Measuring Progress in Access to Health Services

While management gurus point out that the ‘you can't manage what you can't measure’ dictum is not universally true, robust measurement of progress – or the lack thereof – can provide clarity, transparency and drive. In this spirit, federal, provincial and territorial governments recently endorsed a set of measures to support the 10-year investment agreement made in 2017 (Government of Canada 2018).

The 12 agreed measures were evenly split between indicators of access to mental health and addictions services and indicators of access to home and community care (Box 1). The Canadian Institute for Health Information (CIHI) is slated to begin annual reporting in 2019. (Note: The federal government and Quebec agreed to an asymmetrical arrangement. Likewise, given the then-recent election in Ontario, the province could not officially endorse the recommended measures.)

Box 1. Recommended indicators of access agreed by federal, provincial and territorial governments (CIHI 2018).

Recommended indicators for access to mental health and addictions services:

• Wait times for community mental health services, referral/self-referral to services

• Early identification for early intervention, age 10–25

• Awareness and/or successful navigation of mental health and addictions services (self-reported)

• Rates of repeat emergency department and/or urgent care centre visits for a mental health or addiction issue

• Hospitalization rates for problematic substance use

• Rates of self-injury, including suicide

Recommended indicators for access to home and community care:

• Wait times for home care services, referral to services

• Alternate level of care length of stay for in-patients requiring home care services

• Home care services helped the recipient stay at home (self-reported)

• Caregiver distress

• (In)appropriate move to long-term care

• Death at home/not in hospital

These are not “do the best that you can with the data that you have” indicators. A few – such as time spent in alternative levels of care by hospitalized patients who need home care – are widely tracked today. But some require further definitional work (e.g., early identification for early mental health intervention in youth) and many imply new types of data collection and reporting, including patient-/client-reported measures.

In addition to setting out a pan-Canadian measurement agenda, the indicators imply a broad policy, practice and research program. For example, they invite questions about best practices for successful navigation of mental health and addiction services or for the provision of home care services that help a recipient stay at home, both from the client's point of view. Understanding what works best for whom in what context will be an important enabler of improvement.

While there is much more to learn and to do, these are the types of questions that several authors address in this issue of the journal. From prehospital care and aging at home to the changing landscape of continuing care and specialty consultations, they provide insights on how care is delivered today and how it is evolving. Other articles focus on broader policy contexts, touching on a range of issues including geographical mobility of those who work in healthcare and how stakeholders view solutions to improve health system performance. As we look ahead via governments' shared priorities and on broader health system improvement questions, I encourage you to contribute your own insights to future issues of Healthcare Policy/Politiques de Santé as authors in this issue have done.