Measuring Primary Health Care Performance

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Thanks to a rare collaboration of 16 major players in Ontario, we will soon start to better understand how primary health care is delivered across the province. Last November, Health Quality Ontario (HQO) and CIHI teamed up to launch a new initiative called the Ontario Primary Care Performance Measurement Steering Committee.

The 16 committee members and a broad range of stakeholders—government, regional organizations, clinicians, health care organizations—gathered for the first-ever Ontario Primary Care Performance Measurement Summit last November. They all had a shared interest in aligning measures used to assess primary care performance.

The summit’s goal was to identify priority areas for measuring such performance, which will lead to specific measures used by decision-makers at the system level and by primary care clinicians to improve care.

“I don’t think anything to this extent has ever been developed in Canada,” said Brian Hutchinson, Co-Chair of the initiative and professor emeritus at McMaster University.

That thought was echoed by Co-Chair Greg Webster, who is CIHI’s Director of Acute and Ambulatory Care Information Services. “The commitment of these 16 organizations to take a common approach to primary care performance measurement is a substantial step forward and opportunity for Ontario,” he said.

Primary Health Care

The summit proved successful, with 10 measurement priority areas confirmed (see below). Webster said these will guide planning, management and quality improvement at all levels of the primary health care (PHC) system in Ontario—and perhaps in other Canadian jurisdictions keeping an eye on this project.

Until now, coordinated measurement of PHC hadn’t been in the cards. But, Hutchinson said, times have changed. “This work is necessary and there is a real appetite for it among providers, managers and policy-makers,” he said.

There is a renewed recognition that PHC, independent of the acute care sector, helps maintain a population’s health and benefits the rest of the health system. Plus there is greater interest in helping manage chronic disease—led at the PHC level. And the time is ripe, with electronic medical records (EMRs) rolling out across the sector.

CIHI’s Role

With HQO, CIHI has brought its expertise to the table—and helped bridge the gaps between various organizations. “Consistent with CIHI’s mandate, we are helping a large province address the challenge of leading a coordinated and efficient approach to measuring health system performance,” Webster said.

Hutchinson said that, as the players involved develop specific measures for the priority areas, CIHI’s previous efforts have already laid the groundwork. “The fact that CIHI has been through the process of developing pan-Canadian primary health care indicators is particularly helpful,” he said.

CIHI is a key player in data infrastructure and the standards that guide its collection and use. Of help to the committee will be CIHI’s PHC EMR standards, a prototype EMR voluntary reporting system and survey tools that can augment the EMR data.

Simplicity Is Key

Hutchinson said that PHC performance measurement could start bearing fruit in early 2014. “The key is to design a system so that the burden on providers is minimal,” he said. “Most practices are small, with few non-clinical staff. They don’t have the capacity to do this type of measurement alone.”

Webster said it will be critical for EMRs to include data standards and clinician-friendly user interfaces that support measuring performance. “The priority data must be extracted easily, in a privacy appropriate manner, and EMRs must allow clinicians to capture high quality data in a way that requires no extra time.”

Of course, measuring performance is one thing, and acting on data is another. Webster said that to achieve maximum benefits, clinicians need timely reports on how well they are meeting patient needs and be able to compare their performance improvements over time and with those of similar clinics.

Steering Committee

Association of Family Health Teams
Association of Ontario Health Centres
Cancer Care Ontario
Cancer Quality Council of Ontario
C-CHANGE Initiative
eHealth Ontario
Institute for Clinical Evaluative Sciences
Local Health Integration Network Collaborative
Ontario College of Family Physicians
Ontario Medical Association
Ontario Ministry of Health and Long-Term Care
Ontario Patient Relations Association
Patients’ Association of Canada
Registered Nurses’ Association of Ontario

Top Ten Primary Care Performance Measurement Priorities*

  1. Medication management
  2. Timely access to care
  3. Screening for and management of risk factors for heart disease and other chronic conditions
  4. Management of multiple chronic conditions
  5. Shared clinical decision-making between patients and providers
  6. Continuity of care and coordination with other health care providers
  7. Information sharing across the continuum of care
  8. Patient experience
  9. Recognition and management of adverse events
  10. Meaningful use of EMRs

* Adequate resourcing and equity have also been added.