Typology of organizational innovation components: building blocks to improve access to primary healthcare for vulnerable populations.

Background: Achieving equity of access to primary healthcare requires organizations to implement innovations tailored to the specific needs and abilities of vulnerable populations. However, designing pro-vulnerable innovations is challenging without knowledge of the range of possible innovations tailored to vulnerable populations' needs. To better support decision-makers, we aimed to develop a typology of pro-vulnerable organizational innovation components - akin to "building blocks" that could be combined in different ways into new complex innovations or added to existing organizational processes to improve access to primary healthcare.

Primary medical care continuity and patient mortality: a systematic review.

Background: A 2018 review into continuity of care with doctors in primary and secondary care concluded that mortality rates are lower with higher continuity of care.

Aim: This association was studied further to elucidate its strength and how causative mechanisms may work, specifically in the field of primary medical care.

Design And Setting: Systematic review of studies published in English or French from database and source inception to July 2019.

Promoting cross-jurisdictional primary health care research: developing a set of common indicators across 12 community-based primary health care teams in Canada.

AimTo describe the process by which the 12 community-based primary health care (CBPHC) research teams worked together and fostered cross-jurisdictional collaboration, including collection of common indicators with the goal of using the same measures and data sources. BACKGROUND: A pan-Canadian mechanism for common measurement of the impact of primary care innovations across Canada is lacking. The Canadian Institutes for Health Research and its partners funded 12 teams to conduct research and collaborate on development of a set of commonly collected indicators.

Organizational interventions improving access to community-based primary health care for vulnerable populations: a scoping review.

Unlabelled: Access to community-based primary health care (hereafter, 'primary care') is a priority in many countries. Health care systems have emphasized policies that help the community 'get the right service in the right place at the right time'. However, little is known about organizational interventions in primary care that are aimed to improve access for populations in situations of vulnerability (e.

Personal Characteristics and Experience of Primary Care Predicting Frequent Use of Emergency Department: A Prospective Cohort Study.

Objective: A small number of patients frequently using the emergency department (ED) account for a disproportionate amount of the total ED workload and are considered using this service inappropriately. The aim of this study was to identify prospectively personal characteristics and experience of organizational and relational dimensions of primary care that predict frequent use of ED.

Methods: This study was conducted among parallel cohorts of the general population and primary care patients (N = 1,769).

Validation of a new measure of availability and accommodation of health care that is valid for rural and urban contexts.

Context: Patients are the most valid source for evaluating the accessibility of services, but a previous study observed differential psychometric performance of instruments in rural and urban respondents.

Objective: To validate a measure of organizational accessibility free of differential rural-urban performance that predicts consequences of difficult access for patient-initiated care.

Design: Sequential qualitative-quantitative study.

Barriers and Facilitators for Primary Care Reform in Canada: Results from a Deliberative Synthesis across Five Provinces.

Introduction: Since 2000, primary care (PC) reforms have been implemented in various Canadian provinces. Emerging organizational models and policies are at various levels of implementation across jurisdictions. Few cross-provincial analyses of these reforms have been realized.

Development of a measure of health care affordability applicable in a publicly funded universal health care system.

Objective: Direct measures of health care affordability from the user perspective are needed to monitor equitable access to publicly funded health care in Canada. The objective of our study was to develop a survey-based measure of healthcare affordability applicable to the Canadian context.

Methods: We developed items after focus group exploration of access and cost barriers in the healthcare trajectory.

Providing care to vulnerable populations: a qualitative study among GPs working in deprived areas in Montreal, Canada.

Background: Communication barriers between persons living in poverty and healthcare professionals reduce care effectiveness. Little is known about the strategies general practitioners (GPs) use to enhance the effectiveness of care for their patients living in poverty.

Objective: The aim of this study was to identify strategies adopted by GPs to deliver appropriate care to patients living in poverty.

Providing high-quality care in primary care settings: how to make trade-offs.

