CBPHC Common Indicator Project
Sabrina Wong, RN, PhD
Professor, University of British Columbia
CBPHC Indicator Working Group Chair
February 2015
1
Questions being addressed by Indicators
Working Group
• What are the attributes of: (a) community based primary
health care (CBPHC) innovations that address adult and
child populations? (b) alternative models of chronic
disease prevention and management in CBPHC on patient
and system outcomes (e.g., health outcomes, cost,
access, equity)?
• What structures (e.g. governance, financing, etc.) and
context influence the cost, implementation, delivery, scaleup and impact of PHC models of care?
• What underlying methods, theories, or frameworks can be
used to advance the science of comparative research?
2
Agreed upon Dimensions
• Access (accommodation)
• Comprehensiveness (primary health care support
for self-management of chronic conditions, scope of
services
• Coordination (team functioning, system integration,
information continuity, management continuity)
• Effectiveness (self-efficacy, patient empowerment,
patient centeredness, health and well-being, EQ5D5L)
• Equity (horizontal and vertical)
3
Summary of Agreed upon
Dimensions and Related Indicators
Dimension/sub-dimension
• Access (difficulty getting
access, accommodation)
• Comprehensiveness
(PHC support for selfmanagement of chronic
conditions, scope of
services)
• Coordination (team
functioning, system
integration, information
continuity, management
continuity)
Indicator (CIHI and other)
• Difficulties accessing
routine or ongoing PHC
• PHC support for selfmanagement of chronic
conditions; Scope of PHC
services
• HC Team Effectiveness
Score; Collaborative Care
with other health care
organizations
4
Summary of Agreed upon
Dimensions and Related Indicators (2)
Dimension/sub-dimension
• Effectiveness (selfefficacy, patient
empowerment, patient
centredness, global health)
• Equity (horizontalequality, vertical)
Indicator (CIHI and other)
• ACSC hospitalization
rate, ED visits for
asthmas; using patient
reported impacts and
outcomes of care
• No CIHI indicators in CIHI
PHC Update report; using
pt. reported impacts and
outcomes of care
• Work in this area
completed by researchers5
in Canada
Coverage by Common Indicator across
CBPHC Teams
6
Coverage by common indicator
• Teams validated on ability to report on access,
comprehensiveness, effectiveness,
coordination, cost, equity and multimorbidity
using the recommended common indicator and
common measure/instrument
7
Data sources
Source
Qualitative interviews
Patient surveys
Administrative data
Provider/practice surveys
Cost data
Organization survey
Teams
12
10
9
7
7
5
8
Work to date
• Agreement on: research questions,
common dimensions of CBPHC, common
indicators, common measures and data
sources
• Completed reviews of sampling,
dimensions, indicators, and measures
across teams
• Working on mapping individual team’s
work to expanded chronic care model;
asking teams to develop their logic model
9
Coverage by common indicator
*For “all teams” column, data was interpreted for the 2 non-validated teams.
Domain
Indicator
Access
Comprehensiveness
*Difficulties accessing routine or ongoing PHC
*PHC support for self-management of chronic conditions
Comprehensiveness
*Scope of PHC services
Coordination
Coordination
*PHC team effectiveness score
*Collaborative care with other healthcare organizations
Effectiveness
ACSC hospitalization rate
Effectiveness
Effectiveness
Effectiveness
Cost
PROM: Functional health
Self-efficacy for managing chronic disease
Patient empowerment
Direct (utilization) + indirect costs (e.g., out-of-pocket)
Equity
Multimorbidity
N/A
N/A
10
Next Steps
• Overarching logic model
• Analytic plan for common
dimensions of CBPHC
• Case study protocol
11
Extra information
12
Access: Difficulties accessing routine or
ongoing PHC
• 9/10 teams teams reported “Yes”
Comments
Team
Grunfeld (Yes)
Haggerty (Yes)
Kaczorowski (Yes)
Katz (Yes)
Liddy (Yes)
Ploeg (Yes)
Stewart & Fortin (Yes)
Wong (Yes)
Young (Yes)
•
•
•
•
•
•
In RCT
N/A
Patient survey within RCT
With First Nations Regional Health Survey
Patient survey in nurse practitioner-led clinics
RCT 1 & RCT 2: In planned participant
questionnaire
• Can include in patient self-reported questionnaire,
but do not expect changes
• With questions recommended to 12 teams
• Secondary analysis of existing CCHS data;
question will be similar to the patient survey.
13
Comprehensiveness: PHC support for selfmanagement of chronic conditions
• 10/10 teams reported “Yes”
Comments
Team
Grunfeld (Yes)
•
In RCT
Haggerty (Yes)
Harris (Yes)
•
•
N/A
Could incorporate into the Readiness Tool provider survey
and modify for relevance to indigenous populations.
Could also use Clinical readiness tool or report qualitatively
from clinical and community teams.
