Characteristics of primary care practices associated with high quality of care

Abstract

A health care system is only as strong as its primary care sector, 1 which provides "entry into the system for all new needs and problems, provides person-focused (not disease-oriented) care over time, provides care for all but very uncommon or unusual conditions …" 2 Patient enrolment, team-based care, information technology, and funding and remuneration schemes that foster comprehensiveness and collaboration are key characteristics of effective primary care systems.3 None can be singled out as the most determining, but how they are clustered defines a limited set of organizational models that have been associated with a variety of outcomes. 4 Canadian provinces have implemented different primary care models with different scopes of changes.5 Research has not yet identified a "winning" model. For example, in Ontario, community health centres deliver better chronic illness care 6 but have less accessibility than feefor-service enrolment models, 7 and no model provided more comprehensive preventive care. Walk-in clinics achieved better quality scores than did family medicine clinics for treatment of a set of acute problems.9 How the work is organized may be as important, if not more important, than what the model is called.These observations suggest that the challenges associated with providing high-quality services differ depending on the nature of care considered.9-11 Even if chronic illness is a major challenge, the quality of care must not be improved at the expense of accessibility, preventive or good episodic care, which are all essential components of primary care.In this study, we report the results of the quantitative component of a multimethod observational study conducted in Quebec to determine which organizational characteristics of primary care practices are associated with high-quality care. We sought to find a quality measure of care that would encompass the comprehensive nature of primary care (episodic, chronic and preventive care), and we explored how the contribution of organizational characteristics varied based on the type of care provided.

The Team Climate Inventory as a Measure of Primary Care Teams’ Processes: Validation of the French Version

“…In addition, the results of our observational study provide evidence on the construct validity of our short French version because the TCI score was associated with the overall technical quality of PC score (Beaulieu et al 2013). Having access to a valid and reliable measure of team processes in both French and English is an asset for Canadian health services researchers and decision-makers.…”

“…A shortened 14-question version has been proposed by a Finnish team (Kivimäki and Elovainio 1999), but that version is not based on a robust methodology and has yet to be associated with health outcomes. However, the authors of the original TCI have validated a shorter 19-item version (M. West, personal communication, October 1, 2008) that we translated into French and used in a study of the association between organizational characteristics of PC practices and quality of care (Beaulieu et al 2013). In that study, we demonstrated that this short version of the TCI was among the predictors of better quality of care.…”

“…Higher performance on the TCI has been associated with improved health outcomes (Beaulieu et al 2013;Bower et al 2003), better access to care, improved patient satisfaction (Bower et al 2003;Goh and Eccles 2009;Poulton and West 1999;Proudfoot et al 2007) and improved job satisfaction and openness to innovation (Gosling et al 2003;Lemieux-Charles and McGuire 2006;Poulton and West 1999;Proudfoot et al 2007). Team effectiveness, as measured by the TCI, is one of the 24 priority indicators for providers in the Canadian Institute for Health Information' s Pan-Canadian Primary Health Care Indicator Update Report (CIHI 2012).…”

“…The study population is composed of 471 family physicians, healthcare professionals (mainly nurses) and administrative staff working in a random sample of 37 primary care practices recruited in the province of Quebec for an observational study of organizational predictors of quality of care (Beaulieu et al 2013). Community primary care centres (CLSCs), traditional fee-for-service practices and Family Medicine Groups (FMGs) are the three main PC organizational models in Quebec.…”

Practice Context Affects Efforts to Improve Diabetes Care for Primary Care Patients: A Pragmatic Cluster Randomized Trial

“…Other studies investigating relationships between diabetes/ chronic disease care and practice characteristics (including EHR, 33 Medicaid percentage, 34 community health centers, [35][36][37] and practice size 38,39 ) have reported mixed results. Interestingly, we find that rural and smaller practices, which often do not have as many connections to resources as urban practices, showed significantly greater improvement in both the CQI-and RAP-facilitated arms, while urban practices, usually with more available resources, saw more improvement in the self-directed arm.…”