Each year, staff at Health Quality Ontario read the Quality Improvement Plans (QIPs) submitted by Ontario hospitals, primary care organizations, long-term care homes, and local health integration networks (which administer home care). We identified some stand-out examples from the 2017/18 QIPs showing how organizations have engaged patients or residents and their families and caregivers, and reached out to the people involved to find out more about their experiences.
Here, QIP Team Lead Laurie Dunn spoke with Stephanie Skopyk, a nurse practitioner at the Canadian Mental Health Association Durham Nurse Practitioner-Led Clinic. Stephanie discussed the lessons her team learned during a project aimed at understanding complexity in the patients they serve.
What was the problem you were
trying to solve?
We
were interested in measuring or quantifying complexity; it was our perception
that the patients attending our clinic had greater and greater needs. The
problem was, how to measure and reflect that complexity? Particularly, from a
review of the literature, how to find a measure of complexity with established
reliability?
What did you do?
We
started with a literature review to look at what others had done to define
client complexity and found some work from the University of Minnesota, who had
developed a tool called the Intermed. Over time and with continued research,
this tool evolved to be called the
patient complexity assessment method (PCAM).
We hoped to enhance the PCAM by seeing how the tool relates to the issue of frailty, and comparing the PCAM results to our Quality of Life (QoL) assessment. We collaborated with the University of Minnesota to run the study and will be publishing the results shortly.
We worked with 172 randomly selected patients over one year to compare the results of the QoL and the PCAM tools, and used the results to inform our Practice Profile.
The team did a process mapping exercise to figure out at what points in the clinical process the tool results would be helpful. This helped us learn things about what questions to ask early, and what resources would be needed at what point in the intervention. We actually developed a study algorithm, and the tool itself (PCAM) is what allowed us to prioritize information/interventions ranging from “routine care” to “need to act now”.
For instance, one thing we learned is that 48% of patients required additional services beyond what we could offer, and we had to build in time for outreach and referral.
Who was involved?
- First, our patient cohort. Ninety percent of our clinic population have a mental health diagnosis.
- Our team is multidisciplinary and includes nurse practitioners, nurses, a pharmacy team, case manager and a consulting physician.
- The Association of Ontario Health Centres continues to work with us to refine our population profile.
- Rebekah Pratt and Teresa McCarthy, from the University of Minnesota, partnered with us on this research.
Sharing best
practices and lessons learned
By using the two tools, we learned that:
- As we expected, there was a negative correlation between self-reported QoL and PCAM scores (the lower the quality of life, the higher the complexity of the patient).
- 90% of the population we serve is on social assistance, and it would be important to support these patients to reapply for benefits and supports regularly, and maintain continuity of care.
- 64% reported being socially isolated and we needed to provide education and plan around this in a relevant way, understanding that there may not be caregiver support to help.
- When we meet at LHIN resource planning tables, we are able to take these statistics with us to contrast and compare the local situation to the statistics provided about social isolation, and caregiver support captured through published or province-level surveys. This is important because people who are marginalized may not be reflected in population-level data.
What would you recommend to other providers with psychologically complex patient populations who are interested in improving the population profile to better understand their patient population?
Developing your population profile is really helpful to predict acuity and anticipate resources required. It is important to establish good partnerships as the needs of complex populations may require extensive referrals and/or shared care.
While we recommend a robust approach to fully understand your population profile, as a basic step, it appears that considering QoL question #16 (which references independence, doing things for yourself) is a good indicator of patient complexity, in order to guide and focus enhanced treatment efforts.
You may also be interested in:
Quorum’s Indicators & Change Ideas page. Find more information about QIP indicators and related change ideas.