Page 1

2013/14 Evaluatorʼs
 Report#


Table of Contents Executive Summary!

1!

About the KCPCN!

18 !

Enablers to Program Delivery- Activities and Challenges!

21 !

Core Programs- What We Did and Who We Served!

29 !

Access to Care!

30!

Chronic Disease and Complex Care!

35!

Health Promotion and Education !

38!

Results- The Difference for Patients!

43!

Increased Access!

45!

Improved Integration and Coordination!

53!

Patient Engagement, Acceptability and Satisfaction!

55!

Increased Knowledge of Health and Health Management!

58!

BSW., RSW., Msc. #

Increased Self-Efficacy and Action-Taking!

61!

Improved or Maintained Functioning, Health or Quality of Life !

64!

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Results- The Difference for Providers !

71!

Physician Satisfaction!

72!

KCPCN Staff Satisfaction!

75!

Conclusions and Recommendations!

81!

Appendices!

90!

Carole Loiseau 



Executive Summary# E$


The Kalyna Country Primary Care Network (KCPCN) is one of 42 primary care networks (PCN) in Alberta. It is located in east central Alberta and provides programming and services to a patient population estimated to be at over 47, 000 residents. ! ! Within the geographic boundaries of the KCPCN, there are 5 physician clinics with a total of 18 physician members in the KCPCN. When primary care physicians become members of a PCN their patients become attached or part of the Primary Care Network. Based on $62/ attached patients, in 2013/14 the KCPCN received $1,168,206 in funding.! !

While it began as the Vegreville PCN in 2010 it merged with the Viking PCN to form the Kalyna Country Primary Care Network at the start of 2012/13 I$

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Enablers to Program Delivery-Activities and Challenges# There are many important enablers that support effective PCN delivery. Each year depending on the maturity of a PCN and its context, the PCN focuses on different activities and experiences different challenges, both of which ultimately impact programming and services to the patient. ! •  The KCPCN experienced stability within its governance structure and activities.! •  Regarding healthcare program planning and management, the KCPCN launched its Geriatric Program earlier than planned and expanded it in response to high demand and resource availability. ! •  In terms of clinical decisions and activities, one of the largest impacts on KCPCN program delivery was the availability or unavailability of appropriately trained and experienced clinical staff. ! •  The KCPCN worked with others through integration and coordination to improve clinical access and quality by: a) collaborating with home care, lodges and supportive living to provide remote clinics to residents; b) partnering with Covenant Health, to significantly increase patient access to visiting specialists; and c) working with Mental Health Services in Vegreville to implement mental health assessment using the Psychiatric Triage Rating Scale. ! •  The KCPCN utilizes multi-disciplinary teams (MDTs). According to the results of the Healthcare Team Effectiveness Survey all MDTs were the strongest in the sub domain of team member capabilities. They demonstrated overall effectiveness ranging from 242 to 303 (out of 354). The Vermilion and Vegreville (at March 2014) MDTs had somewhat lower results. ! •  The Vegreville KCPCN team began participating in Access Improvement Measures (AIM), a one year quality improvement collaborative focused on improving various access measures. ! !

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Core Programs- What We Did and Who We Served# Physicians and MDTs work together to deliver the best possible care. The programs offered by the KCPCN are determined based on patient and population needs, available evidence (best practice, literature, innovative programming in other PCNs) and stakeholder consultations. The KCPCN moved forward with almost all of its planned programming for 2013/14 in three core program areas including:! ! Access to Care! •  Despite being established partway through the year, there were 503 patient visits through various forms of alternative clinics (evening clinics, remote clinics, walk-in clinics). ! •  There were 401 patient visits in the Viking pre and post natal program ! •  There were 17 completed patient assessments in the first 3 months of the Geriatric Program. The purpose of the program is to provide older adults who often have complex needs with the intensive support of an MDT from assessment through care. Another 28 patients were awaiting their assessment by year end. ! ! Chronic Disease and Complex Care ! •  Another consistent focus of primary care networks is providing comprehensive support to patients with chronic diseases and complex care. ! •  There were 417 new patient visits and 1137 follow-up patient visits. This was a substantial increase from 160 patients in 2011/12. ! •  There were 874 specialist referrals coordinated for the chronic disease and complex care patients in Vermilion. ! !

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Health Promotion and Education! •  Primary care also emphasizes health promotion, which is the process of enabling people to increase control over, and to improve their health. The KCPCN utilizes several approaches to support patients in this regard. While some programming was developed and implemented in 2013/14 more is planned for the future. ! •  The KCPCN offered the WeightWise lifestyle and education program in Vermilion that included 51 attendees.! •  They offered a handful of lifestyle and health communication sessions and laid the groundwork in their communications area with general website and social media development.! •  KCPCN staff attended 17 different kinds of training, 12 of which related to increasing staff knowledge and capacity to support patient health outcomes. !

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The Difference for Patients# As with any healthcare program or service, the KCPCN is ultimately trying to make a difference for the patients it serves in several key areas. ! $ Increased access to local primary care services! •  The KCPCN provided programs and services that would not otherwise be available e.g., womenʼs health, geriatric program, complex care and chronic disease! •  It connected patients to needed specialists through the specialist coordination and referral program that coordinated 874 referrals in 2013/14 and by partnering with Covenant Health to bring numerous specialists to Vegreville.! •  It also provided 503 patient visits through various alternative clinics. ! •  While the wait time for physicians and MDT members was definitely longer than same day access, the KCPCN offered most patients a reasonable wait time. Patient survey results and available tracking did reveal some potential issues with longer wait times. ! •  The KCPCN likely contributed to a reduction in the use of the Viking emergency department for semiurgent and non-urgent care from 83.24% in 2010/11 to 71.1% in 2013/14. ! $ Improved integration and coordination! •  Patient survey results regarding integration and coordination questions were somewhat lower than other areas suggesting that KCPCN staff could improve in areas of care coordination between and among providers.! !

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Patient engagement, acceptability and satisfaction! •  Patient survey results indicated that patients experienced high levels of engagement, acceptability and satisfaction. This was an area of strength for the KCPCN. ! •  89.3% of survey respondents agreed or strongly agreed that they were satisfied with the care they received from their main provider. ! ! Increased knowledge about health and healthcare management! •  Patients surveyed indicated experiencing increased levels of knowledge of health and health management although the results were lower regarding patients being encouraged to access other community supports.! ! Increased self-efficacy and action taking to manage health and health conditions! •  While overall results were high, there were lower regarding patients knowing how to prevent or reduce problems with health and in patientsʼ action taking to make changes in their health. ! ! Improved and/or maintained functioning, health and/or quality of life! •  Overall, 88.6% of survey respondents involved in the Chronic Disease and Complex Care programs reported either maintenance (46.6%) or improvements (42%) to their health over the previous year.! $ !

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The Difference for Providers# Physician Members! •  Surveyed physicians reported high levels of satisfaction with board governance of the KCPCN. They were familiar with board members and felt that the board adequately solicits opinions from PCN physicians on significant and important issues. ! •  They responded that the AGM is productive and provides sufficient opportunity for physicians to have a say in the PCN operations. A third of physician respondents felt that it would be ideal for the AGM to provide CME learning opportunities. 89% agreed or strongly agreed that their experience of being a member physician has matched their expectations since joining the KCPCN. ! •  Physicians are very satisfied with KCPCN programs and services. They agree that KCPCN programs meet their needs, and more importantly that they make a difference to the patients. ! •  Overall, respondents reported that they were highly satisfied with their physician experience of membership since joining the KCPCN. On a scale of 1-10 with being extremely satisfied, 77.7% scaled their satisfaction at either 9 or 10. ! $ !

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The Difference for Providers# KCPCN Staff Members! •  Staff satisfaction with their individual work or roles varied depending on the question. They felt they had the opportunity to apply their professional competencies, exercise appropriate decisionmaking authority, and the tools and resources they needed to do their jobs. They also understood how their personal objectives and goals contribute to the success of the PCN. They were less satisfied with the manageability of their workload and workload coverage while they were away. ! •  Staff satisfaction with their team experience was quite high on all questions except having a clear idea regarding their teamʼs progress toward PCN goals.! •  Staff satisfaction with management varied depending on the question. Staff had high levels of satisfaction with compensation and consideration of their ideas and suggestions. They had reasonably high levels of satisfaction with fair dealings regarding their performance, recognition for their contributions, and overall fairness and transparency with PCN employees. They were less satisfied with the clarity of future direction provided by management, the effectiveness of dealing with performance issues, and with their opportunities to participate in continuing education. ! •  While the level of satisfaction demonstrated in the results was reasonable, the questions regarding change and change management elicited the most comments from staff completing the survey. While between 73-75% of staff agreed or strongly agreed with the five change management questions, consistently, the other 25% of staff members disagreed or strongly disagreed with each area and provided comments. ! •  Overall, KCPCN staff was very satisfied with their work at the PCN and with the PCN as a place to work. They universally indicated that they would recommend the KCPCN to a colleague as a good place to work. !

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Conclusions and Recommendations# Conclusion#

Recommendations#

The KCPCN is providing solid programming and readily meets the five Primary Care Initiative objectives. #

1.1 The KCPCN could improve alternative clinics by ensuring they are provided at consistent times on consistent days. While this is the case for most of the clinics, any degree of inconsistency creates challenges and barriers for the patient.! ! 1.2 The KCPCN could improve alternative clinics by increasing the number of clinic hours that occur outside of regular business hours. At present, evening clinics are only offered weekly in Vegreville and monthly in Innisfree and Irma.! ! 1.3 The KCPCN could improve alternative clinics by working with physicians and the community to better promote them. In many of the clinics, the number of patients served is quite low per session ranging from 3.5 to 5 patients. Most of the clinics are less than a year old and it may take some time and effort to consistently fill them.!

Objective 1: The KCPCN has increased the promotion of residents with access to primary care through increasing patient attachment, providing its various programming, and its many forms of alternative clinics.! Objective 2: The KCPCN provides some after hours clinics. ! Objective 3: All KCPCN programming is geared to health promotion, disease prevention, care of the medically complex patient and those with chronic diseases. ! Objective 4: The KCPCN participated in a number of initiatives aimed at improving coordination and integration including: collaborating with homecare, lodges and supporting living in Vegreville and Viking to provide services to residents; partnering with Covenant Health to bring in additional specialists; working with Mental Health Services to implement mental health assessments with appropriate patients. ! Objective 5: The KCPCN utilizes MDTs in all three communities and supports them through various forms of monthly and quarterly meetings.! !

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Conclusion#

Recommendation(s)#

The KCPCN has made good progress on implementing its business plan #

2.1 The KCPCN should continue its efforts to increase patient and community awareness of the PCN.! !

The KCPCN moved forward with almost all of its planned programming for 2013/14. ! In fact, in response to demand and resource availability it was able to move forward with the Geriatric Program in all three communities faster than planned. ! The area with the least progress was the lifestyle and health communication. This was largely due to available resources and the need to first promote the KCPCN. ! Results from the Patient Experiences Survey and its mail out to community members clearly showed that there is some lack of awareness about PCNs. This is understandable given the complexity of healthcare services from the patient perspective and the relative newness of the KCPCN. !

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Conclusion#

Recommendation(s)#

The KCPCN is making a difference and demonstrating the achievement of outcomes with its patients. #

3.1 KCPCN staff should increase their attention to providing health care Patients surveyed indicated high levels of engagement, acceptability information and suggestions and satisfaction.! for accessing other community supports. ! •  89.3% of survey respondents agreed or strongly agreed that they were satisfied with the care they received from their main provider. ! ! 3.2 The KCPCN should •  Overall, 88.6% of survey respondents involved in the Chronic consider providing its main Disease and Complex Care programs reported either maintenance providers with additional (46.6%) or improvements (42%) to their health over the previous training to support increased year.! patient knowledge, efficacy and behavior change e.g., •  While results were still high, they were lower regarding patients Stages of Change, coaching, receiving health information, patients knowing how to prevent or reduce problems with health and in patientsʼ action taking to make or something similar.! changes in their health. ! ! Physicians are highly satisfied with their membership in the PCN and moving toward integration of physicians within the PCN and MDTs is an ongoing process. # •  Overall, physicians reported that they were highly satisfied with their physician experience of membership since joining the KCPCN. On a scale of 1-10 with being extremely satisfied, 77.7% scaled their satisfaction at either 9 or 10. !

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4.1 Continue to work toward engaging physicians in the PCN through planning, information sharing, MDT activities, quality improvement activities focused on access time and patient health outcomes etc. !


Conclusion#

Recommendation(s)#

The KCPCN has made good progress in implementing measurement and evaluation. #

5.1 The KCPCN needs to continue with existing measurement such as program tracking, the SF-12, patient experiences survey and integrate them as part of ongoing business. ! 5.2 The KCPCN needs to improve its data collection regarding access measures particularly time to third next available appointment (TNA) and CTAS classification for alternative clinics. These measures were introduced in 2013/14 however, significant gaps occurred with data collection. ! 5.3 The KCPCN needs to spend considerable time and effort mapping its data requirements from the EMRs and then adjusting its data entry to accommodate desired measurement.! 5.4 The KCPCN needs to explore alternative options (to its current excel spreadsheets) for tracking and analyzing patient health information. This includes looking into options such as the CDM worksheet in Accuro (to be released in June 2014).! 5.5 As new measurement standards and requirements are released the KCPCN needs to update its evaluation framework and measurement tools as needed to ensure its continued accountability.!

•  The KCPCN has a comprehensive evaluation framework that was development in consideration of future accountability requirements that were certain to materialize following the 2012 Auditor Generalʼs report. ! •  Over the last 18 months the KCPCN has been steadily implementing various data collection to support ongoing performance measurement and evaluation. ! •  There are still gaps in needed data to have a fulsome and comprehensive picture of the KCPCN effectiveness. ! •  There are significant challenges pulling patient information and health data from the various electronic medical records (EMRs) in a manner that has either reliability or validity. There are 3 different EMRs within the clinics that are part of the PCN including Accuro, Med Access and Wolfe. ! •  Partly because of the EMRs challenges, several of the KCPCN programs e.g., Chronic Disease are utilizing excel spreadsheets to track patient health information through time. This is cumbersome, not sustainable and not ideal for data analysis.!

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Conclusion#

Recommendation(s)#

While the KCPCN is increasing patient access through its programming and alternative clinics, access times may need improvement in some cases. #

6.1 If further data collection reveals that wait times are high, the KCPCN needs to implement a quality improvement process to decrease them. The recommended standard by AIM is same day access.!

•  The KCPCN has some but limited data to understand access times and issues. ! •  The snapshot of physician access at one clinic ranged from 4 to 55 days and averaged from 12.4 to 16.8 days. ! •  The snapshot of MDT members at one clinic ranged from 0 to 11 days. The wait time for the Nurse Practitioner was higher with the average being 5.6 days for short appointment and 6.7 for long appointments. ! • 

The Patient Experiences Survey responses indicated reasonable satisfaction with wait time on three measures but on the fourth measure only 66.6% of respondents disagreed or strongly disagreed that over the past 12 months they had difficulty getting the healthcare or advice they needed. They cited waiting too long and difficulty getting an appointment as their top two reasons for the difficulty. !

•  The Vegreville MDT team began participating (January 2014) in the AIM collaborative which is focused on increasing office efficiency and reducing patient wait time. As a result, it is probable that wait times will decrease among the KCPCN MDT members in Vegreville.!

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Conclusion#

Recommendation(s)#

The KCPCN may have played a key role in the reduction in emergency department (ED) utilization in Viking. #

7.1 The KCPCN should bring together appropriate healthcare providers and stakeholders to explore the factors that contributed to the decrease in emergency department utilization in the Viking Health Centre for semi-urgent and non-urgent care to better understand overall and in particular the role the KCPCN played. ! ! 7.2 Depending on the discoveries, the KCPCN should explore and support replicating the factors in both Vegreville and Vermilion.!

â&#x20AC;˘â&#x20AC;Ż From 2010/11 to 2013/14 use of the ED in the Viking Health Centre for semi-urgent and non-urgent care (CTAS 4 & 5) decreased by 11.53% (from 83.24% to 71.71%). The decrease occurred over several years suggesting it may be a permanent reduction.!

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Conclusion#

Recommendation(s)#

The KCPCN has grown quickly and is in the growth stage of organizational development with a need to manage its growth and establish additional organizational maturity. #

8.1 As much as possible, the KCPCN needs to prioritize its growth. Like most PCNs, it is at the centre of many opportunities and demands. If the right ones are harnessed it will support stability and steady expansion. If not, the risk is that staff and programming will become overwhelmed and efforts will be diluted from too many directions. !

•  The KCPCN underwent a merger between the Vegreville and Viking PCNs two years ago. ! •  The numbers of clinics and physicians joining and therefore patients attaching is steadily increasing. Correspondingly, the level of funding is increasing steadily as well.! •  The KCPCN is in the growth stage of organizational development with noticeable signs of needed maturity related to areas such as planning, change management, new member integration and quality improvement as shown in the results of both the Healthcare Team Effectiveness and Staff Satisfaction surveys. ! •  There are increasing external demands on all PCNs including the KCPCN related to evolution and accountability. These requirements are over and above program delivery in areas such as governance, panel management, measurement etc. At times, the requirements from different external bodies are conflicting in terms of direction, resource requirements and timelines.!

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8.2 The KCPCN should supplement its current planning to include plans for initiatives related to organizational capacity or growth. The current business plan template as provided and required by the Primary Care Initiative (PCI) office only includes program planning. The result is that the time, energy and resources needed for things like planning, measurement, panel management, quality improvement, policy development etc. are not planned for. Without this, these areas are either not well attended to or occur above and beyond full programming. !


Conclusion#

Recommendation(s)# 8.3 To further support successful growth, the KCPCN needs to shore up its change management and communication with staff. This may include working on less initiatives and slowing them down so that better change management and communication can happen. KCPCN management may want to consult with staff and based on input consider establishing more routine vehicles or mechanisms for communication to staff.! 8.4 As is often needed as part of an organization始s maturity, the KCPCN needs to consider enhancing its performance management system to ensure it is encouraging accountability, identifying strength and areas for growth, and connecting performance to KCPCN strategies and goals.! 8.5 The KCPCN needs to explore additional ways to improve workload management. Given the KCPCN始s rural setting which causes recruitment challenges and its part-time staffing for many positions, there are issues with workload coverage. KCPCN management needs to work with staff to find ways to address this issue over time through cross-training, vacation coverage etc. Possibly, as the KCPCN manages its growth and receives additional funding it may want to consider adding more FTEs to address workload issues before expanding programming further.!

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About the KCPCN# EO$


The Kalyna Country Primary Care Network (KCPCN) is one of 43 primary care networks (PCN) in Alberta. It is located in east central Alberta and provides programming and services to a patient population estimated to be at over 47, 000 residents. ! ! Within the geographic boundaries of the KCPCN, there are 5 physician clinics with a total of 18 physician members in the KCPCN. When primary care physicians become members of a PCN their patients become attached or part of the Primary Care Network. Based on $62/ attached patients, in 2013/14 the KCPCN received $1,168,206 in funding.! $ ! 2012/13 ! Number of:! participating in the PCN!

Clinics! 3!

within the PCN geographic area!

3!

2013/14!

2013/14!

15!

Clinics! 5!

Physicians! 18!

16!

5!

18!

2012/13 Physicians!

While it began as the Vegreville PCN in 2010 it merged with the Viking PCN to form the Kalyna Country Primary Care Network at the start of 2012/13 EP$

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Apr-Sep !

Oct-Mar!

Apr-Oct !

Number of:! Patients in the geographic area!

2012/13! 47,000!

2012/13! 47,000!

2013/14! 47,000!

Attached patients!

17,357!

17, 597!

18, 467!

19,189!

% of attached patients !

36.9%!

37.4%!

39.3%!

40.8%!

Oct-Mar 2013/14! 47,000!

When primary care physicians become members of a PCN their patients become attached or part of the Primary Care Network. As shown below, the number and percentage of attached patients has been steadily increasing. PCN funding is based on the number of attached patients at a rate of $62/year. In 2013/14 the KCPCN received $1 168,206 in funding. ! !

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Enablers to Program Delivery# Activities and Challenges!

