Understanding patient populations by reviewing measures and monitoring practice trends to make decisions that improve patient care and clinic functionality is inspiring. Health Care on Yates is a Nurse Practitioner led primary care clinic in Victoria, B.C. Their goal is to deliver comprehensive team based primary health care services. When Kent Marley, Health Data Coalition’s (HDC) Clinical Services Manager, visited the clinic in 2022, he and Lynn Guengerich, Pediatric Nurse Practitioner and Health Care on Yates’ Outgoing Clinic Director looked at the clinic’s measures they had been monitoring. What stood out for both of them validated some of the challenges the clinic had been experiencing and sparked curiosity for further examination.
Healthcare on Yates is one of four Nurse Practitioner primary care clinics launched in British Columbia in 2020. As part of Kent’s role, he supports clinics to understand and examine their practice measures to empower care providers to recognize trends, identify strengths, and consider opportunities in their practices and their communities.
“We didn’t do a lot with the practice measures initially because we’ve been so busy,” shares Lynn. “But Kent came into our clinic and did a one-on-one training session and reviewed our practice trends with us. We compared what we were doing to the aggregate data of other clinics in Victoria and to the other Nurse Practitioner clinics. This discussion sparked curiosity and we started wondering about projects that we could do, that could be easily captured within our EMR.”
Together they looked at a variety of clinical measures such as anxiety and phobias, mood disorders and asthma, identifying which therapeutic areas stood out in their community as being higher than other parts of Vancouver Island and the rest of the province. Panel management and attachment are ongoing initiatives at the clinic, as are QI projects, to inform which patient populations the clinic could focus its efforts. Lynn saw that access to HDC measures, and larger regional or provincial aggregates provide context and insights into the population characteristics of the geographic area. This valuable insight allows clinics to invest in areas that benefit their patients the most.
As part of their review, Lynn and Kent were surprised to see that mental health was an area that stood out. “Mental health diagnosis, such as anxiety & depression, were 3 to 4 times higher than the provincial average,” shares Kent. These findings resonated with what the NPs were feeling regarding patient visits (see below image).
“When we looked at mood disorders, we realized how much higher our average was than the other clinics in Victoria. This really validated how tired we’ve been,” continues Lynn. “The data made it easy to determine that our clinic services a high ratio of patients with complex needs, relative to other clinics on Southern Vancouver Island. While we recognize that perhaps we may be more consistent in our documentation, this overall understanding caused us to look at the data with a different perspective.”
Lynn was able to use this data in the clinic’s 2021-2022 Annual Report. Graphs clearly showcase the difference between the patient profiles at Healthcare on Yates compared to other clinics, especially other Nurse Practitioner Primary Care Clinics on Vancouver Island, and the Lower Mainland.
Nurse Practitioner Primary Care Clinics are having an impact on their communities around the province. In BC, there are currently four Nurse Practitioner clinics, including Healthcare on Yates, that have registered with HDC Discover. They have created their own data group which helps illustrate their collective contribution and how that differs from other clinics and clinic groups. Any individuals or clinics using the HDC Discover application can form their own custom groups, such as the four Nurse Practitioner clinics, to view and track on-going collective efforts and trends.
Taking a wider look at the aggregates for four Nurse Practitioner primary care clinics, Lynn and Kent observed that their collective overall prevalence measures showed that they had more patients living with a mental health diagnosis than the average clinic. The prevalence measures include patients living with mental health diagnoses such as bipolar, eating disorders, generalized anxiety disorder, major depressive disorders, mood disorders, neurodevelopment and PTSD. Additionally, the Nurse Practitioner Primary Care clinics also showed a significantly higher level of screening of patients for colorectal cancer, diabetes and HIV.
At future meetings with her team, Lynn feels the practice measures could contribute and inform discussions around QI projects and other changes to clinic operations. “We’re getting together later this month and it’ll be interesting to talk about the measures and see what we could use between the clinics. I’m interested in looking at the different areas and seeing what the trends are showing.” The clinic intends to continue using HDC Discover measures to learn more about their practice, observing trends and areas where support is needed.
As the HDC Discover measures are automatically generated every 3 months, users can utilize the measures to help spark a discussion. “Trends tell a story, either about an individual clinic, a group of clinics, an area of the province or our population in general,” shares Kent. “I enjoy the opportunity to discover the story behind the measures. To take a step back, discuss how they want the trend lines to change and what actions are required. It’s inspiring when I come back every 6 or 12 months and we can validate that their efforts have made a clear impact for both their patients and the clinic.”
For Healthcare on Yates, it has aided in demonstrating where potential new supports are needed for patients with mental health challenges, as well as showing areas of excellence such as their screening percentages that surpass the provincial aggregate. “Not only did our practice measures validate what we were feeling, it also motivated us to keep working on the right things and where to focus when we are feeling stretched,” stated Lynn. “Our practice trends are shining a light on the great things that our team is accomplishing and that does feel good.”