Integrated whole-person chronic care - views from the Canadian system
-
Upload
bureau-of-health-information -
Category
Health & Medicine
-
view
653 -
download
1
Transcript of 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
Bureau of Health Information Trusted information. Informed decisions. Improved healthcare. 3
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
Bureau of Health Information Trusted information. Informed decisions. Improved healthcare. 4
1. Healthcare delivery1
Bureau of Health Information Trusted information. Informed decisions. Improved healthcare. 5
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
Bureau of Health Information Trusted information. Informed decisions. Improved healthcare. 6
Access to care and medical home affiliation
Percentage of adults aged 55 years and over who had a medical home, 2014
Bureau of Health Information Trusted information. Informed decisions. Improved healthcare. 7
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
Bureau of Health Information Trusted information. Informed decisions. Improved healthcare. 8
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
Bureau of Health Information Trusted information. Informed decisions. Improved healthcare. 9
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
Bureau of Health Information Trusted information. Informed decisions. Improved healthcare. 10
2. Chronic disease care2
Bureau of Health Information Trusted information. Informed decisions. Improved healthcare. 11
Chronic care model - Wagner
Bureau of Health Information Trusted information. Informed decisions. Improved healthcare. 12
Patient stratification integrated models
Bureau of Health Information Trusted information. Informed decisions. Improved healthcare. 13
The Patient’s Medical Home
Bureau of Health Information Trusted information. Informed decisions. Improved healthcare. 14
2. Patients and providers perspectives3
Bureau of Health Information Trusted information. Informed decisions. Improved healthcare. 15
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
Bureau of Health Information Trusted information. Informed decisions. Improved healthcare. 16
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
Bureau of Health Information Trusted information. Informed decisions. Improved healthcare. 17
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
Source: Commonwealth Fund International Health Policy survey of older adults, 2014
Bureau of Health Information Trusted information. Informed decisions. Improved healthcare. 18
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
Source: Commonwealth Fund Internatioal Health Policy survey of older adults, 2014
2. Informed, activated patients : self-management
Bureau of Health Information Trusted information. Informed decisions. Improved healthcare. 19
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
Source: Commonwealth Fund International Health Policy survey of older adults, 2014
Bureau of Health Information Trusted information. Informed decisions. Improved healthcare. 20
3. Prepared, proactive team: case management
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
Source: Commonwealth Fund Internatioal Health Policy survey of older adults, 2014
Bureau of Health Information Trusted information. Informed decisions. Improved healthcare. 21
3. Prepared, proactive team: case management
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
Bureau of Health Information Trusted information. Informed decisions. Improved healthcare. 22
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
Source: Commonwealth Fund International Health Policy survey of primary care physicians, 2012
Bureau of Health Information Trusted information. Informed decisions. Improved healthcare. 23
4. Prepared, proactive team: decision support
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
Source: Commonwealth Fund International Health Policy survey of primary care physicians, 2012
Bureau of Health Information Trusted information. Informed decisions. Improved healthcare. 24
4. Prepared, proactive team: decision support
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
Bureau of Health Information Trusted information. Informed decisions. Improved healthcare. 25
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
Source: Commonwealth Fund International Health Policy survey of older adults, 2014
Bureau of Health Information Trusted information. Informed decisions. Improved healthcare. 26
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
Source: Commonwealth Fund Internatioal Health Policy survey of older adults, 2014
Bureau of Health Information Trusted information. Informed decisions. Improved healthcare. 27
3. Insights from Ontario4
Bureau of Health Information Trusted information. Informed decisions. Improved healthcare. 28
A decade of reform
Bureau of Health Information Trusted information. Informed decisions. Improved healthcare. 29
Positively evaluated models of primary care
Bureau of Health Information Trusted information. Informed decisions. Improved healthcare. 30
Example from Ontario
Bureau of Health Information Trusted information. Informed decisions. Improved healthcare. 31
Example from Ontario
Bureau of Health Information Trusted information. Informed decisions. Improved healthcare. 32
Example from Ontario
Bureau of Health Information Trusted information. Informed decisions. Improved healthcare. 33
Example from Ontario
Bureau of Health Information Trusted information. Informed decisions. Improved healthcare. 34
Example from Ontario
Bureau of Health Information Trusted information. Informed decisions. Improved healthcare. 35
Example from Ontario
Bureau of Health Information Trusted information. Informed decisions. Improved healthcare. 36
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
Bureau of Health Information Trusted information. Informed decisions. Improved healthcare. 37
Thank you!