WORKSHOP 1B: MAKING DATA WORK – UNTANGLING INPUT, OUTPUT AND REPORTING

1. Making data work –
Untangling input, output and
reporting
Jennifer Rayner
Canadian Association of
CHCs

2. Objectives and problems to
discuss
 Data measurement, data management, clinical
decision making, reporting and analytics – power
of data
 Administrative data, EMR data, evaluation data –
what is important to collect
 EMR data (or how to collect data without an
EMR)
 How do we measure the impact of team-based
care (when most EMRs are built for individual
practitioners)
 What is meaningful?
 Discussion – core data for national reporting

3. Data Requirements
 Funding requirements/reporting
 Financial reporting
 HR reporting
 Evidence based decision making
 Quality Improvement/
benchmarking/target setting
 Planning
 Population health
 Program evaluation
 Prediction (projections) analyses
 Research

6. Electronic Medical Records
(EMR)
 Often built for physicians (not
team-based)
 Prescriptive (individuals have
little input in how system is
designed)
 Providers use EMRs as
electronic charts – free text, no
data standards, etc
 Users cannot get data out at all
or in a meaningful way
 Often data rich but information
poor

7. Next Steps/Gaps Identified in
survey
• 64% indicated they have
data on primary care
clients (54% for non
community governed)
• 36% said they collect
data on heath promotion
and outreach (28% for
non community
governed)
• 49% have data on gender
• What can we do about
this?

8. What makes you unique?

9. When is it important to standardize?

10. US/Ontario Story
 Commitment to working collaboratively at the
national, regional/state, and local levels to
make the case with available data
 Commitment to “Tell Our Story”
 Recognition of the importance of research
and data in “Telling Our Story”
 Recognition that the “right” partnerships with
academia and other community partners is
key to success

11. Ontario Evaluability Assessment
 Do we have enough in common
to see ourselves as a ‘program’ –
late 1990’s
 Accessibility
 Wellness and Prevention
 Coordination and Integration
 Holistic, client centred
(comprehensive)
 Community ownership
 54 CHCs operational
 Tested and refined in 2000 – all
CHCs have common data
elements (only use system for
electronic, administrative data,
scheduling and client roster
 2003 – transition to EMR  3
EMRs  common EMR

12. Results
Based Logic
Model
Evaluation
Questions
and
Indicators
Data
Elements
CHC Evaluation Framework

13. Original logic model
Accessible
Services
Accessible location
Convenient hours of operation
Services available in different languages
Culturally relevant programs and services
Outreach
Communities/individuals identify their own needs
Community involvement in running
centres/programs/activities
Community development programs/activities
Health education/promotion
Health education/promotion activities with
individuals/groups (clinical and community focus)
Use of multi-disciplinary teams and assessments
of all aspects of lives
Multi-disciplinary interventions and appropriate
referrals
Team approach
Internal referral systems, meetings, case
conferences
Fostering external linkages
Empowering
individuals and
communities
Focus on Wellness
and Prevention
Holistic approach
to provision of
Health Care
Provision of
Coordinated
services/programs
Reach and serve
groups who would
not access
relevant services
elsewhere
Community
participation (in
decision-making/
leadership)
Change in health
care
Awareness
Attitudes
Behaviour
Provision of
relevant services
Presence on
community
boards
Establishment of
coordinating
groups/ projects
Joint program
planning
Impact on
determinant
s of health of
individuals
and
communities
Improve
health status
of
individuals
and
communities

14. CHC Program Evaluation System
Broad Organization
•Main Intended Populations
•Broad Issues Addressed
Client Demographics
Individual Service Events
Personal Development Groups
Community Initiatives

15. Original standardized data elements
 Accessibility (individual client characteristics, hours of
operation, language of service, issues addressed location
of encounter, etc)
 Interprofessional Teams – provider roles, referrals,
consultations, etc
 Focus on Wellness and Prevention – types of services,
PDGs, health education, health promotion activities, issues
addressed
 Coordinated Services – referrals, care coordination, system
navigation

16. Model of health and well-being

17.  Supports on-going assessment and evaluation of our
programs and services – common starting point
 Includes a series of discrete components
 Results based logic model
 Evaluation questions
 Process evaluation questions (nature of people served, extent
to which the program has been implemented as expected
 Outcome/impact questions (attendance caused a positive
outcome)
 Indicators (measures)
 Data sources
 Data entry manual (also produced)
Revised Ontario Evaluation
Framework

