cbphc common indicator project sabrina wong, rn, phd professor, university of british columbia cbphc...

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, scale-up and impact of PHC models of care?

• What underlying methods, theories, or frameworks can be used to advance the science of comparative research?

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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, EQ5D-5L)

• Equity (horizontal and vertical)

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Summary of Agreed upon Dimensions and Related

IndicatorsDimension/sub-dimension

• Access (difficulty getting access, accommodation)

• Comprehensiveness (PHC support for self-management 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 self-

management of chronic conditions; Scope of PHC services

• HC Team Effectiveness Score; Collaborative Care with other health care organizations

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Summary of Agreed upon Dimensions and Related

Indicators (2)

Dimension/sub-dimension• Effectiveness (self-efficacy,

patient empowerment, patient centredness, global health)

• Equity (horizontal-equality, 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 researchers in Canada

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Coverage by Common Indicator across CBPHC Teams

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Coverage by common indicator

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• Teams validated on ability to report on access, comprehensiveness, effectiveness, coordination, cost, equity and multimorbidity using the recommended common indicator and common measure/instrument

Data sources

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Source TeamsQualitative interviews 12

Patient surveys 10Administrative data 9

Provider/practice surveys 7Cost data 7

Organization survey 5

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

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Coverage by common indicator*For “all teams” column, data was interpreted for the 2 non-validated teams.

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Domain Indicator

Access *Difficulties accessing routine or ongoing PHC

Comprehensiveness *PHC support for self-management of chronic conditions

Comprehensiveness *Scope of PHC services

Coordination *PHC team effectiveness score

Coordination *Collaborative care with other healthcare organizations

Effectiveness ACSC hospitalization rateEffectiveness PROM: Functional healthEffectiveness Self-efficacy for managing chronic diseaseEffectiveness Patient empowerment

Cost Direct (utilization) + indirect costs (e.g., out-of-pocket)

Equity N/AMultimorbidity N/A

Next Steps

• Overarching logic model• Analytic plan for common

dimensions of CBPHC• Case study protocol

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Extra information

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Access: Difficulties accessing routine or ongoing PHC

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• 9/10 teams teams reported “Yes”Team Comments

Grunfeld (Yes) • In RCT

Haggerty (Yes) • N/AKaczorowski (Yes) • Patient survey within RCT

Katz (Yes) • With First Nations Regional Health SurveyLiddy (Yes) • Patient survey in nurse practitioner-led clinicsPloeg (Yes) • RCT 1 & RCT 2: In planned participant

questionnaireStewart & Fortin (Yes) • Can include in patient self-reported questionnaire,

but do not expect changesWong (Yes) • With questions recommended to 12 teamsYoung (Yes) • Secondary analysis of existing CCHS data;

question will be similar to the patient survey.

Comprehensiveness: PHC support for self-management of chronic conditions

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• 10/10 teams reported “Yes”Team Comments

Grunfeld (Yes) • In RCT

Haggerty (Yes) • N/AHarris (Yes) • 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) • Could incorporate into baseline, but maybe not beyondWong (Yes) • N/A

Young (Yes) • Could incorporate within planned provider survey

Comprehensiveness: Scope of PHC services

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• 6/10 teams reported “Yes,” 1 reported “Maybe”Team Comments

Haggerty (Yes) • N/AHarris (Yes) • Could incorporate into the Readiness Tool

provider survey and modify for relevance to indigenous populations.

Katz (Yes) • N/ALiddy (Maybe) • Will use patient-centred medical home org.

survey, but willing to adapt or change if necessary.

Ploeg (Yes) • RCT 1 & RCT 2: In practice questionnaireWong (Yes) • N/AYoung (Yes) • Based on existing information

Coordination: PHC team effectiveness score

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Grunfeld (Maybe) • Maybe in RCT: May want to include an oncology-specific scale.

Haggerty (Yes) • Patient survey only. Information Continuity scaleHarris (Yes) • Could incorporate into the Readiness Tool provider

survey and modify for relevance to indigenous populations.

Kaczorowski (Yes) • Patient survey within RCT

Katz (Yes) • N/A

Liddy (Yes) • In patient survey

Ploeg (Yes) • RCT 1 & RCT 2: TCI 19 items; in practice questionnaire

Stewart & Fortin (Yes) • Can add the information continuity sub-scale to our patient questionnaire.

Wong (Yes) • N/A

Young (Yes) • Modified CIHI survey for own provider survey

Coordination: Collaborative care with other healthcare organizations

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Harris (Yes) • Could incorporate into the Readiness Tool provider survey and modify for relevance to indigenous populations.

