1. CENTRAL PATIENT ATTACHMENT REGISTRY (CPAR)
Catch the CPAR Wave
A Fluid Record of Each Patient’s Primary Provider
Welcome to the webinar on Continuity and the Central Patient Attachment Registry.

2. Presenter Disclosure Presenters: Chris Diamant Barbra McCaffrey
Relationships that may introduce potential bias and/or conflict of interest:
No relationships to declare.

3. Agenda What is Panel? What is CPAR?
Why is Continuity of Care Important?
Why is CPAR Important?
What will PCNs have to do?
What will Practices have to do?
Leading Practices and Confirmation Rate
CPAR Upload Options
Timelines

4. What is Panel?
Panel is a group of patients whose comprehensive, longitudinal care a physician or nurse practitioner is responsible for.
Primary providers have panels.
Other providers will have a caseload this will include consultants and those who provide a specialist service such as a women’s health clinic or a vasectomy clinic. Some providers have a mix: 90 % of clinic time can be spent as a primary provider offering comprehensive care and the other 10% with a caseload of vasectomy patients.

5. Panel – Mutual Agreement
I am choosing to see you as my family doctor for comprehensive care.
I will be your regular family doctor and provide comprehensive care.
Try to come to this medical home and see me first.
I will always try to come to this medical home first.
Panel based care means a mutual agreement between the patient and provider. Some clinics are getting explicit communicating to patients to always try to receive care in their medical home before seeking care elsewhere.

6. What is CPAR?
Registry of primary providers and their attached patients
Panels
Registry can accommodate
Shared panels
When a provider has multiple panels (from different locations)
CPAR is a common provincial database that will host information of primary providers (both physicians and nurse practitioners) across the province and their panels. It has been designed to accommodate shared panels – for example where one provider works Monday – Wed – Friday and the other Tues – Thurs and provide care to a common group of patients. It can also accommodate for those individual providers who work in separate clinics and have a separate panel in each location.

7. CPAR will…
Capture attachment and will be updated each quarter because panel is fluid
Be an authoritative, trusted, reliable source of patient – primary provider attachment
Inform Netcare and the health system in the future

8. Patient Story…

9. Why is Continuity of Care Important?

10. If we could only do one thing…
“Having a family doctor, being able to access the family doctor, and most importantly, continuity of care with a family doctor, is probably the single most important thing a health care system can provide to its population.”
Dr. Richard Lewanczuk, Senior Medical Director, Primary Health Care, AHS

11. Relational continuity matters. Why
Relational continuity matters. Why? Because it impacts all of the facets of heath care: Utilization, mortality, preventive care, health, cost, quality, satisfaction and adherence.
When a patient has a continuous relationship with a physician the overall result (in all these areas) is better than when that care is disjointed and broken.
Again, evidence shows that patients with higher relational continuity have better health outcomes and mortality than those that do not.
The evidence summary:

12. Continuity of Care is essential:
Continuity of care is essential to achieve health system transformation and to achieve improved patient outcomes.
to achieve health system transformation
to improve patient outcomes

13. System Wide Drivers of Continuity
For continuity to improve at the system level in Alberta, multiple elements have to be in place.
To name a few, there have to be sufficient physicians in all geographic areas and those physicians must have timely access. Information has to follow to and from primary care to across the health system so that primary care has the information they need to provide quality patient care. And patients must value and understand the benefits of continuity to a single primary care provider.

14. Why is CPAR Important?
Foundational building block for informational continuity
Technical enabler for relational continuity

15. CPAR and Patient’s Medical Home
CPAR is a good fit with clinics already confirming patient attachment and creating up to date lists of patients that are used for proactive panel based care in the form of screening care (like ASaP), disease management or care planning.
CPAR is also a good fit for clinics that have advanced in their medical home implementation and are working on organized evidence-based care in their panel management.
Learning from the PCNs that are already doing this (Chinook, SCPCN) it fits very well with panel management and this includes disease management because you can ensure that CDM nursing occurs with uniquely paneled patients.
If a practice is establishing their panel process, it is a good fit to add on once they have processes in place.

16. Clinic Workflow Clinic confirms panel list at practice
Registration of panel administrator (PA) and provider panels
Upload panel list (per provider panel) to CPAR
Registry looks for duplicates and mismatches
PA receives panel conflict and mismatch reports
Panel conflicts are resolved with panel management; deceased removed
Panel lists are validated
Repeat
Quarterly

17. Supports for PCNs PCN Readiness tools STEP Documents
CPAR Readiness Checklist
EMR Guides
PCN, Provider & Team Toolkit
Approaches
Using reports
Scripts
Panel size & access
EMR Guides & Videos
Panel lists
Extracting & saving
Clinic confirms panel list at practice
Registration of panel administrator (PA) and provider panels
Upload panel list (per provider panel) to CPAR
Registry looks for duplicates and mismatches
PA receives panel conflict and mismatch reports
Panel conflicts are resolved with panel management; deceased removed
Panel lists are validated
CPAR Training
Downloading reports
Sorting reports
Prioritizing
Access Management
Registration Support
Access Admin
Panel Admin
CPAR Guide
How to login & use

