Table 2.
Scales for the measurement of performance
| Quality of Health Care Service Deliverya (items in the scale, categories in the likert scale of each item) | Source of data | Overall score rangesc | |
|---|---|---|---|
| Access | First contact accessibility (4, 4) | Patient survey | 74% - 83% |
| First contact utilization (3, 4) | Patient survey | 96% - 98% | |
| Patient-Provider | Humanism (8, 7) | Patient survey | 90% - 91% |
| Relationship | Trust (10, 5) | Patient survey | 87% - 88% |
| Cultural competency (3, 4) | Patient survey | 83% - 85% | |
| Family centeredness (3, 4) | Patient survey | 89% - 90% | |
| Continuity | Ongoing care (4, 4) | Patient survey | 85% - 90% |
| Technical Quality of Clinical Care Deliveryb- Adherence to recommended guidelines (items in the scale) | |||
| Health Promotion | Healthy lifestyle counseling (7) | Patient survey | 46% - 59% |
| Prevention | Preventive care (6) | Chart audit | 52% - 68% |
| Chronic Disease Management | Chronic disease management (9) | Chart audit | 60% - 72% |
a All health care service delivery scales are based on the PCAT[16,17], except for the Humanism, [42] and Trust[43] scales.
A respondent's scale was included only if at least 50% of its items contained a response. Performance scores for each health service delivery scale were derived by summing the individual item scores and normalizing these to a percentage. For example, for first contact accessibility, the sum of the scores for the four questions, each on a likert scale of 1-4, is divided by 16
bHealth promotion and prevention evaluations were based on the Canadian Task Force on Preventive Health Care (CTFPHC) clinical practice guidelines[44]. Chronic disease management was assessed against recommended guidelines accepted in Ontario for the management of the conditions [45-51].
For health promotion, patients were asked to indicate which of 7 subjects were discussed with them on that day's visit. We assessed whether at least one subject was discussed on that visit, and estimated the overall extent of health promotion delivered yearly by multiplying the number of subjects discussed at the index visit by the patient's estimated number of visits to that practice for the year. Preventive care was determined by assessing the performance of 6 indicator manoeuvres in the chart audit. The prevention score was the proportion of preventive manoeuvres for which the individual was eligible that were documented. Finally, chronic disease management was also evaluated by chart audit using 2-4 indicators in each of three conditions (Diabetes, Coronary Artery Disease and Congestive Heart Failure). For each condition the score was derived as for prevention, and the overall chronic disease management score was the average of the individual disease scores.
cIndicates the range of scores for each scale in the four models.