A New Comprehensive Measure of High-Value Aspects of Primary Care
A New Comprehensive Measure of High-Value Aspects of Primary Care
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DOI：
10.1370/afm.2393
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发表时间：
2019-05-01
影响因子：
4.4
通讯作者：
Stange, Kurt C.
中科院分区：
文献类型：
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作者：
Etz, Rebecca S.;Zyzanski, Stephen J.;Stange, Kurt C.
目的 开发和评估基于患者、临床医生和医疗保健支付者经验的简明初级保健衡量标准。 方法 我们要求 412 名患者、525 名初级保健临床医生和 85 名医疗保健支付者组成的众包样本来描述初级保健的价值，然后在 21/2 天的国际会议上要求 70 名初级保健和卫生服务专家提供更多见解。一个多学科团队对合并数据进行了定性分析，以开发一套简洁的患者报告项目。我们使用因子分析、Rasch 模型和来自不同患者群体的 2 个在线样本和 4 个临床样本之间的关联分析来评估项目。 结果 由此产生的以人为中心的初级保健衡量标准简单地代表了初级保健的广泛范围，每个领域由一个项目代表 11 个领域：可及性、宣传、社区背景、全面性、连续性、协调、家庭背景、目标导向的护理、健康促进、整合和关系。主轴因子分析确定了单个因子。在线样本 (n = 2,229) 中的因子载荷和校正的项目总相关性 >0.6，临床样本 (n = 323) 中的 >0.5。在线患者样本中的因子得分呈相当正态分布，而在护理点患者样本中则倾向于较高的评分。 Rasch 模型显示了人员和项目得分的广泛分布、可接受的项目拟合统计数据以及很少的项目冗余。初步的并发有效性分析支持了假设的关联。 结论 以人为本的初级保健措施可靠、全面且简约地评估了患者、临床医生和付款人认为代表高价值初级保健的护理方面。该措施已准备好进行进一步验证和结果分析，并用于将注意力集中在初级保健的重要事项上，同时减轻测量负担。
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 21/2 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.