Haggerty (Yes) • Patient survey and organizational surveyKaczorowski (Yes) • Patient survey within RCT

Katz (Yes) • N/ALiddy (Yes) • Incorporated into patient survey

Ploeg (Yes) • RCT 1 & RCT 2: In practice questionnaire

Stewart & Fortin (Yes)

• Not part of survey, but can incorporate within in-depth provider interviews)

Wong (Yes) • N/A

Effectiveness: ACSC hospitalization rate

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• 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

Haggerty (Yes) • Expect to use admin data, but in QC

Katz (Yes) • Using an adapted version to be shared with the group.

Liddy (Yes) • Y for NL & ON cohort studies; TBC for ON

Stewart & Fortin (Yes) • N/A

Wong (Yes) • N/A

Effectiveness: Functional Health (VR-12)

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Grunfeld (Yes) • RCT

Haggerty (Yes) • N/A

Kaczorowski (Yes) • Incorporated into patient survey within RCT

Katz (Yes) • Likely in conjunction with CIHI patient planned survey; see if this has been validated with First Nations

Liddy (Yes) • Through patient survey

Wong (Yes) • N/A

Ploeg (No) • Using SF-12

Stewart & Fortin (No) • EQ-5D and SF-12 (could include PROMIS)

Effectiveness: Self-efficacy for managing chronic disease

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Grunfeld (Yes) • RCT: Likely if it passes face validity

Haggerty (Yes) • N/A


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

Effectiveness: Patient empowerment

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Grunfeld (Yes) • RCT: If there is a breast cancer specific tool, would need to use that. Don't believe there is one.


Liddy (Yes) • Could be incorporated, but concerned about response burden


Wong (Yes) • N/A

Cost: direct (utilization) + indirect costs (e.g. out-of-pocket) (will use EQ5D-5L)

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Grunfeld (Yes) • 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)

Haggerty (Maybe) • “Probably” will use

Katz (Yes) • With admin data; but in First Nations communities, would really only have hospitalization data because other access is not captured.

Liddy (Yes) • For NL & ON cohorts & possibly MB

Ploeg (Yes) • RCT 1 & RCT 2: In participant questionnaireStewart & Fortin (Yes) • Plan to use admin data

Wong (Yes) • N/A

Young (Yes) • Economic evaluation of patient transportation

Equity

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Grunfeld (Yes) • RCT: 6-digit postal code

Haggerty (Yes) • Economic, immigrant/refugee status (specific ethnicities); aboriginal; age (young adult and elderly); rurality; residential stabiltiy; mental health

Harris (Yes) • Not using admin data, but from chart data can do sex/gender, age, geography in terms of province and degree of rural/remoteness.

Kaczorowski (Yes) • N/A

Katz (Yes) • Yes for some of the basic equity measuresLiddy (Yes) • 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.Ploeg (Yes) • N/A

Stewart & Fortin (Yes) • Will use gender, age and the Grunfeld questionnaireWong (Yes) • N/AYoung (Yes) • Existing databases on health status, determinants and utilization

for Ab vs non-Ab and North vs South.

Multimorbidity

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Team Comments

Grunfeld (Maybe) • 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 ADGsHaggerty (Yes) • N/A

Harris (Yes) • Will capture most items from chart data but will not do a survey or admin data.

Katz (Maybe) • Not sure about asking directly about the chronic conditions, and about others like TB, HIV, other mental health issues beyond depression & anxiety.

Liddy (Maybe) • Potential for NP study in patient questions (should HIV be added to increase comparability?).

• Will capture through admin data for cohorts.Ploeg (Yes) • In patient questionnaire for RCT 1 & RCT 2


• 4/10 teams reported “Yes,” 3 reported “Maybe”

Data sources possibilities 1

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*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

Asterisk denotes teams that have not been validatedBold texts denotes methods related to the common indicators


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Haggerty 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

Liddy 1. Admin, lab, registry, chart/clinical, HIV cohort data (including HRQoL like SF-36 for ON), 2. CIHI organizational survey, 3. semi-structured interviews with PM stakeholders, 4. cost (billing data, ON case costing initiative)

Ploeg 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


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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

cbphc common indicator project sabrina wong, rn, phd professor, university of british columbia cbphc...

Documents

team work

primary health care

health outcomes

researcherresearch team

team meeting

team grants

amazing work

impact of phc models