Ontario’s publicly funded healthcare system is under intense pressure from a combination of spiralling costs, an aging population and government budgetary austerity. The challenge of delivering high-quality care to all Ontarians remains, however, critically important. In order to meet the needs of the population, Ontario’s healthcare system must consistently adopt evidence-based practices that can improve outcomes, eliminate waste in the system and organize the delivery of healthcare around the patient to create a smooth journey for the individual. This is essential to ensuring that our health system is sustainable for future generations.
One of the roles of Health Quality Ontario (HQO) is to monitor and report to Ontarians on how well our healthcare system is performing.
This Quality Monitor is HQO’s seventh annual report. It describes how the different parts of the system – primary care, home care, long-term care and hospitals – perform across nine dimensions of quality: accessible, effective, safe, patient-centred, equitable, efficient, appropriately resourced, integrated and focused on population health. It analyzes whether quality has improved or worsened and, where possible, how Ontario compares to best-performing jurisdictions in Canada and internationally. HQO also has a role in driving change throughout the system. It identifies the evidence-based practices that healthcare providers should implement, and recommends practice standards, also based on evidence, that organizations need to follow. It makes recommendations on how health services should be funded in order to encourage
the highest quality. It amasses knowledge about the different tools or approaches that are useful in implementing best practices and spreads this knowledge to healthcare providers.
To that end, this year’s Quality Monitor is divided into a series of two-page themes. The first page describes key findings and presents data on how we compare to others and whether or not we have improved. The second page describes improvement strategies.
It highlights the evidence-based practices that should be implemented, including those recommended by the Ontario Health Technology Assessment Committee (OHTAC), now part of HQO. It also lists practical ideas on how to implement best practices, and references ‘change packages’ developed by HQO that describe these implementation tips in greater detail. Ideas for implementation include specific improvements to processes of care, tips on how to measure quality and feed-back results to providers, clinical decision supports to remind providers to carry out important tasks, staff skills that need to be developed, resources that need to be acquired or reconfigured, opportunities for patient engagement to enhance implementation, and accountability mechanisms or incentives that need to be designed. These strategies for improvement are also classified according to the different audiences that have to implement them – providers, patients and policy-makers.
This year’s printed version of Quality Monitor features a more compact design to enhance readability. Additional content, including full graphs for all indicators, will be made available online in stages after the print report is released. There are two-page summaries of key findings for hospitals, long-term care, homecare and primary care, with questions intended to stimulate self-reflection in leaders and caregivers. This year’s report continues to highlight local success stories closely linked to its key findings that demonstrate improvement is possible. Additional stories will also be made available online.
How we compiled this report
HQO examined data from sources that include Ministry of Health and Long-Term Care (MOHLTC) databases, Statistics Canada census data and international surveys from the Commonwealth Fund and others. The Institute for Clinical Evaluative Sciences (ICES) helped us conduct many of the data analyses. Researchers, clinical experts and healthcare executives reviewed our findings for accuracy and validity.
Key findings
All sections of this year’s report point to one overall theme: progress is being made in many areas, but it has been slow. In order for Ontario’s healthcare system to achieve true excellence, the rate of progress needs to be accelerated. Three areas in particular demonstrate the extent to which this is the case:
• chronic disease management and avoidable hospitalizations
• wait times
• hospital safety
Chronic disease management and avoidable hospitalizations
Chronic diseases are common within the Ontario population. Although there are some positive signs of improvement in the management of chronic diseases, there is still huge room for improvement. People are not routinely receiving all of the evidence based best practices in chronic disease management that could maintain their health. Care is fragmented, especially when people are discharged from hospital or move from one provider to another or have multiple providers. This creates excessive burden on individuals and their families, and leads to hospitalizations and readmissions that likely could be avoided.
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