An audit is an official, systematic examination of the record of any aspect of patient care. A clinical audit is conducted by a family practice to identify opportunities for improving the medical care provided to patients and to provide a mechanism for realizing those improvements. In the Quality Book of Tools, we recommend regular audits – annual, biannual (twice a year) and biennial (every two years), for instance – as a means of assessing whether the criterion has been met. Then a plan must be devised to improve the audit results.
There are eight categories:
Category A – Patient-Centred
Category B – Equitable
Category C – Timely and Accessible
Category D – Safe
Category E – Effective Clinical Practice
Category F – Efficient
Category G – Integrated and Continuous
Category H – Appropriate Practice Resources
Community Care Access Centres
Community Care Access Centres (CCACs) provide a simplified service-access point. They are responsible for determining patient eligibility for services; buying (on behalf of consumers) the highest-quality, best-priced visiting professional and homemaker services provided at home and in publicly funded schools; determining eligibility for, and authorizing all admissions to long-term care facilities (nursing homes and homes for the aged); planning services and case management for each client; and providing information on and referral to all other long-term care services (including volunteer-based community services).
Ontario Association of Community Care Access Centres. Main Page [Internet].
[cited 2010 Jul 21].
Available from: http://oaccac.on.ca/
Community Care Access Centres
Any patient who actually or potentially receives primary care
Continuous Quality Improvement (CQI)
CQI is the process of collecting data about a particular practice or service to benchmark performance, tracking and validating indicators that affect outcomes, and recognizing problems in processes of care and practice management. The culture of CQI is of never-ending improvement of the whole system as part of normal daily activity, continually striving to act according to the best available knowledge.
Criteria are the elements of care that can be counted or measured in order to assess the Indicator. They are discrete, definable, measurable and explicit. A criterion should be so clearly defined that we can say definitively whether it is present or not. These criteria were adopted from the NZ Aiming for Excellence 7 and refined by the authors in the development of the Quality Book of Tools.
There are three types of Criteria:
Legal and Safety – required by law*
Essential – required to demonstrate best practice
Desirable – required to demonstrate additional quality
(*Assumptions about legal indicators are based on the nature of these indicators and the regulations that qualify them)
In this book we have chosen to use the sub-category heading “Drugs” to encompass all prescription and non-prescription medications (over-the-counter, herbal and street drugs).
Family Health Group (FHG)
An enhanced fee-for-service model offered to groups of three or more physicians to provide comprehensive primary care to their enrolled/assigned patients 24/7 through a combination of regular office hours, after-hours services and access to the Telephone Health Advisory Service (THAS).
Family Health Network (FHN)
A blended capitation payment model for groups of three or more physicians offering patients care 24/7 through a combination of regular physician office hours, after-hours services and access to a registered nurse toll-free through THAS.
Family Health Organization (FHO)
Similar to the FHN; however, including a different base rate payment associated with a larger basket of core services.
Family Health Team (FHT)
A Family Health Team (FHT) brings together various interdisciplinary health-care providers to coordinate enhanced quality of care for the patient. FHTs consist of physicians working with other providers such as:
- Nurses, nurse practitioners
- Mental health workers
- Social workers
- Educators and others
FHTs may choose from three governance structures:
- Community-led groups
- Provider-led groups
- Mix of provider groups and community groups
Ministry of Health & Long-Term Care (Ontario). Family Health Teams [Internet]. 2002
[updated 2014 Jul 08; cited 2014 Jul 09].
Available from: http://www.health.gov.on.ca/en/pro/programs/fht/
A family practice consists of the physical space and the people (health-care providers and staff) who provide family medicine/primary care services in one location. The interdisciplinary primary care professionals who work in a family practice include family physicians, nurse practitioners, family practice nurses, registered practical nurses, social workers, dietitians, pharmacists, specialists, educators and others. Staff members include receptionists, practice managers and administrative support.
The method of billing for health services whereby a physician or other practitioner charges the Ontario Health Insurance Plan (OHIP) or the patient for each patient encounter or service rendered.
Each indicator has a section that provides links to the most useful Canadian or international sites with further information to guide the practice. These have been reviewed and are up to date as of the publication of this book. The most frequently cited references and sites include: CPSO, CMPA, OMA, OCFP, QIIP, Canadian Family Physician and American Family Physician, and The Cochrane Library.
Guidelines are “systematically developed statements to assist practitioners and patient decisions about appropriate health care for specific circumstances.”5 Guidelines are a summary of the recommendations based on the evidence for best practice in clinical settings.
Clinical indicators assess particular health structures, processes and outcomes. They can be rate- or mean-based, providing a quantitative basis for quality improvement, or sentinel, identifying incidents of care that trigger further investigation. They can assess aspects of the structure, process, or outcome of health care. Further, indicators can be generic measures that are relevant for most patients or disease-specific, expressing the quality of care for patients with specific diagnoses.6 In the Quality Book of Tools there are two types of indicators: practice management and clinical. They identify elements of practice performance for which there is evidence or consensus that can be used to assess and produce a change in the quality of care provided. Indicators define the practice issue or disease to be assessed. The indicators are organized into eight categories and 34 sub-categories.
Outcomes are all possible demonstrable results that stem from causal factors or activities.
A patient is someone who identifies the practice (the family doctor, nurse practitioner and other members of the clinical team) as their primary care provider. The patient may be in a fee-for-service practice or “rostered/enrolled” in a FHG, FHN, FHO, FHT. For some clinical providers, it is more appropriate to refer to patients as “clients.”
Patient Satisfaction Questionnaire/Survey
This questionnaire is used to assess patient satisfaction with different aspects of their health care. In the tool, we recommend that patient satisfaction surveys be used to obtain feedback and suggestions on the quality of services provided by the practice. We recommend regular surveys (annual, bi-annual, or as needed when making changes, etc.).
Plan, Do, Study, Act (PDSA)
A number of models and cycles can be used in an ongoing way in order to apply CQI. One of the most commonly used approaches that has been successful in family practice settings is the Plan-Do-Study-Act (PDSA) cycle. The PDSA cycle enables change by developing a plan to test the change (Plan), carrying out the test (Do), observing and learning from the consequences (Study), and determining what modifications should be made to the test (Act).
Institute for Healthcare Improvement. Plan-Do-Study-Act (PDSA) Worksheet (IHI Tool) [Internet]. [cited 2010 Jul 21]. Available from: www.ihi.org/IHI/Topics/Improvement/ImprovementMethods/Tools/Plan-Do-Study-Act+(PDSA)+Worksheet.htm
The Quality Book of Tools has Sub-Categories which further define the categories. The sub-categories group similar indicators.
A team is a group of people with different skills and different tasks who work together on a common project, service, or goal, with a meshing of functions and mutual support. In the tool, we refer to teams in different ways: “the clinical team”; “the practice” or “the practice team.”
- The clinical team refers to all the clinical health professionals providing care to patients in the practice.
- The practice team refers to all the clinical health professionals and staff members in the practice. “The practice team can describe” means that all members of the practice are familiar with and can describe a policy or process in a criterion.
The practice refers to the family practice building, the practice team and all activities undertaken as part of the family practice.
The Practice Management
The practice management refers to the leadership responsible for maintaining quality in the practice. The practice management is responsible for producing written policies, reports, etc.
Urgent care is medical care for a condition which is not an emergency but is severe or painful enough to require treatment or evaluation within a reasonable period of time, in order to avoid serious deterioration in the patient’s condition or health.