چکیده (انگلیسی):

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 familyphysician. 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 patientswere 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 priorityto 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 thatsimilar mechanisms should use available data to identify the
best strategies for reducing variations and improving performance.