Research

Update on Primary Care Performance Assessment

The Primary Care Performance Assessment Project involves primary care physicians in the development of evidence-based practice assessment tools, including quality indicators for preventive care, screening and health promotion, management of acute and chronic conditions, and practice organization and management. During 2002 indicator data were abstracted from medical records at ten practice sites. Subsequent to each practice visit the investigators provided the family physicians and associated office staff with an interactive workshop to:

• Discuss data quality, performance measurement, and the usefulness and feasibility of the quality indicators.
• Provide feedback on the individual provider results/findings of the chart review, survey and direct observation at the practice, plus comparisons to the aggregate of practice sites.
• Suggest recommendations for data quality improvement.
• Exchange information on practice innovations and standardized forms.

Nine of the eleven scheduled workshops have been completed. Two workshops were temporarily postponed related to the SARS Alert.

The study has offered benefits to the participating family physicians, and to the investigative team. Each family physician study participant receives Continuing Medical Education credits (2.0 MAINPRO-MI credits) after attending the program. Several participants plan to pursue their own quality improvement efforts based on the findings of this study, and can then apply to the College of Family Physicians of Canada for additional credits.

The investigative team will analyze and disseminate forms designed by the participating family physicians for record keeping, and will use feedback from study participants on the usefulness of these specific indicators to their everyday practice, the facilitators and barriers to chart review, and suggestions about additional acute care management indicators (e.g. low back pain, urinary tract infections) for ongoing research initiatives.

The project team is involved in a number of collaborative activities related to primary care. For example, Whitney Berta is leading team efforts to develop an electronic version of the chart-based data collection instrument in conjunction with Bell University Health Communication Labs, Faculty of Medicine. Liisa Jaakkimainen is leading a team that will survey family physicians to assess the impact of the SARS Alert. Jan Barnsley and Susan Bondy (Institute for Clinical Evaluative Sciences, Public Health Sciences) are team members. This group is collaborating with researchers in Hong Kong who are conducting a similar survey in Hong Kong, Taiwan, and Singapore.

Jan Barnsley to Present Paper at AHRQ Conference

Dr. Jan Barnsley , has been invited to present a paper at the 5th International Conference on the Scientific Basis of Health Services: Global Evidence for Local Decisions, sponsored by the Agency for Healthcare Research on Quality (AHRQ). The conference takes places in Washington DC from September 20 to 23, 2003. See www.icsbhs.org for more information. The paper is entitled Selecting Primary Care Performance Indicators: Data Quality and Performance Measurement..

Ontario Walk-in Clinic Study

Dr. Jan Barnsley, HPME Associate Professor, and Eugene Vayda, Emeritus Professor, were co-authors of a study examining differences in patient satisfaction and quality of care for common acute conditions at Ontario walk-in clinics, family practices and emergency departments.

The principal investigator of this study was Dr. Brian Hutchinson from McMaster University. It was published in the April 15, 2003 issue of the Canadian Medical Association Journal.

A total of 12 walk-in clinics, 16 family practices and 13 emergency departments from 11 geographic regions in greater Toronto, Hamilton-Burlington and London were recruited. Abstractors reviewed 600 patients charts to assess whether quality-of-care criteria for eight common acute conditions had been met. A questionnaire was used to assess the satisfaction of 433 patients with communication, physician attitude and delay in the waiting room. Data were adjusted for patient characteristics.

Walk-in clinic patients were significantly more satisfied than emergency department patients on three satisfaction scales. Family practice patients were significantly more satisfied than walk-in clinic patients for satisfaction with waiting time. Adjusted mean quality scores for emergency departments, walk-in clinics and family practices were 73.1%, 69.9% and 64.1%, respectively. The scores for walk-in clinics and emergency departments were significantly higher than those of family practices.

Research and Teaching Profiles

Faculty associated with the Department of Health Policy, Management and Evaluation (HPME) are involved in a broad range of research activities with a variety of organizations. Success of the HPME Knowledge Transfer initiative is dependent on presenting our stakeholders with a unified, clear image of the depth and breadth of Departmental expertise. To promote greater internal awareness of the knowledge developed through HPME, faculty research profiles will be included as a regular feature of this newsletter.

This issue of the HPME newsletter features a research profile for:

• Steini Brown, an Assistant Professor in HPME. His research focuses on evaluating the quality of health care in a variety of settings using several methods. Most notably he is the Principal Investigator of the Hospital Report Project but also consults nationally and internationally to a broad range of private sector clients on strategy in health care, health care financing, and quality improvement topics..
  
