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Research ArticleOriginal Research

How the Novel Person-Centered Primary Care Measure Performs in Canada

Erica Li, Lidija Latifovic, Rebecca Etz, Noor Ramji, Richard H. Glazier and Tara Kiran
The Journal of the American Board of Family Medicine July 2022, 35 (4) 751-761; DOI: https://doi.org/10.3122/jabfm.2022.04.210427
Erica Li
From Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania (EL); MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Ontario (LL, RG, TK); Princess Margaret Cancer Center, University Health Network, Toronto, Ontario (LL); Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario (LL); Larry A. Green Center for the Advancement of Primary Health Care for the Public Good, Richmond, Virginia (RE); Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia (RE); Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Ontario (NR, RG, TK); Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario (NR, RG, TK); Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario (RG, TK).
MD, MSc
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Lidija Latifovic
From Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania (EL); MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Ontario (LL, RG, TK); Princess Margaret Cancer Center, University Health Network, Toronto, Ontario (LL); Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario (LL); Larry A. Green Center for the Advancement of Primary Health Care for the Public Good, Richmond, Virginia (RE); Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia (RE); Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Ontario (NR, RG, TK); Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario (NR, RG, TK); Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario (RG, TK).
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Rebecca Etz
From Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania (EL); MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Ontario (LL, RG, TK); Princess Margaret Cancer Center, University Health Network, Toronto, Ontario (LL); Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario (LL); Larry A. Green Center for the Advancement of Primary Health Care for the Public Good, Richmond, Virginia (RE); Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia (RE); Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Ontario (NR, RG, TK); Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario (NR, RG, TK); Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario (RG, TK).
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Noor Ramji
From Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania (EL); MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Ontario (LL, RG, TK); Princess Margaret Cancer Center, University Health Network, Toronto, Ontario (LL); Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario (LL); Larry A. Green Center for the Advancement of Primary Health Care for the Public Good, Richmond, Virginia (RE); Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia (RE); Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Ontario (NR, RG, TK); Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario (NR, RG, TK); Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario (RG, TK).
MD, MSc
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Richard H. Glazier
From Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania (EL); MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Ontario (LL, RG, TK); Princess Margaret Cancer Center, University Health Network, Toronto, Ontario (LL); Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario (LL); Larry A. Green Center for the Advancement of Primary Health Care for the Public Good, Richmond, Virginia (RE); Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia (RE); Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Ontario (NR, RG, TK); Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario (NR, RG, TK); Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario (RG, TK).
MD, MPH
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Tara Kiran
From Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania (EL); MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Ontario (LL, RG, TK); Princess Margaret Cancer Center, University Health Network, Toronto, Ontario (LL); Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario (LL); Larry A. Green Center for the Advancement of Primary Health Care for the Public Good, Richmond, Virginia (RE); Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia (RE); Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Ontario (NR, RG, TK); Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario (NR, RG, TK); Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario (RG, TK).
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Article Figures & Data

Figures

  • Tables
  • Figure 1a.
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    Figure 1a.

    Person-Centered Primary Care Measure (PCPCM) by years with provider.

  • Figure 1b.
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    Figure 1b.

    Person-Centered Primary Care Measure (PCPCM) by health status.

  • Figure 1c.
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    Figure 1c.

    Person-Centered Primary Care Measure (PCPCM) by income quintile.

  • Figure 2a.
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    Figure 2a.

    Person-Centered Primary Care Measure (PCPCM) by same day/next day access.

  • Figure 2b.
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    Figure 2b.

    Person-Centered Primary Care Measure (PCPCM) by involvement in care.

  • Figure 2c.
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    Figure 2c.

    Person-Centered Primary Care Measure (PCPCM) by opportunity to ask questions.

  • Exhibit 2.
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    Exhibit 2.

    Patients Who Responded to the Practice's Patient Experience Survey and Were Included in the Analysis.

  • Exhibit 3.
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    Exhibit 3.

    Person-Centered Primary Care Measure (PCPCM) Stratified by Sociodemographic Variables.

  • Exhibit 3a.
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    Exhibit 3a.

    Person-Centered Primary Care Measure (PCPCM) by Clinic.

  • Exhibit 3b.
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    Exhibit 3b.

    Person-Centered Primary Care Measure (PCPCM) by Age.

  • Exhibit 3c.
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    Exhibit 3c.

    Person-Centered Primary Care Measure (PCPCM) by Gender.

  • Exhibit 3d.
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    Exhibit 3d.

    Person-Centered Primary Care Measure (PCPCM) by Provider Type.

  • Exhibit 3e.
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    Exhibit 3e.

    Person-Centered Primary Care Measure (PCPCM) by Birth Place and Immigration Status.

