Table 3 Results of the KPIs by area and component for each municipality and PHC.
Area | Component | Score | Municipality 1 | Municipality 2 | Municipality 3 | ||||
|---|---|---|---|---|---|---|---|---|---|
PHC 1 | PHC 2 | PHC3 | PHC4 | PHC5 | PHC 6 | PHC 7 | |||
Change Management | Decision makers support (PHC director and managers) | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 |
Leader for the implementation of the MPCM at the PHC | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | |
Local training plan of MPCM for new employees | 1 | 1 | 0 | 1 | 1 | 0 | 1 | 1 | |
Change Management Total Score | 3 | 3 | 2 | 3 | 3 | 2 | 3 | 3 | |
Operational | Adult population stratified by risk, available and with patients ID | 3 | 3 | 3 | 3 | 3 | 3 | 3 | 1 |
Unified drug prescription | 3 | 3 | 3 | 3 | 3 | 3 | 1 | 3 | |
Alert system informing PHC teams of patients consulting at emergency room and hospitalization | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | |
Integrated multimorbidity scheduled appointments | 2 | 2 | 1 | 2 | 2 | 0 | 2 | 2 | |
Operational Conditions Total Score | 9 | 9 | 8 | 9 | 9 | 7 | 7 | 7 | |
New Roles | Clinical Pharmacist | 1 | 1 | 1 | 1 | 1 | 1 | 0 | 0 |
High-complexity primary physician | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | |
Case Manager | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | |
Transition Nurse | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | |
New Roles total Score | 4 | 4 | 4 | 4 | 4 | 4 | 3 | 3 | |
Activities and services | Individualized Care Plans | 3 | 3 | 1 | 3 | 3 | 0 | 3 | 2 |
Phone counseling | 3 | 3 | 0 | 2 | 3 | 0 | 0 | 2 | |
Continuity of care with a professional from the team | 3 | 0 | 0 | 0 | 3 | 0 | 0 | 2 | |
Rescue after hospital discharge | 1 | 0 | 0 | 0 | 1 | 0 | 0 | 1 | |
Implementation of an induction plan | 3 | 3 | 0 | 3 | 3 | 0 | 3 | 0 | |
Transition care | 2 | 2 | 2 | 1 | 2 | 1 | 2 | 2 | |
Activities and services total Score | 15 | 11 | 3 | 9 | 15 | 1 | 8 | 9 | |
Total Score | 31 | 27 | 17 | 25 | 31 | 14 | 21 | 22 | |
Implementation progress percentage | 100% | 87% | 55% | 81% | 100% | 45% | 68% | 71% | |