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There are many important enablers that support effective PCN delivery. Each year depending on the maturity of a PCN and its context, the PCN focuses on different activities and experiences different challenges. Both of these ultimately impact programming and services to the patient. ! ! In 2013/14, the KCPCN experienced stability within its governance structure and activities. Although there was a great deal of larger change regarding primary care networks happening at the provincial level it was mostly in development and being communicated. While discussion about things like the Primary Care Evaluation Framework and PCN Evolution 2.0 were necessary, major decisions and required actions will fall to 2014/15 and beyond. ! # Regarding healthcare program planning and management, in 2013/14 the KCPCN started and quickly expanded its new Geriatric program. The program was intended to occur one day per month in Vegreville. In response to demand within the communities, availability of the visiting specialist (family physician with care of the elderly training) and funding room, the program was expanded to one day per month in each of the three main KCPCN communities. This decision increased access for geriatric patients threefold. ! # In terms of clinical decisions and activities, one of the largest impacts on KCPCN program delivery was the availability or unavailability of appropriately trained and experienced clinical staff. Recruitment and retention of staff in rural communities is a common challenge. In addition to some staff turnover the KCPCN needed to respond to several maternity leaves in 2013/14. # $$ !

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As a result, for most of 2013/14 the KCPCN experienced a partial vacancy with the Nurse Practitioner role. This meant that programming needed to be shifted to registered nurses with a smaller scope of practice or that some programming was reduced. Due to a maternity leave foot care services in Viking were transferred to a private provider. Client feedback for this program has not been as positive this year and the number of clients accessing the program has decreased. In 2014/15 this program will once again be provided by the PCN on a fee for service cost recovery basis. It is expected that this program may be also provided in Vegreville in 2014/15. In Vermilion the Referral Coordinator also went off on maternity leave. This position was difficult to recruit to and retention was difficult due to the temporary nature of the position. As a result three different staff covered this position. In response to recruiting for a social worker to provide mental health and community supports, the KCPCN hired a psychiatric nurse. While this provides strong mental health supports for patients it moves away from providing community supports. ! ! In addition to its core programming (some of which occurs in collaboration with Alberta Health Services and Covenant Health), the KCPCN worked with others through integration and coordination to improve clinical access and quality in a number of ways. ! •  In both Vegreville and Viking, the KCPCN collaborated with home care, lodges and supportive living to ensure that residents were receiving appropriate and accessible healthcare. ! •  In partnership with Covenant Health, the KCPCN has significantly increased patient access to visiting specialists. Through coordination and by providing space, reception time, and medical equipment, by the end of 2013/14 the following specialists were available: internist, cardiologist, gynaecologist, orthopedic surgeon, pediatrician, and podiatrist.!

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•  The KCPCN partnered with the Camrose PCN to provide a grief and bereavement program. Unfortunately despite evidence of interest and demand, enrolment was low so the program did not run. It is unknown what factors (e.g., time of program, communication of program) may have contributed to the poor result. ! •  In Vegreville, the KCPCN physicians and clinical staff worked with Mental Health services to implement mental health assessment with appropriate patients using the Psychiatric Triage Rating Scale. The scale explores areas such as suicidal ideation and support systems and ultimately classifies patients into three categories including: high intensity crisis, medium intensity crisis and low end crisis. Based on the assessment results, KCPCN physicians and clinical staff refer patients to Mental Health Services who respond within set timelines depending on the patient classification e.g., within 24 hours for high intensity crisis. KCPCN physicians and clinical staff in Viking and Vermilion will be working similarly with Mental Health services in 2014/15. !

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The KCPCN utilizes multi-disciplinary teams. This means patients are served not only by their physician, but also by other members of a multi-disciplinary team (MDT) and the various programs offered by the network. The table outlines the MDT staff members within the KCPCN. The outlined number of staff is configured into three MDTs at each of the main KCPCN sites. It is well accepted that effective MDTs contribute to the patient experience and to patient health outcomes. In 2013/14 the KCPCN placed additional emphasis on its MDTs. On a quarterly basis in each of Vegreville, Vermilion and Viking all members of the MDT including physicians and staff met to share information and plan together. Further, on a monthly basis in each community, the physician leads and all staff members met to share information and coordinate programming. This approach further activated the clinical involvement of physicians. ! ! Various configurations of the MDTs have completed a Healthcare Team Effectiveness Survey which explores various domains of alignment, relationships and methods. It is important to remember that these types of surveys are a snapshot in time and many variables can impact responses and results.! The KCPCN also utilizes some contractors for specialized support e.g., IT support, measurement and evaluation. !

2013/14 KCPCN Staff! Nurse Practitioners !

1.0!

Registered Nurses !

2.4!

Social Worker/Psych. Nurse!

0.6!

Pharmacists !

1.1!

Referral Coordinators !

0.8!

Dietician

0.6

Medical Office Assistants!

2.4!

Admin Assistants!

1.0!

Community Coordinator!

0.4!

Executive Director !

0.7!

Total !

11.0!

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FTEs!


The summary table outlined below shows the degree of effectiveness of each MDT that completed the surveys overall and within each domain and sub domain. All MDTs were the strongest in the sub domain of team member capabilities. None of the teams required improvement in this area indicating that the knowledge, skills and experience within the MDTs is very high. The scoring in the sub domain of interpersonal communication was also quite high across all of the teams through time. ! $ The KCPCN teams demonstrated overall healthcare team effectiveness ranging from 242 to 303 (out of 354). The Vermilion and Vegreville (at March 2014) MDTs had lower results. These two teams needed development across the three main domains within 4-6 sub domains such as planning, managing change, conflict resolution, recognition, meeting, new member integration and continuous improvement. Areas in red indicate a need for improvement or development. ! ! The remaining teams had individual areas that needed improvement but to a lesser degree. A complete table outlining all results by questions and sub domains is available in the Appendices.! !

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MDT Healthcare Team Effectiveness Survey Summary Results!

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May 2012 KCPCN MDT !

Feb 2013 Vermilion MDT!

Feb 2013 Viking MDT!

Feb 2013 Mar 2014 Vegreville MDT! Vegreville MDT!

# of team members completing survey!

!!

6!

6!

9!

7!

DOMAIN: ALIGNMENT !

88!

82!

95!

86!

74!

Sub domain: Planning !

35!

32!

37!

34!

28!

Sub domain: Team Member Capabilities !

26!

24!

28!

25!

26!

Sub domain: Managing Change!

27!

26!

30!

26!

21!

DOMAIN: RELATIONSHIPS !

100!

82!

105!

95!

87!

Sub domain: Norms, Diversity, Values!

28!

26!

30!

27!

25!

Sub domain: Interpersonal Communication !

26!

21!

27!

25!

23!

Sub domain: Conflict Resolution!

19!

16!

21!

18!

15!

Sub domain: Recognition!

26!

20!

27!

25!

23!

DOMAIN: METHODS !

96!

81!

103!

90!

81!

Sub domain: Team Operating Procedures !

29!

25!

32!

27!

25!

Sub domain: Meetings !

28!

25!

31!

28!

24!

Sub domain: New Member Integration!

15!

13!

15!

13!

11!

Sub domain: Continuous Improvement!

24!

19!

25!

22!

21!

OVERALL Healthcare Team Effectiveness!

284!

245!

303!

271!

242!

Totals!

-! 114! 48! 30! 36! 120! 36! 30! 24! 30! 120! 36! 36! 18! 24! 354!


Quality improvement is the effort used to understand and improve the activities and processes of providing healthcare and the outcomes of that care. There are many approaches to quality improvement. Within the Alberta health system, a number of formal approaches have been developed by Alberta Health Services, the Alberta Medical Association and others. ! ! They are often implemented by engaging local healthcare programs and practitioners including PCNs. Through the collaborative process, staff are trained in quality improvement and supported to implement quality improvement efforts within their organizations. One such approach is Alberta AIM which focuses quality improvement efforts specifically on improving patient access to care. The Vegreville KCPCN team began participating in AIM in January 2014. The one year collaborative program focuses on educating and supporting teams of frontline practitioners to understand and improve various access measures. While some of the group始s collected data is discussed in a later section, by the end of 2013/14, it was too early in the process to provide improvement results. ! !

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Core Programs# What We Did and Who We Served!

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! !

Alternative Clinics# The KCPCN provides various types of alternative clinics throughout the geographic area including: ! •  Evening walk in clinics in Vegreville. These are provided by the Nurse Practitioner on a weekly basis for one evening. ! •  Morning walk-in clinics in Vegreville. These are offered within the physician clinic by the Nurse Practitioner. They are offered from Monday to Thursday as the Nurse Practitioner is available. ! •  Remote clinics in several Seniorʼs Facilities including Homestead Lodge and Vegreville Manor. These clinics involve both the Nurse Practitioner and the Pharmacist from Vegreville. The NP conducts assessments, orders diagnostic tests, diagnoses, follows up on results, provides treatment and prescriptions as appropriate, and coordinates referrals to physicians and specialists as required. In addition, she offers health screening and health promotion to patients. ! •  Remote clinics with the Nurse in the Viking Lodge. ! •  Remote clinics in Mannville and Wainwright. These are near monthly clinics provided by an RN from Vermilion. These clinics were only operational for a portion of 2013/14. ! •  Remote clinics in Irma on a monthly basis provided by a physician which the KCPCN. ! ! !

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The following table outlines the various clinics and the number of patients served. As shown, many of the clinics were operational for less than the full year. The alternative clinics included a total of 503 patient visits. When projected for a full yearʼs operations this number would be approximately 899 patient visits. ! ! On a per session basis the remote clinics in the Homestead and Vegreville Manor are the busiest with 14.8 patients/sessions. This remains true even when the figure is divided in two because it is a full day clinic. On average 7.4 patients are seen in either a morning or afternoon clinic session. !  ! By the end of 2013/14 the remote clinic in Irma on the other hand, saw the least number of patients and patients per session. While it was slower to get established and attract patients than most of the other alternative clinics, it finally took off. Within the early months of 2014/15, the clinic became fully booked (approximately 20 patients per session) and a second clinic session each month was requested.!

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Alternative Clinic Summary! Vegreville! Vegreville !

Type of Clinic!

Frequency!

Practitioner!

Total # of patient visits!

Evening walk in clinic!

Weekly !

Morning walk-in clinic!

Tues 4-6pm! Mon-Thurs as NP is available!

Nurse Practitioner! Nurse Practitioner!

Annual # of patient visits!

217!

Average # of patients/clinic session! 5!

54*!

3.6!

~ 324**!

217!

(2 mths)!

Vegreville!

Remote clinic in Homestead Lodge and Vegreville Manor!

One day per month, am and pm clinics!

Nurse Practitioner and Pharmacist!

148!

14.8!

148!

Viking !

Remote clinic in Viking Lodge !

Monthly !

RN and Pharmacist!

15*!

5!

~ 60**!

Innisfree!

Remote evening walk-in clinic!

Monthly one evening from 4-7pm!

Nurse Practitioner!

3.5!

~ 42**!

(6mths)!

Remote clinic !

Weekly!

RN !

28*!

4.0!

~ 48**!

3.5!

~ 42**!

1.5!

~ 18**!

-!

~ 899**!

Mannville!

(3mths)!

21*!

(7 mths)!

Wainwright!

Remote clinic!

Weekly!

RN!

14*! (4 mths)!

Irma!

Totals !

Remote evening walk-in clinic!

Monthly one evening from 4-7pm!

Physician!

-!

-!

-!

6*! (4 mths)!

503!

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Women始s Health through the Lifespan# The KCPCN offers programming to women through the lifespan. In Viking, a Pre and Post Natal Program serves the PCN geographic area from the Viking Medical Clinic. The registered nurse who runs the program provides pre and post natal care when it is not readily available or when additional care is needed. Referrals are from physicians. Linkages to prenatal care provided by AHS and other resources are offered. Additional support includes: assessment; counseling; initiation of prenatal record; one to one prenatal support; preadmission paperwork at 36-38 weeks and hospital tours as required; as well as post natal follow up at 1 to 2 weeks after delivery and lactation support. The program also provides (in conjunction with Public Health in Viking) group support and education sessions for new or struggling mothers. ! ! ! ! A Women始s Health Clinic is offered one day per week in Vegreville in collaboration with Covenant Health (who funds the NP). The KCPCN provides clinic space and Medical Office Assistant support.!

2013/14 Pre and Post Natal Program# # of patients visits! Obstetric (new patients)!

122!

Obstetrics (follow-ups)!

197!

Prenatal !

82!

Total !

401!

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Geriatric Support Program# In 2013/14 the KPCPN began a Geriatric Program one day per month in Vegreville. In response to demand, it was immediately expanded to Viking and Vermilion. ! The program uses a roving team and a visiting specialist (family physician with care of the elderly training). The purpose of the program is to provide older adults who often have complex needs with the intensive support of a multidisciplinary team (MDT) from assessment through care. ! Â ! As outlined, the Geriatric Program started near the end of 2013/14. It is clear in looking at the numbers that already the demand is high and that the KCPCN is meeting an unmet healthcare need. ! ! ! Referral from family Completion of Home visit Assessment visit by physician checklist geriatrician !

2013/14 Geriatric Support Program# # of patient referrals! Vegreville!

14*!

# of completed patient assessments! 6*!

Vermilion!

17*!

6*!

Viking!

14*!

5*!

Total!

45*!

17*!

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Development of assessment report or care plan

Review of care plan by MDT and copy to family physician

Interventions by various MDT members and follow-up appointments

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! !Chronic

Disease Management and Complex Care Program# The KCPCN offers chronic disease and complex care programming in each of Vegreville, Vermilion and Viking. An MDT provides comprehensive assessment, coordinated care and follow-up. Patients participate in developing individualized care plans. They are also educated on their care and conditions and empowered to self-manage their health and health conditions. Health priorities include but are not limited to: diabetes, heart health, obesity, weight management, mental health and smoking cessation. ! ! In 2011/12 the KCPCN supported 160 patients in the Chronic Disease Management and Complex Care Program. It has more than doubled its reach in two years. In 2013/14 a total of 417 new patient visits were provided to chronic disease and complex care patients. Another 1137 follow up visits were tracked by MDT staff across all 3 sites. ! ! In addition, another 131 new and follow-up patient visits were tracked by the Pharmacist in Viking. While the exact nature of each visit is unknown, the majority are believed to be related to chronic disease and complex care patients. ! ! Given current tracking practices, it is not possible to definitively determine the total number of new chronic disease and complex care patients or the total number of follow-up chronic disease and complex care patients overall, by site or by practitioners. !

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! !

2013/14 Chronic Disease and Complex Care Vegreville- RN!

# of new patient visits!

# of follow-up patient visits!

74*!

^^!

Vegreville- Pharmacist!

50!

346!

Vegreville- NP!

54!

395!

Vermilion-RN!

125*!

246*!

Viking-RN!

114!

150!

Chronic Disease!

Totals!

417!

1137!

Diabetes!

81.4%!

131**!

131**!

High blood pressure!

70.1%!

High cholesterol !

41.6%!

Arthritis!

24.6%!

Obesity!

23.4%!

Depression and/or Anxiety!

19.8%!

Chronic Pain!

18.0%!

Heart disease, congestive heart failure! Asthma!

13.2%!

Cancer!

11.4%!

Sleep Apnea!

11.4%!

Viking- Pharmacist!

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In the 2013-14 KCPCN Patient Experiences Survey conducted with patients from the Chronic Disease and Complex Care programs, most patients reported at least three or four chronic diseases each. The three most common were diabetes, high blood pressure and high cholesterol. ! ! ! 10 Most Commonly Reported Rate!

12.0%!

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Specialist Coordination and Referral#

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This program utilizes Referral Coordinators to support the Physicians and Nurse Practitioner working with chronic disease and complex care patients in Vermilion by coordinating bookings, testing, and specialist appointments and following patients through the process. It also maintains a database of available programs and services. ! Â ! In 2013/14 the program coordinated 874 specialist referrals. Based on the last three years of operations, the program coordinates an average of 883 specialist referrals per year. ! !

Specialist Coordination and Referral

# Specialist Referrals !

2011/12 (Aug- Mar)!

562!

2012/13!

931!

2013/14!

874!

Total!

2367!

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! !

Lifestyle Program and Education# The KCPCN coordinates, collaborates and partners with other community organizations including AHS in the identification and delivery of programs to support healthy living and prevention of disease for the general public. Health promotion and educational programs/events are based on need/interest, priorities, resources and linkages. Program and events are offered in Vermilion, Vegreville, Viking and surrounding communities and are available to all members of the community. KCPCN patients are referred to and encouraged to participate in exercise programs and education sessions with the community.! WeightWise is a lifestyle and education program focused on supporting participants to gain knowledge, skills and competence in managing their weight. The KCPCN partners with AHS to provide this program in Vermilion. It is offered three times each year. In 2013/14, fifty one patients attended the classes. ! ! 2013/14 Weight Wise ! Vermilion! The program includes ten ! sessions: 1) Getting Started; Program Attendance ! 2) Finding Balance; 3) April –group 1! 8.5*! Managing Hunger; 4) April- group 2! 11.1*! Moving Matters; 5) The September- group 1! 12! Truth: Nutrition; 6) I Know I September – group 2! 12! Should: Nutrition; 7) Eating Away From Home; 8) January -group 1! 2.4*! Minding Stress; 9) Craving January –group 2! 5*! Change: Part 1; 10) Craving Total! 51! Change: Part 2. ! Yb+5#3$01$+*#8+4#$Z$0C$+..#13##5$+28055$."#$EQ$ ! 5#55/015?$ ! KEX(&,/-(-Q)#/(U)$850(U$/)(+,&//)/($.(@)8#)6$,,)(&.*(@$A$.8:$$

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Health Promotion and Education# Primary care also emphasizes health promotion, which is the process of enabling people to increase control over, and to improve their health. The KCPCN utilizes several approaches to supporting patients in this regard. While some programming has been developed and implemented, more is planned as part of the 2013/14-2015/16 business plan. !

!


Lifestyle and Health Communication# Another approach to supporting KCPCN patients and community members to understand and improve their health is to develop and deliver user-friendly health and lifestyle information. ! ! For several reasons despite ambitious plans, the KCPCN was only able to get an initial start in this program area in 2013/14. They specifically engaged, supported or educated the public on lifestyle and health communication in a couple of ways including:! •  A KCPCN display and foot care booth at the Flu clinic in Viking. ! •  A KCPCN presentation on good diet and exercise at the Seniorʼs Fair in Vegreville. ! •  Proving a discounted pass to the Lakeland College exercise facility for individuals attending Weight Wise classes. ! •  HUTV has been installed in the Vegreville and Vermilion KCPCN clinics with programming to follow.! While the KCPCN was first funded in 2010, its first year or two was focused on a merger with another PCN. Given this, it is a relatively new PCN with only a couple of years of strong programming. Before a PCN would be well positioned to provide lifestyle and health communication to patients and the public through hard-copy, in-person presentation, television and social media, a lot of development is needed. The public first needs to know about the PCN in general. !

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`(a(5-7#/>(+,$).0(/),13#)4-#0$.8>(7/)(-1(/-+$&,(%)*$&:((E&#*(+-4'(#)/-7#+)/(9$,,( $.+,7*)($.1-#%&0$-.(4&+A&8)/(-.(6&#$-7/(5)&,05'(,$1)/0',)(&.*(9),,.)//(0-4$+/(05&0(/744-#0(A.-9,)*8)(&.*(4&#0$+$4&0$-.(/7+5(&/(/),1(%&.&8)%).0( *$&#$)/b5)&,05(#)+-#*:($

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Indeed, in 2013/14 the KCPCN spent considerable effort spreading the word about the KCPCN and its programs to patients and the community. !

KCPCN Website Statistics sessions!

•  They developed a number of materials including KCPCN program brochures and fact sheets, and banner signs. !

users!

•  They engaged local media regarding KCPCN news stories. ! •  They engaged and educated physicians and MDT members on KCPCN programming through in-person meetings on a quarterly basis. ! •  They developed a Facebook page that has not yet launched, to support a stronger social media presence. ! •  They also updated their website and increased the number of users, returning users, and sessions. While these changes resulted in a reduced bounce rate, it decreased the number of pages per session and the average duration per session. It is important to note that individual PCN websites are supported through the Primary Care Initiative (PCI) Office. As such, the KCPCN must work with and through the PCI office to make changes to its site and it is limited by the templates provided.! •  The most commonly viewed content page on the KCPCN website was the Services page with 608 page views. This indicates that the majority of website users are accessing the website to learn about the programs offered by the KCPCN.! ! KQ$

2012/13!

