WATERLOO REGION NURSE PRACTITIONER CLINIC
Quality Improvement Plans (QIP): Progress Report for 2014/15 QIP
PC= Primary care
BME = Best managed elsewhere
CB = Collect Baseline
CMG = Case Mix Groups
Final: April 1, 2015
ID
1
Measure/Indicator from
2014/2015
Current
Performance
as stated on
QIP14/15
Percent of patients/clients able to see 80%
a doctor or nurse practitioner on the
same day or next day, when needed.
Change Ideas from Last Years QIP (QIP
2014/15)
Target
as
Current
stated Performance
on QIP
2015
14/15
85%
Was this
change idea
implemented
as intended?
(Y/N button)
Yes



Increased patient awareness of same day
appointments.
Yes
It is important to note the following when considering this
results;
• •20% of patients who completed the survey
marked this category “N/A”
• •34% indicated they were able to see their provider
within 2-19 days
• •This question does not take into consideration
patients who did not want or could not be seen
same day/next day due to work, childcare or
transportation issues
• •Survey was conducted during a time when there
was a 3-week absence of a full time Cambridge
provider
Lessons Learned: (Some Questions to Consider) What was your experience
with this indicator? What were your key learnings? Did the change ideas
make an impact? What advice would you give to others?

Maximize use of and availability of same day/next
day appointment for patients
54.55%
Comments



All Nurse Practitioners had 3 same day appointments per day, at a
standardized time across two sites in Fiscal 2014/15.
Conducted a 3rd next available appointment audit and same day utilization
for a 4 week period starting November 10, 2014.
3rd next available audit revealed a wide availability discrepancy between
providers.
Same day appointment audit revealed a higher demand for same day
appointments on specific days of the week and for specific providers so we
adjusted the number of same day appointments to provide a better balance
between same day appointments and pre-booked appointments.
Put posters in the waiting area
Distributed magnets to new patients indicating same days are available and
how to book
Same day appointments are explained during group intake session and on
1|Page
WATERLOO REGION NURSE PRACTITIONER CLINIC
Quality Improvement Plans (QIP): Progress Report for 2014/15 QIP
PC= Primary care
BME = Best managed elsewhere
CB = Collect Baseline
CMG = Case Mix Groups
Final: April 1, 2015
handout material.
ID
2
Current
Target as
Measure/Indicator from Performance
Current
stated on
2014/2015
as stated on
Performance 2015
QIP 14/15
QIP14/15
Percent of patients/clients
who visited the ED for
conditions best managed
elsewhere (BME).
CB
CB
Comments
An ED audit was
 Out of the 37 patients seen in ED, 25 could
conducted in March
have been seen or assessed at our clinic.
2014 indicating that
The remaining 12 were outside of clinic
2% of our patients
hours or required care beyond clinic
were seen in the ED
scope i.e.; sutures
between Sept 2013 &  The organization continues to advocate
Jan 2014
for more effective ways to access this
kind of data from our EMR. Currently we
are unable to effectively extract this
information in an efficient way.
Was this change
Lessons Learned: (Some Questions to Consider) What was your
idea implemented experience with this indicator? What were your key learnings? Did
Change Ideas from Last Years QIP (QIP 2014/15)
as intended? (Y/N the change ideas make an impact? What advice would you give to
button)
others?
Create a baseline to understand the number of patients
that are visiting ED for conditions that would BME.
Yes
Increase patient awareness/education around hours the
clinic is open, availability of same day/next day
appointments and "Why should I go to the emergency
department".
Yes
•
•
•
•
•
•
Work with Local Hospitals to collect ED data on BME visits
Yes
•
•
•
Work with HealthLink to develop care plans for top 10%
system users
Yes
•
Lobby Ministry of Health and Long Term Care to NP's
Yes
•
ER chart audit conducted patient visits to ER from Sept-Dec 2014.
Reviewed results developed and implemented recommendations.
Repeat audit in March 2015.
To increase patient awareness of same day appointment availability,
placed posters in the reception and waiting areas
NPs reminded patients to let our clinic know if they have been seen in a
hospital. This was also added to our group intake session information.
Established routine appointments with key clients who are “super
users” of ER.
WRNPLC has developed a link with all 3 area hospitals.
Requiring NPs to obtain courtesy privileges.
Clinic Director has communicated our commitment to avoid BME visits
with hospital administration and ER staff.
Developed 12 care plans for high risk patients identified through our
participation in Cambridge In-Home program through Cambridge
Healthlink.
Through AOHC & NPAO WRNPLC staff played a key role in analysis of
2|Page
WATERLOO REGION NURSE PRACTITIONER CLINIC
Quality Improvement Plans (QIP): Progress Report for 2014/15 QIP
PC= Primary care
BME = Best managed elsewhere
CB = Collect Baseline
CMG = Case Mix Groups
Final: April 1, 2015
rostering to NP in NPLC. In January 2015 WRNPLC Board passed a
motion to support rostering to individual NP’s.
roster their patients in order to have access to data
ID
Measure/Indicator from 2014/2015
Current
Performance as
stated on QIP14/15
3 Percent of patients/clients who saw their primary
CB
care provider within 7 days after discharge from
hospital for selected conditions (based on CMGs).
Change Ideas from Last Years QIP (QIP
2014/15)
Create a baseline to understand the number of
patients who were seen by their primary care
provider within 7 days after discharge from
hospital.
Target as
stated on
QIP 14/15
10%
CB
Comments

