Background
Objective
Study context: Quebec’s healthcare system
Centralized waiting lists for unattached patients in Quebec
Methods
Study design: GACO performance over one year
Data source: administrative databases
Participants: all GACOs in the SIGACO database
Performance indicators
Assessing performance: use of a Balanced Scorecard
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Process indicatorsThree process indicators were selected to describe mechanisms that precede achievement of the GACOs’ expected outcomes.1)New requests for an FP: This indicator includes every new request made in 2013–2014. It reflects the population’s and health professionals’ knowledge of the GACOs’ existence, as well as how easy it is to make a request to the GACO. The number of new requests for an FP is presented per 10,000 population. Larger numbers of new requests were considered to indicate better GACO performance.2)Patients waiting for an FP in GACOs: This rate indicates the number of pending requests for an FP as of March 31, 2014, per 10,000 population. There are three types of patients waiting for an FP in GACOs: a) patients not yet evaluated by the GACO nurse (unknown vulnerability); b) vulnerable patients, evaluated by the nurse and with at least one of the 20 vulnerability codes defined by the RAMQ (chronic disease or age 70+); and c) patients evaluated by the nurse and not vulnerable (none of the 20 vulnerability codes). We considered that, for all three types of patients, a small number indicates better GACO performance because ideally patients should be evaluated quickly by a nurse and then attached to an FP as soon as possible.3)Change in the number of patients waiting for an FP in GACOs: The number of patients on the waiting list (indicator 2) at a given date also reflects a GACO’s performance in previous years. Patients on the GACO can accumulate from year to year when there are more requests than attachments to physicians. Therefore we developed an indicator to reflect the change in number of patients on the list during 2013–2014, i.e., to capture whether the number increased or decreased over that time. This indicator is presented in both median percentage and rate per 10,000 population. This indicator captures more precisely the GACO’s performance in 2013–2014. We considered that a greater decrease in number of patients on the list reflected better GACO performance, since it indicated that more patients were attached to an FP than there were new requests for an FP during the year.
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Outcome indicatorsThe outcome indicators presented below reflect the dual objectives of GACOs: to attach patients to an FP and to prioritize the attachment of vulnerable patients.4)Patients attached to an FP through GACOs: This indicator measures the number of patients who were attached to an FP through GACOs during the year 2013–2014 per 10,000 population. We considered that larger numbers of patients being attached to an FP during the year indicated better GACO performance.5)Vulnerable patients attached to an FP through GACOs: This indicator measures the proportion, in percentage, of patients attached to an FP through GACOs during the year who were identified as vulnerable (with at least one of the 20 vulnerability codes). GACOs that had attached a larger proportion of vulnerable patients were considered as showing better performance, in terms of success in prioritizing those identified as having specific health needs.
Statistical analysis
Results
Median rates of patients who have not been evaluated by the nurse (unknown vulnerability) | Intra-regional range | Median rates of patients who are vulnerable (at least one of 20 chronic disease vulnerability codes or aged 70+ years) | Intra-regional range | |
---|---|---|---|---|
A | 54 | 0; 208 | 192 | 56; 333 |
B | 13 | 0; 696 | 69 | 24; 266 |
C | 14 | 1; 36 | 83 | 73; 116 |
D | 1 | 0; 149 | 26 | 7; 274 |
E | 6 | 0; 193 | 2 | 0; 284 |
F | 8 | 0; 128 | 98 | 1; 399 |
G | 54 | N/A | 95 | N/A |
H | 33 | 0; 66 | 45 | 1; 88 |
I | 4 | 0; 539 | 81 | 51; 309 |
J | 12 | 0; 386 | 80 | 21; 149 |
K | 22 | 4; 209 | 27 | 15; 69 |
L | 41 | 0; 207 | 137 | 11; 529 |
M | 12 | 1; 287 | 122 | 40; 266 |
N | 16 | 0; 173 | 45 | 7; 361 |
Province | 21 | 0; 696 | 68 | 0; 529 |
Number of GACOs in the region | Increase/decrease in the rate of patients on the GACOs per 10, 000 population | Median change for the GACOs in the region (%) | Standard deviation (%) | Intra-regional range (best performance; worst performance) (%) | |
---|---|---|---|---|---|
A | 5 | 192 | +22 | 19 | +15; +56 |
B | 8 | −10 | +45 | 38 | −48; +64 |
C | 4 | 185 | +57 | 24 | +19; +71 |
D | 5 | 52 | +46 | 25 | +44; +91 |
E | 7 | 118 | +13 | 302 | −703; +90 |
F | 5 | −188 | −1 | 108 | −231 +6 |
G | 1 | 155 | +33 | N/A | N/A |
H | 2 | 132 | +30 | 2 | +28; +31 |
I | 7 | 81 | +25 | 22 | −29;+35 |
J | 8 | 147 | +34 | 39 | −67; +49 |
K | 12 | 92 | +41 | 16 | +20; +65 |
L | 11 | 135 | +40 | 21 | +14; +84 |
M | 5 | 151 | +16 | 41 | −74; +26 |
N | 6 | 79 | +7 | 165 | −364 +79 |
Province | 86 | 115 | +30 | 101 | −703; +91 |
Median for the GACOs in the region (%) | Intra-regional range (worst performance; best performance;) (%) | |
---|---|---|
A | 57 | 21; 68 |
B | 48 | 7; 51 |
C | 46 | 41; 51 |
D | 50 | 24; 53 |
E | 15 | 0; 46 |
F | 46 | 30; 48 |
G | 44 | N/A |
H | 39 | 38;41 |
I | 46 | 26; 68 |
J | 45 | 27; 69 |
K | 38 | 26; 69 |
L | 39 | 31; 52 |
M | 28 | 26; 55 |
N | 33 | 27; 56 |
Province | 41 | 0; 69 |