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Strengthening Primary Care in Grey Bruce
Dr. Keith Dyke
Sub-Region Clinical Lead
November 7, 2017
Grey Bruce Primary Care AllianceAgenda
Item Time Topic or Subject Presenter
1. 4:45 (5 minutes) Welcome and Opening Dr. Keith Dyke
2. 4:50 (10 minutes) Introductions
LHIN Sub-region Team Dr. Keith Dyke
3. 5:00 (30 minutes)
Overview of vision for SW
PCA Nominations for Co-
Chair
Dr. Keith Dyke
4. 5:30 (30 minutes)
Current areas of focus
Opioid Strategy
SW PCA Website
New MRI/DI Tools
for the South West
• Clinical Connect
Dr. Keith Dyke
Helen Kononiuk
5. 6:00 (45 minutes) Discussion, Questions,
Concerns All
6. 6:45 Adjourn and next meeting
South West LHINWho’s Who!
South West LHIN Senior Leadership Team
Donna LadouceurVP, Home and
Community Care
Kelly GillisVP, Strategy, System
Design and IntegrationActing CEO
Mark BrintnellVP, Quality, Performance
and Accountability
Maureen BedekVP, Human Resources
Hilary AndersonVP, Corporate Services
Cathy FauldsChief Clinical Lead
Grey Bruce Sub-region Team
Dr. Keith Dyke
Sub-Region Clinical Lead
Tolleen Parkin
Sub-Region Lead
Ian Reich Manager, Home and Community
Care
Lisa Rigg Executive Assistant
Rose PeacockHealth System
Planner
Sub-Regions• Grey Bruce
• Huron Perth
• London Middlesex
• Elgin
• Oxford
Sub-Regions “Will and Will Not”
LHIN Sub-Regions Will…
• Bring together health system and community partners, as well as clinical leadership, at the local level in health system planning and improvement.
• Enable more focus on assessing population health need and service capacity.
• Provide health system data and information for the population of the sub-region
LHIN Sub-Regions Will Not…
• Result in more bureaucracy. Sub-regions will utilize existing LHIN staff in more effective ways - no new organizations are being formed.
• Impede ministry or LHINs’ obligations to engage with provincial and regional partners and patients. These will continue.
• Infringe on traditions or established jurisdictions in the planning, delivery or improvement of health services.
Strengthening care communities within our sub-regions
• High performing health care systems require high quality integrated primary care. Primary care needs to coordinate itself to:– Work together as a cohesive sector
– Integrate better with other parts of the health care sector to improve patient outcomes
• Working as a cohesive sector will enable primary care to:– Provide advice and recommendations to the LHIN– Be better positioned to identify and act on sector-specific
and cross-sector issues, challenges and opportunities.– Advocate collectively for primary care providers and
patients
Why are we here tonight?
Sub-Region Primary Care Alliances
• A core representative group of the community of primary care providers within each sub-region, representing the broader primary care sector
• Each PCA would be supported by 2 co-chairs– The South West LHIN Sub-region Clinical Lead(me)
– A representative elected from the sub-region PCA by the members (one of you). The elected co-chair will be accountable to the local primary care sector to represent their identified needs, interests and opinions
Proposed Role and Function of the Sub-Region Primary Care Alliances
• Advance a culture where PC functions as a cohesive sector
• Empower and encourage any member of the PC sector to identify and raise issues, challenges and opportunities
• Be accountable to ensure that issues, challenges and opportunities that they are made aware of are discussed and a best course of action is identified. Be action oriented
• Act as the communication/feedback conduit for issues requiring PC input
• Foster an environment of shared responsibility
• Work together to reduce duplication and increase integration of services
• Influence, inform and guide practice change
• Be accountable to follow through or indicate that they will not action something (so things don’t get dropped)
Cohesive Primary Care Sector
Primary Care Alliance
Primary Care Alliance Co-Chairs
Relationship Between Primary Care Sector and PCA
Sub-Region Integration Table (SRIT) Overview
• Sub-region Integration Tables will be supported by the LHIN sub-region Administrative Lead and Clinical Lead
• The tables will each consist of 10 to 15 members (tables with large populations and/or specific priority populations may increase up to 18 members)
• Time-limited work groups may also be formed to support the work of the sub-region integration tables
• The tables will meet monthly- Before PCA in GB
SRIT Actions and Deliverables• Enable, enhance and champion collaboration between
patients, providers and other system stakeholders
• Establish sub-region priorities for improvement in line with Patients First and the Integrated Health Service Plan
• Ensure local priorities include consideration of Francophone and Indigenous people in the sub-region
• Ensure local alignment with LHIN-wide programs
• Work together to reduce duplication and integrate services
• Foster an environment of shared responsibility
• Leverage current communication and reporting structures to share information
Relationship between Primary Care Sector and Sub–region Integration Table
The role of the co-chairs as primary care representatives on the SRIT is to:• actively contribute to achieving the overall aim of the
SRIT;• work with the SRIT members to collectively improve
the health care system; and• ensure the flow of information between the SRIT, the
PCA and the broader primary care sector.
