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Ann Fam Med. 2019 May;17(3):221-230. doi: 10.1370/afm.2393.

A New Comprehensive Measure of High-Value Aspects of Primary Care.

Author information

1
Larry A. Green Center for the Advancement of Primary Health Care for the Public Good rebecca.etz@vcuhealth.org.
2
Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia.
3
Center for Community Health Integration, Departments of Family Medicine & Community Health, Population & Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio.
4
Larry A. Green Center for the Advancement of Primary Health Care for the Public Good.
5
Departments of General Medical Sciences and Sociology, and Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio.

Abstract

PURPOSE:

To develop and evaluate a concise measure of primary care that is grounded in the experience of patients, clinicians, and health care payers.

METHODS:

We asked crowd-sourced samples of 412 patients, 525 primary care clinicians, and 85 health care payers to describe what provides value in primary care, then asked 70 primary care and health services experts in a 2½ day international conference to provide additional insights. A multidisciplinary team conducted a qualitative analysis of the combined data to develop a parsimonious set of patient-reported items. We evaluated items using factor analysis, Rasch modeling, and association analyses among 2 online samples and 4 clinical samples from diverse patient populations.

RESULTS:

The resulting person-centered primary care measure parsimoniously represents the broad scope of primary care, with 11 domains each represented by a single item: accessibility, advocacy, community context, comprehensiveness, continuity, coordination, family context, goal-oriented care, health promotion, integration, and relationship. Principal axes factor analysis identified a single factor. Factor loadings and corrected item-total correlations were >0.6 in online samples (n = 2,229) and >0.5 in clinical samples (n = 323). Factor scores were fairly normally distributed in online patient samples, and skewed toward higher ratings in point-of-care patient samples. Rasch models showed a broad spread of person and item scores, acceptable item-fit statistics, and little item redundancy. Preliminary concurrent validity analyses supported hypothesized associations.

CONCLUSIONS:

The person-centered primary care measure reliably, comprehensively, and parsimoniously assesses the aspects of care thought to represent high-value primary care by patients, clinicians, and payers. The measure is ready for further validation and outcome analyses, and for use in focusing attention on what matters about primary care, while reducing measurement burden.

KEYWORDS:

measurement; metrics; population health; primary care; quality

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