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“A Comprehensive Assessment of Primary Care Performance: What does it tell us? Relationship Between Performance Dimensions"
Presenters: Simone Dahrouge & William Hogg, University of Ottawa
June 21, 2012
Background: There are important dimensions to measure when assessing primary care performance. These include measures of health service delivery (e.g. accessibility, continuity and trust) as well as measures of technical quality of care (e.g. prevention, health promotion and chronic disease management). The extent to which these dimensions are related is not well understood. For example, there is some work suggesting that improvements in accessibility are achieved at the expense of continuity of care. Understanding the relationship between these various dimensions is useful as it can inform policy planning on the potential impact of investment in one dimension over another dimension.
Methods: We used data from the Comparison of Models study conducted in 137 Fee For Service, Capitation and Community Health Centre practices to assess the relationship between 10 different dimensions of care using linear regressions. We relied on 5,361 patient surveys (based on the Primary Care Assessment Tool [PCAT]), which measured health service delivery and health promotion, and 4,601 chart reviews, which measured prevention and chronic disease management. The analyses were conducted at the practice level. We report on the R2 of the regressions, which ranges from 0% to 100%, with higher values representing stronger association between the variables.
Results: Most health service delivery dimensions were strongly positively related to one another. For example, an astounding positive correlation between Trust, Humanism and Family Centered Care (R2 ranging from 62% to 82%) was observed. That is, practices with higher scores on the Trust scale were significantly more likely to have higher scores on the Humanism scale and on the Family Centered Care scale. Contrary to common beliefs, we found that First Contact Accessibility was positively related to Relational Continuity (R2 = 16%). Interestingly, the health service delivery indicators were not related to the technical quality of care measures. For example, higher First Contact Accessibility and Continuity scores were not associated with higher Health Promotion, Prevention or Chronic Disease Management scores (R2 <5%). However, practices that were strong in Health Promotion also tended to have higher Prevention scores (R2 = 11%).
Conclusions: This study measured the association between primary care performance dimensions and cannot make inferences about their causal relationship. It provides policymakers and researchers insight into the potential synergism or trade-offs between dimensions considered important in primary care practices.