Development of comparable algorithms to measure primary care indicators using administrative health data across three Canadian provinces

INTRODUCTION

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.

OBJECTIVES

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.

Achieving cross provincial comparisons of osteoporosis screening performance from administrative health data

Administrative databases can be used to measure healthcare performance. This can lead to identification of high-performing practice characteristics and inform innovations. However, a key challenge is that administrative data cannot be easily combined across provinces. Comparable measures must be defined across provinces but operationalized within each province. The purpose of this work is to provide an example of defining a population health concept, osteoporosis screening, and creating measures to examine it across British Columbia, Ontario, and Nova Scotia, Canada. TRANSFORMATION is a study that seeks to improve the science and reporting of Primary Health Care performance. We used administrative data from the above three provinces to examine osteoporosis screening in those aged 65 years and older. Challenges of databases with different data elements and levels of methods development (e.g. macros) can be overcome for purposes of cross-provincial comparisons. Flexibility of analytic methods and frequent communication is needed.