Our 2014 patient satisfaction survey
indicated that 75% of our patients who
were in hospital were seen by their
provider within 7 days of discharge.
Lessons Learned: (Some Questions to Consider) What was your
experience with this indicator? What were your key learnings? Did
the change ideas make an impact? What advice would you give to
others?
Was this change idea
implemented as
intended? (Y/N button)
Yes
Current
Performance
2015




Requiring NPs to obtain courtesy privileges.
Clinic Director has communicated our commitment to avoid BME visits
with hospital administration and ER staff.
Participation in Clinical Care Connect a secure web portal which
connect WRNPLC to 31 regional hospitals, CCAC and Oncology
information in real time.
There is some work to be done on building relationships with
community hospitals so that we can receive notice of admission,
discharge and ER records in a timelier manner.
3|Page
WATERLOO REGION NURSE PRACTITIONER CLINIC
Quality Improvement Plans (QIP): Progress Report for 2014/15 QIP
PC= Primary care
BME = Best managed elsewhere
CB = Collect Baseline
CMG = Case Mix Groups
Final: April 1, 2015
ID
4
Current
Performance
as stated on
QIP14/15
Measure/Indicator from 2014/2015
Percent of a primary care organization’s patients/clients who
are readmitted to hospital after they have been discharged
with a specific condition (based on CMGs).
CB
Target as
stated on
QIP 14/15
10%
Current
Performance
2015
CB
Comments


Change Ideas from Last Years QIP (QIP 2014/15)
Create a baseline to understand the number of patients who
were readmitted to hospital after they have been discharged
with a diagnosis of stroke, COPD, pneumonia, CHF, DM,
cardiac conditions and gastrointestinal disorders.
Lessons Learned: (Some Questions to Consider) What
Was this change idea
was your experience with this indicator? What were your
implemented as
key learnings? Did the change ideas make an impact?
intended? (Y/N button)
What advice would you give to others?
No
•
•
•
•
Development of community care plan for WRNPLC
" High users " via HealthLink
Currently WRNPLC
does not have a way to
track this information.
Continue to link with
area hospitals to
create an efficient
system.
Yes
•
WRNPLC has developed a link with all 3 area hospitals.
Requiring NPs to obtain courtesy privileges.
Clinic Director has communicated our commitment to avoid
BME visits with hospital administration and ER staff.
There is some work to be done on building relationships
with community hospitals so that we can receive notice of
admission, discharge and ER records in a timelier manner.
Developed 12 care plans for high risk patients identified
through our participation in Cambridge In-Home program
through Cambridge Healthlink.
4|Page
WATERLOO REGION NURSE PRACTITIONER CLINIC
Quality Improvement Plans (QIP): Progress Report for 2014/15 QIP
PC= Primary care
BME = Best managed elsewhere
CB = Collect Baseline
CMG = Case Mix Groups
Final: April 1, 2015
ID
Measure/Indicator from 2014/2015
Current
Target as
Performance as
stated on
stated on QIP14/15 QIP 14/15
5 Percent of patients who stated that when they see the doctor 69%
or nurse practitioner, they or someone else in the office
(always/often) give them an opportunity to ask questions
about recommended treatment?
75%
Current
Performance
2015
92.59%
Comments

WRNPLC 2014 patient satisfaction
survey indicates that 78% of our
patients feel they are given the
opportunity to ask questions
about their treatment. We are very
pleased with our high patient
response to this question.