•
Kaczorowski (Yes)
•
Patient survey within RCT
Katz (Yes)
•
N/A
Liddy (Yes)
•
Patient survey and similar questions for patient centred
medical home survey
Ploeg (Yes)
•
RCT 1 & RCT 2: In planned participant questionnaire
Stewart & Fortin (Yes) •
Wong (Yes)
•
Young (Yes)
•
Could incorporate into baseline, but maybe not beyond
N/A
14
Could incorporate within planned provider survey
Comprehensiveness: Scope of PHC services
• 6/10 teams reported “Yes,” 1 reported “Maybe”
Team
Haggerty (Yes)
Harris (Yes)
Katz (Yes)
Liddy (Maybe)
Ploeg (Yes)
Wong (Yes)
Young (Yes)
Comments
• N/A
• Could incorporate into the Readiness Tool
provider survey and modify for relevance to
indigenous populations.
• N/A
• Will use patient-centred medical home org.
survey, but willing to adapt or change if
necessary.
• RCT 1 & RCT 2: In practice questionnaire
• N/A
• Based on existing information
15
Coordination: PHC team effectiveness score
• 9/10 teams reported “Yes,” 1 reported “Maybe”
Team
Grunfeld (Maybe)
•
Haggerty (Yes)
Harris (Yes)
•
•
Kaczorowski (Yes)
Katz (Yes)
Liddy (Yes)
Ploeg (Yes)
•
•
•
•
Stewart & Fortin (Yes) •
Wong (Yes)
Young (Yes)
•
•
Comments
Maybe in RCT: May want to include an oncologyspecific scale.
Patient survey only. Information Continuity scale
Could incorporate into the Readiness Tool provider
survey and modify for relevance to indigenous
populations.
Patient survey within RCT
N/A
In patient survey
RCT 1 & RCT 2: TCI 19 items; in practice questionnaire
Can add the information continuity sub-scale to our
patient questionnaire.
N/A
16
Modified CIHI survey for own provider survey
Coordination: Collaborative care with
other healthcare organizations
• 8/10 teams reported “Yes”
Comments
Team
Harris (Yes)
Haggerty (Yes)
Kaczorowski (Yes)
Katz (Yes)
Liddy (Yes)
Ploeg (Yes)
Stewart & Fortin
(Yes)
Wong (Yes)
• Could incorporate into the Readiness Tool provider
survey and modify for relevance to indigenous
populations.
• Patient survey and organizational survey
• Patient survey within RCT
• N/A
• Incorporated into patient survey
• RCT 1 & RCT 2: In practice questionnaire
• Not part of survey, but can incorporate within indepth provider interviews)
• N/A
17
Effectiveness: ACSC hospitalization rate
• 5/10 teams reported “Yes,” 1 reported “Maybe”
Team
Comments
Grunfeld (Maybe)
• RCT: Depends on conditions; will be measuring
ED & hospitalizations associated w/chemotherapy
toxicity.
• Admin data: Likely yes, possibly in a few provinces
• Expect to use admin data, but in QC
Haggerty (Yes)
Katz (Yes)
Liddy (Yes)
• Using an adapted version to be shared with the
group.
• Y for NL & ON cohort studies; TBC for ON
Stewart & Fortin (Yes) • N/A
Wong (Yes)
• N/A
18
Effectiveness: Functional Health (VR-12)
• 6/10 teams reported “Yes”
Comments
Team
Grunfeld (Yes)
• RCT
Haggerty (Yes)
• N/A
Kaczorowski (Yes)
• Incorporated into patient survey within RCT
Liddy (Yes)
• Likely in conjunction with CIHI patient planned
survey; see if this has been validated with First
Nations
• Through patient survey
Wong (Yes)
• N/A
Ploeg (No)
• Using SF-12
Katz (Yes)
Stewart & Fortin (No) • EQ-5D and SF-12 (could include PROMIS)
19
Effectiveness: Self-efficacy for managing
chronic disease
• 7/10 teams reported “Yes”
Comments
Team
Grunfeld (Yes)
• RCT: Likely if it passes face validity
Haggerty (Yes)
• N/A
Kaczorowski (Yes)
• Incorporated into patient survey within RCT
Liddy (Yes)
• Through patient survey
Ploeg (Yes)
• RCT 1 & RCT 2: In participant questionnaire
Stewart & Fortin (Yes) • SE-MCD; can add Patient activation questions
Wong (Yes)
• N/A
20
Effectiveness: Patient empowerment
• 5/10 teams reported “Yes”
Team
Comments
Grunfeld (Yes)
• RCT: If there is a breast cancer specific tool,
would need to use that. Don't believe there is one.
• Incorporated into patient survey within RCT
Kaczorowski (Yes)
• Could be incorporated, but concerned about
response burden
Stewart & Fortin (Yes) • N/A
Liddy (Yes)
Wong (Yes)
• N/A
21
Cost: direct (utilization) + indirect costs
(e.g. out-of-pocket) (will use EQ5D-5L)
• 7/10 teams reported “Yes,” 1 reported “Maybe”
Team
Grunfeld (Yes)
•
•
Comments
Admin data if we link to admin data - from societal
perspective, therefore need patient costs, but may need a
cancer-specific one
Collecting encounters during diagnostic, treatment and
survivorship phase, and then cost out cancer services
(possibly only ON)
“Probably” will use
Haggerty (Maybe)
•
Katz (Yes)
•
Liddy (Yes)
•
With admin data; but in First Nations communities, would
really only have hospitalization data because other
access is not captured.
