title: Assessing methods for measurement of clinical outcomes and quality of care in primary care practices.
abstract: OBJECTIVE
  To evaluate the appropriateness of potential data sources for the population of performance indicators for primary care (PC) practices.
  
  
  METHODS
  This project was a cross sectional study of 7 multidisciplinary primary care teams in Ontario, Canada. Practices were recruited and 5-7 physicians per practice agreed to participate in the study. Patients of participating physicians (20-30) were recruited sequentially as they presented to attend a visit. Data collection included patient, provider and practice surveys, chart abstraction and linkage to administrative data sets. Matched pairs analysis was used to examine the differences in the observed results for each indicator obtained using multiple data sources.
  
  
  RESULTS
  Seven teams, 41 physicians, 94 associated staff and 998 patients were recruited. The survey response rate was 81% for patients, 93% for physicians and 83% for associated staff. Chart audits were successfully completed on all but 1 patient and linkage to administrative data was successful for all subjects. There were significant differences noted between the data collection methods for many measures. No single method of data collection was best for all outcomes. For most measures of technical quality of care chart audit was the most accurate method of data collection. Patient surveys were more accurate for immunizations, chronic disease advice/information dispensed, some general health promotion items and possibly for medication use. Administrative data appears useful for indicators including chronic disease diagnosis and osteoporosis/ breast screening.
  
  
  CONCLUSIONS
  Multiple data collection methods are required for a comprehensive assessment of performance in primary care practices. The choice of which methods are best for any one particular study or quality improvement initiative requires careful consideration of the biases that each method might introduce into the results. In this study, both patients and providers were willing to participate in and consent to, the collection and linkage of information from multiple sources that would be required for such assessments.
authors: Department of Family Medicine, Queen's University, Kingston, Ontario, Canada. michael.green@dfm.queensu.ca
authors: Michael E
authors: ME
authors: Green
authors: William
authors: W
authors: Hogg
authors: Colleen
authors: C
authors: Savage
authors: Sharon
authors: S
authors: Johnston
authors: Grant
authors: G
authors: Russell
authors: R Liisa
authors: RL
authors: Jaakkimainen
authors: Richard H
authors: RH
authors: Glazier
authors: Janet
authors: J
authors: Barnsley
authors: Richard
authors: R
authors: Birtwhistle
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002908:Chronic Disease / Q000453:epidemiology / Q000628:therapy; D003430:Cross-Sectional Studies; D003953:Diagnosis-Related Groups / Q000706:statistics & numerical data; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006306:Health Surveys; D006801:Humans; D008297:Male; D008485:Medical Audit / Q000379:methods; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D017063:Outcome Assessment, Health Care / Q000379:methods*; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data; D010350:Patient Credit and Collection; D010361:Patients / Q000523:psychology; D010821:Physicians, Family / Q000523:psychology* / Q000592:standards; D011314:Preventive Health Services / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000592:standards*; D019984:Quality Indicators, Health Care; D012923:Social Class