Our positive responses
(always/often) were up 9% total
and 3% higher than our target
Lessons Learned: (Some Questions to Consider) What was
Was this change idea
your experience with this indicator? What were your key
Change Ideas from Last Years QIP (QIP 2014/15)
implemented as
learnings? Did the change ideas make an impact? What advice
intended? (Y/N button)
would you give to others?
Increase the number of “always” and “often” responses
on our in house survey around patients being provided
with complete responses to questions about
recommended treatment.
Yes
•
Ensuring language on the survey is simple and appropriate for
our patient population will result in more participation and less
“N/A” answers
Increase the number of surveys that are distributed to
patients.
Yes
•
Expanding how we offer the survey to patients other than those
patients directly presenting to the clinic during the survey
period.
Provide a wider opportunity to participate by having laptop
access, volunteer assistance and website access.
•
5|Page
WATERLOO REGION NURSE PRACTITIONER CLINIC
Quality Improvement Plans (QIP): Progress Report for 2014/15 QIP
PC= Primary care
BME = Best managed elsewhere
CB = Collect Baseline
CMG = Case Mix Groups
Final: April 1, 2015
ID
Current
Performance as
stated on QIP14/15
Measure/Indicator from 2014/2015
6 Percent of patients who stated that when they see the doctor or
88%
nurse practitioner, they or someone else in the office (always/often)
involve them as much as they want to be in decisions about their
care and treatment?
Target as
stated on
QIP 14/15
90%
Current
Performance
2015
92.68%
Comments


Change Ideas from Last Years QIP (QIP
2014/15)
Was this change idea
implemented as
intended? (Y/N button)
Increase the percentage of “always” and “often”
responses on in house survey around patient
involvement in decisions about their care and
treatment.
No
Increase the number of surveys that are
distributed to patients.
Yes
It is important to note that
15% of patients surveyed
answered “N/A” to this
question
We will continue to look
for change ideas to be
implemented in 20105/16
Lessons Learned: (Some Questions to Consider) What was your
experience with this indicator? What were your key learnings? Did
the change ideas make an impact? What advice would you give to
others?
•
•
•
•
Ensuring language on the survey is simple and appropriate for our
patient population will result in more participation and less “N/A”
answers.
We question whether the target was too ambitious for a young
organization taking on many new patients in a fluid staff environment.
Expanding how we offer the survey to patients other than those
patients directly presenting to the clinic during the survey period.
Provide a wider opportunity to participate by having laptop access,
volunteer assistance and website access.
6|Page
WATERLOO REGION NURSE PRACTITIONER CLINIC
Quality Improvement Plans (QIP): Progress Report for 2014/15 QIP
PC= Primary care
BME = Best managed elsewhere
CB = Collect Baseline
CMG = Case Mix Groups
Final: April 1, 2015
ID
Measure/Indicator from 2014/2015
Current
Performance as
stated on
QIP14/15
7 Percent of patients who stated that when they
77%
see the doctor or nurse practitioner, they or
someone else in the office (always/often) spend
enough time with them?
Target as
stated on
QIP 14/15
85%
Current
Performance
2015
94.32%
Comments



Was this change idea
Change Ideas from Last Years QIP
implemented as intended?
(QIP 2014/15)
(Y/N button)
WRNPLC 2014 patient satisfaction survey
indicates that 86% of our patients feel that
enough time is spent with them when they
are in the clinic to see their provider.
Our positive responses (always/often)
increased by 9% and were 1% higher than
our target
We are very pleased with our high patient
response to this question.
Lessons Learned: (Some Questions to Consider) What was your
experience with this indicator? What were your key learnings? Did the
change ideas make an impact? What advice would you give to others?
Increase the number of always and often
responses to practitioners spending
enough time with patients.
Yes
•
Ensuring language on the survey is simple and appropriate for our patient
population will result in more participation and less “N/A” answers.
Increase the number of surveys that are
distributed to patients.
Yes
•
Expanding how we offer the survey to patients other than those patients
directly presenting to the clinic during the survey period.
Provide a wider opportunity to participate by having laptop access, volunteer
assistance and website access.
•
Extended appointment times for patients
who required more complex care
Increased the number of appointment
available in extended hours between
5 – 8 pm on Tuesday’s and Thursday’s
Yes
Yes
•
•
Developed 12 care plans for high risk patients identified through our
participation in Cambridge In-Home program through Cambridge Healthlink.
Offered extended appointment times to more complex patients allowing for
time to review their care plans
•
•
•
•
Added 2 NP’s seeing patients in extended hours 2 days per week
Added 1 NP seeing patients in extended hours 1 day per week
Added Dietitian seeing patient in extended hour 1 day per week
Added Social Worker seeing patients in extended hour 2 days per week
7|Page
WATERLOO REGION NURSE PRACTITIONER CLINIC
Quality Improvement Plans (QIP): Progress Report for 2014/15 QIP
PC= Primary care
BME = Best managed elsewhere
CB = Collect Baseline
CMG = Case Mix Groups
Final: April 1, 2015
ID
Measure/Indicator from
2014/2015
Current
Target as
Performance as stated on
stated on QIP14/15 QIP 14/15
8 Percent of patient/client
CB
population over age 65 that
received influenza immunizations.
50%
Current
Performance
2015
16%
Comments

