• Share
  • Email
  • Embed
  • Like
  • Save
  • Private Content
CADTH_2014_D1_Bridging_the_Gap_Between_Evidence_and_Practice__Supercharging_Change_at_the_Front_Lines_of_Healthcare__Phillip Morehouse
 

CADTH_2014_D1_Bridging_the_Gap_Between_Evidence_and_Practice__Supercharging_Change_at_the_Front_Lines_of_Healthcare__Phillip Morehouse

on

  • 120 views

From Evidence to Policy

From Evidence to Policy

Statistics

Views

Total Views
120
Views on SlideShare
120
Embed Views
0

Actions

Likes
1
Downloads
1
Comments
0

0 Embeds 0

No embeds

Accessibility

Categories

Upload Details

Uploaded via as Adobe PDF

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment

    CADTH_2014_D1_Bridging_the_Gap_Between_Evidence_and_Practice__Supercharging_Change_at_the_Front_Lines_of_Healthcare__Phillip Morehouse CADTH_2014_D1_Bridging_the_Gap_Between_Evidence_and_Practice__Supercharging_Change_at_the_Front_Lines_of_Healthcare__Phillip Morehouse Presentation Transcript

    • Supercharging Change at the Front Lines of Healthcare Phillip Morehouse, Director Performance Excellence Cape Breton District Health Authority 2014 CADTH Symposium April 6-8, 2014 Hilton Lac-Leamy, Gatineau, Quebec
    •   Volume of evidence, information & technology  15 - 20 years to reach routine clinical practice  Systematic reviews vs. single studies  Few have resources to find or use evidence  Knowledge or policy on its own will not change practice
    •  Shewart and Deming  Systems thinking- process driven  Starts with a concept of improvement  Testing and learning cycles  Data and feedback driven  Variation exists
    •  Initiated March 2010  MAC/CEO involvement  One test per month alternating between Lab & DI- March 2010  Behavioural Factors ◦ Pre-disposing factors:  Distribution and review of test ordering guidelines  “Do You Need That Scan” (Canadian Association of Radiologists) ◦ Re-enforcing factors:  Identify the top 50% of physicians + peer comparison  Cost of testing
    • Laboratory Diagnostic Imaging ESR    PSA   CEA    Folate    Vitamin D 25-hydroxy  Vitamin D 1, 25-dihydroxy    Urine C&S (No change) Lipid Profile  Throat Culture    Rapid Throat Screen (No change) ANA  Testosterone  BUN  TSH & Free T4  Liver- ALT  Lumbar Spine X-Ray   Chest X-Ray   Portable Chest X-Ray   Abdominal Ultrasound (No change) Pelvic Ultrasound   CT Head  Thyroid Ultrasound  CT Lumbar Spine  CT Chest  Barium Swallow  Barium Enema    OBS Ultrasound-Early  Rib X-Ray    0-5% No Change 5-10%  10-20%   > 20%   
    • • Reduced direct costs • Reduced follow up testing/consultation • Increased capacity • Reduced wait times • Reduced radiation exposure Test/Exam Analysis Time= <15 hours Since March 2010- $1,197,374 # of Tests Test/Exam Variance % Variance Annualized Value Lab Tests 17 (57,612) 16.7% $151,125 DI Exams 13 (14,280) 9.5% $215,013 Total 30 (71,892) 14.4% $366,138 Utilization Project Analysis (March 2010 – April 2013)
    •  10 family practices participated, MOU’s signed  Over 1100 patients with Type 2 Diabetes, over the age of 18 and not living in a nursing home.  Monthly data submissions and feedback reports;  Quarterly workshops;  Incentives: ◦ Office support; ◦ GPs eligible for 25 Mainpro C credits, and 24 M1 credits; ◦ $1000 every 3 months (compensate for time collecting data); and ◦ Compensation for time spent at workshops.  Governance: Quality Collaborative Executive Leadership Team, monthly meetings; Advisory Committee, quarterly meetings Quality Collaborative: Diabetes
    • 0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 80.0 90.0 100.0 PercentofT2DMpopulation Comparison of baseline to final clinical and process measures for the CBDHA Quality Collaborative Baseline, N=1119 Final, N=1065 Sept 2012
    •  2011 ◦ 91 C-difficile cases ◦ 15 deaths  2012 ◦ NS Auditor General/Public Health Agency of Canada/ Infection Prevention & Control NS  2013 ◦ Hand Hygiene Program & Database ◦ Pilot on 2 Medical Units  Hand Hygiene auditing at the unit level  Front line empowerment- individual pins and trophies
    • Pre-Intervention Post-Intervention % Difference Unit 1 86.25% 93.00% 6.75% Unit 2 86.50% 90.75% 4.25% DHA 82.50% 82.25% -0.25% 0 10 20 30 40 50 60 70 80 90 100 Hand Hygiene Compliance Rates Monthly % June 2012 – Feb 2014
    • Reference: Best Care at Lower Cost: The Path to Continuously Learning Health Care in America Released: September 6, 2012 Evidence Learning FamilyHealth Care Provider Patient Policy Practice Data&Feedback Process ImprovementResources Process Technology Incentives IncentivesTechnology
    • morehousep@cbdha.nshealth.ca