What Quantifies Good Primary Care in the United States? A Review of Algorithms and Metrics Using Real-World Data

Authors

Yun Wang, Chapman UniversityFollow
Jianwei Zheng, Chapman UniversityFollow
Todd Schneberk, University of Southern California,
Yu Ke, University of California, Irvine
Alexandre Chan, University of California, Irvine
Tao Hu, Oklahoma State University
Jerika Lam, Chapman UniversityFollow
Mary Gutierrez, Chapman UniversityFollow
Ivan Portillo, Chapman UniversityFollow
Dan Wu, School of Hygiene and Tropical Medicine, London
Chi-Hung Chang, Washington University in St. Louis
Yang Qu, Chapman University
Lawrence Brown, Chapman UniversityFollow
Michael B. Nichol, University of Southern California

Document Type

Article

Publication Date

6-24-2023

Abstract

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.

Comments

This article was originally published in BMC Primary Care, volume 24, in 2023. https://doi.org/10.1186/s12875-023-02080-y

This scholarship is part of the Chapman University COVID-19 Archives.

Recommended Citation

Wang, Y., Zheng, J., Schneberk, T. et al. What quantifies good primary care in the United States? A review of algorithms and metrics using real-world data. BMC Prim. Care 24, 130 (2023). https://doi.org/10.1186/s12875-023-02080-y

Copyright

The authors

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 License.