Table 2.

Population segments for inclusion in primary care performance measurement framework

Population group	Description	Rationale for inclusion in a primary performance measurement framework
Healthy	No ongoing medical conditions or behavioural risk factors. Possible acute conditions that require time-limited treatment (e.g., pregnancy, accidental injury).	Comprises the majority of the population; expected use of primary care is low (Porter et al. 2013). The role of primary care is maintenance of health and possible management of time-limited acute conditions.
At risk of developing a chronic conditior	Presence of medical risk factors for developing a chronic disease (e.g., overweight or obese, smoking excessive alcohol consumption, recreational drug use, sedentary lifestyle)	A growing proportion of the population; expected use of primary care is low but this is a priority group as primary care has a role in treatment plans for modifiable risk factors (Thorpe 2005). Primary care has an important role in preventive medicine such as behavioural programs for weight management and smoking cessation. Successful strategies could result in patients moving into the healthy population group as opposed to developing chronic disease(s) (Porter et al. 2013).
One chronic condition	One ongoing chronic condition with impact on functional status (e.g., diabetes mellitus, hypertension).	A growing proportion of the population; expected use of primary care is moderate with the majority of primary care patients having at least one chronic disease (Bayliss et al. 2014; Milani and Lavie 2014). Evidence-based guidelines are available to guide the care of these patients; technical quality of care metrics may be useful for this patient group. Successful management may prevent the development of additional chronic diseases. Primary care has a role in ongoing disease management and prevention of secondary complications (Porter et al. 2013).
Multiple chronic conditions	Two or more ongoing chronic conditions with impact on functional status	A growing proportion of the population; expected use of primary care is high (Banerjee 2014; Bayliss et al. 2014; Fortin et al. 2012; Koller et al. 2014). There are few evidence-based guidelines or quality metrics currently available to guide care for this patient group. As such, data on the performance of primary care for this group has particular utility. Primary care has a role in ongoing disease management and prevention of secondary complications (Porter et al. 2013).
Advanced complex chronic conditions	Multiple advanced chronic conditions with complications or patient approaching the end of life	The smallest population segment, but these patients use more healthcare services than any other group (Lunney et al. 2002; Lynn et al. 2007); expected use of primary care will vary and there are concerns about the quality of care (e.g., over-reliance on hospital services, underutilization of primary care or palliative services). Primary care has a role in ongoing disease management, prevention of secondary complications with the aim of avoiding the need for unplanned hospital care (Porter et al. 2013).