To evaluate the appropriateness of potential data sources for the population of performance indicators for primary care (PC) practices.
This project was a cross sectional study of 7 multidisciplinary primary care teams in Ontario, Canada. Practices were recruited and 5-7 physicians per practice agreed to participate in the study. Patients of participating physicians (20-30) were recruited sequentially as they presented to attend a visit. Data collection included patient, provider and practice surveys, chart abstraction and linkage to administrative data sets. Matched pairs analysis was used to examine the differences in the observed results for each indicator obtained using multiple data sources.
Seven teams, 41 physicians, 94 associated staff and 998 patients were recruited. The survey response rate was 81% for patients, 93% for physicians and 83% for associated staff. Chart audits were successfully completed on all but 1 patient and linkage to administrative data was successful for all subjects. There were significant differences noted between the data collection methods for many measures. No single method of data collection was best for all outcomes. For most measures of technical quality of care chart audit was the most accurate method of data collection. Patient surveys were more accurate for immunizations, chronic disease advice/information dispensed, some general health promotion items and possibly for medication use. Administrative data appears useful for indicators including chronic disease diagnosis and osteoporosis/ breast screening.
Multiple data collection methods are required for a comprehensive assessment of performance in primary care practices. The choice of which methods are best for any one particular study or quality improvement initiative requires careful consideration of the biases that each method might introduce into the results. In this study, both patients and providers were willing to participate in and consent to, the collection and linkage of information from multiple sources that would be required for such assessments.
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BACKGROUND: Childhood-cancer survival is dismal in most low-income countries, but initiatives for treating paediatric cancer have substantially improved care in some of these countries. The My Child Matters programme was launched to fund projects aimed at controlling paediatric cancer in low-income and mid-income countries. We aimed to assess baseline status of paediatric cancer care in ten countries that were receiving support (Bangladesh, Egypt, Honduras, Morocco, the Philippines, Senegal, Tanzania, Ukraine, Venezuela, and Vietnam). METHODS: Between Sept 5, 2005, and May 26, 2006, qualitative face-to-face interviews with clinicians, hospital managers, health officials, and other health-care professionals were done by a multidisciplinary public-health research company as a field survey. Estimates of expected numbers of patients with paediatric cancer from population-based data were used to project the number of current and future patients for comparison with survey-based data. 5-year survival was postulated on the basis of the findings of the interviews. Data from the field survey were statistically compared with demographic, health, and socioeconomic data from global health organisations. The main outcomes were to assess baseline status of paediatric cancer care in the countries and postulated 5-year survival. FINDINGS: The baseline status of paediatric oncology care varied substantially between the surveyed countries. The number of patients reportedly receiving medical care (obtained from survey data) differed markedly from that predicted by population-based incidence data. Management of paediatric cancer and access to care were poor or deficient (ie, nonexistent, unavailable, or inconsistent access for most children with cancer) in seven of the ten countries surveyed, and accurate baseline data on incidence and outcome were very sparse. Postulated 5-year survival were: 5-10% in Bangladesh, the Philippines, Senegal, Tanzania, and Vietnam; 30% in Morocco; and 40-60% in Egypt, Honduras, Ukraine, and Venezuela. Postulated 5-year survival was directly proportional to several health indicators (per capita annual total health-care expenditure [Pearson's r(2)=0.760, p=0.001], per capita gross domestic product [r(2)=0.603, p=0.008], per capita gross national income [r(2)=0.572, p=0.011], number of physicians [r(2)=0.560, p=0.013] and nurses [r(2)=0.506, p=0.032] per 1000 population, and most significantly, annual government health-care expenditure per capita [r(2)=0.882, p
In November 2002, the Royal Commission on the Future of Health Care in Canada, headed by Mr. Roy J. Romanow, will deliver its final report to the Governor-in-Council of Canada. In October 2001 the Society of Obstetricians and Gynaecologists (SOGC) submitted to Mr. Romanow concrete ideas and proposed actions to improve the health of Canadian women and their families, and to sustain and strengthen Canada's publicly funded health care system, in its report Ensuring Women's Health: Options for the Future of Canada's Health Care System. This Commentary brings to you the thoughts that the SOGC will continue to forward after the Romanow Commission's report is delivered next month.
The objective of this work is to explore the satisfaction of a sample of 300 frail elders living in a rural Russian area with the support services provided by social service agency staff. The client population lives in extremely difficult conditions in terms of housing and associated communal services. They reported very high levels of satisfaction with the agency-provided services, both general satisfaction and their satisfaction with the specific services received during the reference visit inquired about by the interviewer. The degree of satisfaction is likely related to the difficulty of their living environment and their probable poverty, as well as the quality of services received. Attempts to relate the variance in the satisfaction ratings to the extent of activity limitations and the volume of formal and informal care using multivariate analysis met with limited success, owing in part, at least, to the limited variance in the dependent variables. Nevertheless, the patterns identified are broadly consistent with expectations based on modeling previously done for the U.S. populations receiving at-home care. The results clearly indicate the value of providing such services to frail elders in such circumstances.
In 1994, immunization against hepatitis B was implemented in schools in Quebec, targeting grade 4 students. In 1996-1997 and 1997-1998, one Local Community Service Centre (CLSC) replaced the school-based program in its district with vaccination offered in community clinics after school hours. The aim of the current study was to compare the effectiveness and costs of school-based and clinic-based programs.
Vaccination coverage data were collected in the CLSC with the clinic-based program (CBP), and in three matched CLSCs with a school-based program (SBP), from 1994 to 2000. Surveys were conducted to estimate costs to parents, to schools and to CLSCs in 1997-1998.
With the implementation of the CBP, the vaccination coverage fell to 73%, compared with over 90% in the SBPs. Coverage increased to 90% when the CBP was abandoned. Costs to the CLSC were not much lower in the CBP. Societal costs were $63 per student vaccinated in the CBP, and
To examine the effectiveness of a home visit program to improve home safety and decrease the frequency of injury in children. We examined the effects of the program on 1) parental injury awareness and knowledge; 2) the extent that families used home safety measures; 3) the rate of injury; and 4) the cost effectiveness of the intervention.
A randomized, controlled trial.
A multicenter trial conducted at 5 hospitals in 4 Canadian urban centers.
All 17 studies of family practice maternity care have shown reduced procedure rates for comparable populations of women cared for by family physicians versus those cared for by obstetricians, while maternal and infant outcomes are as good or better for the patients of family practitioners. System issues are the most predictive of positive outcomes such that in settings in which continuity and intimacy is high and women of no defined risk are cared for by providers specifically oriented to such care, outcomes are the best. In contrast, when such women are cared for by providers specifically oriented for high-risk or tertiary settings, their care becomes medicalized and they become sick. Staff attitudes, rules, and organizational structures are more predictive of outcome than professional labels. Family physicians in all settings can do more to lower their intervention rates and "humanize" care.