Elevating primary care reporting in Ontario
Over the last five years, several organizations in Ontario have developed and shared reports to support primary care clinicians in their efforts to improve patient care. Until now, these reports were produced independently and in a largely uncoordinated fashion.
Each of these initiatives were intended to fill an important gap in access to information. It wasn’t too long ago that there was no mechanism for family physicians practicing in Ontario to see comparative data on their own practice. As recently as 2015, less than a third of family physicians in Ontario reported routinely receiving information on how the clinical performance of their practice compared with that of peers. In contrast, 70% of family physicians practicing in the UK reported receiving this type of information.
Though well-intended, the number of reports in Ontario then became overwhelming. Many family physicians indicated they did not access or read the reports they were receiving due to time pressures, little relevance or concerns about validity. This was expressed by physician leaders at a roundtable called to address the issue. Not suprisingly, there was clear and shared understanding across providers of the reports that these multiple uncoordinated reporting efforts could lead to disengagement and accelerate burnout.
This frustration echoes broader concerns about an increasing burden on health care practitioners related to documentation and other requirements that can take them away from frontline care. For example, Dr. David Kaplan, a North York physician with 1100 patients (and now also Chief, Clinical Quality for Health Quality Ontario) notes: “While it’s great to get information about your practice, the reality is it’s difficult to know where to place your focus when you could be receiving up to six or seven different reports from different groups across the province. Streamlining audit and feedback reporting into one report will help us as clinicians focus on what’s important to improve on.”
As a result of all of these concerns, several organizations came together as an Alliance and developed a shared vision for aligning practice reports as well as other tools and resources to improve primary care quality. The Primary Care Reporting Alliance represents all the main organizations providing primary health care and engaged in primary care performance measurement in Ontario. They are listed here.
In an assessment of the existing reports, Alliance members acknowledged they were each essentially trying to reach the same busy target audience and trying to achieve overlapping goals which all focused on improving patient outcomes in primary care. As a result, Alliance members agreed to pool their efforts and collaborate on a coordinated reporting effort. Building on recently published work by Canadian experts and others in audit and feedback, the Alliance looked at optimizing the effectiveness of feedback interventions. These included, recommending specific actions under the control of the recipient and addressing the barriers to the use of feedback.
The work of the Alliance has followed core principles including:
- Acknowledging primary care is critical to a high performing health system,
- Advancing the Quadruple Aim: Enhancing the patient experience; improving population health; reducing costs and; improving work life of professionals,
- Delivering better information that is valued by clinicians and patients, and
- Striving to reduce the data burden on clinicians and ensuring that information collected is usable.
The Alliance has committed to a number of next steps:
- Instead of 7 separate efforts, collaborating on a joint report with a first release planned for the end of this year
- Co-designing that report with clinicians
- Developing a capacity-building model to support local, frontline improvement efforts.
The creation of the Alliance and the outcome from its deliberations has demonstrated the commitment of all primary care partners in Ontario to enhancing the quality of patient care while at the same time responding effectively to significant concerns voiced by those committed to delivering care.
Articulating a well-aligned vision and working to reduce unnecessary duplication in the efforts provides a model for all sectors to reduce reporting burden while increasing support for improvement. This is a key element for building a better work-life for frontline professionals.
Adalsteinn Brown, is Dean, Dalla Lana School of Public Health University of Toronto and Anna Greenberg is Interim President and CEO, Health Quality Ontario