  • Exhibit 3f.
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    Exhibit 3f.

    Person-Centered Primary Care Measure (PCPCM) by Education.

  • Exhibit 4.
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    Exhibit 4.

    Person-Centered Primary Care Measure (PCPCM) Stratified by Patient Experience Measures.

  • Exhibit 4a.
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    Exhibit 4a.

    Person-Centered Primary Care Measure (PCPCM) by Length of Time between Making Appointment and Visit.

  • Exhibit 4b.
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    Exhibit 4b.

    Person-Centered Primary Care Measure (PCPCM) by Access by Phone.

  • Exhibit 4c.
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    Exhibit 4c.

    Person-Centered Primary Care Measure (PCPCM) by Access to Evening, Weekend, or Holiday Care.

  • Exhibit 4d.
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    Exhibit 4d.

    Person-Centered Primary Care Measure (PCPCM) by Continuity with Preferred Provider.

  • Exhibit 4e.
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    Exhibit 4e.

    Person-Centered Primary Care Measure (PCPCM) by Time Spent with Provider.

  • Exhibit 4f.
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    Exhibit 4f.

    Person-Centered Primary Care Measure (PCPCM) by Length of Time between Making Appointment and Most Recent Visit.

Tables

  • Figures
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    Table 1.

    Demographic Characteristics of Respondents and Person-Centered Primary Care Measure (PCPCM) Score Stratified by Sociodemographic Variables

    Variablen%PCPCMp
    Age
        Under 18522.03.56<0.001
        18 to 24391.53.20
        25 to 3431712.33.33
        35 to 4959623.13.46
        50 to 6483432.43.48
        65 to 7962524.33.53
        > 801124.33.54
        Missing6
    Gender
        Male96137.43.50<0.001
        Female154960.33.46
        Transgender251.03.40
        Do not know, prefer not to answer321.22.94
        Missing14
    Self-reported health status
        Excellent46618.13.57<0.001
        Very good101239.33.53
        Good77430.13.39
        Fair2549.93.34
        Poor692.73.20
        Missing6
    Immigration
        Born in Canada171667.03.480.036
        Immigrated >10 years ago1967.73.38
        Immigrated within past 10 years64925.33.46
        Missing20
    Education
        Elementary school or less572.23.600.003
        High school29611.53.56
        College or university diploma or degree131851.43.46
        Graduate diploma or degree89334.83.45
        Missing17
    Income Quintile (Area-Based, After Tax)
        Income quintile 1 (lowest income)51722.83.470.417
        Income quintile 243819.33.46
        Income quintile 334915.43.50
        Income quintile 436416.13.51
        Income quintile 5 (highest income)59926.43.51
        Missing314
    Clinic
        Clinic 146818.33.55<0.001
        Clinic 258522.83.50
        Clinic 332212.63.48
        Clinic 41234.83.48
        Clinic 577430.23.47
        Clinic 629211.43.27
        Missing17
    Provider Type
        Staff Physician233290.93.49<0.001
        Resident Physician2048.03.31
        Nurse Practitioner301.23.21
        Missing15
    Years with Provider
        <1 year421.83.12<0.001
        1 year to <6 years103943.93.36
        6 years to < 10 years62526.43.55
        10 to 20 years47920.33.62
        >20 years1807.63.75
        Missing216
    Total2581100.03.47
    • View popup
    Table 2.

    Person-Centered Primary Care Measure (PCPCM) Score Stratified by Patient Experience Measures

    Patient Experience Measuren%PCPCMp
    Last time that you were sick, how quickly could you get to see a doctor, nurse, or nurse practitioner at our Family Health Team?
        Same day or next day88368.93.58<0.001
        Within 2 to 7 days28822.53.36
        More than 1 week or never1118.72.96
    How would you rate the length of time it took between making the appointment and the actual visit?
        About right100777.33.59<0.001
        Somewhat too long20115.43.19
        Much too long947.22.82
    When you call our Family Health Team with a medical question or concern during regular practice hours, how often do you get an answer the same day?
        Always78840.83.66<0.001
        Often70236.43.54
        Sometimes31316.23.16
        Rarely or never1286.62.96
    Last time when you needed medical care in the evening, weekend or holiday, how easy or difficult was it to get care at our Family Health Team?
        Very easy44342.33.63<0.001
        Somewhat easy36234.53.43
        Somewhat difficult15614.93.22
        Very difficult878.32.95
    How often do you see or speak to the physician or nurse practitioner you prefer?
        Always116549.93.62<0.001
        Often78133.53.49
        Sometimes27311.73.25
        Rarely1034.43.05
        Never120.52.80
    When you see your physician or nurse practitioner, how often do they or someone else in the office give you an opportunity to ask questions about recommended treatment?
        Always199477.43.59<0.001
        Often32412.63.10
        Sometimes1576.13.02
        Rarely542.12.92
        Never461.83.00
    When you see your physician or nurse practitioner, how often do they or someone else in the office spend enough time with you?
        Always192674.83.62<0.001
        Often43516.93.17
        Sometimes1445.62.80
        Rarely552.12.48
        Never140.52.65
    When you your physician or nurse practitioner, how often do they or someone else in the office involve you as much as you want to be in decisions about your care and treatment?
        Always204879.53.59<0.001
        Often36914.33.13
        Sometimes1034.02.79
        Rarely331.32.23
        Never230.92.51
    Thinking about your most recent visit, on a scale of poor to excellent, how would you rate the length of time it took between making your appointment and the visit you just had?
        Excellent119946.53.67<0.001
        Very good76829.83.43
        Good34213.33.27
        Fair1766.82.99
        Poor923.62.72
    • View popup
    Table 3.

