The MyPractice Primary Care Report is a practice-level report for family physicians and executive directors of Family Health Teams and Community Health Centres. It includes personalized data, along with suggestions to improve care for patients.
These Spotlight Stories highlight initiatives and learnings around the use of practice-level data from the MyPractice Primary Care Report for leading quality improvement (QI) in primary care practice.
Ontario Health reached out to Petawawa Centennial Family Health Centre (PCFHC) to learn more about their quality initiatives that they have developed using their MyPractice Primary Care Report data. In this Spotlight Story, Judy Hill, Executive Director at PCFHC and Lisa Hawkins, the Quality Improvement Decision Support
Specialist share how they used data from the MyPractice Primary Care Report for the following initiatives:
- Hemoglobin A1c (HgA1c) % completed annually
- Opioid use comparison of Family Health Team and across Ontario
Can you briefly describe your team, including interprofessional team members, administrators, and experts that are involved in QI?
Regardless of the project, the Quality Improvement Decision Support Specialist (QIDSS) is always involved. Other participants are project dependent. QI projects are discussed at clinical and staff meetings that are held monthly. All staff are invited to attend and participate: clinical staff (physicians, nurse practitioners, and interdisciplinary health providers) and administrative staff (including management). Depending on the QI project, community organizations and partners may collaborate as well.
How has MyPractice Primary Care Report data helped you drive change in your organization?
Information is disseminated to the Board of Directors and to staff by circulating the MyPractice Primary Care Report itself and a report that compiles year-over-year results to assess trends. This helps us identify areas that require attention (improvement). Each physician also receives their own MyPractice Primary Care Report, so QI initiatives are identified at a team level but also through individual providers.
Can you provide a brief overview of the improvement initiative, including any QI methodologies or tools used?
HgA1c: We reviewed HgA1c testing data that was below the provincial average on the MyPractice Primary Care Report through discussion at staff meetings, then identified and made the following changes to our internal processes:
- Implemented a reminder to consider meeting guidelines for this measurement
- Implemented a discussion/reminder of where to document this measurement in electronic medical records (EMRs) to ensure that information is accurately captured in the MyPractice Primary Care Report
- Brought data forward to the Diabetes Education Centre Outreach Team (which is embedded in our Family Health Team 4 days per month with access to our EMR and can operate under medical directives)
- Developed searches (facilitated by the QIDSS) where data is tracked quarterly and monitored, and target options are discussed
Opioid use: To facilitate understanding of our in-house prescribing practices, MyPractice Primary Care Report data was drilled down to segregate in-house versus out-of-house prescribing data. Questions from physicians about their individual prescribing rates drove the initial conversations and eventual QI project. This information was discussed at a clinical meeting, including comparisons of in-house data compared with data across Ontario. Searches developed in Oscar (our EMR system) by the QIDSS and pharmacist helped to clarify in-house versus out-of-house prescribing rates, and comparisons were made to the provincial rate for in-house and out-of-house usage.
What improvements were achieved?
Our team aims for improvement in the outcomes (%) and will continue tracking quarterly to facilitate improvement or identify a need for increased focus or new solutions.
HgA1c: The HgA1c testing initiative is being monitored to improve results. Individualized targets for HgA1c testing have been included in our EMRs to facilitate enhanced patient care and avoid overtesting.
Opioid use: Through the EMR searches developed for opioid prescribing patterns and clinical meetings, we were able to help our physicians understand their prescribing patterns, which are in compliance with appropriate prescribing requirements. New internal processes were implemented such as the completion of Narcotic Agreements with patients and scheduled appointments for refills to help ensure patient safety.
Can you share any lessons learned, challenges experienced, or enablers that helped with this initiative?
HgA1c: We found that individualized targets are more applicable than guidelines. Guidelines specify that HgA1c should be measured twice per year, or less often if stable, which is more challenging to search (the definition of “stable” may vary). A new parameter was added to EMRs: “Target for HgA1c individualized and achieved?”
Opioid use: Breaking down opioid usage in the MyPractice Primary Care Report by in-house and out-of-house usage clarified the area of focus for PCFHC clinicians. The combination of in-house and out-of-house usage was overwhelming for the clinicians and made it difficult to identify solutions (thus difficult to enlist their participation in this project).
To help provide safe care to your patients and to better understand your performance, refer to these resources from Ontario Health:
1. Quality Standards:
2. MyPractice Primary Care Report technical appendices
References:
1. Hser Y, Mooney L, Saxon A, Miotto K, Bell D, Zhu Y, et al.
High mortality among patients with opioid use disorder in a large healthcare
system. J Addict Med. 2017;11(4):315-19