My name is Christopher Licskai. I am a Respirologist, Professor of Medicine and Health System Innovation at Western University. I am the medical director and CEO of the Best Care in primary care program.
It is my pleasure today to present Best Care in primary care. Best Care is a front line clinical program operated by a not for profit corporation with the community Board of Governors, funded by the Ontario Ministry of Health. Now, at more than 270 sites across Ontario. We've created a community of practice of registered nurses, registered respiratory therapists who are also certified respiratory educators up scope with additional training to be guideline experts. We propose to embed these expert team members into your clinical practice. Best Care in primary care was designed by primary care providers to work in primary care practices. We've done well more than 100,000 visits in primary care. We're embedding a certified respiratory educator who is also a case manager to work side by side in your practice, seeing your patients in their medical home, the patient receives all elements of evidence-based care that are recommended by provincial program standards or international or national guidelines. This includes proactive case identification, diagnostic support with on-site spirometry, medication optimization, support for the patient to become active managers in their own disease, an action plan, and additional case management such as immunization as required. On a clinic day, we need five minutes of your time to review and approve a treatment plan that's been created for one of your patients. It works in primary care. It aligns to your workflow. It does not add any administrative burden. For the patient, it is a trusting continuing care relationship. over time. We make knowledge translation easier. When you say yes, we do the rest. It is a complete knowledge translation program. We are delivering all elements of evidence-based best care. I know that because we measure it in every single visit. We're supporting pharmacologic management in terms of guideline directed medical therapy and we're supporting non pharmacologic management in terms of diagnosis, diagnosis. For example, if I look at some of the metrics from the last fiscal year, we performed 19,000 spirometry in primary care practices. 85% of our patients with COPD had their diagnosis confirmed by spirometry. Additionally, and from a case management perspective, you can see our immunization rates for pneumococcal and influenza are approaching 70% of our patients who are clearly at risk. If we look at pharmacologic management and focus for a moment on GOLD E patients. Remember gold E patients with COPD, these are the highest risk group. They've had multiple exacerbations or a hospitalization. The current recommendation for these patients is that they should receive triple therapy, an inhaled corticosteroid, a long acting beta agonist and a long acting antimuscarinic therapy. What you can see circled here is that 80% of our patients are now on triple therapy. If we dig a little deeper, we can see that about 15% were on single inhaler triple therapy when they came into the program and we increased that more than threefold. When last measured it was at 51%. Best Care is improving patient and health system outcomes.
That Best Care COPD is a trajectory changing intervention for patients and for the health system. When I say that it's proven effective, I can say that with confidence. We have the highest levels of scientific evidence including a randomized control trial and an interrupted time series analysis to support my assertion. In the interest of time, I can only present one piece of data today. And I wanna focus on the interrupted time series analysis that we just recently published in Thorax, an international peer-reviewed BMJ journal. What you're seeing on the bottom are two panels, COPD related hospital admissions on the left and COPD related ED visits on the right. You're looking at six years of data from 2400 patients from the Best Care program. What we did is this, we linked our patients to the ICES administrative data set. This means that we connected our patients so we could measure specifically their health service utilization from within the provincial health system. If we focus on the right panel COPD related ed visits, what you can see is that every dot every black dot represents a monthly health service use rate for our patients in the Best Care program. Time zero here in the center of the graphic is when they entered the Best Care program. So to the left of that, what you are looking at is three years of data from before we ever met them. What you can see is that over the course of three years, there was an increasing trend of health services use. If we extend that trend into the three years after we were involved in their care, we create a counterfactual control group. A prediction of what would have happened if Best Care had not been introduced at time zero. What you can very clearly see visually is that we've converted from a rising trend in health services use to a rapid decline and then a declining trend over three years at 36 months, about a 70% reduction in the predicted health services use rate. This is very important for patients. An exacerbation that's severe, that requires an emergency department visit or a hospitalization is a devastating life event with long term impacts on quality of life. Similarly, it's a very important event for our health system as patients with COPD, require high levels of health service use. Best Care is a scalable model of care. We started with a regional program and over a three year interval had an opportunity to assess our spread and scale potential. And what we were able to identify is that over three years, we grew by 10 fold, about 100% of providers that we approach say yes, we want Best Care. And last year we served 1300 primary care providers at 270 primary care sites across Ontario. This year will be launching four sites in Quebec. Best Care is a partner in advancing your goals for your clinic, for your practice for your patients. Best Care reduces administrative burden by delivering a concise report into your electronic health record. But more importantly, we support your care with a real person embedded in your practice, a new team member to support the delivery of all internationally proven evidence-based best practices. That individual also helps with vertical integration or with shared care with our specialist colleagues. We are definitely reducing urgent visits to the emergency department and hospitalizations. But important to your practice, we are also reducing urgent visits back to you for exacerbations. We're improving your experience with the health system. We know because we've measured, we know because 1300 providers tell us we make a difference in their practice. We're creating an opportunity to transform health care locally. But importantly, to share it nationally and internationally. In summary Best Care provides excellence in clinical care. By delivering the guidelines in every visit. It's supported by strong science foundationally and by specific program related health outcomes data published in peer reviewed journals. It is scalable at the health system level and it works in all models of care. It's trusted by primary care practitioners and it supports the placement of primary care as the foundation of our future proactive preventive resilient health system. Best Care is expanding services across Ontario, rapidly increasing comprehensive team based care. I want to thank you for the opportunity to introduce Best Care to you today.
