Development and evaluation of comparable primary care indicators from administrative health data across three Canadian provinces (original) (raw)
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Establishing a Primary Care Performance Measurement Framework for Ontario
Healthcare policy = Politiques de sante, 2017
A systematic approach to Primary Care Performance Measurement is needed to provide useful information on a regular basis to inform planning, management and quality improvement at both the practice and system levels. Based on an environmental scan, a summit of primary care stakeholders and a stakeholder survey and supported by Measures and Technical Working Groups, the Ontario Primary Care Performance Measurement Steering Committee, representing 20 stakeholder organizations, identified system- and practice-level measurement priorities and related specific performance measures across nine domains of primary care performance. This initiative addressed measures' selection and technical specification. It did not include data collection. Lessons learned in Ontario can assist other jurisdictions developing frameworks for monitoring and reporting on primary care performance. Cross-country alignment could lead to a coordinated approach to measure and target areas for primary care perform...
Prioritizing and Implementing Primary Care Performance Measures for Ontario
Healthcare Policy | Politiques de Santé, 2020
In the fall of 2014, Health Quality Ontario 1 released A Primary Care Performance Measurement Framework for Ontario. Recognizing the large number of recommended measures and the limited availability of data related to those measures, the Steering Committee for the Primary Care Performance Measurement (PCPM) initiative established a prioritization process to select two subsets of high-value performance measures-one at the system level and one at the practice level. This article describes the prioritization process and its results and outlines the initiatives that have been undertaken to date to implement the PCPM framework and to advance primary care performance measurement and reporting in Ontario. Establishing a framework for primary care measurement and prioritizing systemand practice-level measures are essential steps toward system improvement. Our experience suggests that the process of implementing a performance measurement system is inevitably non-linear and incremental. Résumé À l' automne 2014, Qualité des services de santé Ontario 1 publiait le Cadre de mesure du rendement des soins primaires en Ontario. Conscient du nombre important de mesures recommandées et de la disponibilité limitée des données associées à ces mesures, le comité directeur pour la mesure du rendement des soins primaires (MRSP) a mis au point un processus de priorisation afin de sélectionner deux sous-ensembles de mesures de la performance à forte valeur ajoutée-le premier au niveau du système, l' autre au niveau des cabinets. Cet article décrit le processus de priorisation et ses résultats, puis souligne les initiatives qui ont été entreprises à ce jour pour mettre en oeuvre le cadre de MRSP et pour favoriser, en Ontario, la mesure du rendement et la publication de rapports en ce sens. La mise au point d' un cadre de mesure du rendement des soins primaires et la priorisation de telles mesures au niveau du système et des cabinets sont des étapes essentielles pour l' amélioration du système. Notre expérience suggère que le processus de mise en oeuvre d' un système de mesure de la performance est inévitablement non linéaire et incrémentiel.
Evaluating Primary Health Care in Canada: The Right Questions to Ask
National Envelope National Strategies National Evaluation Strategy The National Evaluation Strategy (NES) was established to address the need expressed by First Ministers at their 2000, 2003 and 2004 meetings on health system renewal for better information throughout the health system. The objective of the NES was to generate evidence on primary health care. More specifically, it would: * Facilitate a process to generate evidence on the various approaches to primary health care, including the Primary Health Care Transition Fund and its impact on primary health care renewal; and * Increase national capacity to evaluate primary health care, now and in the future. The Strategy consisted of three initiatives: * Evaluating Primary Health Care in Canada: The Right Questions to Ask; * The Pan-Canadian Primary Health Care Indicator Development Project; and * Toolkit of Primary Health Care Evaluation Instruments. Evaluating Primary Health Care in Canada: The Right Questions to Ask National Envelope Lead and Partner Organization(s) Primary and Continuing Health Care Division, Health Policy Branch, Health Canada Background and Goals To better understand and improve primary health care (PHC) renewal, Health Canada established the Primary Health Care Transition Fund National Evaluation Strategy (NES). The NES had two objectives: to facilitate a process to generate evidence on various approaches to PHC and the impact of PHC renewal; and to increase national capacity to evaluate PHC. The NES comprises three initiatives (evaluation questions, indicator development and a toolkit of evaluation instruments), of which Evaluating Primary Health Care in Canada: The Right Questions to Ask is the first. The objective of this initiative was to develop a set of evaluation questions pertinent to the PHC sector; these questions would then serve as the basis for developing a set of indicators and evaluation tools. The five common objectives of the PHCTF were used as the initial organizing framework for classifying these questions. Activities In Octob er 2004, Health Canada began a process to identify a set of evaluation questions. A variety of strategies