In 2010, the Excellent Care for All Act (ECFAA) was introduced as part of the Ministry of Health and Long-Term Care’s provincial Action Plan for Health Care. ECFAA required Ontario hospitals to develop and submit annual Quality Improvement Plans (QIPs) with identified and measurable quality improvement initiatives. These hospital-focussed QIPs were one pillar of a broader mandate of systemic quality improvement in Ontario. To that end, it had always been understood that the Ministry’s quality focus would eventually widen to encompass other sectors.
Access, Integration and Patient-Centredness: The Three Areas of Focus for Primary Care
Primary care is the second sector to have been mandated to develop and submit QIPs. On April 1 of this year, Community Health Centres (CHCs) and inter-professional teams such as Family Health Teams (FHTs), Nurse Practitioner-Led Clinics (NPLCs) and Aboriginal Health Access Centres (AHACs) submitted their first QIPs to Health Quality Ontario (HQO) with performance targets and improvement initiatives in each of three areas of Ministry-identified focus:
- Access (access to timely care)
- Integration (timely primary care appointments post-discharge from hospital)
- Patient-centeredness (patient/client involvement in care decisions)
Organizations were also given the opportunity to develop additional context-specific quality goals. Examples of additional quality improvement measures suggested by the Ministry included hospital readmissions within 30 days of selected CMGs or percent of patients/clients who visited the emergency department for conditions best managed elsewhere.
The Differences between Primary Care QIPs and Hospital QIPs
Unlike hospitals, the requirement to develop and submit QIPs by primary care organizations is not mandated in ECFAA. Rather, primary care organizations must submit their QIPs to HQO pursuant to the “Other Reports” section of their funding agreements. Currently, although this mandate only applies to AHACs, CHCs, FHTs and NPLCs, other primary health care providers are being encouraged to use the guidance provided, on a voluntary basis, to develop QIPs for their organizations. Some long-term care homes, for example, have already done so. The lack of the ECFAA statutory regime for primary care means that there is no obligation to establish a pay-for-performance regime related to the achievement of quality improvement goals set out in the QIP. And, at the time of this writing, there has been no indication that such a model will be applied to the primary care sector. Additionally, there is no ECFAA-mandated requirement that primary care QIPs be publicly posted, although organizations are urged to do so.
At time of publication of this blog, few primary care organizations had publicly posted their QIPs and HQO had not yet made available any analysis of the submitted plans.