Why measure time spent?
There is interest among AFHTO members in measuring the human resource capacity for team-based primary care. There is also concern about the effort required to capture reliable data on this and at the same time concern about the quality of data captured in less cumbersome ways. As a first step to addressing this, D2D 3.0 included an exploratory indicator, Time Spent Delivering Primary Care, in which teams were asked to submit qualitative data (stories) about their approaches to this problem.
Why count FTEs?
In D2D 4.0, we are attempting a second step: Determining the degree to which the team-level physician FTEs as reported in the addendum to the Primary Care Practice Report (PCPR) correlate with the actual time spent by physicians delivering primary care. If a robust and reliable correlation exists, we can develop an algorithm to estimate Time Spent based on reported FTEs. To do this, we are undertaking two actions in tandem: Asking teams to share the FTE data from the PCPR addendum as a part of their D2D 4.0 data submission, and recruiting physician volunteers to participate in a validation study. The estimate of FTE reported in the PCPR addendum is based on billing data extracted from EMRs and sent to the MOHLTC. This in turn is sent to the Institute for Clinical and Evaluative Sciences (ICES), who use the billing data to calculate FTEs. It is this number that we are asking teams to submit for the updated exploratory indicator Time Spent Delivering Primary Care in D2D 4.0.
Testing FTEs as a reflection of time spent
The corresponding validation study will involve direct observation of a sample of physician volunteers for a short period of time (e.g., 1 week), tracking how much time they spend on primary care activities. Activities outside the office will be tracked by daily self-report from the physicians. Observation will be conducted by trained research associates, not physicians themselves. The process of observation has been tested and refined through a nurse practitioner study and was reportedly well received and non-disruptive. Processes for establishing provider and patient consent were developed to the mutual satisfaction of patients, providers and the Research Ethics Board. Total time spent on primary care by each physician in the study will be compared to ICES’ FTE estimates for these physicians in search of a correlation.
Expanding the indicator to include the entire primary care team
Even if Physician FTEs turn out to be a robust reflection of the time spent by physicians in delivering primary care, this is not a reflection of the work done by the entire team. AFHTO is continuing to explore strategies for measuring the time spent by all clinicians in order to better measure capacity and the contribution of all team members to the delivery of care.
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