Supporting Patients First
Grey Bruce Sub-region Integration Table Members
Tolleen Parkin Sub-region Lead
Dr. Keith Dyke Sub-region Clinical Lead
Rose Peacock Health System Planner
Barbara West Bartley Patient, Family, Caregiver Partner
Annemarie Fleer Patient, Family, Caregiver Partner
To be recruited Patient, Family, Caregiver Partner
Vanessa Ambtman-Smith Indigenous Collaborative Leadership Partner
PCA Co- Chair Primary Care Partner
Megan Garland Long-Term Care Partner
Andy Underwood Community Support Services Partner
Ian Reich Home and Community Care Partner
Claude Anderson Mental Health and Addictions Partner
Dr. Lynn/ Arra Public Health Partner
Paul Rosbush Hospital Partner
Gerry Glover Primary Care Partner/FHT ED
Grey Bruce PCA -Co-Chair Election Process
• Candidates have expressed interest in running for the Co-Chair position. Deadline for additional names and Bio is Friday Nov 10
• Short bio from each candidate with link to vote will be emailed out by Nov 13
• Vote using survey monkey from Nov 13 to 15. Successful Candidate revealed on Nov 16
South West PCA – Web Site• www.swpca.ca
Opioid Strategy• Ontario is implementing a strategy to prevent
addiction and overdose through:– Modernizing opioid prescribing and monitoring;– Improving the treatment of pain; and– Enhancing addiction supports and harm reduction
• HQO has convened stakeholders to develop an approach to support clinicians – plan is to start with supports for PC clinicians, then move to other prescribing groups
• Effort is to improve pain management through a coordinated approach that will support clinicians and patients in the best possible management of pain and improved connections to services and supports to enhance decision making
Opioid Strategy Continued• Supports that are available now• Medical Mentoring for Addictions and Pain (available through the Ontario
College of Family Physicians)
• Digital tools like eConsult and EMR dashboard for optimizing the use of your EMR and the data in it to understand current patterns of care. Expert users of these tools are also available to help you through a Peer Leader Program (allavailable through OntarioMD)
• Safer Opioid Prescribing webinars and workshops (available through the University of Toronto Faculty of Medicine, Continuing Professional Development)
• Quality Improvement Decision Support Specialists (QIDSS) and analytic support for Family Health Teams (available through the Association of Family Health Teams of Ontario)
• Ontario’s Narcotics Strategy, stemming from the National Narcotics Monitoring Network, lets you see whether a patient is obtaining drugs from multiple providers (available through the Ministry of Health and Long-Term Care)
Opioid Strategy Continued• Supports that are coming• A confidential report (My Practice: Primary Care) lets you see your
own opioid prescribing patterns compared with the provincial average (available through Health Quality Ontario)
• Quality Standards outlining what quality care looks like for people with acute or chronic pain considering opioid therapy, and people with opioid use disorder (available through Health Quality Ontario; grounded in the 2017 Canadian Guideline for Opioids for Chronic Pain)
• One-on-one educational outreach visits (Academic Detailing) and access to clinical tools and supports focused on delivering providers with objective, balanced, evidence-informed information on best practice (available through the Centre for Effective Practice)
• Outreach to increase awareness of available supports and programs, and investments to increase access to addiction services (coordinated through the Local Health Integration Networks)
SW LHIN Medical Imaging Integrated Care Project
• More than ~30% of diagnostic imaging scans are inappropriate/ or potentially avoidable
• The project(s) aim to discover, plan and implement efficiencies to current processes and distribution services for patients
• This first project/phase will address the regional improvement needs above by focusing on MRI.
Medical Imaging Integrated Care (MRI)
- There are 6 MRIs in the SWLHIN (Owen Sound, Stratford, LHSC-VC, LHSC-UH, SJHC, Woodstock)
– Each booking office has their own requisition form and had their own protocols
– There is no coordination of bookings across the LHIN
SW LHIN Medical Imaging Integrated Care Project - MRI
• Optimize Access to (MRI) services for patients: effective utilization of services & capabilities, so the right patient can access the right service within acceptable timeframe.
• Standardization of Quality: every patient has access to the same quality services and quality experience no matter where they receive (MRI) services in the LHIN.
• Enhanced Appropriateness: referral and scheduling that supports greater appropriateness, urgency and prudent prioritization for all patients and all modalities
MRI- What’s New!
