Regional variation in primary care improvement strategies and policy: case studies that consider qualitative contextual data for performance measurement in three Canadian provinces
Objective To explore regional primary care improvement strategies that are potentially determinants of primary care performance.Design Multiple comparative embedded case study.Setting Three regions in Canada: Fraser East, British Columbia; Eastern Ontario Health Unit, Ontario; Central Zone, Nova Sco...
Saved in:
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2019-10-01
|
| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/9/10/e029622.full |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849220411141652480 |
|---|---|
| author | John L Campbell Catherine Scott Fred Burge Sabrina T Wong Ruth Martin-Misener Sharon Johnston Stephanie Blackman William Hogg Anne M Grool Sara Wuite |
| author_facet | John L Campbell Catherine Scott Fred Burge Sabrina T Wong Ruth Martin-Misener Sharon Johnston Stephanie Blackman William Hogg Anne M Grool Sara Wuite |
| author_sort | John L Campbell |
| collection | DOAJ |
| description | Objective To explore regional primary care improvement strategies that are potentially determinants of primary care performance.Design Multiple comparative embedded case study.Setting Three regions in Canada: Fraser East, British Columbia; Eastern Ontario Health Unit, Ontario; Central Zone, Nova Scotia.Data sources (1) In-depth interviews with purposively selected key informants (eg, primary care decision-makers, physician leads, regulatory agencies) and focus groups with patients and clinicians (n=68 participants) and (2) published and grey literature (n=205 documents).Outcome measures Variations in spread and uptake of primary care improvement strategies across the three study regions. NVivo (V.11) was used to manage data and perform content analysis to identify categories within and across cases. The coding structure was developed by researchers through iterative collaboration, using inductive and deductive processes.Results Six overarching primary care improvement strategies, differing in focus and spread, were implemented across the three study regions: interprofessional team-based approaches, provider skill mix expansion, physician groups and networks, information systems, remuneration and performance measurement and reporting infrastructure.Conclusion The addition of information on regional improvement strategies to primary care performance reports could add important contextual insights into primary care performance results. This could help identify possible drivers of reported performance outcomes and levers for change in practice, regional and system-level settings. |
| format | Article |
| id | doaj-art-eadcafa6b75845c2ae3a44cf953e83f8 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2019-10-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-eadcafa6b75845c2ae3a44cf953e83f82024-12-13T16:35:10ZengBMJ Publishing GroupBMJ Open2044-60552019-10-0191010.1136/bmjopen-2019-029622Regional variation in primary care improvement strategies and policy: case studies that consider qualitative contextual data for performance measurement in three Canadian provincesJohn L Campbell0Catherine Scott1Fred Burge2Sabrina T Wong3Ruth Martin-Misener4Sharon Johnston5Stephanie Blackman6William Hogg7Anne M Grool8Sara Wuite91 Medical School (Primary Care), University of Exeter, Exeter, UK5 PolicyWise for Children & Families, Calgary, Alberta, CanadaPrimary Care Research Unit, Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada14 Centre for Health Services and Policy Research and School of Nursing, The University of British Columbia, Vancouver, British Columbia, CanadaFaculty of Health, Dalhousie University, Halifax, Nova Scotia, CanadaUniversity of Ottawa Department of Family Medicine, Ottawa, Ontario, Canada4 Family Medicine, Dalhousie University, Halifax, Nova Scotia, CanadaDepartment of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada8 Radiology, University Medical Center Utrecht, Utrecht, the Netherlands4 Family Medicine, Dalhousie University, Halifax, Nova Scotia, CanadaObjective To explore regional primary care improvement strategies that are potentially determinants of primary care performance.Design Multiple comparative embedded case study.Setting Three regions in Canada: Fraser East, British Columbia; Eastern Ontario Health Unit, Ontario; Central Zone, Nova Scotia.Data sources (1) In-depth interviews with purposively selected key informants (eg, primary care decision-makers, physician leads, regulatory