Assessing Clinical Governance in Primary Care. Results of a diagnostic review in an Italian Local Health Trust Luca Valerio European Forum of Primary Care Pisa 2010

Primary Care and Clinical Governance

how to evaluate the degree of implementation of Clinical Governance in Primary Care? But it was not easy.

What is DistriCARE -It should: 1.Be reproducible 2.Evaluate both global consistency with Clinical Governance and consistency with single areas 3.Result in an operational plan for improvement An instrument for the evaluation of the degree of implementation of the tools of Clinical Governance in a specific setting of Primary Care

Development of DistriCARE 1.Literature search 2.Expert Panel (DELPHI approach) 3.Software templates

The areas DistriCARE analyzes Areas of Clinical Governance Structural and Functional Prerequisites

Areas 1 to 6: the CG roots Planning and control Organization Culture to Learn Information Technology Research & Development Institutional Marketing

Areas 7 to 24: the CG Areas

MATERNAL- CHILD CARE CHRONIC DISEASES ELDERLY CARE DRUG AND ALCOHOL

The DistriCARE methodology Stage 2Stage 3Stage 1 Week 1Week 2Week 3Week 4Week 5 PreparationSurvey Results development

The DistriCARE methodology

Who interviews? -Project Team: -experts of CG with a medical background -experts of governance and business management -in partnership with an inter-professional working group pertaining to Regional authorities.

3 different levels of interviews: 1.LHT level interviews: 11 forms A, B, C, D, E, F, D 1A, 2A, 3A, 4A, 5A 2.HD level interviews: 9 forms (1D, 2D, 3D, 4D, 5D, 6D, 7D, 8D, 9D) 3.Areas of Need: 4 forms (1AB, 2AB, 3AB, 4AB) Who is interviewed? -24 analysis areas (6 CG roots and 18 CG branches), usually requiring separate interviews

Who is interviewed? Health Authority Level Direzione Sanitaria Direzione Amministrativa dei Distretti Programmazione e politiche di budget Controllo di gestione Ufficio Qualità Risk Management Sistema informativo direzionale Sistemi informatici Ufficio epidemiologico OSRU e Ufficio Formazione Ufficio relazioni con il pubblico District and Need Areas Level Direzioni di Distretto Referente Dip. Materno Infantile Responsabile UVG Distretto di Cuneo Responsabile S.S. Psicogeriatria Responsabile Dipartimento di Patologia delle Dipendenze Responsabile S.S.D. Endocrinologia – Area Diabete Further consultations Direttore Dipartimento DSM Dipartimento Prevenzione (two representatives)

What are they asked? -478 items (single or multiple answer)

The first application of DistriCARE

- 22 interviews (11 board level, 11 other professionals) - Average duration: >70 minutes

The first application of DistriCARE: Results for CG Prerequisites (roots) Planning and control Organization Culture to Learn Information Technology Research & Development Institutional Marketing

The first application of DistriCARE: Results for CG Areas - 1 1A-Analysis of needs – HA level 1D-Analysis of needs – District level 4D-Audits- District level 5D -Evaluation & improvement 2A - Performance evaluation

4A- Quality Systems 2D- Evidence Based Practice 3D - Accoun tability 3A- HTA 5A-Risk Manage ment 6D-Risk Manage ment 7D- Citizen info&invo lvement 8D- Continuity of Care 9D-Social and Healthcare integration The first application of DistriCARE: Results for CG Areas - 1

The first application of DistriCARE: Results for Areas of Need 1AB-Healthcare integration and continuity – MATERNAL-CHILD 2AB-Healthcare integration and continuity – CHRONIC DISEASES 3AB-Healthcare integration and continuity – ELDERLY CARE 4AB-Healthcare integration and continuity – DRUG AND ALCOHOL

The first application of DistriCARE 1D- Analysis of needs 2D- Evidenc e Based Practice 3D - Accoun tability 5D- Evaluation improvem ent 6D-Risk Manage ment 7D- Citizen info&invo lvement 8D- Continuity of Care 9D-Social and Healthcare integration 4D - Audit

The first application of DistriCARE Borgo Dronero Ceva CuneoSaluzzo Mondovì Savigliano- Fossano

The first application of DistriCARE -Output: a 17-point operational plan, including four types of actions: E = Education and training; I= Information technologies; O = Organisational review (roles, processes, activities); T = new Tools and working methods. -All 17 points were included in the Health Trusts 2010 Strategic Plan, 6 in the short term, 11 in the medium/long term

The first application of DistriCARE nINTERVENTO Tipo di intervento Priorità di intervento Aree della clinical governance impattate 15 Intervento prioritario in questo ambito risulta essere lattivazione di un sistema diffuso di rilevazione della soddisfazione dellutente, ad oggi non riscontrato. Si suggerisce di implementare un sistema in grado di rilevare la soddisfazione anche a 30 giorni, finalizzata a rilevare, soprattutto, alcuni elementi piú specifici utili alla valutazione delloutcome / esito. Coinvolgimento delle persone assistite 16 Si sono riscontrate due aree importanti di miglioramento: i sistemi di monitoraggio della qualità della continuità assistenziale e i sistemi informativi di supporto. Relativamente ai sistemi di monitoraggio, si suggerisce di attivare, in via sperimentale ed iniziando dai percorsi più rilevanti, un progetto per la mappatura delle dimensioni più significative da sottoporre a monitoraggio sistematico. A tale primo progetto andrà collegata unanalisi sui sistemi informativi per verificare tempi di realizzazione. Si suggerisce, in questo senso, di avviare le analisi a partire dagli esistenti protocolli per la continuità, anche come occasione per verificare lefficacia della mappatura e valutare le differenze eventualmente esistenti tra Distretti. Continuità assistenziale FS O

Conclusions From description to action

Conclusions Thank you