Transforming community-based primary health care delivery through comprehensive performance measurement and reporting

This award is co-funded by Health Research BC, through CIHR’s Community-Based Primary Health Care (CBPHC) Innovation Teams Grant. 

 

Most Canadians enter the health care system through a visit to a doctor, nurse practitioner or healthcare team based in their communities for the treatment and management of a wide variety of acute and chronic health problems. CBPHC covers a range of services across the continuum of care: primary prevention (including public health) and primary care services; health promotion and disease prevention; chronic disease diagnosis, treatment and management; rehabilitation support; home care and end-of-life care.

 

Although Canada is spending an increasing share of its revenue on healthcare, it is falling behind other industrialized nations in obtaining value for its investment. While Canada has made substantial financial investments in renewing CBPHC over the last decade, no information system exists to routinely capture whether renewal efforts improve CBPHC performance or quality of care in Canada.

 

Dr. Sabrina Wong, a professor in the School of Nursing and Centre for Health Services and Policy Research at the University of British Columbia (UBC) co-led a multi-provincial research program to improve the science and reporting of performance measurement of the primary health care system in Canada.

 

Working with co-PIs, Drs. William Hogg and Sharon Johnston of the Bruyère Institute in Ottawa and Fred Burge at Dalhousie University, the team conducted four studies over the five-year research program using data collected and analyzed from three study regions in British Columbia, Ontario and Nova Scotia with similar socio-demographic characteristics. The aim of their work was to learn how comprehensive performance measurement and reporting could support improvements and innovation in the delivery of primary care services to Canadians, especially populations vulnerable by multiple poor determinants of health.

 

By measuring and reporting on how regions within the health system performs, Wong’s research — the first of its kind in British Columbia and Nova Scotia — provides a foundation to transform the organization and delivery of the Canadian CBPHC system, leading to an enhanced patient experience, improved health outcomes and reduced costs.


End of Award Update – February 2022

Most exciting outputs

The TRANSFORMATION study set out to improve the science of performance measurement in primary health care in Canada. As the project comes to a close, it has demonstrated success in identifying performance measures of significance to patients, clinicians, and policy makers; advancing methods for the collection of patient reported experience and outcome measures; developing health segmentation methods and inter-provincially comparable indicators of primary care performance using health administrative data. Findings have been shared through conference presentations, journal publications, and engagement of policy makers and health region administrators.

 

Impact so far

The study has advanced the use of mixed methods in this area of research. Knowledge translation and the training of graduate and post-graduate students in primary health care research methods has resulted in spin-off projects. The Public Health Agency of Canada has recently funded a project to address vaccine hesitancy through primary care practices using a patient outreach and survey system piloted as part of the Transformation project. In Nova Scotia, the study has informed development of annual surveys of patient health experience required for institutional accreditation.

 

In BC, work completed by TRANSFORMATION on the patient reported experiences and outcomes survey was used to inform the office of Patient Centred Measurement in their work on development of a population-based primary care experiences survey (originally slated to roll out in 2021). This work was also used by Doctors of BC in their development and implementation of a practice-based patient experiences survey. Work completed on using administrative data to formulate population segments informed the work of the BC Ministry of Health in how different segments of the population use primary care services. The work of TRANSFORMATION has also been used by scholars and research students, providing opportunities to publish, present results, and connect with other leading primary health care researchers across Canada.

 

Potential future influence

Learnings from this project are being used to inform development of the patient reported indicator surveys for the Organisation for Economic Co-operation and Development. Knowledge, methods, partnerships and software developed through this project is already increasing the capacity for performance measurement, including by developing supporting infrastructure for a primary care learning health system in Canada.

 

Next steps

Our next stage of work is moving the science, theory, and discoveries from this work, into practice. This work is in progress, including the further development of automated systems to collect data from patients in a timely manner and provide practices with data for near real time QI efforts. In addition, there is interest in integrating data from electronic medical records to support quality improvement and performance measurement in primary health care. Future work will be needed to refine methods for using these measures to influence behaviour – both at the level of primary care patients and practices and at the health policy level.

 

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