How to Measure Quality of Care in Family Practice Using Administrative Data Alan Katz, Ruth-Ann...
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Transcript of How to Measure Quality of Care in Family Practice Using Administrative Data Alan Katz, Ruth-Ann...
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 population1,2 and may affect population health more than specialized services3,4
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 AdministrativeClaims 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
0
10
20
30
40
50
60
70
0-24 25-49 50-74 75+
Child Immunization
Influenza Vaccination
Cervical Screening
% P
hys
icia
ns
% Patients with recommended care
Chronic Disease Management
0
10
20
30
40
50
60
70
80
0-24 25-49 50-75 75+
Antidepressant
Asthma
Diabetes
Post-MI care
% P
hys
icia
ns
% Patients with recommended care
Prescription(s) for Benzodiazepines
0
10
20
30
40
50
60
70
80
90
100
0-24 25-49 50-74 75+
% P
hys
icia
ns
% 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. 2002/2003-17).
The authors thank Michelle Albl, Beth Edwards, and Stephanie Smith for their help in putting this lecture together.