were used to generate these questions, including: * A scan of national and international policy documents: The international scan was limited to the United Kingdom, Australia and New Zealand. More than 800 explicit and implicit evaluation questions were abstracted and mapped, according to the PHCTF objectives. * Further synthesis: With the input of a small group of PHC experts in Canada, the United Kingdom and Australia, the initial set of questions was further synthesized to 100 questions that addressed all the major inputs, activities, outputs and outcomes of the PHC Results-Based Logic Model developed by Watson et al. in 2004. Wherever possible, questions were formulated in a way that would suggest indicators. * A two-day workshop: The synthesized questions and the insights that emerged from the scan of policy documents were presented to a group of pan-Canadian PHC researchers, evaluators and policy-makers. Participants clarified which PHC objectives should be evaluated, and identified key evaluation questions. At the workshop, small groups were asked to integrate the broader system objectives of equity, cost-effectiveness and sustainability of public funding into the questions. * A final review of questions: Thirty-nine questions were agreed upon by key experts in the field. Nineteen were identified as being important to the PHC objectives and 20 were identified as being necessary supports for the successful delivery of PHC. Modification of the five PHCTF objectives took place, resulting in seven PHC objectives. Resources * A list of 39 evaluation questions for PHC * A revised list of seven PHCTF objectives Key Learnings The list of evaluation questions developed through this initiative provides an overview of the performance of the PHC system as a whole, not just that of the PHCTF initiatives. This set of questions has helped the two subsequent initiatives of the NES to frame related endeavours. It was noted that the broader system goals of an efficient, effective and equitable system were implicit in the PHCTF objectiv es. As well, evaluators who took part in the initiative and policy documents consistently raised the issues of productivity, quality of health care, and responsiveness of providers to patients. These attributes of care represent an intermediate stage of achieving system efficiency, effectiveness and equity. Although they are largely under the direct control of PHC providers, it was felt that they should be included in the PHCTF objectives. In view of these and other insights, experts at the national workshop said that the language in the PHCTF objectives was ambiguous and did not address all the policy concerns of interest in PHC performance evaluation. As a result, the original five PHC objectives were expanded to seven. Primary Health Care Transition Fund Phone: 613-954-5163 E-mail: phctf-fassp@hc-sc.gc.ca The full report is available in the language of the author on the PHCTF website, www.healthcanada.gc.ca/phctf.
Operational Definitions of Attributes of Primary Health Care: Consensus Among Canadian Experts
The Annals of Family Medicine, 2007
PURPOSE In 2004, we undertook a consultation with Canadian primary health care experts to defi ne the attributes that should be evaluated in predominant and proposed models of primary health care in the Canadian context. METHOD Twenty persons considered to be experts in primary health care or recommended by at least 2 peers responded to an electronic Delphi process. The expert group was balanced between clinicians (principally family physicians and nurses), academics, and decision makers from all regions in Canada. In 4 iterative rounds, participants were asked to propose and modify operational defi nitions. Each round incorporated the feedback from the previous round until consensus was achieved on most attributes, with a fi nal consensus process in a face-to-face meeting with some of the experts. RESULTS Operational defi nitions were developed and are proposed for 25 attributes; only 5 rate as specifi c to primary care. Consensus on some was achieved early (relational continuity, coordination-continuity, family-centeredness, advocacy, cultural sensitivity, clinical information management, and quality improvement process). The defi nitions of other attributes were refi ned over time to increase their precision and reduce overlap between concepts (accessibility, quality of care, interpersonal communication, community orientation, comprehensiveness, multidisciplinary team, responsiveness, integration). CONCLUSION This description of primary care attributes in measurable terms provides an evaluation lexicon to assess initiatives to renew primary health care and serves as a guide for instrument selection.
Open medicine : a peer-reviewed, independent, open-access journal, 2009
Many industrialized nations have initiated reforms in the organization and delivery of primary care. In Ontario, Canada, salaried and capitation models have been introduced in an attempt to address the deficiencies of the traditional fee-for-service model. The Ontario setting therefore provides an opportunity to compare these funding models within a region that is largely homogeneous with respect to other factors that influence care delivery. We sought to compare the performance of the models across a broad array of dimensions and to understand the underlying practice factors associated with superior performance. We report on the methodology grounding this work. Between 2004 and 2006 we conducted a cross-sectional mixed-methods study of the fee-for-service model, including family health groups, family health networks, community health centres and health service organizations. The study was guided by a conceptual framework for primary care organizations. Performance across a large nu...