18. Commitment to health through the lens of social determinants, community vitality belonging, health equity &
social justice
Increased community
capacity-building
Reduced risk,
incidence, duration
and effects of acute
& episodic
conditions
Increased
civic
engagemen
t and social
capital
Improved level and distribution of
population health and wellness
Improved capacity of communities to be involved in
decision-making about their health
Increased seamless delivery
of services, appropriateness
of time, place and inter-
professional team through
integration and coordination
Improved functioning, health, resilience &
wellbeing of Individuals, families & communities Improved Health Equity across Sectors
Reduced risk,
incidence and
effects of chronic
through HP
Increased access
for people who
experience the
greatest barriers
Resources - Financial, Material
and Human
Community Knowledge Synthesis - Community and client input, Needs
assessments, Environmental scans
Client & community driven health care programs, services and initiatives with particular focus on those who face
barriers to health
Highest Quality, People and Community Centred Health and Wellbeing
H
Improved equity in access to CENTRE
services by eliminating barriers and
advocating for healthy public policy
Reduced negative impact of SDOH
on health and wellbeing of clients
How Many?
(Volumes, clients,
etc)
What services do we
deliver?
(e.g., PHC, CD, etc
How do we deliver services?
(i.e., 8 MoHWB Attributes)
With Whom?
(priority populations )
Increased
community
partnerships
AccessibleIP, integrated
& coordinated
Community
governed
Based upon the
SDOH
Culturally
Safe
Accountable
and Efficient
Community
Development
Approach
Population
and Needs-
based

19. Current standardized data
 Individual client data and
sociodemographic information
 Encounter data – All individual
encounters and personal
development groups (specific
data fields)
 Community development
initiatives
 Financial data – MIS compliant
 Client experience
 Quality Improvement Plans
 MSAAs – Accountability

20. Continue to demonstrate our impact
and success...
 Collective evidence to
continue telling our
story, improve &
demonstrate our
effectiveness
 Tools and Data
 BIRT, Organizational
Survey, QIPs, MSAA, CI
Tool, PCPM, Practice
Profile, CI Tool, Activity
Based Costing data

21. Importance of standard data – a few
examples
 Data linkage with health
databases
 Comparison of primary care
models
 Health equity analyses
 Costing comparisons
 Population planning &
prevalence data
 Accountable care
organizations
 Risk adjustment
 Having our clients included
in population health studies

22. 1.84
1.26
1.07 1.11
1.04
1.22
0.95
0
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
1.8
2
CHC FHG FHN FHO FHT Other NON
Primary Care Models - ALL
Standardized ACG Morbidity Index
(SAMI) by primary care model

23. 0
10
20
30
40
50
60
70
80
90
%
Cancer Screening
Mammography
Colorectal Screening
Cervical Screening

24. CHC Dashboard
 Quality information driver for
better care
 Clinical team have
undertaken a review of QBT
and PCPM and prioritized a
subset of measures to
benchmark and QI
 Provide an active
performance monitoring tool
for clinical engagement,
operational effectiveness,
clinical outcomes & patient
experience

25. Example – Economic/Costing
Analyses
 Outcomes
overshadowed by
unsubstantiated
statement that `model is
expensive`
 Tricky to allocate costs
and potential benefits
 Primary health care,
community development,
health promotion all
under one roof
 Creating an activity
based costing
methodology

26. Lessons learned
 Importance of having key
people on hand for on-going
training
 Super-users (clinicians
included)
 Use the data for more than just
accountability – use the data in-
house
 Ensure that standardized data
is going to be used (clinician
time) + force queries to do
some of the work
 Data quality an on-going issue
 Importance of working together
as a sector to tell our story
 Importance of using data

27. Types of Services at CHCs
• 100% of CHCs provide primary care
services
• 82% provide self-management programs
• 62% provide primary care through home
visits
• 33% provide primary care through street
outreach or within a mobile unit
• 73% offer harm reduction programs
• 69% offer mental health counseling

28. Canadian CHCs: whom does this
include?
1.Publicly-funded, not-for-profit or government
agency;
2.Principally offers primary health, social, rehabilitation
and other non-institutional services;
3.Health promotion, health education and community
health and development programs;
4.Inter-professional teams from various disciplines, &
volunteers;
5.Serves an identifiable community
6.Governed by locally representative board of
directors (BOD); or a BOD of a broader health
network/region having an advisory committee made
up of locally representative directors;

30. Questions to consider
 What data do we all
collect now?
 What questions do we
need to answer?
 What data is important to
collect across all CHCs to
demonstrate our collective
impact? Is this possible?
 Other questions that we
need to consider?