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Decision makers in Ontario’s health-care system face the unenviable challenge of allocating limited funding and resources to a diverse group of deserving service providers and health-care related initiatives. These decision makers are looking to evidence to help them decide which high quality, efficient and effective healthcare provider is worthy of investment.
On the other side, service providers recognize that evidence is key and use it to tell compelling stories about utilization and effectiveness of our health care system. Community Health Centres (CHCs) in Ontario, for example, are using the powerful storytelling capabilities of data to demonstrate the value of their community-governed health organizations.
The Association of Ontario Health Centres (AOHC) represents 74 CHCs, 10 Aboriginal health access centres, 10 community family health Teams, and 13 nurse practitioner-led clinics in the province. AOHC’s members work in inter-professional teams and are committed to advancing health equity and promoting a holistic view of health.
I had the opportunity to speak with AOHC’s Chief Information Officer, Rodney Burns on how the organization is using a powerful system called the Business Intelligence and Reporting Tool (BIRT) to collect data and analyze trends to tell the stories of individuals served by CHCs.
CHCs and Complexity of Care
Burns says there are many stories that emerge by analyzing the patterns and trends shown in BIRT. One such story is “complexity.” Complexity is described as the impact of social determinants of health (e.g. education, employment, and housing) and the presence of mental health and addiction issues on an individual’s overall wellbeing.1
In other words, an individual who is homeless and out of work and who lives with a mental health condition is considered to be more complex compared to someone without a mental health condition and who has stable housing.
In general, CHCs serve more complex individuals compared to other primary health care models in Ontario. For example, an estimated 60 percent of the individuals served at City Centre Health Care – one of the few CHCs operated by a local CMHA branch, the Windsor-Essex County Branch – have a diagnosis of a moderate to severe mental illness.2
In fact, the majority of the half million individuals served by CHCs in Ontario live with mental health and addiction issues and/or chronic diseases, and experience health inequities due to barriers such as lack of access to services, unemployment, insecure housing, and social isolation.
Burns says the data shows that complex individuals are often high users of emergency rooms in hospitals. He says these individuals are better served at a community-governed primary health care organization like a CHC.
At a CHC, an individual is able to receive primary health, mental health and addiction services, and receive care focused on disease prevention and management. The holistic nature of CHC services, as well as the inter-professional team approach prevents future visits to emergency rooms, which in turn reduces costs associated with unrequired ER visits.
Another story told by data collected in BIRT relates to utilizing performance indicators for quality improvement, performance monitoring, and decision making. The Primary Care Dashboard in BIRT is a visual tool that displays data in a meaningful way by showing patterns and trends, he says.
For example, BIRT collects data on cervical, colorectal, and breast cancer screening rates, and all CHCs across Ontario are able to monitor their performance using these clinical indicators. Ongoing monitoring of performance allow CHCs to be proactive and efficient in delivering services to individuals they serve.
The collection and organization of data are integral parts of evidence-informed decision making. Analysis of data sheds light into patterns and trends, which in turn tell important stories about individuals served by community-governed primary health care organizations, as well as contribute to quality improvement of programs and services.
Kashfia Alam is the Engagement and Education Officer, Human Services and Justice Services Coordinating Committee Secretariat at the Canadian Mental Health Association, Ontario.
1The Standardized Adjusted Clinical Group Morbidity Index (SAMI) score is used to capture the complexity of a client. This case-mix method was developed by Johns Hopkins to measure morbidity of individuals and populations across multiple care settings. The “average” client or population has a SAMI score of 1. A SAMI score of 1.40 can be interpreted as an expected need for primary health care that is 40 percent higher than in the average Ontarian.
According to the report, “Examining Community Health Centres According to Geography and Priority Populations Served” by ICES, the expected need for primary health care for a CHC client, on average, was 20 percent greater than that of the average Ontarian.
2CHC Based Walk-In Clinic Program, City Centre Health Care. Increasing Access for our Patients, Being There When They Need Us. Retrieved from: https://www.aohc.org/sites/default/files/documents/B10_1_CHC-based_Walk-in_Clinic_Program.pdf