The Ministry is committed to providing performance information related to primary health care indicators to support continuous quality improvement in the delivery of evidence based care for patients. British Columbia has established a number of guidelines and protocols for the delivery of evidence based care for patients with chronic conditions which can be seen at: Clinical Practice Guidelines and Protocols in British Columbia.
BC's guideline and protocol for diabetes recommends that patients with diabetes receive two A1C tests per year. Reporting on the percentage of diabetes patients receiving two A1C tests per year is used as a proxy measure for the complete suite of items outlined in the guideline and protocol.
Experts recommend that patients with congestive heart failure (CHF) be treated with specific classes of drugs including angiotensin-converting enzyme inhibitors (ACE-I) and angiotensin-receptor blockers (ARBs). Reporting on the percentage of CHF patients receiving either ACE or ARB drugs is used as a proxy for the complete suite of items outlined in the guideline and protocol.
Cautions About Using Administrative Data
When doctors provide insured services under the Medical Services Plan they submit a claim for payment. These claims identify the service provided, the patient, and a diagnosis. The Medical Services Plan pays over 58 million claims a year. These claims cover more than 90% of all physician services provided in the province. Services which are not captured are:
- those paid by the Workers' Compensation Board;
- those paid by the Insurance Corporation of British Columbia;
- some services provided under alternate payment arrangements; and,
- services provided outside British Columbia.
An active audit program ensures a high level of accuracy except for diagnostic coding. Diagnoses are reported using the International Classification of Diseases, version 9 (ICD9). Only one diagnosis is reported on a claim. Patients may have a number of disorders, and there are a variety of possible codes that can reasonably be used for any given situation. As a result, the codes are not a totally reliable indication of the reason that a service was provided. Review suggests that, for the purposes of monitoring chronic diseases, the coding should be considered 90% accurate.