Central Patient Attachment Registry to roll out soon

March 23, 2018

Tobias N.M. Gelber, BSc, MD, CCFP (An) | family physician, Pincher Creek and family physician representative, CPAR Steering Committee

Contributed by: Tobias N.M. Gelber, BSc, MD, CCFP (An) | family physician, Pincher Creek and family physician representative, CPAR Steering Committee

As a physician representative on the Central Patient Attachment Registry (CPAR) Working Group, I’ve been providing direction on its development. The Chinook Primary Care Network, of which I am a member, created a similar tool several years ago. I’m sharing the experiences and lessons learned to avoid reinventing the wheel with CPAR. So what is it?

CPAR is a centralized database that captures the attachment of primary care physicians and nurse practitioners and their paneled patients. CPAR is a key technical enabler for better continuity of care for Albertans by facilitating improved relational and informational continuity and data for health care planning. There is significant evidence1 that continuity improves preventative care, decreases utilization and hospitalization, reduces mortality, improves patient health, reduces health care costs, improves overall care quality, increases patient satisfaction and improves patient adherence to care. Continuity of care is essential to improve patient care and achieve health care system transformation.

You’ve probably heard a lot about CPAR through various AMA communications over the last few months. Physicians and other stakeholders are asking lots of questions about CPAR. I want to provide some answers to the most common questions I’ve heard.

Why was CPAR created?

The development of CPAR was a part of the Amending Agreement with Alberta Health signed in October 2016. There was a commitment by both parties to develop this tool for primary care. It is a joint initiative of Alberta Health, Alberta Health Services and Alberta Medical Association. The Section of General Practice (SGP) is leading this work on behalf of the AMA. The SGP and AMA staff have representation on both the CPAR working group and steering committee to keep up with aggressive timelines for the project.

Close to 70% of family physicians in PCNs across Alberta are in an active phase of developing or completing their panel processes with their practices. CPAR is also the logical next step for providers and teams that are actively engaged in proactive panel-based care; it is one more step in this panel process that will consolidate continuity and ultimately improve patient care.

What gap is CPAR filling?

Currently, there is no centralized way for determining to which primary provider patients are attached. When we started the project in Chinook PCN, 27% of patients were paneled to more than one family physician. There was extensive potential for duplication of care and potential confusion when patients receive discordant advice from their primary providers. With CPAR, we are now down to below 4%.

Does CPAR address some of the gaps identified in the auditor general’s report about health care in Alberta?

Yes, CPAR will address some of the gaps. It was noted in the auditor general’s report that there is “a lack of sharing and use of clinical information.” CPAR will help facilitate improved informational continuity. Information continuity is the transfer of relevant patient information between multiple care providers and locations. It includes accumulated knowledge about the patient’s preferences, values and context. These are the benefits of information continuity:

  • Better handoffs between providers
  • Better communication
  • Less duplication
  • Increased patient and provider satisfaction
  • A patient-centered approach to care

Does a central registry exist in other jurisdictions? Has this approach been successful elsewhere?

CPAR is not a new concept; two PCNs have successful initiatives with functionality and capabilities like CPAR. The Chinook PCN and South Calgary PCN created tools like CPAR. Both PCNs have found it extremely valuable. With both tools, providers receive conflict reports (like CPAR will do) that identify patients on their panel who are confirmed on another providers’ panel.

For example, a conflict report showed a conflict for a patient on my panel who was receiving anti-coagulation therapy. While this patient had been on my panel in Pincher Creek, we knew he lived in another town. This patient had been managed by the INR nurse but had not been optimally controlled for a while. When we saw this patient’s name on the conflict report, a member of the team called him to discuss the situation. The patient explained that he liked the way that we did things at our clinic, but it was more convenient to go to his hometown practice. The team member discussed with him the benefits of having a single family physician manage his care, especially his anti-coagulation therapy. He agreed that going to one clinic was the best for his health, so he decided to remain a patient with the family physician in his home town clinic. As a result, we removed this patient from my panel and knew he was receiving ongoing care.

What’s the biggest value that CPAR will have for patient care?

The biggest value that CPAR has for patient care is that it is a technical enabler to improve continuity of care. Evidence is clear that when patients have a longitudinal relationship with a single family physician, results are better quality of care and a reduced overall health care system utilization and costs. Overall, CPAR is the next step in improving care for patients. Importantly, CPAR sets the stage for future improvements in transitions in care; once a patient shows in the registry as attached to one primary provider, the information will be on that patient’s Netcare record. This will allow users across the system to identify the patient’s primary provider.

What do physicians need to have in place to be able to participate in CPAR?

Physicians and their clinic teams who are actively engaged in paneling their patients will be able to participate in CPAR. Foundational is the ability to produce a list of each provider’s paneled patients. There is a readiness assessment that can be accessed on the Toward Optimized Practice website www.topalbertadoctors.org/cpar.

What are the physician benefits of participating in CPAR?

Physicians will have the ability to confirm who is on their panel and identify duplication of patients on multiple panels. This can potentially reduce physician work by clarifying with patients who their family physician is. For practices engaged in panel management, this is a logical next step to ensure proactive care is offered to patients that are verified on a physician’s panel.

Once streamlined, CPAR has the potential to improve integration and transfer of care from acute care facilities. There is also the potential to financially encourage continuity by using the registry and practicing comprehensive care.

Why should physicians participate in CPAR?

If you are among the 70% of family physicians already working on panel processes, this is the next step to strengthen panels/patient registries as a clinical tool. The only catch is encouraging family physicians and clinics to continue to work on panel and registry participation.

Communication is also key to the success of CPAR to physicians and to our patients. SGP has made it clear to Alberta Health that informing patients and the public is a shared effort that cannot be left solely to physicians and our clinics. An Alberta Health public campaign is forthcoming.

What support will be available to implement CPAR?

AMA, Alberta Health and Alberta Health Services are working together to create tools to help physicians, clinic teams and PCNs implement CPAR. For example, step-by-step instructions and videos are currently under development.

What are the timelines for CPAR implementation?

Here are the general timelines for CPAR.

  • In December 2017, the registry technical solution was ready for roster management by alternate compensation programs for January use.
  • In spring 2018, CPAR will be ready for registry registration.
  • In April 2018, CPAR will be ready for panel uploads. Limited production roll-out will occur before broader roll-out.

For more information about CPAR, please visit: www.topalbertadoctors.org/cpar.

Reference available upon request.

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