Scales for the measurement of performance; range of overall PCAT* scores was 86% to 88% (N = 5073): A) Dimensions of quality of health care service delivery; B) Technical quality of clinical care delivery.
| A) | ||
| QUALITY OF HEALTH CARE SERVICE DELIVERY†‡ (ITEMS ON THE SCALE, CATEGORIES ON THE LIKERT SCALE OF EACH ITEM) | N§ | SCORE RANGE,‖ % |
| Access | ||
| • First-contact accessibility (4, 4) | 5033 | 74 to 83 |
| • First-contact utilization (3, 4) | 5323 | 96 to 98 |
| Patient-provider relationship | ||
| • Cultural competency (3, 4) | 4755 | 83 to 85 |
| • Family-centredness (3, 4) | 5146 | 89 to 90 |
| • Humanism (8, 7) | 5292 | 90 to 91 |
| • Trust (10, 5) | 5031 | 87 to 88 |
| Continuity | ||
| • Ongoing care (4, 4) | 5252 | 85 to 90 |
| B) | ||
| TECHNICAL QUALITY OF CLINICAL CARE DELIVERY—ADHERENCE TO RECOMMENDED GUIDELINES (ITEMS ON THE SCALE)¶ | N§ | SCORE RANGE,‖ % |
| Health promotion‡ | ||
| Healthy lifestyle counseling (6) | 4642 | 46 to 59 |
| • Exercise | 4562 | 32 to 40 |
| • Healthy foods | 4592 | 17 to 28 |
| • Family conflicts | 4528 | 10 to 17 |
| • Smoking | 4574 | 13 to 18 |
| • Alcohol | 4551 | 8 to 14 |
| • Home safety | 4527 | 3 to 7 |
| Prevention# | ||
| Preventive care (6) (eligibility) | 3284 | 52 to 68 |
| • Colorectal cancer screening (individuals > 50 y) | 1753 | 30 to 46 |
| • Breast cancer screening (women 50 to 69 y) | 698 | 73 to 85 |
| • Cervical cancer screening (women 17 to 69 y) | 1954 | 65 to 84 |
| • Vision impairment screening (individuals > 65 y) | 735 | 27 to 41 |
| • Hearing impairment (individuals > 65 y) | 651 | 14 to 21 |
| • Influenza immunization (individuals at high risk or > 65 y) | 1365 | 59 to 70 |
| Chronic disease management# | ||
| Chronic disease management (9) | 514 | 60 to 72 |
| • Coronary artery disease (3) | 263 | 66 to 79 |
| • Diabetes (4) | 313 | 52 to 69 |
| • Congestive heart failure (2) | 57 | 56 to 76 |
PCAT—Primary Care Assessment Tool.
↵* Overall PCAT score was computed as the sum of all 17 PCAT questions divided by the maximum potential score (68 if all questions were answered).
↵† All health care service delivery scales are based on the PCAT,20,21 except for the humanism23 and trust25 scales. A respondent’s scale was included only if at least 50% of its items contained a response. Performance scores for health service delivery scales 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 4 questions, each on a likert scale of 1 to 4, is divided by 16.
↵‡ Patient survey.
↵§ The sample size showing represents the number of cases for which age was available and that were included in the age analysis.
↵‖ Indicates the range of each scale’s average scores across the 4 models.
↵¶ Health promotion and prevention evaluations were based on the Canadian Task Force on Preventive Health Care clinical practice guidelines.26 Chronic disease management was assessed against recommended guidelines accepted in Ontario for the management of the conditions.27–33 For health promotion, patients were asked to indicate which of the 7 subjects were discussed with them on that day’s visit. One question relating exclusively to individuals older than 65 years of age (about how to prevent falls) was excluded. We assessed whether at least 1 of the 6 subjects was discussed on that visit, and we analyzed each subject individually.
↵# Chart audit. Preventive care was determined by assessing whether 6 indicator maneuvers were documented in the chart as performed or recommended in the previous 24 months. The prevention score was the proportion of preventive maneuvers for which the individual was eligible that were documented as performed or recommended. Chronic disease management was also evaluated by chart audit using 2 to 4 indicators in each of the 3 conditions. 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.