2013/14!

Change !

779!

2356!

+202.44%!

594!

1670!

+181.14%!

New users!

76.3%!

68.8%!

-7.5%!

Returning users!

23.7%!

31.2%!

+7.5%!

Pages/ session!

4.13 pgs!

2.93 pgs!

-29.10%!

Avg. Session duration ! Bounce rate!

2:18 minutes! 53.53%!

1.31 minutes! 38.77%!

-35.25%! +38.06%!

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Patient Awareness of KCPCN and their Attachment Before reading the above description, did you know what a Primary Care Network was? (170)! Were you aware that you were part of a Primary Care Network? (164) !

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Yes, definitely!

Yes, somewhat!

No!

31.2% (53)!

44.7% (76)!

24.1% (41)!

41.5% (68)!

23.2% (38)!

35.4% (58)!

Near the end of 2013/14, the KCPCN conducted a Patient Experiences Survey which provided an opportunity to check in on patient awareness about PCNs. When Chronic Disease and Complex Care patients were surveyed, there were mixed results in terms of their awareness of what a PCN is and their attachment to one. Patients were provided with a brief description of a PCN and then asked two questions as shown below. ! ! Only, 31.2% of respondents definitely knew what a PCN was, and only 41.5% knew that they were part of a PCN. Further, the evaluator fielded more than two dozen phone calls from survey recipients who were confused and felt they had received the survey in error. These patients had no awareness that they were part of a primary care network. While the KCPCN has made some progress in educating the public and patients, there is a continued need to increase the publicsʼ and patient awareness of primary care networks and what they are about. ! ! !


Physician/Staff Education# The third approach to supporting patients with health promotion is to ensure that physicians and KCPCN staff members are themselves knowledgeable. To this end, the KCPCN supports physicians and staff members to attend key education on health related topics in priority areas that are relevant to PCN programming. Learning occurs through education attendance and cross-training. ! ! In 2013/14, KCPCN staff attended 17 different kinds of training. ! ! While the two most attended types of training were not directly related to supporting patient health, 12 of the 17 were about topics that did increase staff knowledge and capacity to support patient health. ! ! The KCPCN also provides “up to date” for Physicians which is a database they can access on the internet to keep up to date on diagnosis and treatment.!

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2013-14 KCPCN Staff Training/Type of Training !

# of Staff!

Access Improvement Measures (AIM)!

6!

Health/Health Promotion Related! -!

Electronic Medical Record Training!

6!

-!

Diabetes Certification Educator Course!

3!

!!

Prenatal Education !

2!

!!

Geriatric Conference!

1!

!!

Lactation Consultant Education !

1!

!!

Alberta Screening and Prevention (ASaP) Facilitator Training ! Clinical Guidelines Diabetes !

1!

!!

1!

!!

Choices and Changes Workshop!

1!

!!

Multi-therapeutic Update – Diabetes, Mental Health, and Obesity Workshop! Obesity Management!

1!

!!

1!

!!

Incretin Therapies!

1!

!!

CV Risk Level 2!

1!

!!

WeightWise Train the Trainer!

1!

!!

Team Leadership Development !

1!

-!

Alberta Medical Association (AMA)/ Primary Care Initiative PMO Forums ! Communication Consulting Conference!

1!

-!

1!

-!


ResultsThe Difference for Patients# KJ$


As with any healthcare program or service, the KCPCN is ultimately trying to make a difference for the patients it serves. The KCPCN logic model (see Appendices) outlines the specific outcomes or differences that it is trying to make including:! •  Increased access to local primary care services! •  Improved integration and coordination of primary health care services with other healthcare services and providers! •  Reduced risk of health conditions ! •  Patient engagement, acceptability and satisfaction! •  Increased knowledge and about health and healthcare management ! •  Increased self-efficacy and action taking to manage health and health conditions! •  Reduced duration and effects of acute, episodic and continuing health conditions! •  Improved and/or maintained functioning, health and/or quality of life ! Of course, demonstrating these differences requires designing and using different forms of measurement. Implementation of these kinds of measurement systems can take any number of years. In 2013/14 the KCPCN moved forward with putting some of these measures in place. As such, it is now able to measure, understand, and improve upon the difference it is making. ! !

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Through its programming and delivery the KCPCN increased access in several important ways. ! ! First, the KCPCN offers programs and services that would not otherwise be available in the community. Patients would perhaps receive less specialized and /or comprehensive care from their primary care physician or they would travel elsewhere to obtain the care. In this regard the KCPCN provides three key programs.! •  Womenʼs Health – 401 patient visits in the pre and post natal program! •  Geriatric Support – 17 completed assessments (during the programʼs first 3 months)! •  Chronic Disease and Complex Care Management – 417 new patients, 1137 follow-up patients! ! The KCPCN also partners to bring in numerous specialists so that community members/patients do not need to travel into the city to receive appropriate care. The list of currently available specialists includes: internist, cardiologist, gynecologist, orthopedic surgeon, pediatrician, and podiatrist. ! ! Second, as discussed previously the KCPCN offers alternative clinics after hours and in remote locations. In 2013/14, 503 patient visits were provided through alternative clinics. This increases patient access to appropriate care. ! ! !

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Increased Access #


Third, the KCPCN strives to ensure that patients receive timely access. This means that they can access an appropriate practitioner in a reasonable amount of time. The KCPCN does not yet have ongoing and fulsome data to understand the timeliness of its access. However, it has some beginning information as a starting point. ! ! Based on partial tracking: ! •  Almost all physicians were accepting new patients. In a nine month time period only 1-2 physicians per month was/were not accepting new patients. ! •  The average appointment wait time as measured by time to third next available appointment averaged 14.475 days for a sample of 5 physicians over an 8 month period. ! •  The range of appointment wait times for the same 5 physicians was 4 to 55 days. ! Time to Third Next Available Appt (TNA)- 8 Month, Five Physician Sample

60 50 40 Average across all months, all physicians- 14.475

days

30 20 10 0

Month 1

Month 2

Month 3

Month 4

Month 5

Month 6

Month 7

Month 8

Physician A

12

11

9

11

10

14

11

21

Physician B

15

10

7

10

15

12

24

8

Physician C

10

8

10

11

8

10

31

31

Physician D

8

10

8

4

5

55

28

8

Physician E

18

12

11

16

4

26

27

20

Avg- 12.4 Avg- 12.3 Avg- 14.9 Avg- 15.8 Avg- 16.8

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Based on weekly tracking as part of AIM:! •  The average appointment wait time as measured by time to third next available appointment was 3.03 for short appointments when tracked over 8 weeks for three MDT members in the Vegreville clinic. The wait time range was 1-14 days for the Nurse Practitioner, 0-9 days for the Pharmacist and 1-3 days for the Registered Nurse. ! •  Results were similar for long appointments which averaged 3.33 days. ! Time to Third Next Available Appt (SHORT)- Vegreville MDT over 8 weeks 16 14

Average across all weeks, all MDTs- 3.03

12

days

10 8 6 4 2 0

Week 1 Week 2 Week 3 Week 4 Week 5 Week 6 Week 7 Week 8 Week 9 Week 10

Nurse Practitioner

1

7

2

11

8

2

1

2

14

8

Pharmacist

1

9

3

1

8

0

0

0

0

0

Reg. Nurse

1

2

1

1

1

1

1

1

1

3

D&0&(+-,,)+0)*(&/(4&#0(-1(K++)//(F%4#-6)%).0(I)&/7#)/(RKFIS($.(@)8#)6$,,):(

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Avg- 5.6 Avg- 2.2 Avg- 1.3


Time to Third Next Available Appt (LONG)- Vegreville MDT over 8 weeks 16 14

Average across all weeks, all MDTs- 3.33

12

days

10 8 6 4 2 0 Week 1

Week 2

Week 3

Week 4

Week 5

Week 6

Week 7

Week 8

Week 9

Week 10

Nurse Practitioner

1

6

2

12

8

2

1

15

11

9

Pharmacist

1

8

3

1

8

0

0

0

0

0

Reg. Nurse

1

2

1

1

1

1

1

1

3

0

Avg- 6.7 Avg- 2.1 Avg- 1.2

Of course, the ultimate goal for access is same day. We can see that there were consistent improvements with the Pharmacist and the Registered Nurse through time. However access to the Nurse Practitioner remained higher. Her role is in higher demand and more specialized so it stands to reason that larger process and systems changes will be needed to create consistent improvement. As well, there were partial vacancies in the position throughout the year. While the data available for physicians was limited, the access time was consistently high and well beyond the goal of same day access. !

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Another important indicator of access is the patientsʼ perception or experience of accessing healthcare when needed. When KCPCN Chronic Disease and Complex Care patients were surveyed they were asked four main questions about access. ! •  81.6% of respondents agreed or strongly agreed that the wait time from the Doctorʼs referral until their first visit with their main KCPCN provider was acceptable. ! •  86.2% of respondents agreed or strongly agreed that their main KCPCN provider gave them the opportunity for a follow-up by phone or in-person.! •  85.4% of respondents agreed or strongly agreed that the wait time for follow-up appointments with their main provider was acceptable. ! •  Only 66.6% of respondents disagreed or strongly disagreed that over the past 12 months they had difficulty getting the health care or advice they needed! When asked to clarify the type of difficulty they had in getting the healthcare or advice they needed the top three responses were: ! 1) Waiting too long for an appointment on the waiting room (52.6%), ! 2) Difficulty getting an appointment (36.8%), and ! 3) Service or program not available in my area or at time needed (24.6%). ! ! Further at least a dozen respondents provided additional comments regarding access challenges. ! Many were about waiting too long to get an appointment particularly with physicians, or not receiving needed follow-up. There were several comments about being refused care, or told to “come back another day” when trying to access the walk-in clinic. There were also comments related to programs being restricted to new clients only, and programs running on inconsistent days of the week. !

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KCPCN Patient Experiences Survey Chronic Disease and Complex CareResponses to Access Questions 60.0% 52.1% 50.0%

50.9%

47.3% 44.0%

mean-4.2

mean-4.2

mean-4.2

mean-3.7

40.0% 34.3%

34.5%

34.1%

Strongly disagree Disagree

30.0%

Neutral

22.6%

Agree

20.0%

10.1% 10.0%

9.1%

7.2% 1.8% 0.6%

3.0% 1.8%

3.0%

13.7% 11.3%

Strongly agree

4.2%

0.0%

0.0% The wait time from the Doctorâ&#x20AC;&#x2122;s My main provider gave me the referral until my first visit with my opportunity for follow-up by main provider was acceptable. phone or appointment.

The wait time for follow-up appointments with my main provider was acceptable.

Over the past 12 months, I had difficulty getting the health care or advice I needed.

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As shown, patient responses to the same four access questions varied slightly by the main providers. Responses regarding the wait time from the doctorʼs referral compare with the results from the time to third next available appointment data that was collected. The patient experience confirms that the wait time for the Nurse Practitioner is the longest and least acceptable, then the Pharmacist and then the Nurse respectively. The same wait time concern was reflected in the difficulty patients experienced in getting needed healthcare or advice. While the mean responses are below 4.0 for the three main providers they are the lowest for the Nurse Practitioner at only 3.24. The top two reasons for experiencing difficulty were the same for each main provider namely, 1) waiting too long for an appointment on the waiting room, and 2) difficulty getting an appointment. ! !

Overall!

Nurse!

Nurse Practitioner!

Pharmacist!

4.2!

4.11!

3.95!

4.17!

Opportunity for follow-up!

4.2!

4.26!

4.24!

3.98!

Wait time for follow-up appointments!

4.2!

4.17!

4.38!

4.07!

Difficulty getting health or advice !

3.7!

3.76!

3.24!

3.74!

Patients’ Access Responses by Main Provider Wait time from Doctor’s referral!

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One of the longer term results of increasing patient access to primary care are improvements to emergency department utilization, particularly in decreases to use of the emergency department for semi-urgent and non-urgent care (CTAS 4 & 5). When data over a three year period is examined in the KCPCN three main communities we see significant changes in Viking. Use of the emergency department for semi-urgent and non-urgent care decreased from 83.24% in 2010/11 to 71.71% in 2013/14. Unfortunately to date, usage in both Vegreville and Vermilion has remained fairly consistent. ! Emergency Dept Utilization in 3 KCPCN Communities St. Joseph's General Hospital (Vegreville)!

Vermilion Health Centre!

Viking Health Centre!

CTAS 1 & 2 Resuscitation & Emergent!

CTAS 3 Urgent!

CTAS 4 & 5 Semi-Urgent & Non-Urgent!

&'($)!*! 11,864! 12,201! 11,162!

314! 299! 361!

2.65%! 2.45%! 3.23%!

2,579! 2,674! 2,651!

21.74%! 21.92%! 23.75%!

8,422! 8,700! 7,780!

70.99%! 71.31%! 69.70%!

549! 528! 370!

4.63%! 4.33%! 3.31%!

2013/14 YTD!

10,744!

307!

2.86%!

2,433!

22.65%!

7,584!

70.59%!

420!

3.91%!

2013/14!

11,767!

345!

2.93%!

2,713!

23.06%!

8,246!

70.08%!

463!

3.93%!

2010/11!

8,878!

206!

2.32%!

1,455!

16.39%!

6,474!

72.92%!

743!

8.37%!

2011/12!

9,573!

190!

1.98%!

1,722!

17.99%!

6,908!

72.16%!

753!

7.87%!

2012/13!

9,802!

208!

2.12%!

1,873!

19.11%!

6,974!

71.15%!

747!

7.62%!

2013/14 YTD!

9,033!

187!

2.07%!

1,791!

19.83%!

6,540!

72.40%!

515!

5.70%!

2013/14!

9,853!

213!

2.16%!

1,969!

19.98%!

7,102!

72.08%!

569!

5.77%!

2010/11!

6,474!

30!

0.46%!

467!

7.21%!

5,389!

83.24%!

588!

9.08%!

2011/12!

4,230!

28!

0.66%!

384!

9.08%!

3,435!

81.21%!

383!

9.05%!

2012/13!

4,477!

51!

1.14%!

502!

11.21%!

3,470!

77.51%!

454!

10.14%!

2013/14 YTD!

3,704!

89!

2.40%!

613!

16.55%!

2,659!

71.79%!

343!

9.26%!

71.71%!

357!

9.01%!

2013/14! 3,963! 91! 2.30%! 673! 16.98%! 2,842! IQEJSEK$f!VH$/12,-3#5$F;8/,$e7#<$3+.+$WEE$601."5X$$$$$$$$$IQEJSEK$;+8./+,,=$+448#4+.#3$C08$+$C-,,$\52+,$=#+8$ D&0&(X-7#+)(KEX(DFIJ(;&=,)&7O(L%)#8).+'(D)4&#0%).0(D&/5=-&#*(

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09 Unknown!

!"#$%! 2010/11! 2011/12! 2012/13!


Integration and coordination in healthcare improves the patient experiences and their health outcomes. It involves service providers and practitioners working together, collaborating, dissolving barriers, providing joint programming or otherwise ensuring that the patient experience of receiving care is seamless. ! Â ! When KCPCN Chronic Disease and Complex Care patients were surveyed they identified family physicians, pharmacist, and other health professionals as those they access the most beyond their KCPCN main provider. ! 2013-14 KCPCN Patient Experiences SurveyOther Health Professionals Accessed for Care social worker/ registered psychiatric nurse 2%

nurse 8% nurse practitioner 9%

referral coordinator 3% specialist e.g. internist, geriatrician etc 6%

family physician 36%

other health professional 11% pharmacist 25%

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Improved Integration and Coordination#


They were asked five main questions about integration and coordination. ! •  74.6% of respondents agreed or strongly agreed that their main provider worked with other health professionals to coordinate care. ! •  74.7% of respondents agreed or strongly agreed that other professionals they saw knew about their most recent medical history.! •  80.5% of respondents agreed or strongly agreed that other professionals they saw had access to their most recent tests and exam results. ! •  Only 63.5% of respondents agreed or strongly agreed that other professionals they saw knew about changes in their treatment. ! •  Only 56.4% of respondents agreed or strongly agreed that the healthcare they needed from other health professionals was arranged by KCPCN staff. ! The results for the integration and coordination questions are lower than many of the other areas of the survey. In particular, other health professionals knowing about treatment changes and other health professionals being arranged by KCPCN staff were particularly low. When explored by the three main providers, we see that there is some variation by provider. ! Overall!

Nurse!

Nurse Practitioner!

Pharmacist!

Main provider worked with other health professionals in coordinating care!

4.0!

4.09!

3.96!

3.89!

Other professionals knew about most recent medical history!

4.1!

4.12!

4.10!

3.96!

Other professionals had access to most recent tests and exam results!

4.1!

4.10!

4.24!

4.04!

3.9!

4.03!

3.92!

3.68!

3.78!

3.70!

3.75!

Patients’ Integration and Coordination Responses by Main Provider

Other professionals knew about changes in treatment ! Needed health care from other health professionals was arranged by KCPCN staff!

3.8!

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Patient engagement, acceptability and satisfaction are an important outcome of primary health care. They are a reflection of how care is provided. It is believed that the engagement, acceptability and satisfaction of patients are linked to their health outcomes. ! ! !When KCPCN Chronic Disease and Complex Care patients were surveyed they were asked eight questions in this area. Respondents indicated their high levels of engagement, acceptability and satisfaction across all questions. ! •  The highest score overall was in listening to health related concerns with a mean response of 4.4 out of 5. ! •  Other high scores were for giving enough time to share thoughts and feelings (4.3); reviewing medical tests and history (4.2); fully explaining tests and treatments (4.3) and involving patients in decisions about care (4.3). ! •  The lowest score overall was for working with patients to develop a treatment plan where the mean response was only 4.1 out of 5. ! :$ ! !

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Patient Engagement, Acceptability and Satisfaction#


Overall!

Nurse!

Nurse Practitioner!

Pharmacist!

4.2!

4.26!

4.45!

4.23!

91.6%!

4.3!

4.32!

4.45!

4.19!

Main provider listened to health related concerns!

92.9%!

4.4!

4.37!

4.55!

4.16!

Main provider fully explained tests and treatments!

88.1%!

4.3!

4.35!

4.44!

4.13!

Main provider involved patient in decisions about care!

91.1%!

4.3!

4.25!

4.38!

4.07!

Main provider gave clear instructions about symptoms to watch for and when to seek further care of treatment! Main provider talked with patient about main goals in care given health and conditions! Main provider worked with patient to develop a treatment plan!

83.9%!

4.2!

4.17!

4.40!

3.90!

4.2!

4.19!

4.35!

4.07!

4.1!

4.11!

4.13!

3.94!

Patientsâ&#x20AC;&#x2122; Engagement, Acceptability and Satisfaction by Main Provider Main provider reviewed medical tests and history to help patient understand health issues and condition! Main provider gave enough time to share thoughts and feelings!

% Agree or Strongly Agree

91.2%!

87.4%! 81.4%!

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Regarding overall satisfaction:! •  89.3% of respondents agreed or strongly agreed that they were satisfied with the care they received from their main provider. The overall mean was 4.3 out of 5. ! •  88.1% of respondents agreed or strongly agreed that they had confidence in their main provider to support them in managing their health and conditions. The overall mean was 4.3 out of 5.! •  Fewer respondents (only 81.4%) agreed or strongly agreed that their main provider offered everything they needed to manage their health conditions and concerns. The overall mean was 4.0.! •  Respondents were the most satisfied with the Nurse Practitioner in all three areas. ! 2013-14 KCPCN Patient Experiences SurveyOverall Satisfaction with Main Provider 5 4.5 4

4.3

4.55 4.22

4.23

3.5

4

4.28 3.94

4

4.3

4.26

4.42 4.03

3

Overall

2.5

Nurse

2

Nurse Practitioner

1.5

Pharmacist

1 0.5 0 Confidence in main provider to support patient in managing their health and conditions

Main provider offered everything needed to help patient manage health conditions and concerns

Satisfied with care received from main provider

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Ideally, as we work with patients to support them in their health, we want to increase their capability- their knowledge, skills and experience with health and health management. We want them to become increasingly able to understand and care for their health. This approach not only places patients at the centre of their own care, it sees them as competent and responsible. ! . ! ! When KCPCN Chronic Disease and Complex Care patients were !surveyed they were asked eight questions in this area. The first two questions explored patient experiences with their main KCPCN provider 1) offering patient health information and discussing risk factors and 2) providing resource information or encouraging use of community resources. ! •  84.4% of respondents agreed or strongly agreed that their main provider offered patient health information and discussed risk factors. The overall mean was 4.1 out of 5. The mean for each of the three main providers was 4.1, 4.09 and 3.72 for the Nurse, Nurse Practitioner and Pharmacist respectively. ! •  Only 67.5% of respondent agreed or strongly agreed that their main provider gave them resource information or encouraged them to use community resources. The overall mean was 3.8, while the mean for each of the three main providers was 4.02, 3.88 and 3.55 for the Nurse, Nurse Practitioner and Pharmacist respectively. ! ! !

