CBPHC Common Indicator Project - PowerPoint Presentation

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CBPHC Common Indicator Project

Sabrina Wong, RN, PhDProfessor, University of British ColumbiaCBPHC Indicator Working Group ChairFebruary 2015

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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)3Slide4

Summary of Agreed upon Dimensions and Related I

ndicatorsDimension/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 PHCPHC 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-dimensionEffectiveness

(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 careNo CIHI indicators in CIHI PHC Update report; using pt. reported impacts and outcomes of careWork 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/instrumentSlide8

Data s

ources

8

Source

Teams

Qualitative interviews

12

Patient surveys

10

Administrative data

9

Provider/practice surveys

7

Cost data

7

Organization survey

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Work to date

Agreement on: research questions, common dimensions of CBPHC, common indicators, common measures and data sourcesCompleted reviews of sampling, dimensions, indicators, and measures across teamsWorking 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 rate

Effectiveness

PROM: Functional health

Effectiveness

Self-efficacy for managing chronic disease

Effectiveness

Patient empowerment

Cost

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

Equity

N/A

Multimorbidity

N/ASlide11

Next Steps

Overarching logic model

Analytic plan for common dimensions of CBPHCCase study protocol

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Extra information

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Access: Difficulties accessing routine or ongoing PHC

13

9/10 teams teams reported “Yes”

Team

Comments

Grunfeld

(Yes)

In RCT

Haggerty (Yes)

N/A

Kaczorowski

(Yes)

Patient survey

within RCT

Katz (Yes)

With First Nations Regional Health Survey

Liddy

(Yes)

Patient survey in nurse practitioner-led clinics

Ploeg

(Yes)

RCT 1 & RCT 2: In planned participant questionnaire

Stewart & Fortin

(Yes)

Can include in patient self-reported questionnaire, but do not expect changes

Wong

(Yes)

With questions recommended to 12 teams

Young

(Yes)

Secondary analysis of existing CCHS data; question will be similar to the patient survey.Slide14

Comprehensiveness: PHC support for

self-management of chronic conditions 14

10/10 teams reported “Yes”

Team

Comments

Grunfeld

(Yes)

In RCT

Haggerty (Yes)

N/A

Harris

(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 beyond

Wong (Yes)

N/A

Young

(Yes)

Could incorporate within planned provider surveySlide15

Comprehensiveness: Scope of PHC services

15

6/10 teams reported “Yes,” 1 reported “Maybe”

Team

Comments

Haggerty

(Yes)

N/A

Harris (Yes)

Could incorporate into the Readiness Tool provider survey

and

modify for relevance to indigenous populations.

Katz (Yes)

N/A

Liddy (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 questionnaire

Wong (Yes)

N/A

Young (Yes)

Based on existing information Slide16

Coordination: PHC team effectiveness score

16

9

/10 teams reported “Yes,” 1 reported “Maybe”

Team

Comments

Grunfeld

(Maybe)

Maybe

in RCT: May want to include an oncology-specific scale.

Haggerty (Yes)

Patient survey only. Information Continuity scale

Harris

(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 surveySlide17

Coordination: Collaborative care with other healthcare organizations

17

8/10 teams reported “Yes”

Team

Comments

Harris (Yes)

Could incorporate into the Readiness Tool provider survey

and

modify for relevance to indigenous populations.

Haggerty (Yes)

Patient survey and organizational survey

Kaczorowski

(Yes)

Patient survey

within RCT

Katz (Yes)

N/A

Liddy (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/ASlide18

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/ASlide19

Effectiveness: Functional Health (VR-12)

19

6/10 teams reported “Yes”

Team

Comments

Grunfeld

(Yes)

RCT

Haggerty (Yes)

N/A

Kaczorowski

(Yes)

Incorporated

into p

atient 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)Slide20

Effectiveness: Self-efficacy for managing chronic disease

20

7/10 teams reported “Yes”

Team

Comments

Grunfeld

(Yes)

RCT

: Likely if it passes face validity

Haggerty (Yes)

N/A

Kaczorowski

(Yes)

Incorporated

into p

atient survey

within RCT

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/ASlide21

Effectiveness: Patient empowerment

21

5/10 teams reported “Yes”

Team

Comments

Grunfeld

(Yes)

RCT: If there

is

a breast cancer specific tool,

would need to use that. Don't believe there is one.

Kaczorowski

(Yes)

Incorporated

into p

atient survey

within RCT

Liddy

(Yes)

Could be incorporated, but concerned about response burden

Stewart & Fortin

(Yes)

N/A

Wong

(Yes)

N/ASlide22

Cost: direct (utilization

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

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7/10 teams reported “Yes,” 1 reported “Maybe”

Team

Comments

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 questionnaire

Stewart & Fortin (Yes)

Plan to use admin data

Wong (Yes)

N/A

Young (Yes)

Economic evaluation of patient transportationSlide23

Equity

23

10/10 teams reported “Yes”

Team

Comments

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 measures

Liddy (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

questionnaire

Wong (Yes)

N/A

Young (Yes)

Existing databases on health status, determinants and utilization for Ab vs non-Ab and North vs South.Slide24

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 ADGs

Haggerty (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

Stewart & Fortin

(Yes)

N/A

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/10 teams reported “Yes,” 3 reported “Maybe”Slide25

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 validated

Bold texts denotes methods related to the common indicatorsSlide26

Data sources possibilities 2

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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 dataSlide27

Data sources possibilities 3

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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