title: Assessing the performance of centralized waiting lists for patients without a regular family physician using clinical-administrative data.
abstract: With 4.6 million patients who do not have a regular family physician, Canada performs poorly compared to other OECD countries in terms of attachment to a family physician. To address this issue, several provinces have implemented centralized waiting lists to coordinate supply and demand for attachment to a family physician. Although significant resources are invested in these centralized waiting lists, no studies have measured their performance. In this article, we present a performance assessment of centralized waiting lists for unattached patients implemented in Quebec, Canada.
  
  
  
  We based our approach on the Balanced Scorecard method. A committee of decision-makers, managers, healthcare professionals, and researchers selected five indicators for the performance assessment of centralized waiting lists, including both process and outcome indicators. We analyzed and compared clinical-administrative data from 86 centralized waiting lists (GACOs) located in 14 regions in Quebec, from April 1, 2013, to March 31, 2014.
  
  
  
  During the study period, although over 150,000 patients were attached to a family physician, new requests resulted in a 30% median increase in patients on waiting lists. An inverse correlation of average strength was found between the rates of patients attached to a family physician and the proportion of vulnerable patients attached to a family physician meaning that as more patients became attached to an FP through GACOs, the proportion of vulnerable patients became smaller (r = -0.31, p < 0.005). The results showed very large performance variations both among GACOs of different regions and among those of a same region for all performance indicators.
  
  
  
  Centralized waiting lists for unattached patients in Quebec seem to be achieving their twofold objective of attaching patients to a family physician and giving priority to vulnerable patients. However, the demand for attachment seems to exceed the supply and there appears to be a tension between giving priority to vulnerable patients and attaching of a large number of patients. Results also showed heterogeneity in the performance of centralized waiting lists across Quebec. Finally, our findings suggest it is critical that similar mechanisms should use available data to identify the best strategies for reducing variations and improving performance.
authors.affiliation: Charles-LeMoyne Hospital Research Centre, Sherbrooke University, Longueuil Campus, 150 Place Charles-LeMoyne, Office 200, Longueuil, QC, J4K 0A8, Canada. mylaine.breton@usherbrooke.ca.
authors.forename: Mylaine
authors.identifier: 0000-0001-5713-9618
authors.initials: M
authors.lastname: Breton
authors.affiliation: Charles-LeMoyne Hospital Research Centre, Sherbrooke University, Longueuil Campus, 150 Place Charles-LeMoyne, Office 200, Longueuil, QC, J4K 0A8, Canada.
authors.forename: Mélanie Ann
authors.initials: MA
authors.lastname: Smithman
authors.affiliation: Charles-LeMoyne Hospital Research Centre, Sherbrooke University, Longueuil Campus, 150 Place Charles-LeMoyne, Office 200, Longueuil, QC, J4K 0A8, Canada.
authors.forename: Astrid
authors.initials: A
authors.lastname: Brousselle
authors.affiliation: Charles-LeMoyne Hospital Research Centre, Sherbrooke University, Longueuil Campus, 150 Place Charles-LeMoyne, Office 200, Longueuil, QC, J4K 0A8, Canada.
authors.forename: Christine
authors.initials: C
authors.lastname: Loignon
authors.affiliation: École nationale d'administration publique (Montréal), 4750, avenue Henri-Julien, Office 5117, Montreal, QC, H2T 3E5, Canada.
authors.forename: Nassera
authors.initials: N
authors.lastname: Touati
authors.affiliation: Faculty of Nursing, University of Montreal, 2375, chemin de la Côte Ste-Catherine, Office 5103, Montreal, QC, H3T 1A8, Canada.
authors.forename: Carl-Ardy
authors.initials: CA
authors.lastname: Dubois
authors.affiliation: Direction de santé publique, Centre intégré de santé et des services sociaux-Montérégie-Centre, 1255 rue Beauregard, Longueuil, QC, J4K 2M3, Canada.
authors.forename: Kareen
authors.initials: K
authors.lastname: Nour
authors.affiliation: University of Montreal Hospital Research Centre, University of Montreal, 900 Rue Saint-Denis, Montreal, QC, H2X 0A9, Canada.
authors.forename: Antoine
authors.initials: A
authors.lastname: Boivin
authors.affiliation: Charles-LeMoyne Hospital Research Centre, Sherbrooke University, Longueuil Campus, 150 Place Charles-LeMoyne, Office 200, Longueuil, QC, J4K 0A8, Canada.
authors.forename: Djamal
authors.initials: D
authors.lastname: Berbiche
authors.affiliation: Charles-LeMoyne Hospital Research Centre, Sherbrooke University, Longueuil Campus, 150 Place Charles-LeMoyne, Office 200, Longueuil, QC, J4K 0A8, Canada.
authors.forename: Danièle
authors.initials: D
authors.lastname: Roberge
mesh_terms: D000328:Adult; D000368:Aged; D002170:Canada; D002908:Chronic Disease; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006801:Humans; D008875:Middle Aged; D010821:Physicians, Family / Q000600:supply & distribution*; D011792:Quebec; D035862:Vulnerable Populations; D014850:Waiting Lists
keywords: Balanced Scorecard; Centralized waiting lists; Performance; Unattached patients