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June 1, 2017

A Measure of Success – DTES Second Generation Strategy

Quality Improvement (QI) is an ongoing process aimed at improving performance in a given area. A QI plan should be evaluated for effectiveness. VCH Vancouver set out to evaluate the changes underway with the DTES Second Generation Strategy to ensure the changes being made were in fact contributing to improving the health and quality of life for our DTES clients.

“Evaluation is a key part of any quality improvement process,” says Dr. Michael Norbury, Medical Director Primary Care. “We need to make sure the changes we’re making in any area are having the desired impact. The DTES Second Generation Strategy is ground breaking for the organization and could well be used as a model for other cities.” An evaluation working group for the DTES Second Generation Strategy was established in 2016 to develop key quality indicators to focus on for evaluation and QI.

The working group consulted with staff and physicians to develop and validate quality indicators, based on best practices, and determine how to measure results to continue to learn and improve our processes and care for clients.  The ultimate goal of the DTES Second Generation Strategy is to improve the health and quality of life of people living in the DTES. Based on this goal, the QI Working Group established the following indicators:

Clinical outcomes to measure (based on the burden of illness in the DTES):

  • Psychosis
  • Depression
  • Opioid use disorder
  • HIV
  • Hepatitis C
  • Diabetes
  • COPD

Indicators to measure the quality of service:

  • Accessibility, i.e., wait times
  • Care Coordination
  • Core competencies (harm reduction, trauma-informed care, recovery-oriented care, Aboriginal cultural competencies)

System outcomes to measure:

  • Emergency Department use
  • Acute admissions

Once these indicators were established, the next step for the working group was to determine what to measure and how to report information for each indicator. “It may seem like a simple thing,” adds Dr. Norbury, “but if there are variations and inconsistencies in how information is collected and used, we won’t get an accurate measure.”

Also important to note is the fact that each of the indicators has a set of measurements that help determine how effectively the group is achieving their goal. For example, one of the measurements for Accessibility is same-day service. The clinical outcomes also have targets. For example, for clients with HIV the goal is that they have a supressed viral load on their last bloodwork within a specific period of time.

A pilot project is currently underway at Raven Song Primary Care to test the tools and processes developed by our DTES teams. The goal is to ensure easy, efficient documentation that creates useful reports to enable us to learn and improve in a timely manner.  Recognizing the degree of change and other challenges facing our DTES teams, it was decided to test and refine these tools at Raven Song.

Eventually, the tools/processes – developed in the DTES and being tested at Raven Song – will be applied across all Vancouver Community Integrated Primary Care teams. This will support a more consistent approach to charting and reporting, as we continue to integrate our services and teams. We’ll keep you posted.