agencies) and focus groups with patients and clinicians (n=68 participants) and (2) published and grey literature (n=205 documents).Outcome measures Variations in spread and uptake of primary care improvement strategies across the three study regions. NVivo (V.11) was used to manage data and perform content analysis to identify categories within and across cases. The coding structure was developed by researchers through iterative collaboration, using inductive and deductive processes.Results Six overarching primary care improvement strategies, differing in focus and spread, were implemented across the three study regions: interprofessional team-based approaches, provider skill mix expansion, physician groups and networks, information systems, remuneration and performance measurement and reporting infrastructure.Conclusion The addition of information on regional improvement strategies to primary care performance reports could add important contextual insights into primary care performance results. This could help identify possible drivers of reported performance outcomes and levers for change in practice, regional and system-level settings.https://bmjopen.bmj.com/content/9/10/e029622.full |
| spellingShingle | John L Campbell Catherine Scott Fred Burge Sabrina T Wong Ruth Martin-Misener Sharon Johnston Stephanie Blackman William Hogg Anne M Grool Sara Wuite Regional variation in primary care improvement strategies and policy: case studies that consider qualitative contextual data for performance measurement in three Canadian provinces BMJ Open |
| title | Regional variation in primary care improvement strategies and policy: case studies that consider qualitative contextual data for performance measurement in three Canadian provinces |
| title_full | Regional variation in primary care improvement strategies and policy: case studies that consider qualitative contextual data for performance measurement in three Canadian provinces |
| title_fullStr | Regional variation in primary care improvement strategies and policy: case studies that consider qualitative contextual data for performance measurement in three Canadian provinces |
| title_full_unstemmed | Regional variation in primary care improvement strategies and policy: case studies that consider qualitative contextual data for performance measurement in three Canadian provinces |
| title_short | Regional variation in primary care improvement strategies and policy: case studies that consider qualitative contextual data for performance measurement in three Canadian provinces |
| title_sort | regional variation in primary care improvement strategies and policy case studies that consider qualitative contextual data for performance measurement in three canadian provinces |
| url | https://bmjopen.bmj.com/content/9/10/e029622.full |
| work_keys_str_mv | AT johnlcampbell regionalvariationinprimarycareimprovementstrategiesandpolicycasestudiesthatconsiderqualitativecontextualdataforperformancemeasurementinthreecanadianprovinces AT catherinescott regionalvariationinprimarycareimprovementstrategiesandpolicycasestudiesthatconsiderqualitativecontextualdataforperformancemeasurementinthreecanadianprovinces AT fredburge regionalvariationinprimarycareimprovementstrategiesandpolicycasestudiesthatconsiderqualitativecontextualdataforperformancemeasurementinthreecanadianprovinces AT sabrinatwong regionalvariationinprimarycareimprovementstrategiesandpolicycasestudiesthatconsiderqualitativecontextualdataforperformancemeasurementinthreecanadianprovinces AT ruthmartinmisener regionalvariationinprimarycareimprovementstrategiesandpolicycasestudiesthatconsiderqualitativecontextualdataforperformancemeasurementinthreecanadianprovinces AT sharonjohnston regionalvariationinprimarycareimprovementstrategiesandpolicycasestudiesthatconsiderqualitativecontextualdataforperformancemeasurementinthreecanadianprovinces AT stephanieblackman regionalvariationinprimarycareimprovementstrategiesandpolicycasestudiesthatconsiderqualitativecontextualdataforperformancemeasurementinthreecanadianprovinces AT williamhogg regionalvariationinprimarycareimprovementstrategiesandpolicycasestudiesthatconsiderqualitativecontextualdataforperformancemeasurementinthreecanadianprovinces AT annemgrool regionalvariationinprimarycareimprovementstrategiesandpolicycasestudiesthatconsiderqualitativecontextualdataforperformancemeasurementinthreecanadianprovinces AT sarawuite regionalvariationinprimarycareimprovementstrategiesandpolicycasestudiesthatconsiderqualitativecontextualdataforperformancemeasurementinthreecanadianprovinces |