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

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

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

11. 11

12. 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

13. 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

15. Thank you for your attention 15