How to Measure Quality of Care in Family Practice Using Administrative Data

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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
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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

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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

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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

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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

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Finalizing Indicators

• Physician focus group (included 3 groups) with
  independent review and group discussion
• Examine feasibility of measuring indicators

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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

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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

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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

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Preventive Care
Physicians
Patients with recommended care
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Chronic Disease Management
Physicians
Patients with recommended care
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Prescription(s) for Benzodiazepines
Physicians
Patients with potentially inappropriate
prescriptions for benzodiazepines
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Using Quality Indicators Considerations

• Focus solely on measurable components of care
• Data availability across regions
• Completeness of data

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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

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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.