• New Single SW LHIN wide MRI Requisition Form
MRI REQUISITION (Check one site)
□ Grey Bruce Health Services – Owen Sound F: 519-376-3952 □ London Health Sciences Centre – Vic/Children’s F: 519-667-6826
F: 519-646-6025 □ Huron Perth Healthcare Alliance – Stratford F: 519-272-8247 □ St. Joseph’s Health Care London
□ London Health Sciences Centre - UH F: 519-663-3544 □ Woodstock Hospital F: 519-421-4238
PATIENT INFORMATION:
Surname: _______________________________ First Name: ________________________________ Middle Initial:_____
Gender: ________ Date of Birth (YYYYM DD): _________________ Height: _________ cm Weight: _________ kg
Street Address: _________________ Apartment: ____ City: ______________ Province:___ Postal Code: _____
Telephone (Day): ___________________ (Evening): _____________________ (Cell): _______________________
Long Term Care Inpatient Isolation Precautions: ______________________________
MRN: ________________ Insurance: Province: __ No.: _________________ Research or 3rd
Party No.:__________
WSIB: N WSIB No.: __________________ Date of Injury (YYYYMM DD): _____________________
Mobility: mbulatory eelchair etcher echanical Lift Preferred Language: EN FR _____________ Other
Considerations: laustrophobia Mild Sedation (not provided) General Anaesthesia
Surgery in exam area
Y N Timed: _____________ Requested Date
Relevant rep orts attached
EXAMINATION REQUESTED: _________________________________________________
Working Diagnosis: _______________________________________________________
Clinical Information:________________________________________
_________________
Y N Please check the Y N Contrast Risk Factors following, if applicable
HypertensionBreast feeding
History of cancer Impaired renal function
Medication patch (Foil) MRI contrast reaction
Y N Possible MRI Contraindications
Piercings (Remove On dialysis
prior to exam)
Pregnant ____ wks. Contrast Patient ≥ 60 yrs.:
Shrapnel or bullets Recent serum creatinine result:
Surgery in last 6 wks. ____________________
Sample date: Tattoos ____________________
YYYYMM DD
History of Metal In Eye (X-ray may be required)
Aneurysm surgery*
Cardiac pacemaker or defibrillator*
Cochlear or Ocular Implants*
Coils, filters, grafts, stents *
Electronic devices, implanted or not implanted*
Heart valve*
Implanted stimulators, electrodes or pumps*
Shunts: Programmable* Non-Programmable*
Other ___________________________
* Please forward surgical report and specify the:
Make/Model: _______________________ Date: _________
Institution of surgery: ________________________________
REFERRING PHYSICIAN:
Last Name: _________________________
Address: __________________________
Telephone:_________________________
First Name: ___________________ Signature: _______________________
City: ________________________ Province: ______ Postal Code: ________
Fax: ________________________ Billing No.: _______________________
COPY TO:
Last Name: _________________________
Address: __________________________
First Name: ___________________ Fax: ____________________________
City: ________________________ Province: ______ Postal Code: ________
Appointment Date and Time: ___________________________
OFFICE USE ONLY
Pro tocol:
□ 1 □ □ □ □ med
Contrast X-rays required: □ N □ Staff Initials: ______
NOTE: This requisition may be booked at an alternate site in the South West LHIN to improve patient access.
MRI- What’s New!
• MRI Spine and MRI Knee – Check List –endorsed by Choosing Wisely Canada
_________________________ ________________
MRI KNEE APPROPRIATENESS CHECKLIST
This checklist is required for all outpatient MRI knee referrals. Please include with MRI requisition.
Referring Physician Name: ______________________
CHECK ANY/ALL THAT APPLY:
Patient label placed here, or minimum information below required
Patient Name:
Date:
Date of Birth (YYYYMMDD):
Gender:
MRN:
A. Recent Knee X-rays Recommended For All Patients B. Other Knee Imaging
Required for: Patients > 55 years oldWhat: ______________________________________
Suspected osteoarthritis (weight bearing views) When: ______________________________________
History of trauma Where: ______________________________________
C. MRI is recommended for:
Locked knee/Mechanical symptoms (unable to fully extend knee with relaxed muscles)
Suspected ligamentous injury
Which ligament(s):
Persistent swelling/effusion despite conservative therapy for 4-6 weeks
Suspected soft tissue or bone tumour
D. MRI is NOT recommended if there is:
Moderate or severe osteoarthritis without locking or extension block
MRI is unlikely to alter patient management
E. Consider MRI if all of the following are present:
Absent or mild osteoarthritis
Persistent unexplained pain > 3 months
Failed conservative therapy (physiotherapy and anti-inflammatories)
Patient is surgical/arthroscopy candidate
F. Additional Clinical Information
Please provide any additional information relevant to this request.
Include arthroscopic and surgical reports.