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Increased Knowledge of Health and Health Management #


2013-14 KCPCN Patient Experiences SurveyProvision of Health Information and Resources 70.0% 60.0% 58.1%

50.0%

50.0%

Strongly disagree

40.0%

Disagree 30.0%

Neutral 26.3%

20.0%

Agree 17.5%

10.0% 1.8%

1.8%

7.8%

1.8%

17.5%

Strongly agree

4.8%

0.0% Main provider offered patient health information and Main provider gave patient resource information or discussed risk factors encouraged patient to use other community resources to help with their conditions and health issues

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The other six questions on the Patient Experiences Survey explored increases to the patientʼs knowledge of health and health management. ! •  Overall the questions with the highest results were regarding increases to patient understanding of health monitoring and the right use of medications. In both cases 86.8% of respondents agreed or strongly agreed. ! •  The question with the lowest result was regarding increased understanding of different medical treatment options where only 72.9% of respondents agreed or strongly agreed. ! $ When responses were explored for the three main providers, the Nurse Practitioner consistently had the highest results across all six questions, followed by the Nurse and then the Pharmacist. The only exception was regarding helping the patient to understand the right use of medications, in which case the Pharmacist as would be expected, had a higher result.! Patients’ Increases in Knowledge of Health and Health Management Working with main provider helped me to understand the nature and causes of my health problems and conditions! Working with main provider helped me to understand the health monitoring that relates to my conditions! Working with main provider helped me to understand lifestyle changes that are recommended for my health conditions! Working with main provider helped me to understand the right use of medications for my health conditions ! Working with main provider helped me to understand the different medical treatment options available for my health conditions ! Working with main provider supported me to know how to prevent or reduce problems with my health or with symptoms from my health conditions !

% Agree or Strongly Agree

Overall!

Nurse!

Nurse Practitioner!

Pharmacist!

83.7%!

4.1!

4.04!

4.33!

3.86!

86.8%!

4.2!

4.18!

4.38!

4.00!

83.1%!

4.1!

4.11!

4.27!

3.90!

86.8%!

4.1!

3.98!

4.31!

4.06!

72.9%!

3.9!

3.85!

4.23!

3.79!

81.2%!

4.0!

4.04!

4.14!

3.87!

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Responses from the KCPCN Patient Experiences Survey from Chronic Disease and Complex Care patients provide insight into how their involvement with the KCPCN programs (including their main providers) is linked to their self-efficacy and action taking. ! â&#x20AC;˘â&#x20AC;Ż 83.1% of respondents agreed or strongly agreed that working with their main provider helped them to take a more active role in their health and ability to function. The overall mean was 4.1 out of 5. The mean for each of the three main providers was 4.18, 4.19 and 3.94 for the Nurse, Nurse Practitioner and Pharmacist respectively. ! Working with main provider helped me to take a more active role in my health and ability to function Strongly disagree 1% Neutral 12% Strongly agree 27%

Agree 59%

Disagree 1%

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Patients reported varying degrees of action taking in response to their health conditions. ! •  79.4% of respondents agreed or strongly agreed that they had become more active in their health care over the past 12 months. The overall mean was 4.0 out of 5. Patients identifying the Nurse Practitioner as their main provider had a higher response to having become more active in their health care. ! •  Only 70.5% of respondents agreed or strongly agreed that they had made the lifestyle changes recommended for their health conditions. This is reflective of the challenges in making lifestyle changes. Patients identifying the Nurse as their main provider reported a higher incidence of making lifestyle changes. ! •  82.1% of respondents agreed or strongly agreed that they had become better able to handle the symptoms of their health conditions. ! 2013-14 KCPCN Patient Experiences SurveyPatient Action Taking 5 4.5 4 3.5

4

4.07 4.14

3.84

3.9 4.05 3.88 3.81

4.1 4.08 4.1 3.97

3

Overall

2.5

Nurse

2 1.5

Nurse Practitioner

1

Pharmacist

0.5 0 Over the past 12 months, I have Over the past 12 months, I have Over the past 12 months, I have become more active in my own made the lifestyle changes become better able to handle the health care recommended for my health symptoms of my health conditions conditions

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In the same survey, patients also reported varying degrees of confidence in relationship to their health conditions going forward. ! •  79.4% of respondents agreed or strongly agreed that they were confident in maintaining changes in their health habits and lifestyle changes even during times of stress. ! •  Only 70.2% of respondents agreed or strongly agreed that they were confident in keeping their health problems from interfering in the things they want to do. Overall the questions with the highest results were regarding increases to patient understanding of health monitoring and the right use of medications. In both cases 86.8% of respondents agreed or strongly agreed. ! •  The question with the lowest result was regarding increased understanding of different medical treatment options where only 72.9% of respondents agreed or strongly agreed. ! Patients’ Confidence in Maintaining Changes and Managing Health Problems Confidence in maintaining changes in health habits and lifestyle changes even during times of stress ! Confidence in keeping health problems from interfering in the things the patient wants to do !

% Agree or Strongly Agree

79.4%! 70.2%!

Overall!

Nurse!

Nurse Practitioner!

Pharmacist!

4.0!

4.02!

3.99!

3.94!

3.8!

3.82!

3.95!

3.66!

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By the end of 2013/14, the KCPCN had some beginning measures regarding their impact on improving or maintaining patient functioning, health or quality of life. ! As part of the KCPCN Patient Experiences Survey with Chronic Disease and Complex Care patients, respondents were asked to rate their health in several ways. ! •  Only 15.6% of respondents rated their overall health as either excellent or very good. The overall mean health rating was 2.8 out of 5. Given that respondents were part of either the Chronic Disease of Complex Care programs they have diagnosed health conditions. On average respondents reported having been diagnosed and treated for at least three or four such health conditions. ! •  $21% of respondent rated the amount of stress in their lives as either very low or low. The overall mean stress rating was 3.0 out of 5. !

Patients’ Health Rating Responses Rating of overall health (physical, emotional, mental and spiritual) ! Rating of the amount of stress in one’s life !

Mean!

Excellent!

Mean!

Very low!

2.8! 3.0!

1.8%! 4.1%!

Very good!

13.8%!

Good!

Fair!

Poor!

Low!

Moderate!

48.5%!

29.9%! High!

Very High !

6.0%!

16.9%!

58.7%!

19.2%!

1.2%!

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A more important indicator of improved or maintained functioning health and quality of life is how patients responded when asked to rate their health compared with 12 months ago. ! •  41.3% of respondents rated their health as somewhat better or much better.! •  47.3% rated their health as about the same. ! •  11.4% rated their health as somewhat worse or worse. ! •  The overall mean health rating compared with 12 months ago was 3.4 out of 5, while the mean for each of the three main providers was 3.36, 3.43 and 3.53 for the Nurse, Nurse Practitioner and Pharmacist respectively. ! Overall, 88.6% of survey respondents involved in the Chronic Disease and Complex Care programs reported either maintenance or improvements to their health over the previous year. !

2013-14 KCPCN Patient ExperiencesSurveyRating of Health Compared to 12 months ago Somewhat worse 8%

Worse 3%

Much better 13%

Somewhat better 29% About the same 47%

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The KCPCN implemented use of the SF-12 Health Survey mid-way through 2013/14. The 12 question validated survey by Quality Metric, compares results from KCPCN patients to normative data from a general population sample. It measures health functioning and quality of life in two domains (physical component summary (PSC) and mental component summary (MCS) and eight sub domains. !  ! The KCPCN administers the survey to patients in three programs including: Chronic Disease, Complex Care and the Geriatric Program. These programs are appropriate for this type of measurement because they are designed to have comprehensive assessment, intervention and ongoing follow-up with patients whereby we would hope to see improvements to patient health functioning and quality of life through time. To capture such changes, the survey is administered at various time points including: intake, 3 months, 6 months, 12 months, 18 months and 24 months. !  ! The available data is useful in understanding the health functioning and quality of life of patients within the three program areas at intake. More detailed tables with results are available in the Appendices. ! SF-12 Health Survey Domains and Sub domains

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The aggregate scoring across both domains and all sub domains was below the normative population data of 50 for the 83 patients who completed SF-12 surveys at intake. The aggregate physical component summary (42.09) was considerable lower than the mental component summary (48.33) which was only slightly lower than the norm. In fact, the lowest aggregate scoring was in the physical functioning sub domain at 41.7. The highest scoring sub domain was mental health at 48.31! Â ! Of the 83 patients completing surveys at intake, 32 were male and 49 were female. Males scored higher on almost all sub domains. The sub domains with the largest difference were general health, vitality and mental health. Males scored considerably higher on the mental component summary (51.77) compared with females (46.29). Females scored slightly higher in the physical component summary (42.28 compared with 41.9). ! SF-12 Patient Summary at Intake (Overall and by Gender)

aggregate score (norm 50)

60 50 40 30 20 10 0

PCS

MCS

PF

RP

BP

GH

VT

SF

RE

MH

42.09

48.33

41.7

43.34

43.93

43.85

46.58

46.51

44.19

48.31

Males

41.9

51.77

43.29

43.45

44.2

44.21

49.68

48.56

45.56

52.38

Females

42.28

46.29

40.68

43.56

43.92

43.74

44.45

45.1

43.55

46.06

Overall

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When looking at the same 83 patientsʼ intake surveys by program areas we also see some differences. There were 50, 30 and 2 surveys from Chronic Disease, Complex Care and the Geriatric Program respectively. As two surveys are not enough to generalize results, they will not be discussed further. ! ! Patients in the Chronic Disease program had higher physical component summary (42.09) scores than those in the Complex Care program (39.57). Regarding the mental component summary the opposite was true. Those patients in the Complex Care program had a summary score of 51.3 (higher than the population norm) compared with those in the Chronic Disease program at 47.3. ! SF-12 Summary Scores at Intake by Program 60

aggregate score (norm 50)

50 40 30 20 10 0

MO$

PCS

MCS

PF

RP

BP

GH

VT

SF

RE

MH

Overall

42.09

48.33

41.7

43.34

43.93

43.85

46.58

46.51

44.19

48.31

Overall – All Chronic Disease

43.8

47.3

44.15

44.68

44.74

43.26

46.9

45.87

44.95

47.34

Overall- All Complex Care

39.57

51.3

38.43

42.37

43.3

44.11

46.44

48.9

44.67

50.82

Overall- Geriatric Care

39.57

29.62

33.45

25.73

39.69

47.75

39.23

30.22

22.5

32.66


Analysis is also available comparing the % of patients whose scoring is above, at or below the population norm of 50 for each of the two main domains. As shown in the following table:! •  Overall and across both the Chronic Disease and Complex Care programs we see that patientsʼ scores are well below the norm on the physical component summary. 55% below the norm overall, and 46% for Chronic Disease and 70% below the norm for the Complex Care patients.! •  Generally speaking, the mental component summary results are higher. Overall only 37% was below the norm, with 44% for Chronic Disease patients and only 23% for Complex Care patients. ! •  In fact, regarding the mental component summary, overall 33% of patients scored above the norm at intake, while 30% of Chronic Disease and 40% of Complex Care patients did so.! % of Patients Above, At of Below SF-12 Norms at Intake

Physical Component Summary

Mental Component Summary

!

%! Above Norm!

%! At Norm!

%! Below Norm!

%! Above Norm!

%! At Norm!

%! Below Norm!

10%!

35%!

55%!

33%!

30%!

37%!

Chronic Disease !

14%!

40%!

46%!

30%!

26%!

44%!

Complex Care!

3%!

27%!

70%!

40%!

37%!

23%!

Overall !

A first stage depression screening can also be calculated from the SF12 survey. Twenty percent (20%) of the normative population is flagged. In comparison, 30% of the KCPCN patients overall and 40% of the Chronic Disease patients who completed the survey at intake were flagged. While only 13% of Complex Care patients were flagged, which is in fact, lower than the normative population. !

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In terms of improving or maintaining functioning or quality of life, there is limited available data for comparison. At year end, there were only 3 completed follow-up surveys at 3 months. While this is nowhere near enough information to generalize or conclude program effectiveness it is informative to review. ! Â ! Of the three patients, one reported mixed results at 3 months, with some sub-domain scores increasing and other decreasing. The other two patients reported maintenance or improvement across all subdomains and therefore both the physical component summary and the mental component summary as well. !

Patient SF-12 Scores- 3 Patient Comparison

Sample Size!

PCS!

domain!

MCS

domain!

PF!

RP!

BP!

GH!

SF!

RE!

MH!

Intake!

83!

42.09!

48.33!

41.7!

43.34!

43.93!

43.85!

46.58!

46.51!

44.19!

48.31!

3mths!

3!

45.38!

51.81!

46.57!

47.59!

45.7!

43.11!

55.62!

50.97!

45.89!

50.82!

Patient 1-intake!

1!

62.21!

35.44!

57.06!

57.46!

57.73!

47.75!

49.07!

48.01!

35.49!

41.26!

Patient 1 @ 3 months!

1!

51.16!

57.75!

57.06!

57.46!

57.73!

33.84!

58.9!

56.9!

56.28!

58.47!

Patient 2-intake!

1!

29!

38.78!

25.58!

32.07!

30.67!

33.84!

39.23!

30.22!

35.49!

35.53!

Patient 2-@ 3 months!

1!

34.47!

50.5!

33.45!

40.54!

30.67!

47.75!

49.07!

39.11!

45.89!

47!

Patient 3-intake!

1!

47.79!

24.34!

33.45!

40.54!

48.71!

47.75!

29.39!

30.22!

25.09!

29.79!

Patient 3 @3 months!

1!

50.5!

47.19!

49.19!

44.77!

48.71!

47.75!

58.9!

56.9!

35.49!

47!

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Results – The Difference for Providers#


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Surveyed physicians reported high levels of satisfaction with board governance of the KCPCN. They were familiar with board members and felt that the board adequately solicits opinions from PCN physicians on significant and important issues. For the most part they believe that the PCN board makes decisions that represent PCN physiciansĘź interests and one respondent commented that non-board physicians should be more involved. They responded that the AGM is productive and provides sufficient opportunity for physicians to have a say in the PCN operations. A third of physician respondents felt that it would be ideal for the AGM to provide CME learning opportunities. 89% agreed or strongly agreed that their experience of being a member physician has matched their expectations since joining the KCPCN. ! Physician Satisfaction Re: PCN Governance and Membership

% Agreed or Strongly Agreed!

Could name the PCN Board and Board President

100%

Feel that the Board adequately solicits opinions from PCN physicians regarding significant and important issues

89%

Feel the Annual General Meeting is productive and provides sufficient opportunity for physicians to have a say in the operations of the PCN.

89%

Feel that their experience of being a member physician has matched their expectations since first joining.

89%

Believe that the PCN board makes decisions that represent PCN physiciansâ&#x20AC;&#x2122; interests

78%

F.1-#%&0$-.(&=-70(05)("5'/$+$&.(X&0$/1&+0$-.(X7#6)'<(+-.*7+0)*(='(05)(K,=)#0&(I)*$+&,(K//-+$&0$-.<(&.*( +-%4,)0)(#)/7,0/(+&.(=)(1-7.*($.(05)(K44).*$+)/:(M-#(05)(47#4-/)(-1(05)(/7%%&#'(0&=,)/<(.-(&*]7/0%).0/( 9)#)(.))*)*(&/(&,,(#)/4-.*).0/(+-%4,)0)*(&,,([7)/0$-./(&.*(.-(#)/4-.*).0/(/),)+0)*(.-0(&44,$+&=,):(( g7)/0$-./(9)#)(8#-74)*(='(05)()6&,7&0-#(1-#(05)(47#4-/)/(-1(/5&#$.8(&.*(*$/+7//$.8(#)/7,0/:$

NI$

Physician Satisfaction# !"#$-1/j-#$9+=$0C$;80*/3/14$ "#+,."2+8#$."80-4"$;8/6+8=$2+8#$ 1#.908:5$/5$10.$01,=$3/B#8#1.$C08$ ."#$;+./#1.D$<-.$C08$"#+,."2+8#$ ;80*/3#85$+5$9#,,?$$]/*#1$."/5D$/.$/5$ /6;08.+1.$.0$#>;,08#$."#$;"=5/2/+1$ +13$'&($5.+B$#>;#8/#12#$+13$ 5+./5C+2./01?$$$ '"=5/2/+1$6#6<#85"/;$/5$."#$ C0-13+./01$0C$+$;8/6+8=$2+8#$ 1#.908:?$G.$/5$."80-4"$."/5$."+.$ ;+./#1.5$<#206#$+..+2"#3D$ C-13/14$/5$8#2#/*#3$+13$;8048+65$ 2+1$<#$3#*#,0;#3$+13$3#,/*#8#3?$$$ $

!


Physicians were very satisfied with KCPCN programs and services. They access the chronic disease and complex care programs, the referral coordinator and individual MDT members. They agree that KCPCN programs meet their needs, and more importantly that they make a difference to the patients. One respondent noted that programs and services could be even better with more physician input. Another respondent recognized the high level of knowledge among KCPCN staff in their clinic.!

Physician Satisfaction Re: PCN Programs and Services

! Report improved patient access to care !

100% !

Agree that PCN programs and services are provided in a timely manner !

100% !

Agree that questions and requests are always addressed by the PCN office !

100% !

Agree that PCN staff are always courteous !

100% !

Understand the purpose of the PCN !

89% !

Have a clear understanding of the programs and services provided !

89% !

Feel that the PCN assists with patient care !

89% !

Regularly use PCN programs and services !

89% !

Agree that PCN programs and services meet their needs !

89% !

Agree that PCN programs and services provide timely reporting and follow-up !

89% !

Perceive physicians to have a common understanding of PCN goals and main purpose !

78% !

Agree that patients have positive experiences with PCN programs and services !

78% !

F.1-#%&0$-.(&=-70(05)("5'/$+$&.(X&0$/1&+0$-.(X7#6)'(&.*(#)/7,0/(+&.(=)(1-7.*($.(05)(K44).*$+)/:($

NJ$

% Agreed or Strongly Agreed!


Regarding communication, KCPCN physicians were quite satisfied. By far, their preferred method of communication was through e-mail. ! Physician Satisfaction Re: Communication# % Agreed or Strongly Agreed! Feel that PCN Board decisions are well communicated

89%

Feel that PCN communication keeps them well informed of PCN programs and services

78%

***Preferred method of communication is through e-mail

78%

Overall, respondents reported that they were highly satisfied with their physician experience of membership since joining the KCPCN. On a scale of 1-10 with being extremely satisfied, 77.7% scaled their satisfaction at either 9 or 10. !

F.1-#%&0$-.(&=-70(05)("5'/$+$&.(X&0$/1&+0$-.(X7#6)'(&.*(#)/7,0/(+&.(=)(1-7.*($.(05)(K44).*$+)/:($

NK$


Staff satisfaction with their individual work or roles varied depending on the question. They felt they had the opportunity to apply their professional competencies, exercise appropriate decision-making authority, and the tools and resources they needed to do their jobs. They also understood how their personal objectives and goals contribute to the success of the PCN. They were less satisfied with the manageability of their workload and workload coverage while they were away. ! Staff Satisfaction Re: Individual Work/Role

% Agreed or Strongly Agreed!

Feel they have the opportunity to apply their professional/technical competencies while working within the PCN

100%

Feel they have the appropriate amount of decision-making authority to do their job well

92%

Feel they have the tools/resources (e.g., computers, software, medical equipment, resource books) that they need to do their job

92%

Feel they understand how their personal objectives/goals contribute to the success/goals of the PCN!

