What quantifies good primary care in the United States? A review of algorithms and metrics using real-world data

BMC Primary Care

Review

Yu Ke¹  Alexandre Chan¹  Dan Wu²  Tao Hu³  Todd Schneberk⁴  Chih-Hung Chang⁵  Ivan Portillo⁶  Mary Gutierrez⁶  Lawrence Brown⁶  Yun Wang⁶  Jianwei Zheng⁶  Jerika Lam⁶  Yang Qu⁶  Michael B. Nichol⁷ 

[1] Department of Clinical Pharmacy Practice, School of Pharmacy & Pharmaceutical Sciences, University of California, Irvine, US;Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London, School of Hygiene and Tropical Medicine, London, UK;Department of Geography, Oklahoma State University, Stillwater, US;Gehr Center for Health Systems Science and Innovation, Keck School of Medicine, University of Southern California, Los Angeles, US;Program in Occupational Therapy, Department of Medicine, and Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO, US;School of Pharmacy, Chapman University, Irvine, US;Sol Price School of Public Policy, University of Southern California, Los Angeles, US;

关键词: Primary care;    Quality;    Electronic health records;    Claims data;    Metrics;    Algorithms;   

DOI  :  10.1186/s12875-023-02080-y

 received in 2022-10-31, accepted in 2023-06-09,  发布年份 2023

来源: Springer

【 摘 要 】

Primary care physicians (PCPs) play an indispensable role in providing comprehensive care and referring patients for specialty care and other medical services. As the COVID-19 outbreak disrupts patient access to care, understanding the quality of primary care is critical at this unprecedented moment to support patients with complex medical needs in the primary care setting and inform policymakers to redesign our primary care system. The traditional way of collecting information from patient surveys is time-consuming and costly, and novel data collection and analysis methods are needed. In this review paper, we describe the existing algorithms and metrics that use the real-world data to qualify and quantify primary care, including the identification of an individual’s likely PCP (identification of plurality provider and major provider), assessment of process quality (for example, appropriate-care-model composite measures), and continuity and regularity of care index (including the interval index, variance index and relative variance index), and highlight the strength and limitation of real world data from electronic health records (EHRs) and claims data in determining the quality of PCP care. The EHR audits facilitate assessing the quality of the workflow process and clinical appropriateness of primary care practices. With extensive and diverse records, administrative claims data can provide reliable information as it assesses primary care quality through coded information from different providers or networks. The use of EHRs and administrative claims data may be a cost-effective analytic strategy for evaluating the quality of primary care.

【 授权许可】

CC BY   
© The Author(s) 2023

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