Objective: To gain a deeper understanding of how primary care (PC) practices belonging to different models manage resources to provide high-quality care.

Design: Multiple-case study embedded in a cross-sectional study of a random sample of 37 practices.

Setting: Three regions of Quebec.

An exploration of rural-urban differences in healthcare-seeking trajectories: implications for measures of accessibility.

Comparing accessibility between urban and rural areas requires measurement instruments that are equally discriminating in each context. Through focus groups we explored and compared care-seeking trajectories to understand context-specific accessibility barriers and facilitators. Rural care-seekers rely more on telephone access and experience more organizational accommodation but have fewer care options.

The team climate inventory as a measure of primary care teams' processes: validation of the French version.

Purpose: Evaluate the psychometric properties of the French version of the short 19-item Team Climate Inventory (TCI) and explore the contributions of individual and organizational characteristics to perceived team effectiveness.

Method: The TCI was completed by 471 of the 618 (76.2%) healthcare professionals and administrative staff working in a random sample of 37 primary care practices in the province of Quebec.

Patient-reported confidence in primary healthcare: are there disparities by ethnicity or language?

Objective: To examine whether confidence in primary healthcare (PHC) differs among ethnic-linguistic groups and which PHC experiences are associated with confidence.

Design: A cross-sectional study where patient surveys were administered using random digit dialling. Regression models identify whether ethnic-linguistic group remains significantly associated with confidence in PHC.

Experienced continuity of care when patients see multiple clinicians: a qualitative metasummary.

Purpose: Continuity of care among different clinicians refers to consistent and coherent care management and good measures are needed. We conducted a metasummary of qualitative studies of patients' experience with care to identify measurable elements that recur over a variety of contexts and health conditions as the basis for a generic measure of management continuity.

Methods: From an initial list of 514 potential studies (1997-2007), 33 met our criteria of using qualitative methods and exploring patients' experiences of health care from various clinicians over time.

Transforming primary healthcare by including the stakeholders involved in delivering care to people living in poverty: EQUIhealThY study protocol.

Background: Ensuring access to timely and appropriate primary healthcare for people living in poverty is an issue facing all countries, even those with universal healthcare systems. The transformation of healthcare practices and organization could be improved by involving key stakeholders from the community and the healthcare system in the development of research interventions. The aim of this project is to stimulate changes in healthcare organizations and practices by encouraging collaboration between care teams and people living in poverty.

Respectfulness from the patient perspective: comparison of primary healthcare evaluation instruments.

Unlabelled: Respectfulness is one measurable and core element of healthcare responsiveness. The operational definition of respectfulness is "the extent to which health professionals and support staff meet users' expectations about interpersonal treatment, demonstrate respect for the dignity of patients and provide adequate privacy."

Objective: To examine how well respectfulness is captured in validated instruments that evaluate primary healthcare from the patient's perspective, whether or not their developers had envisaged these as representing respectfulness.

Comprehensiveness of care from the patient perspective: comparison of primary healthcare evaluation instruments.

Unlabelled: Comprehensiveness relates both to scope of services offered and to a whole-person clinical approach. Comprehensive services are defined as "the provision, either directly or indirectly, of a full range of services to meet most patients' healthcare needs"; whole-person care is "the extent to which a provider elicits and considers the physical, emotional and social aspects of a patient's health and considers the community context in their care." Among instruments that evaluate primary healthcare, two had subscales that mapped to comprehensive services and to the community component of whole-person care: the Primary Care Assessment Tool - Short Form (PCAT-S) and the Components of Primary Care Index (CPCI, a limited measure of whole-person care).

Management continuity from the patient perspective: comparison of primary healthcare evaluation instruments.

Unlabelled: Management continuity, operationally defined as "the extent to which services delivered by different providers are timely and complementary such that care is experienced as connected and coherent," is a core attribute of primary healthcare. Continuity, as experienced by the patient, is the result of good care coordination or integration.

Objective: To provide insight into how well management continuity is measured in validated coordination or integration subscales of primary healthcare instruments.