84%

Feel their workload is manageable

67%

Feel their workload is covered adequately while they are away

56%

F.1-#%&0$-.(&=-70(05)(X0&Q(X&0$/1&+0$-.(X7#6)'<(+-.*7+0)*(='(05)(K,=)#0&(I)*$+&,(K//-+$&0$-.<(&.*(#)/7,0/( ='([7)/0$-.(+&.(=)(1-7.*($.(05)(K44).*$+)/:(M-#(05)(47#4-/)(-1(05)(/7%%&#'(0&=,)/<(+&,+7,&0$-./(9)#)( &*]7/0)*(0-(#)%-6)(.-0(&44,$+&=,)(#)/4-./)/(&.*(0-(&*]7/0(1-#(09-($.+-%4,)0)(/7#6)'/:(g7)/0$-./(9)#)( 8#-74)*(='(05)()6&,7&0-#(1-#(05)(47#4-/)/(-1(/5&#$.8(&.*(*$/+7//$.8(#)/7,0/:$

NL$

Staff Satisfaction# A.+B$6#6<#85$+8#$+1$/6;08.+1.$ ;+8.$0C$9"+.$6+:#5$+1$ 084+1/k+./01$#B#2./*#$+13$ 5-22#55C-,?$G1$+$;8/6+8=$2+8#$ 1#.908:$."#=$<8/14$."#$;8048+65$ +13$5#8*/2#5$.0$,/C#?$!"#=$#14+4#$ 9/."$;+./#1.5$.09+83$/6;80*/14$ 2+8#$+13$"#+,."$0-.206#5?$$!"#=$ 908:$.04#."#8$.0$4809$."#$ 084+1/k+./01$+13$,/*#$."#$2-,.-8#?$ !"#/8$5+./5C+2./01$/1$+13$0C$/.5#,C$/5$ /6;08.+1.D$+13$/.$+,50$+$5/41/\2+1.$ C+2.08$/1$."#$;+./#1.$#>;#8/#12#?$$ 708$."#5#$8#+5015D$/.$/5$/6;08.+1.$ .0$#>;,08#$5.+B$5+./5C+2./01$9/."/1$ ."#$%&'&(?$$$


Staff satisfaction with their team experience was quite high on all but one question. Staff felt their coworkers were willing to help them or share expertise, that people in their unit worked as a team, that they are part of a MDT who listens and respects them and that the skills and knowledge of their team were appropriate to meet the performance requirements and goals of the PCN. To a lesser degree, they agreed or strongly agreed that they had a clear idea regarding their teamʼs progress toward PCN goals. ! Staff Satisfaction Re: Team ! Feel their co-workers are willing to help them and/or share their expertise with them

100%

Feel that people in their unit work as a team

92%

Feel they are part of a multidisciplinary team who listens to and respects them

90%

Feel that the skills and knowledge of their team are appropriate to meet the performance requirements/goals of the PCN

90%

Feel that they have a clear idea regarding their team’s progress toward PCN goals (by measuring progress throughout the year)

58%

F.1-#%&0$-.(&=-70(05)(X0&Q(X&0$/1&+0$-.(X7#6)'(&.*(#)/7,0/(+&.(=)(1-7.*($.(05)(K44).*$+)/:($

NM$

% Agreed or Strongly Agreed!


Staff satisfaction with management was varied depending on the question. Staff had high levels of satisfaction with compensation and consideration of their ideas and suggestions. They had reasonably high levels of satisfaction with fair dealings regarding their performance, recognition for their contributions, and overall fairness and transparency with PCN employees. They were less satisfied with the clarity of future direction provided by management and the effectiveness of dealing with performance issues within the PCN. They were even less satisfied with the timeliness of performance issues being dealt with and receiving constructive feedback that helps them improve their performance. ! Staff Satisfaction Re: Management ! Feel they receive fair and equitable compensation

100%

Feel that their ideas and suggestions are given appropriate consideration and follow-up by their supervisor and/or management.!

90%

Feel their supervisor deals fairly with them about their performance!

83%

Feel their supervisor provides appropriate recognition for their contributions!

75%

Feel the PCN is fair and transparent with all PCN employees!

70%

Feel that senior management within the PCN provides clear direction for the future

67%

Feel their supervisor deals effectively with performance issues within the PCN.

60%

Feel confident that performance issues on their team will be addressed in a timely manner!

54%

Feel they receive constructive feedback from their supervisor that helps them improve their performance

42%

F.1-#%&0$-.(&=-70(05)(X0&Q(X&0$/1&+0$-.(X7#6)'(&.*(#)/7,0/(+&.(=)(1-7.*($.(05)(K44).*$+)/:($

NN$

% Agreed or Strongly Agreed!


KCPCN staff felt very strongly that their supervisor demonstrates his/her commitment to customer service and that they receive the information they need to provide excellent customer service. They felt strongly that mistakes within the KCPCN were viewed as learning opportunities and those they are encouraged to explore new ways of doing business. To a lesser degree, they were satisfied with their opportunities to participate in continuing education. They felt there were clear distinctions between ethical and unethical behavior and that they knew how to get help regarding an ethical question or concern.!

Staff Satisfaction Re: Quality, Learning and Improvement !

% Agreed or Strongly Agreed!

Feel that their supervisor demonstrates his/her commitment to customer service through his/her behavior and actions

100%

Feel that if they had an ethical question or concern, they know how to get help to resolve the issue.!

92%

Feel they receive the information they need from your supervisor to provide excellent customer service!

92%

Feel that within the PCN, mistakes are viewed as learning opportunities!

89%

Feel they are encouraged to explore new ways of doing business where/when appropriate

83%

Feel they have had an opportunity to participate in continuing education and/or training!

78%

Feel that within the PCN, there are clear distinctions between ethical and unethical behavior.!

75%

F.1-#%&0$-.(&=-70(05)(X0&Q(X&0$/1&+0$-.(X7#6)'(&.*(#)/7,0/(+&.(=)(1-7.*($.(05)(K44).*$+)/:($

NO$


While the level of satisfaction demonstrated in the results was reasonable, the questions regarding change and change management elicited the most comments from staff completing the survey. Between 73-75% of staff agree or strongly agreed that they felt informed in advance of significant changes, that the reasons for changes were clearly communicated, that they received enough information to understand how changes will impact their work, that they receive support through the transition and that they are able to keep up with changes within the PCN that affect their job. Consistently, the other 25% of staff members disagreed or strongly disagreed with each area. They also provided comments to express their dissatisfaction. !

Staff Satisfaction Re: Change and Change Management ! Feel informed in advance of significant changes affecting their work

75%

Feel the reasons for change are clearly communicated by the person they report to directly â&#x20AC;&#x201C; supervisor, manager or PCN Executive Director

75%

Feel they receive enough information to understand how changes within the PCN impact their work

75%

Feel that when a change is implemented within the PCN, their supervisor provides support throughout the transition

75%

Feel they are able to keep up with changes within the PCN that affect their job.

73%

F.1-#%&0$-.(&=-70(05)(X0&Q(X&0$/1&+0$-.(X7#6)'(&.*(#)/7,0/(+&.(=)(1-7.*($.(05)(K44).*$+)/:($

NP$

% Agreed or Strongly Agreed!


Overall, KCPCN staff was very satisfied with their work at the PCN and with the PCN as a place to work. They universally indicated that they would recommend the KCPCN to a colleague as a good place to work. ! # While these results are near perfect, it is important to note that 2 of the 12 staff members who completed the survey dropped out before responding to the general satisfaction questions. Further, one staff member specifically commented that he/she would recommend the PCN only for the clinical experience. !

Staff Satisfaction Re: Overall Satisfaction ! Enjoy their work within the PCN!

100%

Overall, find the PCN a good place to work!

100%

Would recommend the PCN as a good place to work to a colleague.!

100%

F.1-#%&0$-.(&=-70(05)(X0&Q(X&0$/1&+0$-.(X7#6)'(&.*(#)/7,0/(+&.(=)(1-7.*($.(05)(K44).*$+)/:($

OQ$

% Agreed or Strongly Agreed!


Conclusions and Recommendations# OE$


Conclusions and Recommendations# Conclusion#

Recommendations#

The KCPCN is providing solid programming and readily meets the five Primary Care Initiative objectives. #

1.1 The KCPCN could improve alternative clinics by ensuring they are provided at consistent times on consistent days. While this is the case for most of the clinics, any degree of inconsistency creates challenges and barriers for the patient.! ! 1.2 The KCPCN could improve alternative clinics by increasing the number of clinic hours that occur outside of regular business hours. At present, evening clinics are only offered weekly in Vegreville and monthly in Innisfree and Irma.! ! 1.3 The KCPCN could improve alternative clinics by working with physicians and the community to better promote them. In many of the clinics, the number of patients served is quite low per session ranging from 3.5 to 5 patients. Most of the clinics are less than a year old and it may take some time and effort to consistently fill them.!

Objective 1: The KCPCN has increased the promotion of residents with access to primary care through increasing patient attachment, providing its various programming, and its many forms of alternative clinics.! Objective 2: The KCPCN provides some after hours clinics. ! Objective 3: All KCPCN programming is geared to health promotion, disease prevention, care of the medically complex patient and those with chronic diseases. ! Objective 4: The KCPCN participated in a number of initiatives aimed at improving coordination and integration including: collaborating with homecare, lodges and supporting living in Vegreville and Viking to provide services to residents; partnering with Covenant Health to bring in additional specialists; working with Mental Health Services to implement mental health assessments with appropriate patients. ! Objective 5: The KCPCN utilizes MDTs in all three communities and supports them through various forms of monthly and quarterly meetings.! !

OI$


Conclusion#

Recommendation(s)#

The KCPCN has made good progress on implementing its business plan #

2.1 The KCPCN should continue its efforts to increase patient and community awareness of the PCN.! !

The KCPCN moved forward with almost all of its planned programming for 2013/14. ! In fact, in response to demand and resource availability it was able to move forward with the Geriatric Program in all three communities faster than planned. ! The area with the least progress was the lifestyle and health communication. This was largely due to available resources and the need to first promote the KCPCN. ! Results from the Patient Experiences Survey and its mail out to community members clearly showed that there is some lack of awareness about PCNs. This is understandable given the complexity of healthcare services from the patient perspective and the relative newness of the KCPCN. !

OJ$


Conclusion#

Recommendation(s)#

The KCPCN is making a difference and demonstrating the achievement of outcomes with its patients. #

3.1 KCPCN staff should increase their attention to providing health care Patients surveyed indicated high levels of engagement, acceptability information and suggestions and satisfaction.! for accessing other community supports. ! •  89.3% of survey respondents agreed or strongly agreed that they were satisfied with the care they received from their main provider. ! ! 3.2 The KCPCN should •  Overall, 88.6% of survey respondents involved in the Chronic consider providing its main Disease and Complex Care programs reported either maintenance providers with additional (46.6%) or improvements (42%) to their health over the previous training to support increased year.! patient knowledge, efficacy and behavior change e.g., •  While results were still high, they were lower regarding patients Stages of Change, coaching, receiving health information, patients knowing how to prevent or reduce problems with health and in patientsʼ action taking to make or something similar.! changes in their health. ! ! Physicians are highly satisfied with their membership in the PCN and moving toward integration of physicians within the PCN and MDTs is an ongoing process. # •  Overall, physicians reported that they were highly satisfied with their physician experience of membership since joining the KCPCN. On a scale of 1-10 with being extremely satisfied, 77.7% scaled their satisfaction at either 9 or 10. !

OK$

4.1 Continue to work toward engaging physicians in the PCN through planning, information sharing, MDT activities, quality improvement activities focused on access time and patient health outcomes etc. !


Conclusion#

Recommendation(s)#

The KCPCN has made good progress in implementing measurement and evaluation. #

5.1 The KCPCN needs to continue with existing measurement such as program tracking, the SF-12, patient experiences survey and integrate them as part of ongoing business. ! 5.2 The KCPCN needs to improve its data collection regarding access measures particularly time to third next available appointment (TNA) and CTAS classification for alternative clinics. These measures were introduced in 2013/14 however, significant gaps occurred with data collection. ! 5.3 The KCPCN needs to spend considerable time and effort mapping its data requirements from the EMRs and then adjusting its data entry to accommodate desired measurement.! 5.4 The KCPCN needs to explore alternative options (to its current excel spreadsheets) for tracking and analyzing patient health information. This includes looking into options such as the CDM worksheet in Accuro (to be released in June 2014).! 5.5 As new measurement standards and requirements are released the KCPCN needs to update its evaluation framework and measurement tools as needed to ensure its continued accountability.!

•  The KCPCN has a comprehensive evaluation framework that was development in consideration of future accountability requirements that were certain to materialize following the 2012 Auditor Generalʼs report. ! •  Over the last 18 months the KCPCN has been steadily implementing various data collection to support ongoing performance measurement and evaluation. ! •  There are still gaps in needed data to have a fulsome and comprehensive picture of the KCPCN effectiveness. ! •  There are significant challenges pulling patient information and health data from the various electronic medical records (EMRs) in a manner that has either reliability or validity. There are 3 different EMRs within the clinics that are part of the PCN including Accuro, Med Access and Wolfe. ! •  Partly because of the EMRs challenges, several of the KCPCN programs e.g., Chronic Disease are utilizing excel spreadsheets to track patient health information through time. This is cumbersome, not sustainable and not ideal for data analysis.!

OL$


Conclusion#

Recommendation(s)#

While the KCPCN is increasing patient access through its programming and alternative clinics, access times may need improvement in some cases. #

6.1 If further data collection reveals that wait times are high, the KCPCN needs to implement a quality improvement process to decrease them. The recommended standard by AIM is same day access.!

•  The KCPCN has some but limited data to understand access times and issues. ! •  The snapshot of physician access at one clinic ranged from 4 to 55 days and averaged from 12.4 to 16.8 days. ! •  The snapshot of MDT members at one clinic ranged from 0 to 11 days. The wait time for the Nurse Practitioner was higher with the average being 5.6 days for short appointment and 6.7 for long appointments. ! • 

The Patient Experiences Survey responses indicated reasonable satisfaction with wait time on three measures but on the fourth measure only 66.6% of respondents disagreed or strongly disagreed that over the past 12 months they had difficulty getting the healthcare or advice they needed. They cited waiting too long and difficulty getting an appointment as their top two reasons for the difficulty. !

•  The Vegreville MDT team began participating (January 2014) in the AIM collaborative which is focused on increasing office efficiency and reducing patient wait time. As a result, it is probable that wait times will decrease among the KCPCN MDT members in Vegreville.!

OM$


Conclusion#

Recommendation(s)#

The KCPCN may have played a key role in the reduction in emergency department (ED) utilization in Viking. #

7.1 The KCPCN should bring together appropriate healthcare providers and stakeholders to explore the factors that contributed to the decrease in emergency department utilization in the Viking Health Centre for semi-urgent and non-urgent care to better understand overall and in particular the role the KCPCN played. ! ! 7.2 Depending on the discoveries, the KCPCN should explore and support replicating the factors in both Vegreville and Vermilion.!

â&#x20AC;˘â&#x20AC;Ż From 2010/11 to 2013/14 use of the ED in the Viking Health Centre for semi-urgent and non-urgent care (CTAS 4 & 5) decreased by 11.53% (from 83.24% to 71.71%). The decrease occurred over several years suggesting it may be a permanent reduction.!

ON$


Conclusion#

Recommendation(s)#

The KCPCN has grown quickly and is in the growth stage of organizational development with a need to manage its growth and establish additional organizational maturity. #

8.1 As much as possible, the KCPCN needs to prioritize its growth. Like most PCNs, it is at the centre of many opportunities and demands. If the right ones are harnessed it will support stability and steady expansion. If not, the risk is that staff and programming will become overwhelmed and efforts will be diluted from too many directions. !

•  The KCPCN underwent a merger between the Vegreville and Viking PCNs two years ago. ! •  The numbers of clinics and physicians joining and therefore patients attaching is steadily increasing. Correspondingly, the level of funding is increasing steadily as well.! •  The KCPCN is in the growth stage of organizational development with noticeable signs of needed maturity related to areas such as planning, change management, new member integration and quality improvement as shown in the results of both the Healthcare Team Effectiveness and Staff Satisfaction surveys. ! •  There are increasing external demands on all PCNs including the KCPCN related to evolution and accountability. These requirements are over and above program delivery in areas such as governance, panel management, measurement etc. At times, the requirements from different external bodies are conflicting in terms of direction, resource requirements and timelines.!

OO$

8.2 The KCPCN should supplement its current planning to include plans for initiatives related to organizational capacity or growth. The current business plan template as provided and required by the Primary Care Initiative (PCI) office only includes program planning. The result is that the time, energy and resources needed for things like planning, measurement, panel management, quality improvement, policy development etc. are not planned for. Without this, these areas are either not well attended to or occur above and beyond full programming. !


Conclusion#

Recommendation(s)# 8.3 To further support successful growth, the KCPCN needs to shore up its change management and communication with staff. This may include working on less initiatives and slowing them down so that better change management and communication can happen. KCPCN management may want to consult with staff and based on input consider establishing more routine vehicles or mechanisms for communication to staff.! 8.4 As is often needed as part of an organization始s maturity, the KCPCN needs to consider enhancing its performance management system to ensure it is encouraging accountability, identifying strength and areas for growth, and connecting performance to KCPCN strategies and goals.! 8.5 The KCPCN needs to explore additional ways to improve workload management. Given the KCPCN始s rural setting which causes recruitment challenges and its part-time staffing for many positions, there are issues with workload coverage. KCPCN management needs to work with staff to find ways to address this issue over time through cross-training, vacation coverage etc. Possibly, as the KCPCN manages its growth and receives additional funding it may want to consider adding more FTEs to address workload issues before expanding programming further.!

OP$


Appendices# PQ$


+,,#-./0!12!3'4/5!6'.#)!7!8$)"-$!9':-(%"!;%/<$%"!9$%#!=#(>'%?! Contexts

social, cultural, political, policy, legislative/regulatory, economic and physical contexts population characteristics and public participation PCI governance, policy and funding activities and decisions

Inputs

Activities (enable PCN delivery)

Outputs (products and servicespriority initiatives contribution to PCI objectives)

Short-term Outcomes

Intermediate Outcomes

fiscal resources PCN level evaluation and quality improvement activities

material resources

human resources

PCN level policy and governance decisions and activities PCN level healthcare planning and management decisions and activities PCN level clinical decisions and activities PCN level integration and coordination decisions and activities Multi-disciplinary team development and activities (PCI objective 5) Access to Care Alternative Clinics/Nurse Practitioner Women"s Health through the Lifespan Geriatric Support Program

Chronic Disease and Complex Care chronic disease and complex care clinics specialist coordination & referral

(PCI objectives 1, 2, 3 & 4)

(PCI objectives 1, 3, 4 & 5)

Health Promotion and Education Lifestyle Program Education Lifestyle and Health Communication Physician/Staff Education (PCI objectives 1, 3 & 4)

• increased access to local primary healthcare services (PCI objectives 1 & 2) • improved integration and coordination of primary health care services with other healthcare services providers (PCI objective 4) • reduced risk of health conditions among PCN participants (PCI objective 3)

Satisfaction • physicians • staff members • board members

• patient engagement, acceptability and satisfaction • increased knowledge about health and healthcare management among PCN participants related to program areas (PCI objective 3)

• increased self-efficacy and action taking to manage health and health conditions among PCN participants related to program areas (PCI objective 3)

Long-term Outcomes

Contribution to Primary Health Care System Outcomes

PE$

• reduced duration and effects of acute, episodic and continuing health conditions among PCN participants • improved and/or maintained functioning, health and/or quality of life among PCN participants (particularly those in related programs) healthcare system equity

healthcare system efficiency (reduced utilization)

improved level and distribution of population health and wellness in Alberta

contexts and external factors

sustainable provincial healthcare system


+,,#-./0!@2!;A"B/5/$-!C$DBE$5D'-!C:%F#"! The KCPCN Physician Satisfaction Survey was developed, conducted (using an on-line survey tool) and analyzed by the Alberta Medical Association in Q3-Q4 of 2013/14. The survey was sent to 16 physicians, 9 of whom completed the survey for a 56.6% response rate. All physicians who completed the survey indicated that they had been a physician member of the PCN for 1-5 years.! Strongly agree

Agree!

Neutral!

Disagree!

You have a clear understanding of the purpose of your PCN.!

77.8% (7)!

11.1% (1)!

11.1% (1)!

-!

