1. Citizen, consumer, and patient roles in using publicly reported primary healthcare performance information
Lessons from citizen-patient dialogues in three Canadian provinces
Johnston, S., Abelson, J., Langton, J., Wong, S. T.
May 17th, 2017
Primary Healthcare Research Day
Halifax, NS
MEASURING AND IMPROVING THE PERFORMANCE OF PRIMARY HEALTH CARE IN CANADA

2. Primary Care Performance Reporting
Primary health care performance measurement and reporting is proliferating
Calls to understand how to optimize public reporting for different end-users
Rationales for public reporting
Patient engagement in their healthcare system
May encourage healthcare policy that considers the public’s values
Component of quality improvement

3. Obtaining the public’s perspectives on performance reporting
“Ultimately, transparency of validated data about delivery-system performance has the power to change the culture of health care... The question is not whether there should be public disclosure of information on patient satisfaction, outcomes, and costs — it’s how and by whom it should be done.” Objective: To explore how the public uses and values primary healthcare performance data, to inform effective public reporting systems

4. Deliberative dialogue approach
Directly involves stakeholders in value-based discussions about health care systems Participants are briefed during the session, receiving balanced facts about the topic in order to facilitate informed engagement Emphasis on transformative discussion informed by different types of evidence Varied sizes, structures, and participant mix
It might be helpful here to briefly give examples on how DD’s have been used- look up McMaster Forum and see the types of topics. It will help people see that this is a method to wrestle with and engage when much learning needs to take place by participants as well as leaders.

5. Methods: Recruitment
Study Regions
2 deliberative dialogue sessions per study region (6 in total; n=56)
One with healthy patients
One with patients identified as more complex based on the number of medical conditions
Recruitment
Practice-based survey participants
Volunteer / employment opportunity online platform

6. Methods: Dialogue topics
What to report: Common performance domains and their related indicators
Received descriptions of PHC performance domains such as access, and examples of specific measures in advance and introduction discussion during sessions
Talked about their priorities for public reporting on PHC performance
How information is used: The “public’s” role; citizens, consumers, patients
How they would use performance information
How others should use the information
How to report: PHC performance reporting formats
Infographics
Hard-copy reports (pamphlets, short summaries, long reports)
Interactive websites

7. Public Roles in Health System
Distinct roles emerged in deliberations:
Citizen role:
Focus on system; community
Concerned with the financing and value of healthcare; the distribution of resources
Consumer role:
Focus on with whom or where to receive own care; concerned with differences between providers
Patient role:
Focus on decisions regarding own care; usually working within existing relationship with provider

8. Roles in Health System: Citizen Role
Most common role; advocacy for better PHC in community
“And if you’ve got some districts performing better than other districts and the public knows that, that’s where the pressure comes from to change, and that’s the only way you’ll get change in the healthcare system is by public pressure, pressuring the government and then it works its way down. And that’s the only way to do it.” 
Knowledge of community’s performance key first step in advocacy
Performance information can act as stimulus for interactions with government leaders and voting changes

9. Roles in Health System: Citizen Role
Information as empowerment - though some expressed a lack of ability to enact change
“you’re saying there about the information, it gives that community a sense to become more involved, more involved in helping to open a smaller clinic or helping other people in transportation and giving to those places that will give them the primary care that they need and that if that is out there, that information, it gives the community a sense of belonging…”
Some interest in cross- provincial comparisons of performance
Accountability mechanism for public healthcare spending

10. Roles in Health System: Consumer Role
Lack of choice of primary care providers
“Well, if they got a crappy rating, I might consider doing something about it, depending what the rating was on. If they got—you know, maybe it was they didn’t spend enough time with the doctor, or the doctor didn’t spend enough time with the patient, that might be an issue that was personal to me, and it might be enough to cause me to go somewhere else, but, I don’t know. Most people who do have a GP or are connected with their GP already to some extent, it’s challenging for them to go to another GP if they did get a bad rating. If they get a good rating then they’ll think, “Oh, great. Well, I made the right decision. Obviously.”
Importance of existing relationships and reluctance to change providers
Concerns over “doctor shopping”
Might influence where people settle when considering a new move

11. Roles in health system: Patient Role
Importance of own experience of care with their providers
“if I saw that they had low screening rates, if it was publically provided information, then I could be, like, “Oh, I didn’t know I was supposed to have that screening. Now I know that I should ask.” But if that information’s not provided, then I don’t know that that’s something I’m supposed to be screened for.”
Improving knowledge of what care patients should expect
Public reporting important but professionals (e.g. regulatory colleges) should be key target for public reporting, as they are ultimately responsible
Can help to promote trust in provider

12. Discussion
Key considerations to help guide effective public reporting on primary care performance
Different roles of target audience
Relevancy of information specific to the target audience and their roles in the health system
Barriers to uses of public performance information

13. Discussion
Deliberations revealed public’s priorities in reported information on primary care performance
Not all information was considered valuable
Public reporting was consistently viewed as empowering, especially in the role of citizen advocate
Comparing regions served as a measure of equity

14. Future Considerations
Explore how to empower the public as stakeholders to engage in solution development
Further consideration of which measures are valuable to enhancing public role in subsequent quality improvement