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Specialized multi-disciplinary heart failure clinics in Ontario, Canada: an environmental scan.

ABSTRACT: BACKGROUND: Multi-disciplinary heart failure (HF) clinics have been shown to improve outcomes for HF patients in randomized clinical trials. However, it is unclear how widely available specialized HF clinics are in Ontario. Also, the service models of current clinics have not been described. It is therefore uncertain whether the efficacy of HF clinics in trials is generalizable to the HF clinics currently operating in the province. METHODS: As part of a comprehensive evaluation of HF clinics in Ontario, we performed an environmental scan to identify all HF clinics operating in 2010. A semi-structured interview was conducted to understand the scope of practice. The intensity and complexity of care offered were quantified through the use of a validated instrument, and clinics were categorized as high, medium or low intensity clinics. RESULTS: We identified 34 clinics with 143 HF physicians. We found substantial regional disparity in access to care across the province. The majority of HF physicians were cardiologists (81%), with 81% of the clinics physically based in hospitals, of which 26% were academic centers. There was a substantial range in the complexity of services offered, most notably in the intensity of education and medication management services offered. All the clinics focused on ambulatory care, with only one having an in-patient focus. None of the HF clinics had a home-based component to care. CONCLUSIONS: Multiple HF clinics are currently operating in Ontario with a wide spectrum of care models. Further work is necessary to understand which components lead to improved patient outcomes.

SUBMITTER: Wijeysundera HC

PROVIDER: S-EPMC3506498 | biostudies-other | 2012

REPOSITORIES: biostudies-other

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Specialized multi-disciplinary heart failure clinics in Ontario, Canada: an environmental scan.

Wijeysundera Harindra C HC Trubiani Gina G Abrahamyan Lusine L Mitsakakis Nicholas N Witteman William W Paulden Mike M van der Velde Gabrielle G Kingsbury Kori K Krahn Murray M

BMC health services research 20120803

<h4>Background</h4>Multi-disciplinary heart failure (HF) clinics have been shown to improve outcomes for HF patients in randomized clinical trials. However, it is unclear how widely available specialized HF clinics are in Ontario. Also, the service models of current clinics have not been described. It is therefore uncertain whether the efficacy of HF clinics in trials is generalizable to the HF clinics currently operating in the province.<h4>Methods</h4>As part of a comprehensive evaluation of H ...[more]

PMID: 22863276

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Project description:Quality improvement is attracting the attention of the primary health care system as a means by which to achieve higher quality patient care. Ontario, Canada has demonstrated leadership in terms of its improvement in healthcare, but the province lacks a structured framework by which it can consistently evaluate its quality improvement initiatives specific to the primary healthcare system. The intent of this research was to complete an environmental scan and capacity map of quality improvement activities being built in and by the primary healthcare sector (QI-PHC) in Ontario as a first step to developing a coordinated and sustainable framework of primary healthcare for the province.Data were collected between January and July 2011 in collaboration with an advisory group of stakeholder representatives and quality improvement leaders in primary health care. Twenty participants were interviewed by telephone, followed by review of relevant websites and documents identified in the interviews. Data were systematically examined using Framework Analysis augmented by Prior's approach to document analysis in an iterative process.The environmental scan identified many activities (n=43) designed to strategically build QI-PHC capacity, identify promising QI-PHC practices and outcomes, scale up quality improvement-informed primary healthcare practice changes, and make quality improvement a core organizational strategy in health care delivery, which were grouped into clusters. Cluster 1 was composed of initiatives in the form of on-going programs that deliberately incorporated long-term quality improvement capacity building through province-wide reach. Cluster 2 represented activities that were time-limited (research, pilot, or demonstration projects) with the primary aim of research production. The activities of most primary health care practitioners, managers, stakeholder organizations and researchers involved in this scan demonstrated a shared vision of QI-PHC in Ontario. However, this vision was not necessarily collaboratively developed nor were activities necessarily strategically linked.Within the scope of this research, the scan affirmed that there is currently no province-wide, integrated, and measured quality improvement program for the primary healthcare sector in Ontario. This could be improved by the development of a coordinated plan, an accompanying accountability framework, and an appropriate sustainable funding envelope for QI-PHC at the provincial level.

Project description:BackgroundQuality indicators are important tools to measure and ultimately improve the quality of care provided. Performance measurement may be particularly helpful to grow disciplines that are underutilized and cost-effective, such as home dialysis (peritoneal dialysis and home hemodialysis).ObjectiveTo identify and catalog home dialysis quality indicators currently used in Canada, as well as to evaluate these indicators as a starting point for future collaboration and standardization of quality indicators across Canada.DesignAn environmental scan of quality indicators from provincial organizations, quality organizations, and stakeholders.SettingSixteen-member pan-Canadian panel with expertise in both nephrology and quality improvement.PatientsOur environmental scan included indicators relevant to patients on home dialysis.MeasurementsWe classified existing indicators based on the Institute of Medicine (IOM) and Donabedian frameworks.MethodsTo evaluate the indicators, a 6-person subcommittee conducted a modified version of the Delphi consensus technique based on the American College of Physicians/Agency for Healthcare Research and Quality criteria. We shared these consensus ratings with the entire 16-member panel for further examination. We rated items from 1 to 9 on 6 domains (1-3 does not meet criteria to 7-9 meets criteria) as well as a global final rating (1-3 unnecessary to 7-9 necessary) to distinguish high-quality from low-quality indicators.ResultsOverall, we identified 40 quality indicators across 7 provinces, with 22 (55%) rated as "necessary" to distinguish high quality from poor quality care. Ten indicators were measured by more than 1 province, and 5 of these indicators were rated as necessary (home dialysis prevalence, home dialysis incidence, anemia target achievement, rates of peritonitis associated with peritoneal dialysis, and home dialysis attrition). None of these indicators captured the IOM domains of timely, patient-centered, or equitable care.LimitationsThe environmental scan is a nonexhaustive list of quality indicators in Canada. The panel also lacked representation from patients, administrators, and allied health professionals.ConclusionsThese results provide Canadian home dialysis programs with a starting point on how to measure quality of care along with the current gaps. This work is an initial and necessary step toward future collaboration and standardization of quality indicators across Canada, so that home dialysis programs can access a smaller number of highly rated balanced indicators to motivate and support patient-centered quality improvement initiatives.

Dataset Information

Specialized multi-disciplinary heart failure clinics in Ontario, Canada: an environmental scan.

Publications

Specialized multi-disciplinary heart failure clinics in Ontario, Canada: an environmental scan.

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