2015 Quality Forum, Hyatt Regency Vancouver A4 Opening Doors to Primary Care Serving North Vancouver’s High-Needs, Unattached Patients through an Innovative Model of Primary Care: HealthConnection Clinic Authors: Sarte, A., Edelman, S., Brown, D., Turris, S., Macnutt, J., Simpson, D. Presenter: Sandra Edelman, Manager Public Health, Population Health & Chronic Disease Services Vancouver Coastal Health, North Shore

Disclosure Statement I am unable to identify any actual or potential conflict of interest and have nothing to disclose in relation to this presentation.

Background individuals on the North Shore do not have regular access to primary care (i.e., “unattached”) and are deemed to have “high- needs” 3,000

True Collaboration Vancouver Coastal Health Division of Family Practice Community Partners Practice Support Program Practice Support Program – Technology Group

To improve the health & wellness of vulnerable pop’ns To provide better care coordination & health care utilization To increase attachment to family physicians To improve patients & providers experience To plan for sustain- ability HealthConnection Clinic Goals

Clinic Operations Open 9AM to 12Noon Monday to Friday Location: 148 E. 15 th Street (close to Lions Gate Hospital) Staffed by GP, NP, Case Manager (SW), CDN, MOA Community Partners regularly scheduled to sit in clinic: – Hollyburn Family Services – Lookout Society – Canadian Mental Health Association

Unique Features of the Clinic Partnership between Division of Family Practice & Vancouver Coastal Health Engagement of community partners Built on Triple Aim Evaluation Model Use of a Patient Complexity Assessment Tool (attachment, medical, mental health & addictions & social determinants of health) Training opportunities for medical students, residents (e.g., social work, psychiatry, family medicine, nurse practitioners)

Evaluation Approach Ongoing evaluation to determine the feasibility and value of the clinic and to idenitfy successes, challenges, and lessons learned Guiding principles of evaluation: 1.Participatory 2.Utilization-focused 3.Synergistic 4.Developmental

18-month evaluation results Data current to December 15, 2014

Who are we seeing?

Client Gender 38.2%61.8%

Client Age Average age of client Client ages range from 2-92 years Median age is 50.5 years 49.5 years 49.5 years

Client Housing of clients have an unstable housing situation (i.e., homeless, staying in shelter, with a friend, or in a collective dwelling) 39.7%

Aboriginal/First Nations of clients are Aboriginal/First Nations 18.3%

Referral Sources

Total visits since clinic opened 2010 Total Visits 350 were new visits (17.4%) 1661 were follow up visits (82.6%) As of December 15, 2014

Average Number of Visits per Day since Clinic opened

Profile of Attached Clients Average number of visits8 Minimum number of visits2 Maximum number of visits55 Based on 184 who have had two visits or more, i.e. ‘attached’

What services are our clients using? Health Utilization Data

Important Considerations ONLY clients with 2 visits or more have been included in the analysis (89 clients) ALL clients have been a part of the clinic for a FULL 12 months Analyzed by 12 months before first clinic visit, and the time since that visit Data is current to January 7 th, 2015 Most conservative way to analyze our data

Summary of Health Utilization 22.0 % 39.2 % 2.6% Decrease in Hospital Admissions Slight increase in Emergency Department Visits* Decrease in Hospital Admissions from the ED *85% of ED visits occurred when the clinic was closed. Time spent in ED has decreased (7.7 hrs to 4.6 hrs)

Percentage of Alternative Level of Care Days % 5.8% 12 months before 1 st clinic visit12 months after 1 st clinic visit* *see notes section of slide

Increasing Primary Care Capacity Acute costs 23 Increasing Capacity in Acute

24 What are our clients saying? Client Interview Results

“It’s very good. It seems to provide a service for those who struggle to fit in the mainstream system which requires you to advocate strongly for yourself.” - Client

“This has been excellent. I’ve had more medical care here than I care to shake a stick at. It’s been one thing after another. Some small things, and some big issues with me too. It’s been great. [The NP] is extremely knowledgeable and right on top of things.” - Client

27 What are our providers saying? Memorable Case Studies

“A homeless gentleman with stage 4 cancer was met at the clinic by Outreach. When discovered that he did not have a place to stay, he was secured a bed at the Lookout shelter. Outreach continues to support this gentleman with getting to the clinic regularly and chemo treatments at LGH.” - Survey Respondent

“A client was referred by a community agency. He was a low income and isolated senior. He was reluctant to go to the clinic but had experienced several falls. After meeting the healthcare professional, he became increasingly comfortable and now sees the clinic regularly.” - Survey Respondent

“One of our first patients is a physically disabled man hugely addicted but wanting to get off meds. Over the course of time, we have developed a trusting working relationship with him, he is doing much better, and it is very gratifying. “ - Survey Respondent

Learnings | Next Steps Value of a collaborative approach Importance of identifying & addressing medical and social needs (e.g., housing, poverty) of clients to improve health outcomes over long-term Ongoing evaluation is key to early success & helps to clarify priorities & identify opportunities for improvement Sustainability & clinic growth – Division of Family Practice’s A GP for Me Strategy – Home visiting component to support frail elderly & other vulnerable groups unable to access services at the clinic – Implementation of EMR

Contact Information Sandra Edelman e. p f