Alsabbagh M W, Kueper J K, Wong S T, Burge F, Johnston S, Peterson S, Lawson B, Chung H, Bennett M, Blackman S, McGrail K, Campbell J, Hogg W, Glazier R
University of Waterloo.
The University of Western Ontario.
Int J Popul Data Sci. 2020 Aug 11;5(1):1340. doi: 10.23889/ijpds.v5i1.1340.
Performance measurement has been recognized as key to transforming primary care (PC). Yet, performance reporting in PC lags behind even though high-performing PC is foundational to an effective and efficient health care system.
We used administrative data from three Canadian provinces, British Columbia, Ontario and Nova Scotia, to: 1) identify and develop a core set of PC performance indicators using administrative data and 2) examine their ability to capture PC performance.
Administrative data used included Physician Billings, Discharge Abstract Database, the National Ambulatory Care and Reporting System database, Census and Vital Statistics. Indicators were compiled based on a literature review of PC indicators previously developed with administrative data available in Canada (n=158). We engaged in iterative discussions to assess data conformity, completeness, and plausibility of results in all jurisdictions. Challenges to creating comparable algorithms were examined through content analysis and research team discussions, which included clinicians, analysts, and health services researchers familiar with PC.
Our final list included 21 PC performance indicators pertaining to 1) technical care (n=4), 2) continuity of care (n=6), and 3) health services utilization (n=11). Establishing comparable algorithms across provinces was possible though time intensive. A major challenge was inconsistent data elements. Ease of data access, and a deep understanding of the data and practice context, was essential for selecting the most appropriate data elements.
This project is unique in creating algorithms to measure PC performance across provinces. It was essential to balance internal validity of the indicators within a province and external validity across provinces. The intuitive desire of having the exact same coding across provinces was infeasible due to lack of standardized PC data. Rather, a context-tailored definition was developed for each jurisdiction. This work serves as an example for developing comparable PC performance indicators across different provincial/territorial jurisdictions.
绩效评估已被视为转变初级保健（PC）的关键。然而，尽管高效的初级保健是有效且高效的医疗保健系统的基础，但初级保健中的绩效报告却滞后了。
我们使用了来自加拿大三个省份（不列颠哥伦比亚省、安大略省和新斯科舍省）的行政数据，以：1）利用行政数据识别并制定一套核心的初级保健绩效指标，以及2）检验这些指标捕捉初级保健绩效的能力。
所使用的行政数据包括医师账单、出院摘要数据库、国家门诊护理和报告系统数据库、人口普查和人口动态统计数据。指标是根据对先前利用加拿大现有行政数据开发的初级保健指标的文献综述（n = 158）编制而成的。我们进行了反复讨论，以评估所有辖区内数据的一致性、完整性和结果的合理性。通过内容分析和研究团队讨论（包括熟悉初级保健的临床医生、分析师和卫生服务研究人员），研究了创建可比算法所面临的挑战。
我们的最终清单包括21项初级保健绩效指标，涉及1）技术护理（n = 4）、2）护理连续性（n = 6）和3）卫生服务利用（n = 11）。尽管耗时，但跨省份建立可比算法是可行的。一个主要挑战是数据元素不一致。易于获取数据以及对数据和实践背景的深入理解，对于选择最合适的数据元素至关重要。
该项目在创建跨省份衡量初级保健绩效的算法方面独具特色。在一个省内平衡指标的内部有效性和跨省份的外部有效性至关重要。由于缺乏标准化的初级保健数据，在各省采用完全相同编码的直观愿望是不可行的。相反，为每个辖区制定了根据具体情况量身定制的定义。这项工作为在不同省级/地区辖区开发可比的初级保健绩效指标提供了一个范例。