A chart audit was completed to establish a baseline. 16%
of our patient population over age 65 received influenza
immunizations. We are unclear about our consistency in
documenting flu shots received elsewhere (i.e.
pharmacy, work, etc.).
Lessons Learned: (Some Questions to Consider) What was your
Was this change idea
Change Ideas from Last Years QIP (QIP
experience with this indicator? What were your key learnings? Did
implemented as intended?
2014/15)
the change ideas make an impact? What advice would you give to
(Y/N button)
others?
Create a baseline for patient population over 65
that have received influenza immunizations.
In October, the staff developed a strategy for
upcoming influenza vaccine season to try and
increase percentage of patients vaccinated
Yes
Yes
• A chart audit was conducted to establish a baseline. 16% of our patients
over 65 received influenza immunizations
• Organized a “flu clinic” with RPN- patients could walk in during this time
and receive their vaccination without an appointment
• Posters in the waiting area and on our website indicated that flu shots
were available
• Reception asked each patient when checking in, if they would like to
receive the vaccine
8|Page
WATERLOO REGION NURSE PRACTITIONER CLINIC
Quality Improvement Plans (QIP): Progress Report for 2014/15 QIP
PC= Primary care
BME = Best managed elsewhere
CB = Collect Baseline
CMG = Case Mix Groups
Final: April 1, 2015
ID
Measure/Indicator from
2014/2015
Current Performance
as stated on
QIP14/15
9 Percent of eligible patients/clients who CB
are up-to-date in screening for breast
cancer.
Target as
stated on
QIP 14/15
55%
Current
Performance
2015
48%
Comments



Change Ideas from
Last Years QIP (QIP
2014/15)
Create a baseline for
breast cancer screening
rate.
Was this change idea
implemented as intended?
(Y/N button)
Yes
Audit for cancer screening was completed to
establish baseline
48% of our eligible patients are up to date in
screening for breast cancer
WRNPLC will continue to lobby for a more
effective way of tracking this kind of data.
Currently, we do not have an efficient, effective
way to pull this data.
Lessons Learned: (Some Questions to Consider) What was your experience with
this indicator? What were your key learnings? Did the change ideas make an
impact? What advice would you give to others?
•
•
•
Audit was completed to create a baseline- 48% of our eligible patients are up to date in
screening for breast cancer.
WRNPLC will continue to lobby for a more effective way of tracking this kind of data.
Currently, we do not have an efficient, effective way to pull this data.
Through AOHC & NPAO WRNPLC staff played a key role in analysis of rostering to NP
in NPLC. In January 2015 WRNPLC Board passed a motion to support rostering to
individual NP’s.
9|Page
WATERLOO REGION NURSE PRACTITIONER CLINIC
Quality Improvement Plans (QIP): Progress Report for 2014/15 QIP
PC= Primary care
BME = Best managed elsewhere
CB = Collect Baseline
CMG = Case Mix Groups
Final: April 1, 2015
ID
Measure/Indicator from
2014/2015
Current Performance
as stated on
QIP14/15
10 Percent of eligible patients/clients who CB
are up-to-date in screening
for colorectal cancer.
Target as
stated on
QIP 14/15
40%
Current
Performance
2015
29%
Comments



