Transforming CBPHC Delivery Through Comprehensive Performance Measurement and Reporting

1. Transforming CBPHC Delivery Through Comprehensive Performance Measurement and Reporting

2. Project Team Principal Investigators Nominated PI: Sabrina Wong (University of BC) Co-PI: Bill Hogg (University of Ottawa) Co-I: Fred Burge (Dalhousie University) Co-Investigators Julia Abelson (McMaster University) Antoine Boivin (U of Sherbrooke) John Campbell (University of Exeter, UK) Khaled El Emam (University of Ottawa) Rick Glazier (Institute for Evaluative Sciences) Jeannie Haggerty (McGill) Sharon Johnston (Bruyère Research Institute) Alan Katz (University of Manitoba) Jean-Fred Levesque (Bureau of Health Info, Australia) Kim McGrail (UBC Centre for Health Services & Policy Research) Walter Wodchis (University of Toronto) Cathie Scott (University of Calgary) Decision-Makers John Abbott (Health Council Canada) Heather Davidson (BC Ministry of Health) Victoria Lee (Fraser Health Authority) Michelle Rey & Wissam Haj-Ali (Health Quality Ontario) Paul Roumeliotis (Eastern Ontario Health Unit) Collaborators Annette Browne (University of BC) Marilyn Ford Gilboe (University of Western Ontario) Bev Holmes (Michael Smith Foundation for Health Research) Anthony Mar (Cliniconex) Steve Morgan (UBC Centre for Health Services & Policy Research) Monica Taljaard (Ottawa Hospital Research Institute) Colleen Varcoe (University of BC)

3. Funders, Stakeholders and Partners EQUIP Healthcare

4. The Study Regions 3 Sites in 3 Provinces Fraser East (in Fraser Health) Eastern Ontario Health Unit Capital Health *All regions were selected from Peer Group A, groups identified by Statistics Canada as having similar social and economic make up 3 1 2

5. Sampling • In each of 3 health regions: • 40 practices • 2 clinicians providing general medical care • 20 patients per organization

6. What to Measure • Framework for primary care organizations: the importance of a structural domain. Int J Qual Health Care, 2008; 20(5): 308-313.

7. How to Measure • Linked Patient, Provider and Organizational Surveys • Health Administrative Data

8. The Patient Experience Survey • Length of survey • Linking responses • Cost of survey

9. Study 2: Policy Context Case Study • Objective: • To examine contextual facilitators and barriers that may explain regional variation in CBPHC performance

10. Research Questions • What are the characteristics of: • The populations served by the CBPHC practices in each of the 3 study regions and • The CBPHC practices themselves? • In the past five years, what CBPHC innovations have been implemented in each of the 3 study regions and how have they impacted practices’ performance?

11. Study 3:Deliberative Dialogues on PHC performance Reporting • Research Questions: • What dimensions of CBPHC are of greatest priority for measurement and public reporting to promote accountability and public engagement in health system decision-making? • How is public information on CBPHC performance used by individuals; acting as patients and/or acting as citizens? • What is the best way to report performance results to different stakeholders: governance level (clinic, region, province), format, mode?

12. Deliberative Dialogues • Full day Deliberative Dialogue (DD) sessions in BC, ON, NS with patients from practices • Each region: one DD with complex patients and one with low health system user patients • Discussionson: • Priority indicators to measure and report? • How do patients and the public use publicly reported PHC performance data? • Best formats for reporting on PHC performance.

13. Pilot study: Automating the Patient Survey • Traditional patient survey in waiting room • Captures views of attenders • Long • Less flexibility to adjust centrally and redistribute when paper-based • Tablet-based more expensive and still requires survey administrator • Harder to link to ER • Follow-up timing options are limited

14. Automated Patient Survey • Automated interactive voice response surveys linked to EMR eg. after hospital discharge • Existing primary care practice-based platform for automated patient phone and email reminders for appointments, practice notifications, etc. This is an opportunity to harness emerging technology to create a more flexible and sustainable patient survey method which can be scaled up or limited to a single practice.

15. Automated Patient Survey • Patients who fill out the waiting room survey will be asked to consent to a follow up automated survey of 3-6 questions within 72 hours • Telephone, email preference • Analyse degree of reachabilty by this method and respondent profile

16. Automated Patient Survey • Long term potential would be linked to EMR and deployed by preset parameters • Automated survey questions could be linked to phone call reminders about flu shot clinics, appointment reminders, preventive care reminders, change of clinic hours notices, etc. • Survey question burden per patient minimised as spread over large practice roster

17. Patient Survey Lessons • Timing of questions for patients matters: • Before or after visit, 1 week or 6 months later • How you distribute a survey matters: • Waiting room sample versus roster sample • Be clear on purpose of questions: • Is the question the right one for the purpose? • General satisfaction is important –but not for the purpose of improvement

18. Thank you

19. sjohnston@bruyere.org • whogg@uottawa.ca