  

+ + PROFILE OF THE MONTH + +

Adalsteinn Brown, PhD

Dr. Brown is an Assistant Professor in HPME specializing in the quality of health care. His research involves performance measurement, cost-effectiveness analysis, and small area variations analysis in hospital, emergency, chronic, rehabilitation, mental health, population health, women's health, and nursing care.

Education and Work Background

Dr. Brown completed an undergraduate degree in government studies at Harvard University and then a doctoral degree in the Department of Public Health and Primary Care at the University of Oxford. He was a Harvard National Scholar and a Rhodes Scholar.

Past work experience includes a position as research assistant for the Provincial Sub-Committee on the Role, Future, and Financing of Academic Health Sciences Centres in Toronto; research associate at the Health Intelligence Unit, Faculty of Medicine, University of Western Ontario; and as senior consultant to SAI, a health care management consulting firm with offices in New York City and Menlo Park, California, of which Dr. Brown was a founding member. Following the sale of SAI to Perot Systems, he was a founding member of Metacine, Inc, a Philadelphia-based firm specializing in the development of clinical language systems to simplify managed care contracting. Metacine was sold to DeNovis, Inc. He has worked with a wide range of private sector clients in Canada, the U.S., Europe, and the Far East on strategy in health care, health care financing, and quality improvement topics. These clients include not-for-profit insurance companies, hospital networks, and investment banks.

In addition to his role with HPME, Dr. Brown currently holds the position of Associate with the Center for Health Policy and the Center for Primary Care and Outcomes Research, Stanford University School of Medicine; Lecturer in the Faculty of Law at the University of Toronto; Adjunct Scientist at the Institute for Clinical Evaluative Sciences; and Instructor in the Department of Family Medicine, University of Western Ontario. Other professional responsibilities include membership in the Ontario Guideline Collaborative, and the Society for Social Medicine; and as peer reviewer for the journals Medical Care, Journal of Medical Internet Research, and Social Science & Medicine.

Research Activities

Dr. Brown is Principal Investigator for the Hospital Report Project which involves more than 35 researchers at three universities and six institutes. This project has developed balanced scorecards for Ontario hospitals published between 1998 and 2002, involving inpatient hospital care, emergency department care, and chronic care. It also includes special reports describing methods for performance measurement in rehabilitation, mental health, population health, women's health, and nursing.

Research conducted in the area of technology assessment includes structured reviews and cost-effectiveness analyses of emerging diagnostic technologies, particularly in the area of cervical cancer screening and the prevention of coronary heart disease. He is the principal investigator for an evaluation of the accreditation framework used by the Canadian Council on Health Services Accreditation; and a co-investigator for a CIHR Training Program in Health Law and Policy, and on a CIHR-CIHI funded study led by Ross Baker, HPME Professor, examining adverse events in Canadian Hospitals.

Teaching and Supervisory Responsibilities

Dr. Brown has taught several courses for HPME including a component of the Comprehensive Examination Preparation Course for Graduate Students in Outcomes and Evaluation; Competition, Cooperation and Strategy in Health Care; and Cases and Methods in Health Policy. For the Faculty of Law he has taught Conflict of Interest in Medicine. Dr. Brown is currently supervising one MSc student; serving on the thesis committees of one MSc student and one PhD student. He is also practicum advisor for the HPME MHSc program; and practicum supervisor for one MHSc student.

Future Research

Research in development includes chart audit and matched clinical data that is routinely collected to examine the sensitivity, specificity and other measures of the effectiveness of the Office of Investigator General Audits applied to hospitals in the US to detect fraud and abuse; perceptions of fraud and abuse in the Canadian health care community; a web-based tool for quality improvement and accountability; development of a web-based platform that allows hospitals to view their own performance data, compare it against benchmark data, link to quality improvement tools, and participate in the validation of their routinely submitted data; cross-sectional study based on survey data and routinely collected hospital data of the relationship between adherence to clinical protocols for select patient groups and hospital outcomes such as complications in pneumonia patients; longitudinal study measuring changes in medical and law students' health protective behaviours, health beliefs, emotional status, and self-efficacy; and a comparison of hospital performance rankings across Ontario using commonly available performance measurement tools and commonly used clinical trial outcomes.

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