Was this change idea
Change Ideas from Last Years QIP
implemented as intended?
(QIP 2014/15)
(Y/N button)
Create a baseline of eligible patients
who have been screened for colorectal
cancer
Yes
Lessons Learned: (Some Questions to Consider) What was your
experience with this indicator? What were your key learnings? Did the
change ideas make an impact? What advice would you give to others?
•
•
•
Linked with Grand River Hospital Nurse
Sigmoidoscopy project to have eligible
patients screened
Yes
Conducted an audit to establish baseline
29% of our eligible patients are up to date in
screening for colorectal cancer.
WRNPLC will continue to lobby for a more
effective way of tracking this kind of data.
Currently, we do not have an efficient, effective
way to pull this data.
•
•
Conducted an audit to establish baseline. 29% of eligible patients are up to
date in screening for colorectal cancer.
WRNPLC will continue to lobby for a more effective way of tracking this kind
of data. Currently, we do not have an efficient, effective way to pull this data.
Through AOHC & NPAO WRNPLC staff played a key role in analysis of
rostering to NP in NPLC. In January 2015 WRNPLC Board passed a motion
to support rostering to individual NP’s.
WRNPLC sent 327 letters to eligible patients regarding Sigmoidoscopy
screening.
As of January 2015, there have been 16 procedures completed.
10 | P a g e
WATERLOO REGION NURSE PRACTITIONER CLINIC
Quality Improvement Plans (QIP): Progress Report for 2014/15 QIP
PC= Primary care
BME = Best managed elsewhere
CB = Collect Baseline
CMG = Case Mix Groups
Final: April 1, 2015
ID
Measure/Indicator from
2014/2015
Current Performance
as stated on
QIP14/15
11 Percent of eligible patients/clients who CB
are up-to-date in screening for cervical
cancer.
Target as
stated on
QIP 14/15
50.00
Current
Performance
2015
20%
Comments



Change Ideas from Last
Years QIP (QIP 2014/15)
Create a baseline of patients who
are up-to-date in screening for
cervical cancer.
Was this change idea
Lessons Learned: (Some Questions to Consider) What was your experience
implemented as intended? with this indicator? What were your key learnings? Did the change ideas make
(Y/N button)
an impact? What advice would you give to others?
Yes
•
•
•
Develop a plan based on learning
from baseline development
Conducted chart audit to establish a baseline.
20% of eligible patients are up to date in
screening for cervical cancer
WRNPLC will continue to lobby for a more
effective way of tracking this kind of data.
Currently, we do not have an efficient, effective
way to pull this data.
Audit conducted established a baseline of 20%
WRNPLC will continue to lobby for a more effective way of tracking this kind of
data. Currently, we do not have an efficient, effective way to pull this data.
Through AOHC & NPAO WRNPLC staff played a key role in analysis of
rostering to NP in NPLC. In January 2015 WRNPLC Board passed a motion to
support rostering to individual NP’s.
No
11 | P a g e
WATERLOO REGION NURSE PRACTITIONER CLINIC
Quality Improvement Plans (QIP): Progress Report for 2014/15 QIP
PC= Primary care
BME = Best managed elsewhere
CB = Collect Baseline
CMG = Case Mix Groups
Final: April 1, 2015
ID
Measure/Indicator from 2014/2015
Target as
Current Performance
stated on QIP
as stated on QIP14/15
14/15
12 Percentage of patients who are offered individual or CB
group counselling and NRT to assist with smoking
cessation
Change Ideas from Last
Years QIP (QIP 2014/15)
Reduce the percentage of
smoker in our clinic by 10%
Access to NRT
Was this change idea
implemented as intended?
(Y/N button)
Yes
10.00

A chart audit was conducted to
establish a baseline
5% of our smoking patients are
offered assistance with
smoking cessation.
Lessons Learned: (Some Questions to Consider) What was your experience
with this indicator? What were your key learnings? Did the change ideas make
an impact? What advice would you give to others?
•
•
•
•
•
Yes
5%
Comments

•
Reduce the number of smokers
in our clinic by 10%
Current
Performance
2015
•
The chart audit done indicated that 5% of our smoking patients are offered
assistance with smoking cessation.
Clinic provided group information sessions at both of our locations to inform
patients of our smoking cessation programs including NRT
Sent letter to patients identified as smokers, informing them of the NRT program
and group information sessions
TEACH certified pharmacist has taken the lead on smoking cessation and RPN
completed TEACH program.
Applied for and received NRT supplies through the STOP program through CMHA.
As of December 30, 2014 our Pharmacist saw 19 patients for counseling related to
smoking cessation. We currently have 15 patients receiving NRT supplies from the
STOP program through CMHA.
Reduced the number of smokers in our practice by 6% as of December 30, 2014.
12 | P a g e