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Improving performance measurement in Primary Health Care

This international gathering aims to explore health services research and improve understanding of primary health care structures and effects, focusing on measurement frameworks and data collection methods.

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Improving performance measurement in Primary Health Care

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  1. Improving performance measurement in Primary Health Care Global PHC Stakeholders Meeting Geneva, 7-8 April 2016 Wienke G.W. Boerma, NIVEL, Utrecht (NL)

  2. …. inquiry to produce knowledge about the structure, processes, and effects of personal health services. A study is classified as health services research if it satisfies two criteria: it deals with some features of the structure, processes, or effects of personal health services; At least one of the features is related to a conceptual framework other than that of contemporary applied biomedical science (Institute of Medicine, 1979). …. a multidisciplinary field of inquiry, both basic and applied, that examines the use, costs, quality, accessibility, delivery, organization, financing, and outcomes of health care services to increase knowledge and understanding of the structure, processes, and effects of health services for individuals and populations (IOM, 1995) …. policy oriented and multidisciplinary research into health services (Mackenbach, 1994) …. evaluation of advantages and disadvantages of health care interventions (Black, 1998) …. the multidisciplinary field of scientific investigation that studies how social factors, financing systems, organizational structures and processes, health technologies and personal behaviors affect access to health care, the quality and cost of health care and ultimately our health and well-being. Its research domains are individuals, families, organizations, institutions, communities, and populations (Lohr and Steinwachs, 2002), adapted by AcademyHealth. PHC performance measurement belongs to the domain of Health Services Research

  3. Measuring PHC is guided by a framework(e.g. the WHO Performance framework) • o Stewardship / governance Delivery of PC services Resource generation Access to services Continuity of care Financing & incentives Comprehensiveness Coordination Outcomes

  4. Observations: • Most measures in PHC user indicators on the structure and process • Outcome measures of PHC are not well developed • Measuring the strength of PHC implies collecting integrated data at national, regional, facility and community level

  5. What is the problem? • PHC performance is not adequately measured? • There is a lack of Health Services Research capacity? • Health Services Researchers miss the relevant policy questions? • Available evidence is not used by decision makers? The available evidence on PHC may be fragmentary and inconclusive, but – for the time being - it is enough for decision makers to take action to strengthen PHC in their country. So: besides methodological restrictions, expanding HSR capacity and the transfer and use of evidence for policy making are at least as important issues.

  6. Translate into Policy makers HS-Researchers What is the state of the health reform? Research questions Design of instrument Policy measures to proceed with reform Exchanges on suitability & feasibility Data(collection) Analysis Debate into Solutions & policy implications Report of results and recommendations

  7. Translate into Policy makers HS-Researchers What is the state of the health reform? Research questions Design of instrument Policy measures to proceed with reform Exchanges on suitability & feasibility Data(collection) Analysis Debate into Solutions & policy implications Report of results and recommendations Measurement

  8. Purposes of measuring PHC performance

  9. A tool to evaluate PHC in transitional countries The PCET Developed for WHO Europe by NIVEL

  10. The QUALICOPC study: 34 countries 2011-2014 26 EU Member States + Iceland Norway Switzerland Turkey Macedonia (fyr) + Australia, New Zealand, Canada, Consortium: 6 partner institutes Coordinated by NIVEL Linked data set: ± 7.000 GPs / ± 70.000 patients

  11. Priorities for future PHC studies Production of better and more routine data on PHC in countries Opening up the black box of ‘strong primary care’ (effects on health systems overall) Explaining which elements of strong primary care are related to specific performances Explain this for different types of health care systems and for urban and rural situations Identifying good practices for wealthy and less wealthy countries and specific enough for policy makers Shorten ‘response time’ of research by anticipating on policy questions

  12. NIVEL attempts to shorten response time to policy questions Continuing panels and monitors, e.g. Consumers panel Panel chronic patients and people with limitation Panel nursing and caring Maintaining databases Continuing care registration in primary care Database communication in care Registers of health professions Surveillance in general practice (incl. environmental threats Yearly consultations with stakeholders to know their information needs

  13. Thank you for your attention www.nivel.nl/en

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