Evidence of Value

D2D 4.0: Unleashing the power of primary care data

Today’s release of Data to Decisions (D2D) 4.0 shows progress in capturing accurate, timely, comparable primary care data from electronic medical records and patient surveys. These advances are:

With D2D 4.0, teams have been able to submit data for more of the core indicators – in particular, those that patients have said are the most important to them. This includes a 13% increase in teams reporting percent of patients who can book an appointment within what they consider a reasonable time, and 10% increase in teams reporting on patient satisfaction with courteousness of office staff.

Data quality has also improved. Based on a comparison of EMR data to administrative data for cancer screening and smoking status, this has increased to 79% from 69% in the previous iteration (D2D 3.0).

Improving EMR data quality makes the following possible:

  • The work of the entire TEAM can finally be reflected, and not just activity from physician billing data.
  • Data is CURRENT, not years old, which is critical for quality improvement efforts.
  • Measures can be more PATIENT-CENTRED, capturing performance relative to individualized targets and care plans.

AFHTO members’ pioneering work on  follow-up after hospitalization is a shining example of what this means. Measurement of follow-up to date had been based on billing data – this only counts visits to the doctor’s office, which is not necessarily the most cost-effective nor patient-friendly way to follow up. AFHTO’s work captures appropriate follow-ups by any team member in any modality, and has been adopted and will be announced shortly by Health Quality Ontario for Quality Improvement Plans for 2017-18.

The data collected enables analysis of the Starfield Principles – comparing a comprehensive measure of primary care quality, weighted according to patient priorities, to total cost of all health care for patients in the practice.  As found in Barbara Starfield’s research in other jurisdictions, AFHTO members’ data shows that patients served by teams that have high quality scores have lower overall healthcare costs.

Voluntary participation is holding steady at about two-thirds of all members. Access to a Quality Improvement Decision Support (QIDS) Specialist appears to be a key factor. A number of teams missed D2D 4.0 because they were in QIDS partnerships experiencing a vacancy in their QIDS Specialist position. One-sixth of teams (about 30) have not contributed to any iteration of D2D – roughly equivalent to the number of teams that, due to funding or other constraints, have not been able to join QIDS partnerships.  QIDS partnerships have been so effective, they offer a blueprint for spreading measurement and improvement across all of primary care, and for fostering the collaborative networks needed for the LHIN subregions proposed by government in Patients First.

Performance on the D2D indicators is holding steady.  Some are already at a relatively high level of performance –patient involvement with decisions, satisfaction with courtesy of office staff, two indicators that are important to patients based on direct input from patients (via Patients Canada survey) as well as the Conference Board’s FHT evaluation.

Measurement puts a lens on what does need work. AFHTO members are increasing their focus on the intensive work required to examine and change established processes to get even better results, in areas that matter most to their patients.  This work includes learning from each other to improve:

D2D 4.0 is the first iteration where teams identify their LHIN. This allows members to compare their performance with neighbouring teams in the same region.  It can help primary care teams and their LHINs to collaborate in tackling system issues and keeping the focus of measurement on the comprehensive ‘generalist’ nature of primary care.

The journey to advance manageable and meaningful measurement and improvement in primary care continues. The next iteration – D2D 4.1 – will be out in in early spring 2017.

Click here to see aggregate results of D2D 4.0.