician’s patient population to provide a confidential, personalized report in which data about the physician’s practice pattern is compared to other physicians in the province. The findings in the report are also accompanied by change ideas for practice improvement.

The format, content and delivery mechanism for the reports are continually reassessed to make them more useable and relevant and confidential data on individual opioid prescribing were added to the report for family physicians in November 2017.  This addresses a point made by Dr. Tara Kiran, quality lead for the Family Health Team at St. Michael’s Hospital and Fidani Endowed Chair of Improvement and Innovation in Family Medicine. In her recent presentation on using data for quality improvement during Quality Rounds hosted by Health Quality Ontario, Dr. Kiran reflected that one should prioritize what matters and she used appropriate opioid prescribing as an example.

For the past four years, Health Quality Ontario’s MyPractice reports have been made available to both primary care physicians and physicians delivering care in long-term care homes. Among the latter, reports have recently been enhanced to provide data on antibiotic prescribing practices as these drugs may not be necessary for the most common uncomplicated infections found among long-term care residents.

And coming soon are customized MyPractice reports for orthopedic surgeons and doctors who are part of either the Ontario Surgical Quality Improvement Network or the General Internal Medicine Quality Improvement Network. These reports will provide data and resources on issues of specific interest to those who subscribe.

While audit and feedback is just one of many levers for implementing quality improvement within the physician community, the recent summit made it clear the science and, to a degree, the will does exist to use it effectively.

How do busy clinicians find the time to do audit and feedback? What does the science say about its value? How are clinicians using them and do they truly make a difference? Listen as we discuss these and other questions in our podcast with Dr. David Kaplan, Health Quality Ontario Chief of Clinical Quality

Read the transcript

(Note: While this post focuses on physicians, our vision – data permitting – is to provide tailored reporting to the many different professionals involved in, and committed to, local initiatives to enhance quality)

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1 comments on article "Quality at the coalface: How front-line providers are upping their game"

Bill Holling

How many physicians outside of the metro area are involved and how many outside that area are involved. In some research I have done I am find most family doctors in small town and rural Ontario are putting in 75 hours per week and a lot of that time is paper work plus the college of Physician and Surgeons is looking at their future requirements. I like the idea of reports and audits but care must be taken re: burn out

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