How to Measure Quality of Care in Family Practice Using Administrative Data Alan Katz, Ruth-Ann Soodeen, Bogdan Bogdanovic, Carolyn De Coster, and Dan Chateau MANITOBA CENTRE FOR HEALTH POLICY Winnipeg, Manitoba, Canada

Background  Primary care is the foundation of the Canadian health care system  A strong Primary Health Care (PHC) system results in a healthier population 1,2 and may affect population health more than specialized services 3,4

Quality of Care “The degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.” 5

Measuring Quality of Care Quality may be measured in terms of:  Structures: refers to measuring characteristics that may include personnel, equipment or finances  Processes: look at the actual care given by physicians which encompasses clinical and interpersonal effectiveness  Outcomes: refers to the consequences of the care which may include health status or user satisfaction

What is Administrative Claims Data?  Data routinely collected for administrative purposes (e.g., keeping track of individuals eligible for certain benefits, paying physicians or hospitals)  Allows longitudinal studies of entire population  They have a high degree of reliability and validity

Finalizing Indicators  Physician focus group (included 3 groups) with independent review and group discussion  Examine feasibility of measuring indicators

Indicator Example  Childhood immunization  Eligibility: Patients born in 1999  Recommended care: % who received their primary course of immunization (i.e., DPT-HiB polio x 4, and MMR) by age 24 months

Step Two: Define Physician Practices  For each patient:  Identify all physicians visited  Determine physician providing most care  Each physician practice comprises patients for whom they provided the most care

Step Three: Measure Indicators For each physician:  Identify eligible patients as per indicator definition (excluding physicians with too few eligible patients)  Calculate number of patients receiving recommended care

Preventive Care % Physicians % Patients with recommended care

Chronic Disease Management % Physicians % Patients with recommended care

Prescription(s) for Benzodiazepines % Physicians % Patients with potentially inappropriate prescriptions for benzodiazepines

Using Quality Indicators: Considerations 1.Focus solely on measurable components of care 2.Data availability across regions 3.Completeness of data

Implications This work provides the potential for:  Physicians to actively engage in the quality improvement process, and to consider aspects of their own practice  Policy-makers to encourage family physicians to retain hospital privileges (important for preventive care) and to create a culture of support for quality improvement  Trainers/Educators to focus educational initiatives on areas identified as needing improved quality of care

Acknowledgments The research presented in this lecture was supported as part of the project “Using Administrative Data to Develop Indicators of Quality in Family Practice,” under contract to Manitoba Health (Manitoba Health Project No. 2002/ ). The authors thank Michelle Albl, Beth Edwards, and Stephanie Smith for their help in putting this lecture together.