Referring Physician Signature Date Version 12.0, June 28, 2017
This checklist is based on the Choosing Wisely criteria and the CORE Back Tool. It is required for all adult (18+) outpatient MRI spine referrals. Please include with MRI requisition . Referring Physician Name:
MRI SPINE APPROPRIATENESS CHECKLIST
A. Red Flags requiring Emergent Management (immediate MRI and consultation to Surgery)(consider sending patient to Emergency Department)
Severe/Progressive Neurologic Deficit Cord Compression or Cauda Equina Syndrome
B. Red Flags requiring Urgent MRI
Suspected Cancer Suspected Spinal Infection Suspected Epidural Abscess or Hematoma
Suspected Fracture (recommend X-ray or CT first)
C. Mechanical Spine Pain Syndrome with no Red Flags requiring Non-Urgent MRI(Check all that apply – there MUST be a check in sections 1, 2, and 3 below to meet imaging criteria)
1. Unbearable Arm (and/or)
or Leg Dominant Pain
Disabling Neurogenic (and/ or)
Claudication
Functionally Significant Neurologic
Deficit
2. Failure to Respond after 6 weeks of conservative care 3. Considering Surgery
D. Suspected or Known Conditions (Check all that apply)
Cancer (please specify) Intradural Tumour Bone Tumour or Metastases
Congenital Spine Anomaly Scoliosis Spinal Radiation
Demyelination or MS Inflammatory Disease Assessment for Vertebroplasty
Prior Spine Surgery (date) Arachnoiditis Post-operative Collections
Follow-up for a Known Condition (please specify)
Condition Not Listed (please specify)
Prior CT or MRI Spine Imaging
When: ____________________________ Where: ________________________________________
Additional Clinical Information
Please provide any additional information below.
Please also clearly indicate the affected area on the image to the right.
Image ©
Alila
07 | D
ream
stim
e.c
om
Vers
ion 10
.0 J
une 9
, 2017
______________________ _______________
Referring Physician Signature Date (YYYY-MM-DD)
Patient Name:
Date (YYYY-MM-DD):
Date of Birth (YYYY-MM-DD):
Gender:
MRN:
Patient label placed here, or minimum information below required MRI SPINE APPROPRIATENESS CHECKLIST
MRI- What’s New!
• All forms will be available in the following formats:
– Hand written
– Fillable PDF
– EMR compatible for Accuro, PS Suite, Oscar and NOD (Downloadable from the SW PCA website).
• Youtube Video’s being produced
Other tools and resources
• Health Links-CCP
What is Coordinated Care Planning?
• About bringing multiple providers together with the individual and their informal supports to understand the goals of the individual
• Develop a care plan to support the person
Who benefits from Coordinated Care Planning?
• Those people who would be best supported by the coordinated efforts of multiple health and social service providers
• Those with high are needs who would be best supported with a team approach
Health Link CCP Video
What is ClinicalConnect?
– Securely aggregates essential electronic patient care data in real-time from Hospitals, LHIN Home and Community Care (formerly CCACs) & Oncology Centres in Southwest Ontario, OLIS, SWODIN, DHDR, DI-CS
– Accessible on desktop computers, tablets or mobile devices
– Physicians in some LHINs have the option to electronically download hospital data into their EMRs
– Single Sign-On and direct launch from select HISs capabilities
How will it benefit me and my patients?
– Reduces duplication of documentation, tests and procedures, saving time, discomfort and cost
– Improves the transfer and coordination of care between healthcare providers and organizations
– Increases patient safety and the quality of care
Videos !!
• https://www.youtube.com/watch?v=DXpqmVuu6fg
• https://www.youtube.com/watch?v=FvMshuVADhU
Health Quality Ontario
http://www.hqontario.ca/Quality-Improvement/Guides-Tools-and-Practice-Reports/primary-care
What’s Coming!• Next Month’s PCA meeting will include
speaker and additional info on OntarioMDe-consult
IT/Digital Strategy
• SW LHIN wide strategy on e-referral
• Central referral/notification system
• Clinical connect with CHRIS and Digital drug repository (DDR)
• More integration between CHRIS/CC/DDR with Accuro/PS/Nightingale
Transforming Musculoskeletal (MSK) Care in Ontario
• The 2017 budget committed $17M for expanding MSK intake and assessments across all LHINs
• Funds will be provided for– Clinical operations i.e. new assessors, admin support, office equipment
etc.– Change management and implementation support i.e. LHIN-based project
managers, hip/knee and spine teams, provincial clinical champion stipend
• In 2017/18– The South West LHIN is working to build capacity for MSK intake and
assessment in all LHINs and to implement a Central Intake and Assessment Centre starting with hip and knee replacement referrals
– Add ISAEC referrals when there is a readiness– Test beta sites for MSK intake
• In 2018/19– Test shared care models for other surgical and non-surgical MSK conditions
(e.g. rheumatology)– Develop and test bundled models for additional MSK QBPs
Transforming MSK Care in Ontario Continued
Grey Bruce PCA• Questions?
• Comments?
• Feedback?
• Next Steps?