18. Handout – PCN & Clinic Process Steps

19. Managing Panel Conflicts
INR Panel conflict story – Dr. Gelber, Chinook PCN

20. Leading Practice Example Readiness Lakeside Clinic

21. 1. Create Patient Awareness

22. 2. Scripts for Team

23. 3. Defined Clinic Process
Document it and communicate amongst the team.
All team members are on the same page

24. 4. Measure and Monitor
Panel Identification and Maintenance Process Measures
Patient Confirmation
January 2018
Physician
# Pts NOT Confirmed
Confirmation Rate
Dr. G
5 not confirmed at last visit
97%
Dr. T
9 not confirmed at last visit
96%
Dr. L
10 not confirmed at last visit
91%
Dr. M
19 not confirmed at last visit
89%
Special Thanks to Dr. Nadine Letwin & Victoria Doyle, Clinic Manager

25. Patient Confirmation – Process Measure
Key step in Panel ID & Maintenance
See EMR Guides & Videos
Added to Accuro and Med Access in 2017
Easy to measure & monitor
Date included in CPAR panel upload

26. Data Uploaded to CPAR Field Field Description Patient ID Alphanumeric
Issuing Authority
Text (e.g., ABH, BCH, SKH)
Patient First Name
Text
Patient Last Name
Patient Preferred Name
Patient Date of Birth
Formatted Date (dd/mm/yyyy)
Partial date is not allowed
Gender
Text (M, F, O)
Last Confirmation Date
Last Visit Date

27. CPAR Upload Options Options to upload panels
Consider participating in Community Information Integration (Automate CPAR upload)
Securely upload panel lists quarterly
From clinic to CPAR
Like attaching a file to an
Secure like H-link

28. Future: Informational Continuity

29. Estimated Timelines 1 2 Communications 3 4 5 6 Awareness
Panel Readiness 2
Awareness and Readiness messaging continues
Confirmed Participation in Limited Production Rollout 3
Limited Production Rollout Registration
LPR Training 4
LPR - Validation of all processes (registration through acting on reports) 5
LPR Evaluation
General rollout registration & training 6
General rollout
Communications

30.
More information and tools are on the TOP website including a Readiness Assessment and FAQs.

31. ?

32. challenges
Practices need to establish a panel process before beginning. Given that this is a provincial priority emphasized by the auditor general this is work that needs to be done.
Some physicians may not see value in the registry. If PMH is not a priority it is not a good fit at the time.
Dealing with panel conflicts will be new work but fits in well with panel management
The amount of panel conflicts appearing will depend on participation. As the number of primary providers increases, so will the panel conflicts. Full success will require all primary providers with panels to participate.

33. How do we get ready? Review clinic panel ID & maintenance processes
Use the Panel and CPAR Readiness Checklist and the Roles and Responsibilities of a CPAR Panel Administrator
Continue to Confirm patients at check in!
The Readiness Checklist and the Roles and Responsibilities of a Panel Administrator documents will support readiness.
At the practice continue to confirm patients at check in and mark the EMR.
It is recommended to do a Confirmation Rate as a PROCESS MEASURE to verify how often teams check-in with their patients.

34. Panel Readiness: STEP Documents Supportive Tools for Every Panel
The STEP Tools (Supportive Tools for Every Panel) can help teams work through panel activities and track their progress. They’re part of a trio of tools for clinics that was developed by the EQuIP team (Elevating Quality Improvement in Practice) which represents the seven (7) Calgary and area PCNs. There is a workbook that was designed so that clinics can work through it as a team, or with the help of an Improvement Facilitator (IF). An IF is a great resource to assist the clinic and/or improvement team, from facilitating meetings to providing helpful resources for completing the activities in this workbook. Perhaps most importantly, improvement facilitators are trained in quality improvement methods designed to help teams take a systematic approach to making changes.
To support the workbook and checklist, there is also an accompanying STEP Toolkit – a document that provides options for helpful tools.
The checklist and a portion of the workbook are in your binders. The other resources can be printed when you’re ready for them.
CHECKLIST

36. Communicating with PCN Members: Readiness Phase
Awareness of CPAR
What is it / what it is not D
Desire: How registry participation aligns with PCN priorities
CPAR as an enabler for continuity of care K
Knowledge of the practice readiness criteria
PCN supports practice readiness and registration
Ability: Tools to help practices be ready (E.g., Checklists)
CPAR toolkit will support practice implementation R
Reinforcement: Reports will be available to PCNs to provide feedback on registry participation information from members

37. ?

38. Thank You!

39. Presenter Disclosure
Presenter: Dr. Tobias Gelber Chris Diamant Barbra McCaffrey
Relationships that may introduce potential bias and/or conflict of interest:
No relationships to declare.
This slide must be visually presented to the audience AND verbalized by the speaker.