Shukor Ali Rafik, Edelman Sandra, Brown Dean, Rivard Cheryl
Regional Primary Care Evaluator for the Vancouver Coastal Health Authority in Vancouver, British Columbia, Canada (
Manager of Public Health and Chronic Disease Services for the North Shore Division of Community Family Health in Vancouver, British Columbia, Canada (
Perm J. 2018;22:18-010. doi: 10.7812/TPP/18-010.
Designing, delivering, and evaluating high-performing primary health care services for complex and vulnerable subpopulations are challenging endeavors. However, there is a relative paucity of research evidence available to support such work.
To provide a case study using HealthConnection Clinic, a public primary care center located in Metropolitan Vancouver's North Shore.
Developmental evaluation approach operationalizing the 10 Building Blocks of High-Performing Primary Care framework using qualitative and quantitative methods.
The clinic provided valuable insights to policymakers and researchers related to development of the Building Blocks' foundational elements, particularly engaged leadership, empanelment, and data-driven improvement. The study highlighted the key enablers, achievements, challenges, and barriers related to operationalizing each Building Block. The Building Blocks were a useful heuristic that enabled the development and evaluation of primary care for complex subpopulations. Particularly salient from a Canadian policy perspective was the demonstration that system integration was possible when highly engaged leaders from a Regional Health Authority and a Division of Family Practice shared a common vision and purpose. HealthConnection Clinic's entrepreneurial spirit has enabled the development of innovative, evidence-based tools such as the AMPS complexity assessment tool (attachment, medical conditions, psychological/mental health/addictions challenges, and socioeconomic status), designed to identify and assess biopsychosocial complexity and needs. The study also highlighted the importance of incorporating community orientation and equity into developmental work.
The study demonstrates how the Building Blocks approach can be adapted to operationalize high-performing primary care standards in settings serving complex and vulnerable populations.
为复杂且脆弱的亚人群设计、提供和评估高效的初级卫生保健服务是具有挑战性的工作。然而，可用于支持此类工作的研究证据相对较少。
以位于大温哥华北岸的一家公立初级保健中心——健康连接诊所为例进行研究。
采用发展性评估方法，运用定性和定量方法实施高效初级保健框架的10个构建模块。
该诊所为政策制定者和研究人员提供了与构建模块基础要素发展相关的宝贵见解，特别是积极参与的领导力、患者注册管理以及数据驱动的改进。该研究突出了与每个构建模块实施相关的关键推动因素、成就、挑战和障碍。这些构建模块是一种有用的启发式方法，有助于为复杂亚人群开发和评估初级保健服务。从加拿大政策角度来看，特别显著的一点是，当地区卫生局和家庭医生部门的高度积极参与的领导者拥有共同愿景和目标时，系统整合是可行的。健康连接诊所的创业精神促成了创新的循证工具的开发，如AMPS复杂性评估工具（依恋、医疗状况、心理/精神健康/成瘾挑战以及社会经济地位），旨在识别和评估生物心理社会复杂性及需求。该研究还强调了将社区导向和公平纳入发展工作的重要性。
该研究展示了如何调整构建模块方法，以便在为复杂和脆弱人群服务的环境中实施高效初级保健标准。