For NL & ON cohorts & possibly MB
Ploeg (Yes)
Stewart & Fortin (Yes)
Wong (Yes)
Young (Yes)
•
•
•
•
RCT 1 & RCT 2: In participant questionnaire
Plan to use admin data
N/A
Economic evaluation of patient transportation
22
Equity
• 10/10 teams reported “Yes”
Comments
Team
Grunfeld (Yes)
Haggerty (Yes)
•
•
Harris (Yes)
•
Kaczorowski (Yes)
•
N/A
Katz (Yes)
Liddy (Yes)
•
•
Yes for some of the basic equity measures
Yes for nurse practioner clinics (age, sex, gender, postal code,
health ins #).
Maybe in admin cohort studies through equity of access to care.
Will have health ins # but might not have postal code.
N/A
•
Ploeg (Yes)
•
Stewart & Fortin (Yes)
Wong (Yes)
Young (Yes)
•
•
•
RCT: 6-digit postal code
Economic, immigrant/refugee status (specific ethnicities);
aboriginal; age (young adult and elderly); rurality; residential
stabiltiy; mental health
Not using admin data, but from chart data can do sex/gender, age,
geography in terms of province and degree of rural/remoteness.
Will use gender, age and the Grunfeld questionnaire
N/A
23
Existing databases on health status, determinants and utilization
for Ab vs non-Ab and North vs South.
Multimorbidity
• 4/10 teams reported “Yes,” 3 reported “Maybe”
Comments
Team
Grunfeld (Maybe)
•
Haggerty (Yes)
Harris (Yes)
•
•
•
Katz (Maybe)
•
Liddy (Maybe)
•
Ploeg (Yes)
•
•
Stewart & Fortin (Yes)
RCT: Not sure if linking to admin data; otherwise, will embed
within patient questionnaire (may use Martin's if relevant to
population)
Admin data: Jon Hopkins ADGs
N/A
Will capture most items from chart data but will not do a
survey or admin data.
Not sure about asking directly about the chronic conditions,
and about others like TB, HIV, other mental health issues
beyond depression & anxiety.
Potential for NP study in patient questions (should HIV be
added to increase comparability?).
Will capture through admin data for cohorts.
In patient questionnaire for RCT 1 & RCT 2
• N/A
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Data sources possibilities 1
Asterisk denotes teams that have not been validated
Bold texts denotes methods related to the common indicators
*Audas
1. Administrative data (including cost), 2. Statistics Canada surveys,
3. Patient/family/provider interviews
Grunfeld
1. Admin, lab, registry data, 2. Focus groups and interviews with
patients and service providers
Harris
1. National Community Profile survey 2. Community readiness tool
(repeated measures), 3. Clinical readiness tool (repeated measures),
4. T2DM registry/surveillance data (chart audit), 5. Participant
observation and interviews, 6. cost data
Kaczorowski 1. Patient questionnaires (CANRISK) in pharmacy, 2. Admin data, 3.
Focus groups & key informant interviews, 4. ChAMP database, patient
EMRs, and patient surveys
Katz
1. CIHI patient, provider, organization surveys, 2. administrative
data (for ACSC hosp.), 3. qualitative case studies (sharing circles and
focus groups), 4. service provider/administrator/manager interviews
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Data sources possibilities 2
Haggerty
Liddy
Ploeg
1. International and national surveys (CMWF, QUALICOPC,
CCHS), 2. interviews and focus groups with key stakeholders, 3.
admin data, 4. patient and organizational questionnaires (EQ-5D,
access measures, unmet need, quality care), 5. costs of
implementation of intervention model
1. Admin, lab, registry, chart/clinical, HIV cohort data (including
HRQoL like SF-36 for ON), 2. CIHI organizational survey, 3. semistructured interviews with PM stakeholders, 4. cost (billing data, ON
case costing initiative)
1. Admin and population survey data (CCHS), 2. Semi-structured
interviews with patients, family members, service providers, 3. family
caregiver survey data (e.g., HRQoL, self efficacy, etc.), 4. Health and
Social Services Inventory for utilization & cost data
26
Data sources possibilities 3
Stewart & Fortin 1. In-depth interviews with patients, providers, informal
caregivers, decision makers regarding context, 2. admin data,
3. patient survey data, 4. cost data (admin data + CIHI
Resource Intensity Weights)
*Wodchis
1. QUALICOPC data from ON, QC, NZ at regional level, 2.
organization, provider and patient survey and key informant
interview data
Wong
1. Modified CIHI patient, provider, organization surveys, 2.
admin data, 3. clinical data (EMRs or chart), 3. case study data
from interviews and focus groups on context
Young
1. key informant interviews, 2. health centre and patient records &
coroners' reports, 3. EMRs, 4. cost data
27