Summary of Categories and Indicators

Category A: Patient-Centred

Indicators in this category cover practice and patient issues: Practice issues include privacy and confidentiality, guiding documents and legal contracts, mandatory reporting and boundary issues; patient issues include feedback and input, rmed decision making and self-management, and the provision of educational resources.
Category A has 7 Sub-Categories with 8 Indicators
A.1 Privacy and Confidentiality
Recommended steps for maintaining patient privacy include drafting a written policy, training staff, obtaining patient consent for the release of notes to third parties, and protecting personal records.
A.2 Guiding Documents and Legal Contracts
Team members are dedicated to comprehensive care and the rights of patients, and are knowledgeable about the practice’s services, legal obligations and contractual requirements.
A.3 Mandatory Reporting
Clinical team members are familiar with regulatory guidelines and record reported cases.
A.4 Boundary Issues
Clinical team members are familiar with their regulatory colleges’ boundaries policies; management knows how to recognize and disclose conflicts of interest.
A.5 Encouraging Patient Feedback and Suggestions
Patients can suggest improvements via questionnaires, committees or suggestion boxes; the practice documents patients’ feedback and communicates it to team members.
The practice has a documented complaints policy and records all complaints and their resolution.
A.6 Informed Decision Making
Patients receive sufficient information and support to make informed decisions and give informed consent; appropriate forms are provided.
A.7 Educational Resources for Patients
Patients receive educational materials, community referrals, written and online resources and information about available public health programs.

Category B: Equitable

Indicators in this category cover equity issues: patients are accepted and treated without discrimination regardless of who they are, where they live, and when required, given extra services.
Category B has 1 Sub-Category with 3 Indicators
B.1 Equitable Care
All clinical team members are aware of their professional obligations to accept new patients into the practice.
The quality of care is the same for all patients, including immigrants, refugees, the homeless and Aboriginal Peoples; quality is not influenced by patients’ sexual orientation, gender, age, language or religion.
The clinical team can provide additional services as required for patients with special needs including cultural issues and language, impaired vision and hearing, and physical and cognitive disabilities.

Category C: Timely and Accessible

Indicators in this category cover issues of timeliness and accessibility: Patients receive appointments, referrals, test results and after-hours or emergency care in a timely manner, and new patients’ medical records are transferred efficiently.
Category C has 2 Sub-Categories with 6 Indicators
C.1 Timely and Accessible
Telephone system, email and/or other electronic systems are user-friendly and facilitate easy access to the practice.
Patients can book longer or shorter appointments as needed and wait-times are monitored.
New patients are registered efficiently and their medical records are transferred to and from the practice according to CPSO guidelines.
There is a system in place to monitor wait times for investigations and referrals.
C.2 After-Hours and Emergency Care
The practice ensures access to 24/7 medical care; alternative arrangements are provided if the clinical team does not provide 24-hour care.
Patients are able to book urgent-care visits; the practice team is trained to recognize and respond to emergencies.

Category D: Safe

Indicators in this category cover safety issues: infection control, vaccine storage, office procedures, disposal of sharps and medical waste, safe and appropriate medical equipment, drug and prescription management, medical record storage, ensuring essential information is included in medical records, tracking test results and incident reporting.
Category D has 8 Sub-Categories with 11 Indicators
D.1 Infection Control
Team members follow disinfection and sterilization guidelines, store sterile instruments appropriately and practise hand hygiene.
D.2 Cold Chain
Guidelines for effective vaccine storage include using a designated refrigerator and ensuring that vaccines are current.
D.3 Office Procedures
The practice has a list of approved procedures, and clinical team members have suitable training and equipment to perform these procedures in accordance with accepted guidelines.
D.4 Disposal of Sharps and Biomedical Waste
The practice team has a system to safely dispose of sharps and contaminated materials.
D.5 Medical Equipment
The practice’s medical equipment is safe, appropriate, available when required, and well-maintained.
D.6 Drugs
Recommended steps for controlling drugs in the practice include authorized access, secure storage, a bi-annual audit, and dispensing records.
Medications ordered for patients are prescribed and managed in the safest manner possible.
D.7 Medical Record-keeping
Steps to ensure that medical records are stored securely and retrievable only by authorized medical staff include safe storage of backup tapes or CDs, computer password protection and lockouts, and an IT strategic plan.
Patient records should include cumulative patient profiles, up-to-date lists of problems and medications, telephone conversations, clinical decisions and all other necessary information about the patient and their care in accordance with best-practice guidelines, legal and local standards.
The practice has an effective system in place for managing test results and medical reports, including follow-up of missing results and notification of patients.
D.8 Incident Reporting
An incident reporting and management system is in place that identifies and addresses adverse events, errors, near-misses, etc.

