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System Performance

Guide to Primary Care Reporting

A strong primary care system is fundamental to the health and wellbeing of people living in Ontario. It is also a critical component of a quality health system. Primary care providers – such as family doctors and nurse practitioners – assess and diagnose patients, help detect problems early, promote healthy behaviours, provide counselling, perform minor procedures, and help coordinate health needs when a referral to other health providers is required.

The nine quality indicators on this site represent the first coordinated and comprehensive system-level public reporting on primary care in the province. The site’s interactive graphs offer patients and health care providers meaningful and timely information.


About the primary care quality indicators

The selection of the primary care indicators used to measure performance was the culmination of many years of work by the Primary Care Performance Measurement Steering Committee, a group of dedicated health system partners and patients with extensive experience and expertise in primary care.

Learn more about primary care quality indicators:

If you have a question about primary care quality indicators, please email us at SystemPerformance@HQOntario.ca.


Data sources

Health Quality Ontario receives quality indicator results from several sources, including the Institute for Clinical Evaluative Sciences, the Ministry of Health and Long-Term Care and Cancer Care Ontario. Specific data sources that Health Quality Ontario uses to produce the indicators are: 

Discharge Abstract Database (DAD) 
DAD is maintained by CIHI and houses information on patients treated in acute care hospitals. Every time a patient is discharged from an acute care bed, the hospital submits an electronic record to CIHI that contains the patient’s demographic information as well as diagnostic and treatment data for that hospital admission.

Health Care Experience Survey (HCES)
The HCES is a voluntary telephone survey of people living in Ontario aged 16 and older. The survey asks randomly selected Ontarians for their views about their health care system, how healthy they are, what health conditions they have, their use and experience with the health care system including primary and specialty care, if they have been to a walk-in clinic or hospital (including emergency department use), and their household and demographic characteristics.

Laboratory Reporting Tool (LRT)
The LRT includes data on fecal occult blood testing kit distribution, dispensing, and results from Colon Cancer Check-participating laboratories, including a unique physician identifier of the ordering physician. Data are available on Colon Cancer Check fecal occult blood testing kits processed from April 2008 onwards.

National Ambulatory Care Reporting System (NACRS)
NACRS is maintained by CIHI and contains data for hospital- and community-based emergency department and ambulatory care (e.g., day surgery, outpatient clinics). CIHI receives data directly from participating facilities or from their respective regional health authorities or the ministry.

Ontario Diabetes Database (ODD)
The ODD uses a validated method to identify people with diabetes using data on hospital stays and physician visits. Records from the DAD, collected by CIHI were used to identify Ontarians with a valid health card number who had been hospitalized with a new or pre-existing diagnosis of diabetes. Physician claim records held by the Ontario Health Insurance Plan (OHIP) were also used to identify individuals with visits to a physician for diabetes. Cases of diabetes related to pregnancy are excluded from the ODD. Individuals were considered to have diabetes if they had at least one hospitalization or two physician service claims over a two-year period that are diabetes-related. People are included in the ODD as new cases when they are first identified as having diabetes in the previously mentioned databases.

Ontario Health Insurance Plan (OHIP)
The OHIP claims database covers all reimbursement claims to the Ministry of Health and Long-Term Care made by fee-for-service physicians, community-based laboratories and radiology facilities. The OHIP database contains encrypted patient and physician identifiers, codes for services provided, date of service, the associated diagnosis and fee paid. OHIP claims are missing some services, such as services received in provincial psychiatric hospitals and diagnostic procedures performed on an inpatient basis. OHIP also excludes services provided by physicians who are on alternative funding plans, which may impact the results of the analysis.

Registered Persons Data Base (RPDB)
RPDB provides basic demographic information about anyone who has ever received an Ontario health card number. This database is maintained by the Ministry of Health and Long-Term Care and used and enriched by ICES with information from other data sets.

ICES Physician Database (IPDB)
The ICES Physician Database (IPDB), which comprises information from the Corporate Provider Database (CPDB), the Ontario Physician Human Resource Data Centre (OPHRDC) database and the OHIP database of physician billings, was used to define health care utilization by physician specialty. The CPDB contains information about physician demographics, specialty training and certification, and practice location. This information is validated against the OPHRDC database, which is updated through periodic telephone interviews with all physicians practicing in Ontario.


Age and Sex-Risk Adjustment

When interpreting and comparing the results of quality indicators in different populations, regions or over time, it is important to account for the underlying differences in the populations being compared. We call this “risk adjustment” and it allows us to make a fair comparison across groups and to distinguish variation that is due to differences in practice. Results can be adjusted to account for differences in the age, sex, or other characteristics of people within a certain population. Characteristics such as age can significantly affect people’s health status and their need for health services. By accounting for differences in age, health status and other factors, data can be risk-adjusted so that quality indicators are comparable across the province and over time.

We apply an age and sex adjustment to the quality indicators to account for differences across Ontario communities. For other indicators, additional characteristics may also need to be taken into consideration such as the prevalence of chronic conditions. For these indicators, we use risk adjustment to account for the differences.


Definitions

Find more details about how we define the demographics when we monitor primary care.

Age (or age groups) refers to the age of a person (or the age range of groups of people) on the date (or period) relevant to the point of measurement. It is determined based on demographic information available in the existing administrative databases (e.g., RPDB) or information provided by the survey respondent.

If you have a question about system performance and reporting on Ontario’s health system, please email us at SystemPerformance@HQOntario.ca.


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Claude Lurette and Kowsiya Vijayartnam, Health Quality Ontario Patient, Family and Caregiver Advisors Council Co-Chairs

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