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

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

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)

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

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

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

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.)

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

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

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