Physicians within the Physician Not-for-Profit Corporation (NPC) share a very similar view of the goal/main purpose of the PCN! You have a clear understanding of the programs and/or services provided.!

55.6% (5)!

22.2% (2)!

22.2% (2)!

-!

-!

66.7% (6)!

22.2% (2)!

-!

11.1% (1)!

-!

Belonging to the PCN has assisted you in the care of your patients.!

77.8% (7)!

11.1% (1)!

11.1% (1)!

-!

-!

Your patients have reported very positive experiences from their experiences with PCN services.! The creation of the PCN has made a positive improvement in access to primary care for residents of your community and surrounding areas! You regularly use the services and programs provided by the PCN.!

55.6% (5)!

22.2% (2)!

22.2% (2)!

-!

-!

77.8% (7)!

22.2% (2)!

-!

-!

-!

77.8% (7)!

11.1% (1)!

-!

11.1% (1)!

-!

The services and programs within the PCN are meeting your needs.!

77.8% (7)!

11.1% (1)!

11.1% (1)!

-!

-!

Question

Of the various programs and services provided by the PCN, which ones have you used the most?

Services/programs provided by the PCN are available in a timely manner.!

PI$

Strong disagree!

-!

• Chronic disease management; • Diabetes management and counseling; • Nurse in our clinic NP; • Nurse assisting with complex care plans and or pharmacist ; Referral Coordinator CCP Diabetes management; • chronic care management 55.6% (5)! 44.4% (4)! -! -! -!

Reporting and follow-up from PCN clinics/services staff is timely.!

55.6% (5)!

33.3 (3)!

Staff within the PCN and within the various clinics/programs are always courteous.!

88.9% (8)!

11.1% (1)!

When making general inquiries into the PCN Office, your questions or requests are always addressed in a timely manner.!

88.9% (8)!

11.1% (1)!

11.1% (1)!

-!

-!

-!

-!

-!

-!

-!

-!


+,,#-./0!@2!;A"B/5/$-!C$DBE$5D'-!C:%F#"7!9'-D-:#.! Question Provide any specific comments regarding how PCN services/programs could be improved upon.!

What service gaps still exist that you believe the PCN should address in the future?!

You could name the current PCN/Physician Lead President of your PCN as well as your NPC Board members.! The PCN’s Physician Board makes decisions that you believe represent the collective interest of all PCN physicians.! The PCN’s Board solicits opinions from NPC physicians adequately on issues of significance or major importance.! How could the PCN’s Board better solicit opinions and/or feedback from physicians to ensure interests are well represented? !

Strongly agree

Agree!

Neutral!

Disagree!

Strong disagree!

• More physician input when physicians have more time • It is fine the way it is • Our staff in our clinic is awesome and very knowledgeable. They make a point of extending their knowledge beyond what is expected. • none • Teaching • Can't think of anything • Psychiatry!!! • none 77.8% (7)! 22.2% (2)! -! -! -! 88.9% (8)!

11.1% (1)!

-!

-!

-!

66.7% (6)!

22.2% (2)!

11.1% (1)!

-!

-!

• Use emails 77.8% (7) • Use of survey tools e.g., Survey Monkey to solicit input 22.2% (2) • Monthly e-newsletters on issues/notable activities 22.2% (2) • Phone calls from PCN Board member for input/feedback 11.1% (1) • Regular visits to clinic by PCN Board 0% (0) • Other % (0) Please provide any comments (both good and bad) related to Board member representation! • In general it is usually the chosen board that makes decisions and actively participate. I feel the non board members should get more involved • Very good board. I trust that they make the best decisions. • They represent me well • I believe the board represents the various communities satisfactory You feel the PCN’s Annual General Meeting has been productive and provides sufficient 66.7% (6)! 22.2% (2)! 11.1% (1)! -! -! opportunity for physicians to have a say in the operations of the PCN.!

PJ$


+,,#-./0!@2!;A"B/5/$-!C$DBE$5D'-!C:%F#"7!9'-D-:#.! Question How could the Annual General Meeting of the PCN be improved?

Communication from the PCN keeps you well informed of programs and services.! Outcomes of decisions within PCN Board Meetings are well communicated.! Please pick the most preferred manner in which you would like to be communicated to by your PCN.

Your current experience of being a member physician within the PCN has matched your expectations since first joining. What reasons, if any, do you think have prevented a physician that could join the PCN from doing so?!

If you had to score your experience of being a member physician within the PCN on a scale of one (strongly dissatisfied) to ten (extremely satisfied), what ranking would you give?! Please note any general comments related to the PCN’s overall performance.!

PK$

Strongly agree

Agree!

Neutral!

Disagree!

Strong disagree!

• Provide CME learning opportunities 33.3% (3) • More time for interaction between physicians 22.2% (2) • More strategic planning time 22.2% (2) • Having interesting notable guest speakers 22.2% (2) • Other, please specify? 22.2% (2) • Held on a different day/not weekend 11.1% (1) 44.4% (4)! 33.3 (3)! 22.2% (2)! -! 44.4% (4)!

44.4% (4)!

11.1% (1)!

-!

• Email 77.8% (7) • Physician PCN Newsletter 11.1% (1) • Clinic visits by PCN Staff/NPC Board Member 11.1% (1) • Website 0% (0) • Phone calls from PCN Board members 0% (0) • Other % (0) 55.6% (5)! 33.3 (3)! 11.1% (1)! -!

-! -!

-!

Comment: I have seen changes in my patients lab parameters ! • Has not been a problem in our PCN. But poor insight might be a reason • none that I can think of • I could not think of any! 10 44.4% (4); 9 33.3% (3); 7 22.2% (2). • I am happy with what we have achieved thus far • None


+,,#-./0!G2!C($H!C$DBE$5D'-!C:%F#"! The KCPCN Staff Satisfaction Survey was developed, conducted (using an on-line survey tool) and analyzed by the Alberta Medical Association in Q3-Q4 of 2013/14. The survey was sent to 13 staff members, 12 of whom completed the survey for a 92% response rate. The response rate dropped to 76% part way through the survey. Three staff had been with the KCPCN for less than one year, four had been with the KCPCN for 12-24 months, four had been with the KCPCN for 24-36 months and one staff member had been with the KCPCN for over 36 months. Seven respondents were clinical staff in the PCN office, three were clinical staff in a physician clinic, one respondent was management and one identified themselves as other and specified communications.! Question You are informed in advance of significant changes that affect your work.

The reasons for change are clearly communicated by the person you report directly to â&#x20AC;&#x201C; your supervisor, manager or PCN Executive Director.! You receive enough information to understand how changes within the PCN will impact your work.!

When a change is implemented within the PCN, your supervisor provides support throughout the transition.!

Strongly agree

Agree!

Neutral!

Disagree!

8.3% (1)!

66.7% (8)!

8.3% (1)!

-!

Strong disagree!

16.7% (2)!

Not applicable

-!

Comment: I find that as changes are made we are expected to "go with the flow" even when time constraints or other factors may make this difficult.! 33.3% (4)! 41.7% (5)! -! 16.7% (2)! 8.3% (1)! -! Comment: I find that these reasons also appear to be "fluid" - they seem to change depending on the day. ! 25.0% (3)! 50.6% (6)! -! 8.3% (1)! 16.7% (2)! -! Comment: As the plans never seem concrete, it seems we have to implement changes first then see how it impacts our work - then it seems like a struggle to change again.! 25.0% (3)! 50.6% (6)! 16.7% (2)! 8.3% (1)! -! -!

You are able to keep up with changes within the PCN that affect your job.!

Comment: There are lots of claims of support but so far I haven't felt very supported.! 16.7% (2)! 50.6% (6)! 16.7% (2)! 8.3% (1)! -! 8.3% (1)!

Senior management within the PCN provides clear direction for the future.!

Comments: ! Communication is regularly sent out but I find it difficult to have enough time in the day to keep up with it,! It's a new position, figuring out as I go the time restraints.! 8.3% (1)! 58.3% (7)! 16.7% (2)! 8.3% (1)! 8.3% (1)! -! Comment: This again seems to change constantly. It is difficult to understand where our future direction lies when program importance varies from day to day.!

PL$


+,,#-./0!G2!C($H!C$DBE$5D'-!C:%F#"7!9'-D-:#.! Question You are encouraged to explore new ways of doing business where/when appropriate.! Your supervisor demonstrates his/her commitment to customer service through his/ her behavior and actions.! Your workload is manageable.! Your workload is covered adequately while you are away.!

You have the tools/resources (e.g., computers, software, medical equipment, resource books) that you need to do your job.! If you had an ethical question or concern, you know how to get help to resolve the issue.! Within the PCN, there are clear distinctions between ethical and unethical behavior.!

You understand how your personal objectives/goals contribute to the success/goals of the PCN.! You have a clear idea regarding your teamâ&#x20AC;&#x2122;s progress toward PCN goals (by measuring progress throughout the year).!

PM$

Strongly agree

Agree!

Neutral!

Disagree!

16.7% (2)!

66.7% (8)!

16.7% (2)!

-!

Strong disagree!

-!

Not applicable

-!

Comment: Our clinic always wants to look at doing new things, however our current staff level prohibit this.! 33.3% (4)! 66.7% (8)! -! -! -! -! 8.3% (1)!

58.3% (7)!

25.0% (3)!

8.3% (1)!

-!

-!

8.3% (1)!

33.3% (4)!

25.0% (3)!

8.3% (1)!

-!

25.0% (3)!

Comment: There is no other RN working in the clinic, so workload is adjusted for when I'm away. ! 41.7% (5)! 50.6% (6)! 8.3% (1)! -! -! -! 33.3% (4)!

58.3% (7)!

-!

8.3% (1)!

-!

-!

41.7% (5)!

33.3% (4)!

8.3% (1)!

8.3% (1)!

8.3% (1)!

-!

Comment: I'm not sure what is available at the PCN level, but practitioners have their own set of ethics and all of our teams seem to fall in line.! 25.0% (3)! 58.3% (7)! 8.3% (1)! 8.3% (1)! -! -! 16.7% (2)!

41.7% (5)!

16.7% (2)! 25.0% (3)!

-!

-!

Comment: Something we are working towards. !

You receive constructive feedback from your supervisor that helps you improve your performance.! You have the appropriate amount of decision-making authority to do your job well.!

8.3% (1)!

33.3% (4)!

50.6% (6)!

-!

8.3% (1)!

-!

33.3% (4)!

58.3% (7)!

8.3% (1)!

-!

-!

-!

Your supervisor deals effectively with performance issues within your PCN.!

16.7% (2)!

33.3% (4)!

8.3% (1)!

16.7% (2)!

8.3% (1)!

16.7% (2)!

You have the opportunity to apply your professional/technical competencies while working within the PCN.!

66.7% (8)!

33.3% (4)!

-!

-!

-!

-!


+,,#-./0!G2!C($H!C$DBE$5D'-!C:%F#"7!9'-D-:#.! Strongly agree

Agree!

Neutral!

Disagree!

-!

75.0% (9)!

8.3% (1)!

Your supervisor deals fairly with you about your performance.!

8.3% (1)!

75.0% (9)!

You are confident that performance issues on your team will be addressed in a timely manner.! You receive fair and equitable compensation.!

8.3% (1)!

Not applicable

8.3% (1)!

Strong disagree!

8.3% (1)!

-!

8.3% (1)!

8.3% (1)!

-!

-!

41.7% (5)!

16.7% (2)!

8.3% (1)!

16.7% (2)!

8.3% (1)!

-!

91.7%(11)!

-!

-!

-!

8.3% (1)!

People in your unit work as a team.!

41.7% (5)!

50.6% (6)!

-!

-!

8.3% (1)!

-!

You receive the information you need from your supervisor to provide excellent customer service.! Customer Service within the PCN could be improved by:

16.7% (2)!

75.0% (9)!

8.3% (1)!

-!

-!

-!

Question Your supervisor provides appropriate recognition for your contributions!

• Increasing the communication and improving team interaction/professionalism • More communication within community.

<"-6'-='6-#>+?'@'/+%='/+-66);'7-$61)+#>5'+2)'/A":)&'2)")B'!

PN$

You feel you are part of a multidisciplinary team who listens and respects you.!

30.0% (3)!

60.0% (6)!

10.0% (1)!

-!

-!

-!

Your co-workers are willing to help you and/or share their expertise with you.!

60.0% (6)!

40.0% (4)!

-!

-!

-!

-!

Within your PCN, mistakes are viewed as learning opportunities.!

30.0% (3)!

50.0% (5)!

20.0% (2)!

-!

-!

-!

Your ideas and suggestions are given appropriate consideration and follow-up by your supervisor and/or management.! You have had an opportunity to participate in continuing education and/or training.!

20.0% (2)!

70.0% (7)!

10.0% (1)!

-!

-!

-!

10.0% (1)!

60.0% (6)!

10.0% (1)! 10.0% (1)!

-!

10.0% (1)!

The skills and knowledge of your team are appropriate to meet the performance requirements/goals of the PCN.! The PCN is fair and transparent with all PCN employees.!

50.0% (5)!

40.0% (4)!

10.0% (1)!

-!

-!

-!

30.0% (3)!

40.0% (4)!

20.0% (2)!

-!

10.0% (1)!

-!

You enjoy your work within the PCN.!

70.0% (7)!

30.0% (3)!

-!

-!

-!

-!

Overall, you find the PCN a good place to work.!

70.0% (7)!

30.0% (3)!

-!

-!

-!

-!

You would recommend the PCN as a good place to work to a colleague.!

70.0% (7)!

30.0% (3)!

-!

-!

-!

-!


+,,#-./0!G2!C($H!C$DBE$5D'-!C:%F#"7!9'-D-:#.! Question Provide any comments/thoughts on what you feel would make the PCN an even better place to work.

You are satisfied with staff communications.! If you could improve staff communications, what would you change?!

If you could change one thing at the PCN, it would be?

PO$

Strongly agree

Agree!

Neutral!

Disagree!

Strong disagree!

Not applicable

• Strong disconnect between management and staff I would recommend the PCN to a colleague for the clinical experience but not the management interference. • We are 3 separate clinics once a year meetings or staff social event would be good to have to see other community clinic staff. 30.0% (3)! 40.0% (4)! 10.0% (1)! 20.0% (2)! -! -! • More frequent designated staff meetings. • Discussed at team meeting; waiting for implementation. • More face to face meetings. • Management. • A raise after 3 month probation. And if not at 3 months should be given at 6 months. • More time to do admin work.


+,,#-./0!I2!6J&!K#$)(A5$%#!&#$<!LH#5DF#-#BB!C:%F#"B! Various configurations of KCPCN MDTs have completed the Health Effectiveness Survey at different intervals. The survey has been coordinated through on-line surveys either by Pfizer or AIM (Access Improvement Measures). Reports were provided summarizing the results. Raw data was not available for further analysis. The following table outlines the mean results of the various surveys by question as well as the aggregate mean results by domain and sub domains. The denominator used to calculate the means is shown in the last column. Areas in red indicate where a mean result is below 70%. ! May 2012 KCPCN MDT-all

Feb 2013 Vermilion MDT!

Feb 2013 Viking MDT

Feb 2013 Vegreville MDT

Mar 2014 Vegreville MDT

# of team members completing survey

!!

6!

6!

9!

7!

DOMAIN: ALIGNMENT

88!

82!

95

86

74!

Sub domain: Planning

35!

32!

37!

34!

28!

current issues in the healthcare environment are well understood

5.00!

4.33!

4.67!

4.78!

4.71!

the team has a clear sense of direction and purpose-why it exists

4.75!

4.17!

5.17!

4.67!

3.71!

medium- and long term team strategies are documented

4.50!

4.67!

4.00!

4.11!

3.29!

short term goals are always clear and documented

4.13!

4.00!

4.33!

4.22!

3.43!

detailed action plans are always developed for key projects

3.38!

3.33!

4.00!

3.89!

2.86!

roles, responsibilities and individual contributions are clear

4.50!

4.33!

5.00!

4.56!

3.57!

the development of team strategy, priorities, and action plans is a team effort

4.75!

4.33!

5.33!

4.44!

3.57!

the team is well prepared with a contingency or worst case plan

3.50!

3.00!

4.17!

3.78!

2.71!

26!

24!

28!

25!

26!

30!

members are aware of one another's skills and experience

5.38!

4.83!

5.50!

5.11!

5.71!

6!

the team has the necessary interpersonal skills to enable healthy working relationships the team has the necessary task related skills, experience and knowledge to meet our goals

5.50!

4.67!

5.83!

5.11!

5.29!

6!

5.13!

4.67!

5.67!

5.11!

5.43!

assignments are matched to experience and capabilities

5.00!

4.50!

5.83!

4.78!

4.86!

6!

sufficient opportunities to develop additional skills and knowledge exist

5.00!

5.17!

5.33!

5.22!

4.43!

6!

Question

Sub domain: Team Member Capabilities

PP$

denominator

-!

114! 48! 6! 6! 6! 6! 6! 6! 6! 6!

6!


+,,#-./0!I2!6J&!K#$)(A5$%#!&#$<!LH#5DF#-#BB!C:%F#"B7!9'-D-:#.! May 2012 KCPCN MDT-all

Feb 2013 Vermilion MDT!

Feb 2013 Viking MDT

Feb 2013 Vegreville MDT

Mar 2014 Vegreville MDT

27!

26!

30!

26!

21!

changes in the organization and their impact on the team's direction are well understood

4.75!

4.50!

4.50!

4.22!

3.57!

change is an opportunity that generates positive member reaction

4.75!

4.83!

5.33!

5.00!

4.41!

planning for change is done through a well-structured process

4.25!

3.33!

4.67!

3.67!

2.43!

planning for change is done proactively

4.38!

4.33!

5.33!

4.11!

3.57!

planning for change is a collaborative team effort

4.88!

3.83!

5.17!

3.89!

3.00!

the team regularly initiates change

4.25!

4.83!

4.83!

4.89!

4.14!

DOMAIN: RELATIONSHIPS

100!

82!

105!

95!

87!

Sub domain: Norms, Diversity, Values

28!

26!

30!

27!

25!

team norms are clear and documented

4.00!

3.83!

4.17!

3.78!

4.43!

norms are regularly reviewed and updated

4.00!

3.50!

4.00!

3.56!

3.71!

out trust level is high because we respect one another's values

5.25!

4.50!

5.67!

5.00!

4.14!

6!

members are aware of individual differences and their effect on team dynamics

4.88!

4.83!

5.33!

5.11!

4.43!

6!

members make an effort to adapt to one another's differences

5.00!

4.83!

5.33!

4.89!

4.14!

6!

adherence to team norms is a shared responsibility

5.00!

4.17!

5.33!

4.56!

4.29!

6!

Sub domain: Interpersonal Communication

26!

21!

27!

25!

23!

30!

members are open and honest when voicing their opinions

5.13!

3.67!

5.33!

4.89!

5.14!

6!

members consistently demonstrate effective listening skills

5.50!

4.50!

5.33!

5.11!

4.57!

6!

issues are debated in an organized and systematic manner!

5.13!

4.33!

5.00!

5.11!

4.14!

6!

enough trust exists to talk freely about mistakes and areas needing development!

5.38!

4.00!

5.67!

5.11!

4.57!

6!

mutual feedback is welcome and is a natural way to work!

5.13!

4.17!

5.50!

5.00!

4.57!

6!

Question

Sub domain: Managing Change

EQQ$

denominator

36! 6! 6! 6! 6! 6! 6!

120! 36! 6! 6!


+,,#-./0!I2!6J&!K#$)(A5$%#!&#$<!LH#5DF#-#BB!C:%F#"B7!9'-D-:#.! May 2012 KCPCN MDT-all

Feb 2013 Vermilion MDT!

Feb 2013 Viking MDT

Feb 2013 Vegreville MDT

Mar 2014 Vegreville MDT

Sub domain: Conflict Resolution

19!

16!

21!

18!

15!

passionate debates are possible without bad feelings shutting down collaboration

4.63!

3.17!

5.17!

4.56!

4.00!

conflicts are handled quickly and effectively (things don't linger)

4.75!

4.00!

5.50!

4.56!

2.86!

all members are capable of resolving conflict

4.88!

4.17!

5.33!

4.33!

3.86!

members stand united by the decisions taken by the team

4.88!

4.33!

5.33!

4.67!

4.43!

Sub domain: Recognition

26!

20!

27!

25!

