1. Improving the performance reporting of primary care patient experience
Wong, S. T., Burge, F., Hogg, W., Johnston, S., Bouharaoui, F., Haggerty, J.
May 17, 2017
Primary Health Care Research Day
Halifax, NS
MEASURING AND IMPROVING THE PERFORMANCE OF PRIMARY HEALTH CARE IN CANADA

3. Primary Care Performance
Canadian primary care performance measurement and reporting is still developing Need for improved science and meaningfulness in performance measurement Multiple ways to measure a variety of primary care dimensions Patient experience a key component of comprehensive performance measurement

4. TRANSFORMATION Study Objectives
Develop infrastructure for comprehensive reporting of PHC regional performance
Obtain insights from patients, clinician and decision-makers on PHC performance measurement and reporting
Study components
Regional case studies (context)
Practice-based patient and provider/organizational surveys linked to administrative data
Day-long deliberative dialogues
Setting: 87 primary care practices in three peer regions
Central Zone, NS (n=39)
Eastern Ontario Health Unit, ON (n=26)
Fraser East, BC (n=22)

5. Developing Patient-Reported Dimensions of Primary Care
Objective: Synthesize multiple measures of patient experience into key dimensions that provide a high-level snapshot of primary care performance
Design: Cross-sectional practice-based waiting room survey of patient experience
Participants: a minimum of 20 patients in each participating practice (n=1929)
Intervention
Self-administered questionnaire
116 questions – validated subscales, indicators and descriptive questions

6. Developing Patient-Reported Dimensions of Primary Care
Iterative, theory-driven approach to constructing patient- reported dimensions
Analyses: missing values analysis, low variance analysis, exploratory confirmatory factor analysis
Grouped factors, subscales and individual survey items into dimensions
Assigned scoring structures to create meaningful spread around the dimension means

7. Results
Indicators and subscales grouped into seven dimensions Enabled survey item reduction (original instrument a 116-item questionnaire) Patient experiences across jurisdictions and practices were similar but experience varied statistically significantly by practice
Accessibility orientation
Relationship-based care
Promoting health
Self-management support
Coordination orientation
Safe healthcare system
Equity orientation

8. Alignment of patient-reported dimensions with the ‘health home’
Person- and family-centred
Ideal sites for training and research
Relationship-based care
Promoting health
Electronic medical records (EMR)
Self-management support
Equity orientation
Commitment to continuous quality improvement and safety
Safe health care system
Strongly supported by governance structures, practice management, the public, etc.
Timely access
Accessibility orientation
Every patient has a most responsible provider
Health homes work in collaboration with other health homes to foster collaboration
Comprehensive scope of services carried out by teams or networks of providers
Continuity and coordination of relationships, & information
Coordination orientation
Note: other components of the TRANSFORMATION Study align with pillars of the health home (e.g. organizational surveys align with comprehensive team-based care, personal family physician, etc.)

9. Results: Mean clinic scores, by dimension and region
ON practices had the highest performance across dimensions, followed by those in NS and BC

10. A closer look: Person- and family-centred care
Fraser East, BC
Eastern Ontario Health Unit
Central Zone, NS
Fraser East, BC
Eastern Ontario Health Unit
Central Zone, NS
Fraser East, BC
Eastern Ontario Health Unit
Central Zone, NS
Fraser East, BC
Eastern Ontario Health Unit
Central Zone, NS
Though limited patient sampling (n=20-52 patients per practice) detects significant between-practice difference, more patients per practice would increase reliability for individual practice feedback
Fraser East, BC
Eastern Ontario Health Unit
Central Zone, NS

11. Conclusion
Synthesizing multiple measures of patient-reported experience into fewer dimensions of primary care can convey high-level info about performance that can become actionable in greater detail Policy interventions aimed at practices, rather than individual clinicians, could lead to more impact on strengthening patient experience Next steps: examine practice characteristics’ relationships to patient-reported experiences; whether patient experiences are related to outcomes