Integrated whole-person chronic care - views from the Canadian system

Integrated whole-person chronic careViews from the Canadian system

Jean-Frederic Levesque, MD, PhDChief Executive Officer, Bureau of Health Information

Conjoint Professor, Centre for Primary Health Care and Equity, UNSW

ADMA National Conference

11 September 2015

Bureau of Health Information Trusted information. Informed decisions. Improved healthcare. 2

Healthcare delivery

Chronic disease care

Patients and providers perspectives

Insights from Ontario

1

2

3

4


The international health policy surveys

• 11 countries - oversampling in Canada and Australia

• 2012 survey of primary care physicians

• 2013 survey of adult population

• 2014 survey of adults aged 55 years and over

– questions specific to chronic diseases management and outcomes


1. Healthcare delivery1


Healthcare delivery in Canada

Foundations of the Canadian healthcare systems

• Universality and integrality of medically required and hospital-based care

• Public administration – provincial systems

• Transferability between provinces

• No mandatory rostering/affiliation – patient “choice”

A strong focus on medical – acute care – hospitals

• Mounting evidence of lack of adaptation of the system to chronic diseases

• Recent reforms based on a local network and medical home model


Access to care and medical home affiliation

Percentage of adults aged 55 years and over who had a medical home, 2014


Timeliness of access to primary carePercentage of adults aged 55 years and over who needed an appointment to see a doctor or nurse, by number of days waiting, 2014


Primary care emergency department use

Percentage of adults aged 55 years and over who said their recent ED visit was for a condition that recent could have been treated by a regular GP, and

percentage of adults who said they visited an ED, public and private hospitals, 2014


Timeliness of access to specialist carePercentage of adults aged 55 years and over who needed to see a specialist, by length of time until appointment, 2014


2. Chronic disease care2


Chronic care model - Wagner


Patient stratification integrated models


The Patient’s Medical Home


2. Patients and providers perspectives3


1. Informed, activated patients : prevention

31

42 42 44 45 4750 50

5659

71

0

10

20

30

40

50

60

70

80

90

100

% o

f a

du

lts

age

d 5

5+

A health professional discussed exercise with you in the past two years

Source: Commonwealth Fund International Health Policy survey of older adults, 2014


1. Informed, activated patients : prevention

0

10

20

30

40

50

60

70

80

90

100

% o

f a

du

lts

age

d 5

5+

A health professional discussed healthy diet and healthy eating with you in the

past two years

Medical home

No medical home

Source: Commonwealth Fund Internatioal Health Policy survey of older adults, 2014


2. Informed, activated patients : self-management

22 22 23 24 25

3740 42

45

50

59

0

10

20

30

40

50

60

70

80

90

100

% o

f a

du

lts

ag

ed

5

5 +

wit

h a

ch

ron

ic c

on

dit

ion

A health care professional you see for your condition gave you a written plan

to help you manage your own care in the past year



0

10

20

30

40

50

60

70

80

90

100

% o

f a

du

lts

ag

ed

55

+ w

ith

a c

hro

nic

co

nd

itio

n

A health care professional you see for your condition gave you a written plan to

help you manage your own care in the past year

Medical home

No medical home


2. Informed, activated patients : self-management


3. Prepared, proactive team: case management

1012 13 15

1721 22 22

30 30

47

0

10

20

30

40

50

60

70

80

90

100

% o

f a

du

lts

ag

ed

55

+ w

ith

a c

hro

nic

co

nd

itio

n

A health care professional contacts you between visits to see how things are

going with your condition




0

10

20

30

40

50

60

70

80

90

100

% o

f a

du

lts

ag

ed

55

+ w

ith

a c

hro

nic

co

nd

itio

n

A health care professional contacts you between visits to see how things are

going with your conditionMedical home No medical home




20

41 43 4451

5968 68

7378

0

10

20

30

40

50

60

70

80

90

100

% o

f p

rim

ary

ca

re p

hys

icia

ns

Practice uses nurse case managers or navigators

for patients with serious chronic conditions

Source: Commonwealth Fund International Health Policy survey of primary care physicians, 2012


4. Prepared, proactive team: decision support

14 1521 21

36 40 42 45

56

67

0

10

20

30

40

50

60

70

80

90

100

% o

f p

rim

ary

ca

re p

hys

icia

ns

After hospital discharge, primary care doctor receives information to manage

patient within 48 hours




413

1813

2228

65

43

66

88

13

2217

36

30

37

11

38

29

7

0

10

20

30

40

50

60

70

80

90

100

% o

f p

rim

ary

ca

re p

hys

icia

ns

Systematically send reminders to patients for preventive care

Yes, using an automated system

Yes, using a manual system




0

10

20

30

40

50

60

70

80

90

100

% o

f p

rim

ary

ca

re p

hys

icia

ns

Practice routinely receives and reviews data on clinical outcomes

2009 2012

Source: Commonwealth Fund International Health Policy survey of primary care physicians, 2009, 2012


5. Productive interactions

5256 56

59 6165 66 67

72 74 75

0

10

20

30

40

50

60

70

80

90

100

% o

f a

du

lts

age

d 5

5+

wit

h a

ch

ron

ic c

on

dit

ion

an

d

tre

atm

en

t p

lan

Your treatment plan has helped you a lot to control or manage your condition



5. Productive interactions

0

10

20

30

40

50

60

70

80

90

100

% o

f a

du

lts

ag

ed

55

+ w

ith

a c

hro

nic

dis

ea

se t

rea

tme

nt

pla

n

Your treatment plan has helped you a lot to control or manage your condition

Has a medical home

No medical home



3. Insights from Ontario4


A decade of reform


Positively evaluated models of primary care


Example from Ontario












Conclusion

Ongoing challenges for Canada

• Challenges in patients and carers engagement and self-management remain

• Lagging developments of clinical governance tools

• Limited changes to provider payment models

• Lack of primary care – specialty integration

Opportunities and innovations

• An ongoing agenda for primary care reform

• Ontario as a model of team-based, mixed-funding, rostered model of

management of chronic diseases


Thank you!


http://www.bhi.nsw.gov.au/

Integrated whole-person chronic care - views from the Canadian system

Health & Medicine