Table 2.

Operational definitions, measurement instrument, and available metric properties of predictor variables

Variable	Measurement Instrument
Patient-centred care	The score for each care dimension is calculated as the mean and then standardized to a 0-to-10 metric.
Relational continuity: A therapeutic relationship between a patient and one or more providers that spans various health care events and results in accumulated knowledge of the patient and care consistent with the patient's needs.	Duration of the relationship - <1 year, 1-3 years, > 3 years (1 item). Primary Care Assessment Survey (PCAS)[74]. Contextual Knowledge of Patient sub-scale (5 items). Rating of regular doctor's knowledge of whole medical history, personal situation, and values on a Likert scale from "poor" (1) to "excellent" (6). α = 0.90.
Interpersonal Communication: The ability of the provider to elicit and understand patient concerns, explain healthcare issues.	PCAS Communication Scale - (6 items). Rating of quality of thoroughness of history taking, listening skills, explanations on a Likert scale from "poor" (1) to "excellent" (6) α = 0.93.
Shared-decision making and empowerment: Ongoing cooperative process between patients and providers to define goals, identify strategies, assume responsibility for implementation of decisions and share accountability for outcomes.	Interpersonal Processes of Care (IPC) [75]. Patient-centred decision making sub-scale (4 items). Empowerment sub-scale (5 items). Frequency of self-efficacy support from providers for self-management and healthy lifestyle on a Likert scale from "never" (1) to "almost always" (5) α = 0.91.
Respectfulness: The extent to which health professionals and support staff meet users expectations about interpersonal treatment, demonstrate respect for the dignity of patients and provide adequate privacy.	Interpersonal Processes of Care [78]. Office staff respectfulness sub-scale (4 items) on a Likert scale from "never" (1) to "almost always" (5) α = 0.93. Patient perception on quality of care - Physical facilities - ratings of physical facilities including cleanliness and privacy.(3 items).
Effectiveness of Care
First-contact accessibility: The ease with which a person can obtain needed care (including advice and support) from the practitioner of choice within a time frame appropriate to the urgency of the problem.	Haggerty, Levesque & Roberge 2007 (unpublished) (5 items). First-contact accessibility consequences due to accessibility barriers.
Organizational accessibility or accommodation: The way primary healthcare resources are organized to accommodate a wide range of patients' abilities to contact healthcare providers and reach healthcare services. (The organization of characteristics such as telephone services, flexible appointment systems, hours of operation, and walk-in periods).	Haggerty, Levesque & Roberge 2007 (unpublished) (7 items). Measure of capacity of regular clinic to adapt to clients' ability to obtain services and differences in problem urgency. α = 0.68. PCAS Organizational access sub-scale (5 items). Rating of opening hours, ability to reach clinic by telephone, wait time for appointment on a Likert scale from "poor" (1) to "excellent" (6) α = 0.83.
Overall coordination of care between providers: The delivery of services by different providers in a timely and complementary manner such that care is connected and coherent.	Veterans Administration Outpatient Customer Satisfaction Survey [78]. Overall coordination sub-scale (6 items). Reporting of problems with information and communication linkage between all providers seen. α = 0.74.
Preventive care:      Blood pressure check      Pap smear      Mammogram      Eye examination      Colorectal cancer screening      Cholesterol screening      Flu shot Health promotion: Providing individuals with advice and tools to make informed lifestyle decisions that improve their health and well-being.	Behavioral Risk Factor Surveillance System (BRFSS) Questionnaire - CCHS p.67 - 84 (6 items). Self reported occurrence in period of time corresponding to prevention guidelines. Good reliability and validity, except mammogram, pap smear, and cholesterol where reliability and validity is only moderate [84]. Adapted list from the Primary Care Assessment Tool (PCAT) comprehensiveness sub-scale (6 items). Recall of regular provider assessing risk for and giving advice about eating habits, alcohol consumption, smoking cessation, occupational risks, prevention of falls, emotional health, family violence on a scale of "definitely not" (1) to "definitely (4).
Chronic Illness Care: Care for chronic illness that is patient-centred, proactive, planned and includes collaborative goal setting; problem-solving and follow-up support.	Patient Assessment of Chronic Illness Care (PACIC) [80]. Sub-scales for Activation, Goal setting and Problem solving- reported frequency of provider actions and planning around self-care for chronic conditions (10 items) α = 0.82, 0.84, and 0.90 respectively (includes elements of shared-decision making).
Patient safety:      Medical errors      Medication review      Patient education	Commonwealth fund Patient Safety questions [87]. Receiving incorrect medication or dose, or incorrect or missing test results. (2 items). Last time medication review done (1 item). IPC - frequency of being told of medication effects and side effects (2 items).
Income	Total household income from all sources. Adapted from CCHS p.280-284 (1 item).
Household Possession	Household possession of car. Owned accommodation and Registered Retirement Savings Plan (RRSP) [25] (3 items).
Social support	Help with activities of daily living, care and affection, leisure and fun activities, confiding in CCHS (4 items).

NB - Reported alpha coefficients (α) refer to statistics obtained in our validation study of different instruments (Haggerty, Levesque & Roberge 2007, unpublished).