Category E: Effective Clinical Practice

Indicators in this category recommend steps for ensuring that patients receive quality clinical care based on best-practice evidence-based guidelines and include the clinical outcomes of lifestyle and prevention, immunization, screening and surveillance, life-cycle clinical management, sexual health, family violence, chronic disease management and palliative care.
Category E has 9 Sub-Categories with 27 Indicators
E.1 Lifestyle and Prevention
The practice team uses an evidence-based approach to help patients quit smoking, and monitors their progress
Recommended ways in which the practice can help patients with alcohol use and abuse problems include screening tools, counselling, medication and referrals to community programs.
Recommended ways in which the practice can help patients with diet and exercise include a regular assessment of medication, referrals to community resources, and the recording of BMI and waist circumference.
E.2 Immunization
The practice team meets the provincial guidelines for baby, childhood and adolescent immunizations, including providing Public Health with regular updates and reporting adverse reactions.
The practice team meets the provincial guidelines for adult immunizations, including reporting adverse reactions to Health Canada.
E.3 Surveillance and Screening
The practice team meets the provincial guidelines for screening, surveillance and recall for early detection of colorectal cancer.
The practice team meets the provincial guidelines for screening, surveillance and recall for early detection of cervical cancer.
The practice team meets the provincial guidelines for screening, surveillance and recall for early detection of breast cancer.
E.4 Life Cycle Clinical Management
The practice team meets the provincial best-practice guidelines for the provision of well baby/child care.
The practice team meets the best-practice guidelines for adolescent care, including sexual health care, immunizations, prescription management, and referrals to Children’s Aid.
The practice team meets the provincial best-practice guidelines for maternity care, including prenatal screenings and referrals to other care providers.
The clinical team meets the best-practice guidelines for the care of both men and women.
The clinical team meets the best-practice guidelines for care of the frail elderly, including identifying vulnerable older patients, assessing their cognitive ability, and monitoring medications.
E.5 Sexual Health
The provision of sexual health care includes testing and follow-up for HIV/AIDS and STIs, and family planning.
E.6 Family Violence
The clinical team routinely screens, manages and follows up on victims of family violence.
E.7 Chronic Disease Management
Best-practice guidelines for the care of patients with mental health disorders include regular medication assessment and shared-care with psychiatrists and other mental health professionals.
Screening and care management for patients with diabetes includes shared-care with specialists and other health professionals and a system for regularly updating patients’ records with lab results and other benchmarks.
The clinical team meets best-practice guidelines for patients with hypertension, including regular medication assessments.
The clinical team meets the best-practice guidelines for patients with coronary heart disease (CHD), including regular medication assessments and an annual audit of care.
Best practice-guidelines for patients with stroke or transient ischemic attacks include a system for care management, regular medication assessments and an annual audit of stroke and TIA patients’ records.
Best-practice guidelines for patients with asthma include a system for care management, regular medication assessments and advice on lifestyle modification.
Recommended management of patients with chronic obstructive pulmonary disease includes shared-care with specialists, medication assessments and lifestyle modification advice.
Recommended management of patients with hypothyroidism includes shared-care with specialists and regular medication assessments.
Recommended management of patients with epilepsy includes shared-care with specialists, regular medication assessments and an annual audit of patients’ records.
Best-practice guidelines for patients with cancer include shared-care with specialists, medication assessments, and carefully maintained records of diagnosis, ongoing treatment and after-care.
E.8 Palliative Care
Recommended management of palliative-care patients includes a system of referrals and shared-care and regular medication assessments.
E.9 Open Indicator
This generic indicator allows the practice team to adapt and apply the framework developed for each indicator group to other clinical problems or issues identified as important and relevant to the practice.

Category F: Efficient

The indicator in this category ensures tests and reports are managed efficiently, avoiding unnecessary duplication and time wastage.
Category F has 1 Sub-Category with 1 Indicator
F.1 Efficient Information Management
The practice has established procedures to manage patients’ test results and reports, avoid duplication of tests and manage appointments efficiently.

Category G: Integrated and Continuous

Indicators in this category ensure integration and continuity of care, including services for patients with complex needs, integration with community care and provision of out-of-office care.
Category G has 2 Sub-Categories with 3 Indicators
G.1 Continuity of Care in the Office
The practice team provides continuous, comprehensive and coordinated medical care, including links with hospital-based services, specialists and community-based agencies. Patients have the opportunity to develop an ongoing relationship with the practice team members.
A system of alerts and management of after-hours care ensures continuous, comprehensive and coordinated medical care for patients with complex needs.
G.1 Continuity of Care in the Office
The practice has a system to ensure patients can be treated at home, in hospital, in rehabilitation and other settings.

Category H: Appropriate Practice Resources

Indicators in this category include human resources management, physical facilities, workplace safety and fire management, and practice improvement and planning.
Category H has 4 Sub-Categories with 11 Indicators
H.1 Human Resources Management
Clinical team members are qualified and certified, and maintain updated licences, credentials and privileges.
The practice has human resources policies and procedures, including documented workplace policies and signed employment contracts for each practice member.
The practice members function as a team; regular practice meetings are provided and recorded.
The practice team members balance work and home life; part-time and flexible work hours are supported, and parental needs incorporated into planning.
H.2 Physical Facilities
The practice is physically accessible to most patients, including those with mobility problems.
Recommendations for the waiting area include four seats per FTE doctor, and room to accommodate guide dogs and mobility scooters.
Each examination room is comfortable and private; conversations cannot be overheard.
H.3 Workplace Safety and Fire Management
The practice provides a safe working environment and complies with all WSIB and OHSA requirements.
Recommendations for fire safety include an approved evacuation plan and appropriate fire protection equipment.
H.4 Practice Improvement and Planning
There is a designated person responsible for ensuring the practice team promotes a culture of continuous quality improvement (CQI).
The practice team undertakes regular purposeful planning for improvement and risk management, including disaster planning.