Relational continuity from the patient perspective: comparison of primary healthcare evaluation instruments.

Unlabelled: The operational definition of relational continuity is "a therapeutic relationship between a patient and one or more providers that spans various healthcare events and results in accumulated knowledge of the patient and care consistent with the patient's needs."

Objective: To examine how well relational continuity is measured in validated instruments that evaluate primary healthcare from the patient's perspective.

Method: 645 adults with at least one healthcare contact in the previous 12 months responded to six instruments that evaluate primary healthcare.

Interpersonal communication from the patient perspective: comparison of primary healthcare evaluation instruments.

Unlabelled: The operational definition of interpersonal communication is "the ability of the provider to elicit and understand patient concerns, to explain healthcare issues and to engage in shared decision-making if desired."

Objective: To examine how well interpersonal communication is captured in validated instruments that evaluate primary healthcare from the patient's perspective.

Method: 645 adults with at least one healthcare contact in the previous 12 months responded to instruments that evaluate primary healthcare.

Accessibility from the patient perspective: comparison of primary healthcare evaluation instruments.

Unlabelled: The operational definition of first-contact accessibility is "the ease with which a person can obtain needed care (including advice and support) from the practitioner of choice within a time frame appropriate to the urgency of the problem"; accommodation is "the way healthcare resources are organized to accommodate a wide range of patients' abilities to contact healthcare providers and reach healthcare services, that is to say telephone services, flexible appointment systems, hours of operation, and walk-in periods."

Objective: To compare how well accessibility is measured in validated subscales that evaluate primary healthcare from the patient's perspective.

Method: 645 adults with at least one healthcare contact in the previous 12 months responded to six instruments that evaluate primary healthcare with four subscales that measure accessibility: the Primary Care Assessment Survey (PCAS), the Primary Care Assessment Tool - Short Form (PCAT-S, two subscales) and the first version of the EUROPEP (EUROPEP-I).

An overview of confirmatory factor analysis and item response analysis applied to instruments to evaluate primary healthcare.

This paper presents an overview of the analytic approaches that we used to assess the performance and structure of measures that evaluate primary healthcare; six instruments were administered concurrently to the same set of patients. The purpose is (a) to provide clinicians, researchers and policy makers with an overview of the psychometric methods used in this series of papers to assess instrument performance and (b) to articulate briefly the rationale, the criteria used and the ways in which results can be interpreted. For illustration, we use the case of instrument subscales evaluating accessibility.

What Patients Tell Us about Primary Healthcare Evaluation Instruments: Response Formats, Bad Questions and Missing Pieces.

Unlabelled: Instruments have been developed that measure consumer evaluations of primary healthcare using different approaches, formats and questions to measure similar attributes. In 2004 we concurrently administered six validated instruments to adults and conducted discussion groups to explore how well the instruments allowed patients to express their healthcare experience and to get their feedback about questions and formats.

Method: We held 13 discussion groups (n=110 participants): nine in metropolitan, rural and remote areas of Quebec; four in metropolitan and rural Nova Scotia.

Differential item functioning in primary healthcare evaluation instruments by french/english version, educational level and urban/rural location.

Unlabelled: Evaluating the extent to which groups or subgroups of individuals differ with respect to primary healthcare experience depends on first ruling out the possibility of bias.

Objective: To determine whether item or subscale performance differs systematically between French/English, high/low education subgroups and urban/rural residency.

Method: A sample of 645 adult users balanced by French/English language (in Quebec and Nova Scotia, respectively), high/low education and urban/rural residency responded to six validated instruments: the Primary Care Assessment Survey (PCAS); the Primary Care Assessment Tool - Short Form (PCAT-S); the Components of Primary Care Index (CPCI); the first version of the EUROPEP (EUROPEP-I); the Interpersonal Processes of Care Survey, version II (IPC-II); and part of the Veterans Affairs National Outpatient Customer Satisfaction Survey (VANOCSS).