    Individual Provider Level Person-Centered Primary Care Measure (PCPCM) by Patient Experience Measures

    Patient Experience MeasureR2
    Last time that you were sick, how quickly could you get to see a doctor, nurse, or nurse practitioner at our Family Health Team?
        Same day or next day0.2453
    How would you rate the length of time it took between making the appointment and the actual visit?
        About right0.4039
    When you call our Family Health Team with a medical question or concern during regular practice hours, how often do you get an answer the same day?
        Always or often0.2132
    Last time when you needed medical care in the evening, weekend or holiday, how easy or difficult was it to get care at our Family Health Team?
        Very easy or somewhat easy0.1167
    How often do you see or speak to the physician or nurse practitioner you prefer?
        Always or often0.1000
    When you see your physician or nurse practitioner, how often do they or someone else in the office give you an opportunity to ask questions about recommended treatment?
        Always or often0.1286
    When you see your physician or nurse practitioner, how often do they or someone else in the office spend enough time with you?
        Always or often0.5083
    When you your physician or nurse practitioner, how often do they or someone else in the office involve you as much as you want to be in decisions about your care and treatment?
        Always or often0.1958
    Thinking about your most recent visit, on a scale of poor to excellent, how would you rate the length of time it took between making your appointment and the visit you just had?
        Excellent or very good0.2750
    • View popup
    Exhibit 1.

    Items and Response Categories for the Person-Centered Primary Care Measure (PCPCM)

    For each item, choose the response that best fits your experience:Response
    1. The practice makes it easy for me to get care.Definitely (4) Mostly (3) Somewhat (2) Not at all (1)
    2. This practice is able to provide most of my care.Definitely (4) Mostly (3) Somewhat (2) Not at all (1)
    3. In caring for me, my doctor considers all of the factors that affect my health.Definitely (4) Mostly (3) Somewhat (2) Not at all (1)
    4. My practice coordinates the care I get from multiple places.Definitely (4) Mostly (3) Somewhat (2) Not at all (1)
    5. This doctor or practice knows me as a person.Definitely (4) Mostly (3) Somewhat (2) Not at all (1)
    6. My doctor and I have been through a lot together.Definitely (4) Mostly (3) Somewhat (2) Not at all (1)
    7. My doctor or practice stands up for me.Definitely (4) Mostly (3) Somewhat (2) Not at all (1)
    8. The care I get takes into account knowledge of my family.Definitely (4) Mostly (3) Somewhat (2) Not at all (1)
    9. The care I get in this practice is informed by knowledge of my community.Definitely (4) Mostly (3) Somewhat (2) Not at all (1)
    10. Over time, this practice helps me to meet my goals.Definitely (4) Mostly (3) Somewhat (2) Not at all (1)
    11. Over time, my practice helps me stay healthy.Definitely (4) Mostly (3) Somewhat (2) Not at all (1)
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The Journal of the American Board of Family     Medicine: 35 (4)
The Journal of the American Board of Family Medicine
Vol. 35, Issue 4
July/August 2022
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How the Novel Person-Centered Primary Care Measure Performs in Canada
Erica Li, Lidija Latifovic, Rebecca Etz, Noor Ramji, Richard H. Glazier, Tara Kiran
The Journal of the American Board of Family Medicine Jul 2022, 35 (4) 751-761; DOI: 10.3122/jabfm.2022.04.210427

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How the Novel Person-Centered Primary Care Measure Performs in Canada
Erica Li, Lidija Latifovic, Rebecca Etz, Noor Ramji, Richard H. Glazier, Tara Kiran
The Journal of the American Board of Family Medicine Jul 2022, 35 (4) 751-761; DOI: 10.3122/jabfm.2022.04.210427
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