23!

all members feel recognized, appreciated and valued

5.63!

4.67!

5.83!

5.33!

4.57!

team successes and milestones are celebrated

5.25!

4.17!

5.67!

5.11!

5.00!

recognition is a habit

5.13!

3.83!

5.33!

4.78!

4.43!

creating an inclusive and appreciative environment is a shared team responsibility

5.38!

3.83!

5.33!

4.78!

4.57!

people outside the team are thanked

4.88!

3.83!

5.17!

4.67!

4.71!

DOMAIN: METHODS

96!

81!

103!

90!

81!

120!

Sub domain: Team Operating Procedures

29!

25!

32!

27!

25!

36!

team interactions are efficient and disciplined

5.00!

5.00!

5.67!

5.00!

4.86!

6!

information sharing is well defined and followed process

5.00!

4.67!

5.17!

4.33!

4.00!

6!

members always keep one another updated the team's decisions are quality because the team spends the right amount of time thinking things through

5.13!

3.83!

5.17!

4.22!

3.86!

6!

5.00!

4.17!

5.17!

4.56!

3.43!

work and hand-offs between members of the team are smooth and timely

5.00!

3.33!

5.17!

4.67!

4.00!

6!

work and hand-offs between our team and other teams are smooth and on time

4.00!

3.83!

5.33!

4.33!

4.43!

6!

Question

EQE$

denominator

24! 6! 6! 6! 6!

30! 6! 6! 6! 6! 6!

6!


+,,#-./0!I2!6J&!K#$)(A5$%#!&#$<!LH#5DF#-#BB!C:%F#"B7!9'-D-:#.! May 2012 KCPCN MDT-all

Feb 2013 Vermilion MDT!

Feb 2013 Viking MDT

Feb 2013 Vegreville MDT

Mar 2014 Vegreville MDT

Sub domain: Meetings

28!

25!

31!

28!

24!

discussions are disciplined and efficient

4.75!

4.33!

5.00!

4.89!

4.29!

Meetings are always focused on priorities meeting discussion outcomes are always clear with specific resolutions and action items

4.75!

4.50!

5.17!

4.89!

4.14!

4.50!

4.33!

5.00!

4.22!

3.14!

we always have full engagement in our meetings

5.00!

4.83!

5.33!

5.11!

4.57!

we have the right amount of meetings

4.00!

2.83!

5.00!

4.00!

4.00!

the right people attend our meetings

4.63!

4.00!

5.17!

4.89!

4.14!

Sub domain: New Member Integration

15!

13!

15!

13!

11!

integrating a new member is a well planned and documented process

5.13!

3.83!

4.83!

3.78!

2.86!

new members feel welcome and quickly start contributing to our success

5.13!

4.50!

5.33!

4.78!

3.71!

integrating a new member is a shared team effort

5.13!

4.50!

5.00!

4.33!

4.57!

Sub domain: Continuous Improvement

24!

19!

25!

22!

21!

consistent efforts are made to reduce or eliminate errors, delays and operational problems

5.00!

4.67!

5.50!

5.00!

5.00!

challenging the status quo is a common practice

4.88!

3.67!

4.83!

4.00!

4.71!

6!

specific metrics exist on which to focus team efforts

4.63!

2.67!

5.00!

3.67!

2.86!

6!

sharing lessons learned and best practices is the way we work

4.75!

4.50!

5.33!

4.78!

4.43!

6!

best practices and innovations are routinely communicated outside our team

4.38!

3.33!

4.67!

4.44!

4.29!

6!

OVERALL

284!

245!

303!

271!

242!

354!

Question

EQI$

denominator

36! 6! 6! 6! 6! 6!

18!

6! 6!

24! 6!


+,,#-./0!M2!@N1GO1I!;$D#-(!L0,#%/#-5#B!C:%F#"7!PF#%$))!Q#B:)(B! The KCPCN Patient Experiences Survey was developed by reviewing, using and adapting several sources including: KCPCN logic model and evaluation framework, Canadian Institute for Health Information (CIHI) Patient Experiences in Primary Health Care Survey, Patient Activation Measure (PAM) as part of the area on increased knowledge and self-efficacy, Red Deer PCN, Wolf Creek PCN, Highland PCN, Rocky Mountain House PCN Patient Experience Surveys for approaches, content and questions.! It measures eight areas including: ! •  Accessibility- wait time to appointment; PCN services meeting patient needs ! •  Coordination- ! •  Acceptability- time with provider ! •  Continuity of Care- consistently taken care of by same provider, confidence in main care provider, knowledge of history, knowledge of patient ! •  Patient Engagement- listening, involvement in decisions, information and explanations given and questions answered, consultation length, empathy! •  General Patient Satisfaction: confidence in main care provider, treated with dignity and respect, PCN services meeting patient needs; referral to family and friends ! •  Self-Efficacy- support for self-efficacy! •  Comprehensiveness- support for self-management of chronic health conditions! The survey was administered to patients in the KCPCN Chronic Disease and Complex Care programs in Q4. Initially this was done by providing hard copy packages (with information/consent letters) on-site for completion. In response to low results, the data collection approach was changed to a mail out. This required pulling program specific patient names from three different EMRs. This proved challenging and required considerable staff resources. In the end, survey packages were sent to approximately 550 patients. However, with duplication, errors in pulling the correct patients, and returned packages as a result of incorrect addresses the more accurate sample size is believed to be around 475. One reminder letter was sent to most patients. !  173 responses were received, for an approximate response rate of 36%. Of those responding,! •  66.5% were with the Chronic Disease program, 33.5% the Complex Care Program! •  54.5% were male, and 45.5% were female. ! •  Their ages ranged from 18-81 years and older, with the majority being 46 years and older. ! •  They reported diabetes (81.4%), high blood pressure (70.1%) and high cholesterol (46.1%), obesity (23.4%), and depression and/or anxiety (19.8%) as their five most common chronic diseases. ! •  Most reported taking between 1-5 medications (42.5%) and 6-10 medications (43.0%) as prescribed by their doctor. ! •  The vast majority of respondents (86%) reported living in their own home. !  An online database was used to enter surveys and conduct analysis. The following table does not include not applicable answers. As such, numbers will not tally perfectly. Mean calculations do not include not applicable responses. The bolded number in brackets beside each question indicates the number of respondents for each question.!

EQJ$


+,,#-./0!M2!@N1GO1I!;$D#-(!L0,#%/#-5#B!C:%F#"7!PF#%$))!Q#B:)(B7!9'-D-:#.! Yes, definitely!

Yes, somewhat!

No!

Before reading the above description, did you know what a Primary Care Network was? (170)!

31.2% (53)!

44.7% (76)!

24.1% (41)!

Were you aware that you were part of a Primary Care Network? (164) !

41.5% (68)!

23.2% (38)!

35.4% (58)!

Chronic Disease!

Complex ! Care!

General Primary Care Network

Which main program provides health care servicesâ&#x20AC;Ś (173)!

66.5% (115)! 33.5% (58)!

Over the past 12 months, in which community did you access Primary Care Network services and programs? (172)!

Vegreville!

Vermilion!

60.5% (104)! 26.2% (45)!

Viking!

Other!

15.7% (27)!

4.7% (8)!

Care Visits- Over the Past 12 Months Over the past 12 months, which of the following health professionals at the Primary Care Network was your main provider? (saw you the most often and knows you the best) (Check only ONE) (171) nurse!

28.7% (49)!

nurse practitioner!

38.6% (66)!

pharmacist ! referral coordinator

18.7% (32)!

!

Over the past 12 months, about how many visits did you have with this main provider? (in person or by phone) (167)

EQK$

social worker/registered psychiatric nurse

!

2.3% (4)!

specialist e.g. internist, geriatrician etc.!

2.3% (4)!

other health professional!

8.8% (15)!

0.6% (1)! 2-5 times!

6-10 times!

11-15 times!

more than 16 times!

61.1% (102)!

22.8% (38)!

10.2% (17)!

6.0% (10)!


+,,#-./0!M2!@N1GO1I!;$D#-(!L0,#%/#-5#B!C:%F#"7!PF#%$))!Q#B:)(B7!9'-D-:#.! Agree!

Neutral!

Disagree!

0.6% ! (1)! 1.8% ! (3)! 0.6% ! (1)! 0.6% ! (1)! 0.6% ! (1)! 1.2% ! (2)! 1.2% ! (2)! 1.2% ! (2)! 0.0% ! (0)! 1.8% ! (3)!

1.8% ! (3)! 0.6% ! (1)! 1.8% ! (3)! 1.8% ! (3)! 1.8% ! (3)! 1.8% ! (3)! 1.2% ! (2)! 3.0% ! (5)! 2.4% ! (4)! 1.8% ! (3)!

10.1% (17)!

47.3% (80)!

34.3% (58)!

4.2!

5.3% (9)!

46.2% (78) !

45.0% (76) !

4.3!

5.4% (9)!

47.9% (80)!

43.7% (73)!

4.3!

4.1% (7)!

45.3% (77)!

47.6% (81)!

4.4!

6.0% (10)!

45.8% (77)!

42.9% (72)!

4.3!

3.6% (6)!

55.0% (93)!

36.1% (61)!

4.3!

11.3% (19)!

47.0% (79)!

36.9% (62)!

4.2!

7.2% (12)!

49.7% (83)!

37.7% (63)!

4.2!

12.0% (20)!

53.9% (90)!

27.5% (46)!

4.1!

7.8% ! (13)!

58.1% ! (97)!

26.3% ! (44)!

4.1!

My main provider gave me resource information or encouraged me to use other community resources to help me with my conditions or other health issues. (e.g., WeightWise, Walking Program, Supervised Exercise) (166)!

1.8% ! (3)!

4.8% ! (8)!

17.5% ! (29)!

50.0% ! (83)!

17.5% ! (29)!

3.8!

My main provider gave me the opportunity for follow-up by phone or appointment.

1.8% ! (3)! 0.0% ! (0)! 1.8% !

3.0% ! (5)! 3.0% ! (5)! 0.0% !

7.2% ! (12)!

52.1% ! (87)!

34.1% ! (57)!

4.2!

9.1% (15)!

50.9% (84)!

34.5% (57)!

4.2!

40.2% !

47.9% !

(3)!

(0)!

(68)!

(81)!

Care Visits- Over the Past 12 Months The wait time from the Doctorâ&#x20AC;&#x2122;s referral until my first visit with my main provider was acceptable. (169)! My main provider reviewed my medical tests and history to help me understand my health issues and conditions. (169)! My main provider gave me enough time to share my thoughts and health related feelings. (167)! My main provider listened to my health related concerns. (170)! My main provider fully explained my tests and treatments. (168)! My main provider involved me in decisions about my care. (169)! My main provider gave me clear instructions about symptoms to watch for and when to seek further care or treatment. (168)! My main provider talked with me about my main goals in care for my health and any conditions. (167)! My main provider worked with me to develop my treatment plan. (167)! My main provider offered me health information and discussed risk factors (e.g., diet, physical activity, weight, tobacco/ alcohol use, managing stress). (167)!

(167)!

The wait time for follow-up appointments with my main provider was acceptable. (165)! I have confidence in my main provider to support me in managing my health and conditions. (169)!

EQL$

Strongly agree

8.9% (15)!

Strong disagree!

Mean

4.3!


+,,#-./0!M2!@N1GO1I!;$D#-(!L0,#%/#-5#B!C:%F#"7!PF#%$))!Q#B:)(B7!9'-D-:#.! Agree!

Neutral!

Disagree!

Strong disagree!

0.6% ! (1)! 0.6% ! (1)! 0.6% ! (1)!

0.6% ! (1)! 1.8% ! (3)! 1.8% ! (3)!

12.0% ! (20)! 15.2% ! (25)! 10.8% ! (18)!

57.2% ! (95)! 55.8% ! (92)! 57.8% ! (96)!

25.9% ! (43)! 23.6% ! (39)! 25.9% ! (43)!

0.6% ! (1)!

2.4% ! (4)!

6.0% ! (10)!

54.5% ! (91)!

32.3% ! (54)!

4.2!

Working with my main provider helped me to understand lifestyle changes like diet, physical activity and stress reduction that are recommended for my health condition (s). (166)!

1.2% ! (2)!

0.6% ! (1)!

10.8% ! (18)!

55.4% ! (92)!

27.7% ! (46)!

4.1!

Working with my main provider helped me to understand the right use of medications for my health condition(s). (167)!

0.0% ! (0)! 0.6% ! (1)! 0.0% ! (0)! 0.6% ! (1)! 1.2% ! (2)! 0.6% ! (1)! 0.6% ! (1)! 1.2% ! (2)!

3.0% ! (5)! 4.2% ! (7)! 1.8% ! (3)! 1.8% ! (3)! 1.8% ! (3)! 1.8% ! (3)! 3.0% ! (5)! 8.3% ! (14)!

7.2% ! (12)! 13.3% ! (22)! 10.2% ! (17)! 12.7% ! (21)! 20.5% ! (34)! 12.0% ! (20)! 14.5% ! (24)! 18.5% ! (31)!

59.9% ! (100)! 51.8% ! (86)! 63.3% ! (105)! 60.0% ! (99)! 53.0% ! (88)! 59.3% ! (99)! 61.2% ! (101)! 50.6% ! (85)!

26.9% ! (45)! 21.1% ! (35)! 23.5% ! (39)! 21.2% ! (35)! 17.5% ! (29)! 22.8% ! (38)! 18.21 ! (30)! 19.6% ! (33)!

Making Health Changes Working with my main provider helped me to take a more active role in my health and ability to function. (166)! Over the past 12 months, I have become more active in my own health care. (165)! Working with my main provider helped me to understand the nature and causes of my health problems and conditions. (166)! Working with my main provider helped me to understand the health monitoring that relates to my condition (e.g., normal range of blood glucose, blood pressure targets). (167)!

Working with my main provider helped me to understand the different medical treatment options available for my health condition(s). (166)! Over the past 12 months, I have become more confident in my ability to take care of my health. (166)! Working with my main provider supported me to know how to prevent or reduce problems with my health or with symptoms from my health condition(s). (165)! Over the past 12 months, I have made the lifestyle changes recommended for my condition (e.g., diet, physical activity, not smoking). (166)! Over the past 12 months, I have become better able to handle the symptoms of my health condition(s) at home. (167)! I am confident that I can maintain changes in my health habits like diet and physical activity even during times of stress. (165)! I am confident I can keep my health problems from interfering in the things I want to do. (168)!

EQM$

Strongly agree

Mean

4.1! 4.0! 4.1!

4.1! 3.9! 4.1! 4.0! 3.9! 4.1! 4.0! 3.8!


+,,#-./0!M2!@N1GO1I!;$D#-(!L0,#%/#-5#B!C:%F#"7!PF#%$))!Q#B:)(B7!9'-D-:#.! Coordination- Over the Past 12 Months Over the past 12 months, did you speak with any other health professionals at the Primary Care Network as part of your care? (Check all that apply) (152) nurse!

16.4% (25)!

social worker/registered psychiatric nurse

nurse practitioner!

17.1% (26)!

specialist e.g. internist, geriatrician etc.!

11.8% (18)!

pharmacist !

46.7% (71) !

family physician!

67.8% (103)!

other health professional!

20.4% (31)!

referral coordinator

!

5.3% (8)!

Coordination â&#x20AC;&#x201C; Over the Past 12 Months My main provider worked with other professionals in coordinating my care. (165)! The other professionals I saw knew about my most recent medical history. (166)! The other professionals I saw had access to my most recent tests and exam results. (164)!

The other professionals I saw knew about changes in my treatment. (162)! The health care I needed from other health professionals was arranged by the staff of the Primary Care Network. (156)!

EQN$

Strongly agree

0.0% ! (0)! 0.0% ! (0)! 1.2% ! (2)! 0.0% ! (0)! 2.6% ! (4)!

!

3.3% (5)!

Agree!

Neutral!

Disagree!

Strong disagree!

3.0% ! (5)! 1.8% ! (3)! 0.6% ! (1)! 1.9% ! (3)! 5.1% ! (8)!

11.5% ! (19)! 10.2% ! (17)! 6.7% ! (11)! 18.5% ! (30)! 14.7% ! (23)!

57.0% ! (94)! 54.8% ! (91)! 56.7% ! (93)! 48.1% ! (78)! 42.9% ! (67)!

17.6% ! (29)! 19.9% ! (33)! 23.8% ! (39)! 15.4% ! (25)! 13.5% ! (21)!

Mean

4.0! 4.1! 4.1! 3.9! 3.8!


+,,#-./0!M2!@N1GO1I!;$D#-(!L0,#%/#-5#B!C:%F#"7!PF#%$))!Q#B:)(B7!9'-D-:#.! Strongly agree

Your Overall Experience

Agree!

1.8% ! 5.4% ! (3)! (9)! 1.2% ! 3.0% ! Over the past 12 months, I was satisfied with the care I received from my main provider. (169)! (2)! (5)! 22.6% ! 44.0% ! Over the past 12 months, I had difficulty getting the health care or advice I needed. (168)! (38)! (74)! If AGREE or STRONGLY AGREE, What type of difficulty did you experience? (Check all that apply) (57) Over the past 12 months, my main provider offered everything I needed to help me manage my health conditions and concerns. (168)!

Difficulty getting an appointment! Waiting too long (to get an appt or in the waiting room)! Service or program not available at time needed! Service or program not available in my area! After hours care not available!

Transportation problems!

EQO$

36.8% ! (21)! 52.6% ! (30)! 24.6% ! (14)! 24.6% ! (14)! 19.3% ! (11)! 21.1% ! (12)!

Neutral!

Disagree!

Strong disagree!

11.3% ! (19)! 6.5% ! (11)! 13.7% ! (23)!

50% ! (84)! 46.7% ! (79)! 11.3% ! (19)!

30.4% ! (51)! 42.6% ! (72)! 4.2% ! (7)!

Mean

4.0! 4.3! 3.7!

5.3% ! (3)! 12.3% ! Not feeling comfortable with available healthcare professional! (7)! 12.3% ! Not knowing where to go to get help! (7)! 12.3% ! Unable to leave the house to get care because of a health problem! (7)! 19.3% ! Other ! (11)! • Sometimes told to “come back another day” for the walk-in clinic • Inconsistent days of the week for programs • Exercise program restricted to new clients only • Humiliated at Diabetic Care, refused to go back. Doctor said I could see him if I’d feel more comfortable. Language problems!


+,,#-./0!M2!@N1GO1I!;$D#-(!L0,#%/#-5#B!C:%F#"7!PF#%$))!Q#B:)(B7!9'-D-:#.! Your Overall Experience What other care or services could the Primary Care Network offer to support you with your health and help you manage your health concerns? (Please specify) • once a week or once a month need specialists to come to Vegreville like before • Strongly emphasize prevention rather than cure. Found getting help was great and adequate. • A more proactive hands on approach and solutions for a single person who has no home support. • My husband has Parkinson’s and it would be nice to have a program or group session for support • To be able to spend more time with patient. • Support with high housing/rent costs • When ill you should not be refused a Doc. not told to come back YOU SHOULD NOT BE REFUSED CARE • More Dr.s so we could see our own Dr. most of the time instead of whichever ones are in the clinic. • Having to wait 7 weeks to see a doctor is terrible. A nurse doesn't replace the doctor. • Unable to get an answer when calling for appointment. • Unable to get an answer when calling for appointment. • Help me find what I need instead of telling me I could try this or this. What you need is on the boxes, is what I was told. Doesn't help when you bake from scratch. • Doctors need to listen and follow-up. Follow-up is non-existent. • Getting to see my Dr. • Further follow-up • When I had a mammogram at Lloydminster I had a X-ray and that was it, where is a Dr. to go over these results and questions we have.

EQP$


+,,#-./0!M2!@N1GO1I!;$D#-(!L0,#%/#-5#B!C:%F#"7!PF#%$))!Q#B:)(B7!9'-D-:#.! About You Has any health professional diagnosed or treated you for any of the following chronic diseases, even if under control? (Check all that apply) (167) addictions e.g., tobacco, alcohol, drugs, gambling etc.! asthma! arthritis! cancer!

5.4% ! (9)! 12.0% ! (20)! 24.6% ! (41)! 11.4% ! (19)!

high blood pressure! high cholesterol! heart disease, congestive heart failure! obesity!