Primary Health Care Research & Development, 2018
Aim: To describe the process by which the 12 community-based primary health care (CBPHC) research teams worked together and fostered cross-jurisdictional collaboration, including collection of common indicators with the goal of using the same measures and data sources. Background: A pan-Canadian mechanism for common measurement of the impact of primary care innovations across Canada is lacking. The Canadian Institutes for Health Research and its partners funded 12 teams to conduct research and collaborate on development of a set of commonly collected indicators. Methods: A working group representing the 12 teams was established. They undertook an iterative process to consider existing primary care indicators identified from the literature and by stakeholders. Indicators were agreed upon with the intention of addressing three objectives across the 12 teams: (1) describing the impact of improving access to CBPHC; (2) examining the impact of alternative models of chronic disease prevention and management in CBPHC; and (3) describing the structures and context that influence the implementation, delivery, cost, and potential for scale-up of CBPHC innovations. Findings: Nineteen common indicators within the core dimensions of primary care were identified: access, comprehensiveness, coordination, effectiveness, and equity. We also agreed to collect data on health care costs and utilization within each team. Data sources include surveys, health administrative data, interviews, focus groups, and case studies. Collaboration across these teams sets the foundation for a unique opportunity for new knowledge generation, over and above any knowledge developed by any one team. Keys to success are each team's willingness to engage and commitment to working across teams, funding to support this collaboration, and distributed leadership across the working group. Reaching consensus on collection of common indicators is challenging but achievable. Background Strong primary care systems are associated with better patient outcomes, particularly for those with chronic conditions (Hansen et al., 2015). Yet around the globe, primary care clinicians report challenges in coordinating care and delivering care to the most complex and vulnerable patients (Osborn et al., 2015). This points to the need for targeted efforts to innovate in the delivery of primary health care with a particular focus on strategies to effectively reach the most vulnerable patients. Research in primary care plays a critical role in informing, evaluating, and helping improve the delivery and organization of health care services (Hutchison et al., 2011; Hutchison and Glazier, 2013). The diversity of primary care activity within and across jurisdictions (eg,
The impact of primary care reform on health system performance in Canada: a systematic review
BMC Health Services Research, 2016
Background: We aimed to synthesize the evidence of a causal effect and draw inferences about whether Canadian primary care reforms improved health system performance based on measures of health service utilization, processes of care, and physician productivity. Methods: We searched the Embase, PubMed and Web of Science databases for records from 2000 to September 2015. We based our risk of bias assessment on the Grading of Recommendations Assessment, Development and Evaluation guidelines. Full-text studies were synthesized and organized according to the three outcome categories: health service utilization, processes of care, and physician costs and productivity. Results: We found moderate quality evidence that team-based models of care led to reductions in emergency department use, but the evidence was mixed for hospital admissions. We also found low quality evidence that team-based models, blended capitation models and pay-for-performance incentives led to small and sometimes non-significant improvements in processes of care. Studies examining new payment models on physician costs and productivity were of high methodological quality and provided a coherent body of evidence assessing enhanced fee-for-service and blended capitation payment models. Conclusion: A small number of studies suggested that team-based models contributed to reductions in emergency department use in Quebec and Alberta. Regarding processes of diabetes care, studies found higher rates of testing for blood glucose levels, retinopathy and cholesterol in Alberta's team-based primary care model and in practices eligible for pay-for-performance incentives in Ontario. However pay-for-performance in Ontario was found to have null to moderate effects on other prevention and screening activities. Although blended capitation payment in Ontario contributed to decreases in the number of services delivered and patients seen per day, the number of enrolled patients and number of days worked in a year was similar to that of enhanced fee-for-service practices.
2010
This environmental scan and capacity map project was commissioned by a Planning Group of stakeholders to determine the nature and extent of quality improvement in primary health care (QI-PHC 1) activity in Ontario and to map the related human resource capacity for QI-related work in this sector. Individual interviews of 20 strategically identified PHC stakeholders were undertaken during February and March 2010. A review of documents and other related online resources also supported collection and analysis of the scan data. The results of this exercise provide background details regarding 43 identified QI-PHC activities in Ontario. Key aspects for each activity were identified, including funding, human resources/expertise, tools associated with the activity, and the available evidence regarding the activity impact. This report provides a high level analysis of these activities situated within national and provincial health systems strengthening through PHC renewal contexts. The scan identified a consistent theme concerning QI-PHC capacity building activities: several key organizations and their partners focused on long-term QI capacity building in their programming while other organizations and individuals primarily focused on time-limited QI-PHC work, such as research, pilots and demonstration projects. We take this project one step further and offer informed recommendations regarding future directions for QI-PHC in Ontario based on a recurring theme (or shared vision) that was underlying most activities examined within the scan: that an integrated provincial framework and plan for quality improvement in the PHC sector must be developed and implemented in Ontario.
Improving measurement of primary care system performance
Canadian family physician Médecin de famille canadien, 2011
P olicy makers, primary care providers, and patients need high-quality information about the performance of their primary care system to enable informed decision making and efficient allocation of resources. When different jurisdictions measure the performance of their primary care sectors in similar ways, it is possible to determine which factors in primary care service delivery are associated with better outcomes. Better understanding of what works and what does not work can help to improve primary care systems, inform policy, and direct reform efforts. This paper focuses on how measuring, comparing, and reporting on the performance of the primary care sector can be improved, including what we know, the limitations of the data, and how we can go about getting the data we need. The intent of this work is to ultimately contribute to improved health status and longevity at the population level.