Assessing the feasibility and acceptability of a quality outcome orientation to primary healthcare in Nova Scotia

Around the world there is growing momentum for change and a desire for new directions in how primary healthcare (PHC) is organized, delivered and paid. In Canada, payment to Family Physicians has, until recently, been based only on how many patients are seen, how complex their care is and what the physician did. Today, there is growing interest among Canadian Ministries of Health to not only pay for the number of patients seen but also the 'quality' of care provided and the outcomes achieved. 'Quality' measures can be calculated by checking patient records to see to what extent recommended care for patients is achieved. Many issues need to be addressed first, including: a) the acceptability to health providers of the quality measures and ways to pay them for achieving the desired outcomes, and b) our ability to define and measure quality in primary healthcare. Our research plan is three-phased. First we will use 38 newly created PHC indicators or measures believed to measure the "technical quality of care in PHC" as the starting point and examine how acceptable they are to an 'expert' panel of PHC providers and decision makers in Nova Scotia. Do they reflect quality of care? Could these indicators be used to create some method of payment to health care providers? In the second phase we will collect the information we need to calculate the agreed upon indicators from primary healthcare practices in Nova Scotia that use electronic patient records. In the last phase, the success of collecting this information will lead to suggestions on how to begin using indicators in PHC, what changes need to be made to the electronic patient to make it happen and provide recommendations for new provider payment options. In this study academic health services researchers, community PHC providers and decision-makers within the provincial government and district health authorities will work together to achieve the project objectives.