70.1% ! (117)! 46.1% ! (77)! 13.2% ! (22)! 23.4% ! (39)!

chronic obstructive pulmonary disease, emphysema, chronic bronchitis!

6.6% ! (11)!

sleep apnea!

11.4% ! (19)!

chronic pain!

18.0% ! (30)!

stroke!

4.2% ! (7)!

81.4% ! (136)!

other medical condition ! e.g., hip replacement, thrombosis, Parkinsonâ&#x20AC;&#x2122;s disease, liver disease, brain injury (MVA), various gastrointestinal diseases, COPD, urinary tract infection !

13.2% ! (22)!

diabetes!

How many medications do you currently take each day? (prescribed by your doctor) (165) 1-5

EEQ$

!

6-10

!

11-15

!

42.4% ! (70)! 43.0% ! (71)! 11.5% ! (19)!

16 or more not sure!

!

1.8% ! (3)! 1.2% ! (2)!


+,,#-./0!M2!@N1GO1I!;$D#-(!L0,#%/#-5#B!C:%F#"7!PF#%$))!Q#B:)(B7!9'-D-:#.! About You In general, how would you rate your overall health (physical, emotional, mental and spiritual) (165)!

In general, how would you rate the amount of stress in your life? (172)!

Excellent

Very good!

Good!

Fair!

1.8% ! (3)!

13.8% ! (23)!

48.5% ! (81)!

29.9% ! (50)!

6.0% ! (10)!

2.8!

Very low!

Low!

Moderate!

High !

Very high !

Mean!

4.1% ! (7)!

16.9% ! (29)!

58.7% ! (101)!

19.2% ! (33)!

1.2% ! (2)!

3.0!

Somewhat Worse!

Worse!

Mean!

3.0% ! (5)!

3.4!

Much better!

12.6% ! (21)!

Compared to 12 months ago, how would you rate your health today? (167)!

Somewhat better!

28.7% ! (48)!

About the same!

47.3% ! (79)!

Poor

8.4% ! (14)!

Mean

About You

What gender are you? (167)!

Male!

Female!

54.5% ! (91)!

45.5% ! (76)!

How old are you? (172) 18-25 years

!

1.2% (2)!

56-65 years !

22.47% (39)!

26-35 years

!

2.3% (4)!

66-75 years

!

32.6% (56)!

36-45 years

!

3.5% (6)!

76-80 years

46-55 years

!

12.8% (22)!

81 years and older !

86.0% (147)!

continuing care centre !

0.0% (0)!

other !

8.8% (15)!

!

12.2% (21)! 12.8% (22)!

What is your place of residence? (171) own home assisted living lodge!

EEE$

! !

4.1% (7)! 1.2% (2)!


+,,#-./0!M2!@N1GO1I!;$D#-(!L0,#%/#-5#B!C:%F#"7!PF#%$))!Q#B:)(B7!9'-D-:#.! Your Overall Experience Other comments… • I feel much more comfortable with my treatment plan and hopeful that I can live a healthier life. • I am very glad that we have this network! They are very helpful, encouraging and know more than my G.P. I know I can count on them to help me. • Really love [the Nurse] at Viking. She is so helpful and often we use email to make contact for appts. Etc. She keeps me informed of courses. She is lovely and so knowledgeable. • My predicted progress health-wise has been negative for years. Being there during the harder times is important. • I feel the primary Care professionals were/are key in getting me to the next level in managing my diabetes. A very positive and empowering experience. • The health professionals I meet with are very helpful and encouraging. They are good at pinpointing my areas I need to work on. I am also encouraging other people I know who may benefit from their help. • They are giving me very good service and concern. • Stop wasting taxpayer dollars • So far am satisfied with PCN • Many Thanks • Totally satisfied with services provided. • Good work • Thank you for your interest in my health.

EEI$


+,,#-./0!R2!@N1GO1I!;$D#-(!L0,#%/#-5#B!C:%F#"7!Q#B:)(B!S"!6$/-!;%'F/.#%! Crosstab analysis was conducted on overall survey results by main provider (survey question # 4). Data was exported to excel where the mean for each of the three main providers was calculated. Mean calculations do not include not applicable responses or respondents. The bolded number in brackets indicates the number of respondents for each question.! !

General Primary Care Network

!Main Provider

Nurse Practitioner (66)

Nurse (49)

Which main program provides health care servicesâ&#x20AC;Ś (173)! Over the past 12 months, in which community did you access Primary Care Network services and programs? (172)

Chronic Disease

Complex Care

Chronic Disease

Complex Care

Chronic Disease

Complex Care

33

16

48

18

19

13

Vegreville!

Vermilion!

Viking!

Vegreville!

Vermilion!

Viking!

Vegreville!

Vermilion!

Viking!

19!

22!

8!

56!

6!

4!

17!

11!

7!

Overall Mean

Nurse Mean (49)

Nurse Practitioner Mean (66)

Pharmacist Mean (32)

The wait time from the Doctorâ&#x20AC;&#x2122;s referral until my first visit with my main provider was acceptable. (169)!

4.2!

4.11!

3.95!

4.17!

My main provider reviewed my medical tests and history to help me understand my health issues and conditions. (169)!

4.3!

4.26!

4.45!

4.23!

My main provider gave me enough time to share my thoughts and health related feelings. (167)!

4.3!

4.32!

4.45!

4.19!

My main provider listened to my health related concerns. (170)!

4.4!

4.37!

4.55!

4.16!

My main provider fully explained my tests and treatments. (168)!

4.3!

4.35!

4.44!

4.13!

My main provider involved me in decisions about my care. (169)!

4.3!

4.25!

4.38!

4.07!

My main provider gave me clear instructions about symptoms to watch for and when to seek further care or treatment. (168)!

4.2!

4.17!

4.40!

3.90!

My main provider talked with me about my main goals in care for my health and any conditions. (167)!

4.2!

4.19!

4.35!

4.07!

My main provider worked with me to develop my treatment plan. (167)!

4.1!

4.11!

4.13!

3.94!

My main provider offered me health information and discussed risk factors (e.g., diet, physical activity, weight, tobacco/ alcohol use, managing stress). (167)!

4.1!

4.09!

4.23!

3.72!

Care Visits- Over the Past 12 Months By Main Provider

EEJ$

Pharmacist (32)


+,,#-./0!R2!@N1GO1I!;$D#-(!L0,#%/#-5#B!C:%F#"7!Q#B:)(B!S"!6$/-!;%'F/.#%! Overall Mean

Nurse Mean (49)

Nurse Practitioner Mean (66)

Pharmacist Mean (32)

My main provider gave me resource information or encouraged me to use other community resources to help me with my conditions or other health issues. (e.g., WeightWise, Walking Program, Supervised Exercise) (166)!

3.8!

4.02!

3.88!

3.55!

My main provider gave me the opportunity for follow-up by phone or appointment. (167)!

4.2!

4.26!

4.24!

3.98!

The wait time for follow-up appointments with my main provider was acceptable. (165)!

4.2!

4.17!

4.38!

4.07!

I have confidence in my main provider to support me in managing my health and conditions. (169)!

4.3!

4.22!

4.55!

4.23!

Care Visits- Over the Past 12 Months By Main Provider

Overall Mean

Nurse Mean (49)

Nurse Practitioner Mean (66)

Pharmacist Mean (32)

Working with my main provider helped me to take a more active role in my health and ability to function. (166)!

4.1!

4.18!

4.19!

3.94!

Over the past 12 months, I have become more active in my own health care. (165)!

4.0!

4.07!

4.14!

3.84!

4.1!

4.04!

4.33!

3.86!

4.2!

4.18!

4.38!

4.00!

4.1!

4.11!

4.27!

3.90!

4.1!

3.98!

4.31!

4.06!

3.9!

3.85!

4.23!

3.79!

4.1!

4.12!

4.13!

4.00!

4.0!

4.04!

4.14!

3.87!

3.9!

4.05!

3.88!

3.81!

4.1!

4.08!

4.10!

3.97!

Making Health Changes By Main Provider

Working with my main provider helped me to understand the nature and causes of my health problems and conditions. (166)! Working with my main provider helped me to understand the health monitoring that relates to my condition (e.g., normal range of blood glucose, blood pressure targets). (167)! Working with my main provider helped me to understand lifestyle changes like diet, physical activity and stress reduction that are recommended for my health condition(s). (166)! Working with my main provider helped me to understand the right use of medications for my health condition (s). (167)! Working with my main provider helped me to understand the different medical treatment options available for my health condition(s). (166)! Over the past 12 months, I have become more confident in my ability to take care of my health. (166)! Working with my main provider supported me to know how to prevent or reduce problems with my health or with symptoms from my health condition(s). (165)! Over the past 12 months, I have made the lifestyle changes recommended for my condition (e.g., diet, physical activity, not smoking). (166)! Over the past 12 months, I have become better able to handle the symptoms of my health condition(s) at home. (167)!

EEK$


+,,#-./0!R2!@N1GO1I!;$D#-(!L0,#%/#-5#B!C:%F#"7!Q#B:)(B!S"!6$/-!;%'F/.#%! Overall Mean

Nurse Mean (49)

Nurse Practitioner Mean (66)

Pharmacist Mean (32)

I am confident that I can maintain changes in my health habits like diet and physical activity even during times of stress. (165)!

4.0!

4.02!

3.99!

3.94!

I am confident I can keep my health problems from interfering in the things I want to do. (168)!

3.8!

3.82!

3.95!

3.66!

Making Health Changes By Main Provider

Overall Mean

Nurse Mean (49)

Nurse Practitioner Mean (66)

Pharmacist Mean (32)

My main provider worked with other professionals in coordinating my care. (165)!

4.0!

4.09!

3.96!

3.89!

The other professionals I saw knew about my most recent medical history. (166)!

4.1!

4.12!

4.10!

3.96!

The other professionals I saw had access to my most recent tests and exam results. (164)!

4.1!

4.10!

4.24!

4.04!

The other professionals I saw knew about changes in my treatment. (162)!

3.9!

4.03!

3.92!

3.68!

The health care I needed from other health professionals was arranged by the staff of the Primary Care Network. (156)!

3.8!

3.78!

3.70!

3.75!

Overall Mean

Nurse Mean (49)

Nurse Practitioner Mean (66)

Pharmacist Mean (32)

Over the past 12 months, my main provider offered everything I needed to help me manage my health conditions and concerns. (168)!

4.0!

3.94!

4.28!

4.00!

Over the past 12 months, I was satisfied with the care I received from my main provider. (169)!

4.3!

4.26!

4.42!

4.03!

Over the past 12 months, I had difficulty getting the health care or advice I needed. (168)!

3.7!

3.76!

3.24!

3.74!

Overall Mean

Nurse Mean (49)

Nurse Practitioner Mean (66)

Pharmacist Mean (32)

3.4!

3.36!

3.43!

3.53!

Coordination- Over the Past 12 Months By Main Provider

Your Overall Experiences By Main Provider

About You By Main Provider Compared to 12 months ago, how would you rate your health today? (167)!

EEL$


+,,#-./0!T2!CU71@!K#$)(A!C:%F#"!Q#B:)(B! The KCPCN implemented use of the SF-12 Health Survey mid-way through 2013/14. The 12 question validated survey by Quality Metric, compares results from KCPCN patients to normative data from a general population sample. It measures health functioning and quality of life. As the survey was implemented mid-way through the year, limited data is available. In all, 86 surveys were available by year end, 83 of which were administered at intake, limiting analysis of changes through time. The available data is useful in understanding health functioning and quality of life for patients at intake. ! The KCPCN administers the survey to patients in three programs including: Chronic Disease, Complex Care and Geriatric Program. These programs are appropriate for such measurement because they are designed to have ongoing follow-up with patients whereby we would hope to see improvements to patient health functioning and quality of life through time. To capture such changes, the survey is administered at various time points including: intake, 3 months, 6 months, 12 months, 18 months and 24 months. ! As the survey was implemented mid-way through the year, with some glitches occurring, limited data is available. In all 86 surveys were available by year end most of which (83) were administered at intake, limiting analysis of changes through time. Such analysis will be possible in another year when more data collection has occurred. The available data is useful in understanding the health functioning and quality of life of patients at intake. ! Analysis results in findings for: !

EEM$

SF-12 Health Survey Domains and Sub domains

'A&H$;"=5/2+,$206;01#1.$5-66+8=$

RA&H$6#1.+,$206;01#1.$5-66+8=$

'7H$;"=5/2+,$C-12./01/14$

`!H$*/.+,/.=$

U'H$80,#H;"=5/2+,$

A7H$502/+,$C-12./01/14$

b'H$<03/,=$;+/1$

U)H$80,#H#60./01+,$

]gH4#1#8+,$"#+,."$

RgH$6#1.+,$"#+,."$


+,,#-./0!T2!CU71@!K#$)(A!C:%F#"!Q#B:)(B7!9'-D-:#.!VW"!+4#!$-.!X#-.#%Y! Category!

EEN$

Sample Size!

PCS!

domain!

MCS

domain!

PF!

RP!

BP!

GH!

VT!

SF!

RE!

MH!

Overall!

83!

42.09!

48.33!

41.7!

43.34!

43.93!

43.85!

46.58!

46.51!

44.19!

48.31!

Males!

32!

41.9!

51.77!

43.29!

43.45!

44.2!

44.21!

49.68!

48.56!

45.56!

52.38!

Females!

49!

42.28!

46.29!

40.68!

43.56!

43.92!

43.74!

44.45!

45.1!

43.55!

46.06!

25-34!

2!

44.63!

60.21!

41.32!

49!

48.71!

52.72!

58.9!

56.9!

56.28!

52.74!

35-44!

12!

44.44!

46.4!

45.26!

45.12!

44.2!

44.44!

44.15!

45.78!

45.45!

47!

45-54!

12!

49.2!

45.87!

48.53!

50.76!

50.21!

41.13!

50.71!

46.52!

43.72!

47.95!

55-64!

20!

42.56!

48.86!

42.89!

44.34!

43.75!

42.68!

47.1!

48.9!

45.63!

47.29!

65-74!

19!

37.43!

50.54!

37.59!

39.87!

40.16!

45.14!

44.41!

43.79!

44.24!

51.83!

75+!

16!

39.81!

47.5!

37.39!

39.48!

43.64!

44.65!

45.38!

45.78!

41.01!

47.36!

Female 25-34!

2!

44.63!

60.21!

41.32!

49!

48.71!

52.72!

58.9!

56.9!

56.28!

52.74!

Female 35-44!

9!

43!

43.94!

43.07!

43.83!

43.7!

41.13!

42.51!

43.07!

44.15!

43.81!

Female 45-54!

8!

49.67!

41.34!

48.21!

48.47!

49.84!

41.29!

47.84!

43.56!

40.04!

44.13!

Female 55-64!

9!

39.84!

47.93!

38.7!

43.83!

41.69!

40.02!

44.69!

48.01!

44.15!

45.73!

Female 65-74!

12!

37.79!

50.87!

37.39!

41.24!

40.44!

45.93!

42.51!

45.04!

46.75!

50.82!

Female 75+!

9!

42.88!

42.23!

37.82!

40.54!

44.7!

47.31!

42.51!

43.07!

38.38!

42.54!

Male 25-34!

0!

0!

0!

0!

0!

0!

0!

0!

0!

0!

0!

Male 35-44!

3!

48.76!

53.8!

51.81!

49!

45.7!

54.38!

49.07!

53.94!

49.35!

56.56!

Male 45-54!

4!

48.27!

54.95!

49.19!

55.35!

50.97!

40.8!

56.44!

52.45!

51.08!

55.6!

Male 55-64!

11!

44.77!

49.62!

46.33!

44.77!

45.43!

44.86!

49.07!

49.62!

46.83!

48.56!

Male 65-74!

7!

36.82!

49.98!

37.95!

37.52!

39.69!

43.78!

47.66!

41.65!

39.95!

53.56!

Male 75+!

7!

35.86!

54.27!

36.82!

38.12!

42.27!

41.22!

49.07!

49.28!

44.4!

53.56!


+,,#-./0!T2!CU71@!K#$)(A!C:%F#"!Q#B:)(B7!9'-D-:#.!VW"!;%'4%$<Y! Category!

PCS!

domain!

MCS

domain!

PF!

RP!

BP!

GH!

VT!

SF!

RE!

MH!

Overall ! Overall â&#x20AC;&#x201C; All Chronic Disease! Overall- Chronic Disease Vegreville! Overall- Chronic Disease Vermilion! Overall- All Complex Care! Overall- Complex Care Vegreville! Overall- Complex Care Vermilion! Overall- Complex Care Viking!

83!

42.09!

48.33!

41.7!

43.34!

43.93!

43.85!

46.58!

46.51!

44.19!

48.31!

50!

43.8!

47.3!

44.15!

44.68!

44.74!

43.26!

46.9!

45.87!

44.95!

47.34!

11!

49.77!

46.63!

47.76!

50.54!

51.17!

46.12!

48.17!

47.2!

46.83!

47.52!

39!

42.12!

47.48!

43.14!

43.03!

42.93!

42.45!

46.54!

45.5!

44.42!

47.29!

30!

39.57!

51.3!

38.43!

42.37!

43.3!

44.11!

46.44!

48.9!

44.67!

50.82!

11!

38.47!

53.3!

36.31!

42.08!

43.79!

44.86!

49.07!

48.01!

46.36!

51.69!

7!

31.24!

50.29!

32.33!

38.12!

37.11!

32.99!

40.63!

45.47!

42.92!

49.46!

12!

45.42!

50.06!

43.94!

45.12!

46.46!

49.9!

47.43!

51.71!

44.15!

50.82!

Overall- Geriatric Care!

2!

39.57!

29.62!

33.45!

25.73!

39.69!

47.75!

39.23!

30.22!

22.5!

32.66!

Category!

Sample Size!

Overall- at intake! Overall- all Chronic Disease! Overall- all Complex Care! Overall- all Geriatric Care!

EEO$

Sample Size!

PCS!

domain!

% above norm

% at norm

% below norm

MCS

domain!

% above norm

% at norm

% below norm

First stage depression screening % at risk (norm 20%)

83!

42.09!

10%!

35%!

55%!

48.33!

33%!

30%!

37%!

30%!

50!

43.8!

14%!

40%!

45%!

47.3!

30%!

26%!

44%!

40%!

30!

39.56!

3%!

27%!

70%!

51.3!

40%!

37%!

23%!

13%!

2!

39.57!

0%!

50%!

50%!

29.62!

0%!

0%!

100%!

50%!


+,,#-./0!T2!CU71@!K#$)(A!C:%F#"!Q#B:)(B7!9'-D-:#.!VW"!&/<#!;'/-(B7!G!;$D#-(!9'<,$%/B'-Y! Category!

EEP$

Sample Size!

PCS!

domain!

MCS

domain!

PF!

RP!

BP!

GH!

VT!

SF!

RE!

MH!

All Time points!

86!

42.21!

48.46!

41.87!

43.49!

43.99!

43.82!

46.89!

46.66!

44.25!

48.4!

Intake!

83!

42.09!

48.33!

41.7!

43.34!

43.93!

43.85!

46.58!

46.51!

44.19!

48.31!

3mths!

3!

45.38!

51.81!

46.57!

47.59!

45.7!

43.11!

55.62!

50.97!

45.89!

50.82!

Patient 1@ intake!

1!

62.21!

35.44!

57.06!

57.46!

57.73!

47.75!

49.07!

48.01!

35.49!

41.26!

Patient 1@ 3 months!

1!

51.16!

57.75!

57.06!

57.46!

57.73!

33.84!

58.9!

56.9!

56.28!

58.47!

Patient 2@ intake!

1!

29!

38.78!

25.58!

32.07!

30.67!

33.84!

39.23!

30.22!

35.49!

35.53!

Patient 2@ 3 months!

1!

34.47!

50.5!

33.45!

40.54!

30.67!

47.75!

49.07!

39.11!

45.89!

47!

Patient 3@ intake!

1!

47.79!

24.34!

33.45!

40.54!

48.71!

47.75!

29.39!

30.22!

25.09!

29.79!

Patient 3 @ 3 months!

1!

50.5!

47.19!

49.19!

44.77!

48.71!

47.75!

58.9!

56.9!

35.49!

47!


Kalyna Country Primary Care Network! 5241 - 43rd Street! Vegreville, Alberta T9C 1R5! 780.603.4455! www.kaylnapcn.ca!

2013 14 evaluator's report  
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