Improving performance measurement in Primary Health Care Global PHC Stakeholders Meeting Geneva, 7-8 April 2016 Wienke G.W. Boerma, NIVEL, Utrecht (NL)

PHC performance measurement belongs to the domain of Health Services Research …. inquiry to produce knowledge about the structure, processes, and effects of personal health services. A study is classified as health services research if it satisfies two criteria: it deals with some features of the structure, processes, or effects of personal health services; At least one of the features is related to a conceptual framework other than that of contemporary applied biomedical science (Institute of Medicine, 1979). …. a multidisciplinary field of inquiry, both basic and applied, that examines the use, costs, quality, accessibility, delivery, organization, financing, and outcomes of health care services to increase knowledge and understanding of the structure, processes, and effects of health services for individuals and populations (IOM, 1995) …. policy oriented and multidisciplinary research into health services (Mackenbach, 1994) …. evaluation of advantages and disadvantages of health care interventions (Black, 1998) …. the multidisciplinary field of scientific investigation that studies how social factors, financing systems, organizational structures and processes, health technologies and personal behaviors affect access to health care, the quality and cost of health care and ultimately our health and well-being. Its research domains are individuals, families, organizations, institutions, communities, and populations (Lohr and Steinwachs, 2002), adapted by AcademyHealth. 2

Delivery of PC services Measuring PHC is guided by a framework (e.g. the WHO Performance framework) o Stewardship / governance Delivery of PC services Resource generation Access to services Continuity of care Financing & incentives Comprehensiveness Coordination Outcomes

Observations: Most measures in PHC user indicators on the structure and process Outcome measures of PHC are not well developed Measuring the strength of PHC implies collecting integrated data at national, regional, facility and community level 4

What is the problem? PHC performance is not adequately measured? There is a lack of Health Services Research capacity? Health Services Researchers miss the relevant policy questions? Available evidence is not used by decision makers? The available evidence on PHC may be fragmentary and inconclusive, but – for the time being - it is enough for decision makers to take action to strengthen PHC in their country. So: besides methodological restrictions, expanding HSR capacity and the transfer and use of evidence for policy making are at least as important issues. 5

Policy makers HS-Researchers What is the state of the health reform? Translate into Debate into Solutions & policy implications Policy measures to proceed with reform Research questions Design of instrument Data(collection) Analysis Report of results and recommendations Exchanges on suitability & feasibility

Policy makers HS-Researchers What is the state of the health reform? Translate into Debate into Solutions & policy implications Policy measures to proceed with reform Research questions Design of instrument Data(collection) Analysis Report of results and recommendations Exchanges on suitability & feasibility Measurement

Purposes of measuring PHC performance Focus of research Vehicles / partners NIVEL examples Feeding the international body of knowledge Scientific journals Scientific conferences European Observatory EU / DG Research Multi-country studies PHAMEU QUALICOPC Feeding national policy makers (on reforms) Press publications Reports Policy briefs Policy dialogues Presentations Social media Development of the PCET for WHO Euro 12 implementations of the PCET NL national panel health care consumers Feeding stakeholder / patient organisations Reports for associations Conferences Workload study NL GPs in international context Feedback to individual providers Maintaining continuing electronic networks Tailor made ‘Mirror feedback’ Routine EMR scans to monitor the quality of GP record keeping

Developed for WHO Europe by NIVEL A tool to evaluate PHC in transitional countries The PCET Developed for WHO Europe by NIVEL Selected covers of single-country PHC evaluation reports This presentation: comparisons and integration

The QUALICOPC study: 34 countries 2011-2014 26 EU Member States + Iceland Norway Switzerland Turkey Macedonia (fyr) + Australia, New Zealand, Canada, Consortium: 6 partner institutes Coordinated by NIVEL Linked data set: ± 7.000 GPs / ± 70.000 patients

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Priorities for future PHC studies Production of better and more routine data on PHC in countries Opening up the black box of ‘strong primary care’ (effects on health systems overall) Explaining which elements of strong primary care are related to specific performances Explain this for different types of health care systems and for urban and rural situations Identifying good practices for wealthy and less wealthy countries and specific enough for policy makers Shorten ‘response time’ of research by anticipating on policy questions

NIVEL attempts to shorten response time to policy questions Continuing panels and monitors, e.g. Consumers panel Panel chronic patients and people with limitation Panel nursing and caring Maintaining databases Continuing care registration in primary care Database communication in care Registers of health professions Surveillance in general practice (incl. environmental threats Yearly consultations with stakeholders to know their information needs

Thank you for your attention www.nivel.nl/en 15