C3 Kelly Mendes - QI in a Prototype Community: Improving Attachment Rates in the Cowichan Valley

QI in a Prototype Community: Improving Attachment Rates in the Cowichan Valley

Presented by:

Valerie Nicol, Executive Lead CVDFP Kelly Mendes, Quality Improvement Advisor, Impact BC

February 28, 2013

The Cowichan Division of Family Practice (CVDFP)

• The CVDFP has been created to provide support to the people and family physicians of the Cowichan region.

• As a Patient Attachment Initiative Prototype Community, we will provide leadership in healthcare innovations, in collaboration with our community.

About the CVDFP:

• Population: 82,871• 90 GP members• 12% of population is Aboriginal

What are we Trying to Improve?

• 5% (4,143) Unattached Patients

• 40% (33,148) Poorly Attached Patients

Attachment Goals

Mar 2011 –

Maternity Clinic, FPHSP attaching patients

Feb 2013

1389+ Pts attached via CMC, FPHSP, New GP recruitment and GP Support

2015 –

All patients who want a GP have one

Data Collection Process

Circle of Care Modelling

Process

GP Interviews

Pt. Attachment Survey

GP Survey

Community Health Centre – “Warmland Health Services”

Primary Internal Features

• On site services• For unattached

patients only

Integrated services

• For unattached patients

• Also available to support patients with a GP

Outreach Services

• Part of the clinic• Provided in

outlying communities

Features of the health centre were

organized into three groupings

“Warmland Health

Services”

The synergistic effect of taking a mixed approach…

… enables the community to develop an overall vision and then implement portions of the vision as funding and resources allow

Attachment Initiatives

Provincial Attachment

Working Group

Family Practice Hospital Support Program

Cowichan Maternity Clinic

Aboriginal Health Working Group

Chronic Pain Working Group

Warmland Health Services:

Unattached Pt Services

End of Life/Palliative Care Working Group

CVDFP Attachment

Working Group

Current Initiatives:

Proposed Initiatives:

Practice Coaching

The Improvement Framework

Impact BC’s Role

Family Practice Hospital Support

Program

Cowichan Maternity Clinic

Aboriginal Health Working Group

Chronic Pain Working Group

CVDFP Attachment Working Group

Project Charters

Prepare Monthly Reports

QI Learning &

Innovation Reporting Structure

Impact BC(Quality Improvement

Advisor)

Data Collection Plan

Proces

s Measures

• # of unattached pts seen in walk-in clinics

• # of unattached pts seen in ED

Outcome

Measures

• # of unattached patients

• # of GPs taking unattached pts

Balancing Measures

• # of ED visits/yr (attached/unattached)

Measures

How will we know a change is an Improvement?Attachment via Existing Programs to Dec 31, 2012:

• 222 Patients Attached

Hospital Support Program

• 63 Patients Attached

Locum Coordinator

Program

• Locum became full service GP in area

• 500+ patients attached

Division Support

• April 2012 – GP suddenly unable to practice - CVDFP matches 600+ pts to division members

1,389+Patients Attached

Next Steps…..

• Addition of Practice Coaching initiative to support Attachment by increasing EMR optimization and office efficiencies

• Re-engaging stakeholders• Patient / Provider satisfaction surveys• Continue collection of measures, learnings,

tests of change to inform CVDFP of progress in these initiatives

Contact Info:

Valerie Nicol,Executive Lead CVDFP [email protected]

Kelly Mendes, Quality Improvement AdvisorImpact BC [email protected]