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BMC Primary Care
Published in: BMC Primary Care 1/2017

Open Access 01-12-2017 | Research article

Assessing the performance of centralized waiting lists for patients without a regular family physician using clinical-administrative data

Authors: Mylaine Breton, Mélanie Ann Smithman, Astrid Brousselle, Christine Loignon, Nassera Touati, Carl-Ardy Dubois, Kareen Nour, Antoine Boivin, Djamal Berbiche, Danièle Roberge

Published in: BMC Primary Care | Issue 1/2017

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Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.
Appendix
Available only for authorised users
Footnotes
1
Death and relocation of patients can also reduce the waiting list. However, because our analysis was comparative, we assumed similar attrition in all GACOs.
 
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Metadata
Title
Assessing the performance of centralized waiting lists for patients without a regular family physician using clinical-administrative data
Authors
Mylaine Breton
Mélanie Ann Smithman
Astrid Brousselle
Christine Loignon
Nassera Touati
Carl-Ardy Dubois
Kareen Nour
Antoine Boivin
Djamal Berbiche
Danièle Roberge
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Primary Care / Issue 1/2017
Electronic ISSN: 2731-4553
DOI
https://doi.org/10.1186/s12875-016-0573-1

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