Toward the measurement of primary care

This study attempts to answer two questions about family-centered primary care: First, to what extent is this type of care performed in a manner consistent with the four characteristics used to define it-continuous, coordinated, comprehensive, and family-centered? Second, does formal residency training in family practice make a difference in the level of performance of this type of care compared with the experiential learning which comes from years of private practice? There were three specific aims for this project to answer these questions: first, to generate criteria fro the performance of the four characteristics of family-centered primary care which measure what a physician actually does when he is performing such care; second, to use these criteria to measure the performance of primary care by Board certified family physician; third, to compare the level of performance between residency-trained family physicians and a matched group of family physician who lacked formal residency training, both groups being Board certified. The test group was composed of fourteen graduates of the University of Utah family practice residency program who are in active family practice in the intermountain west. The control group was selected from the thirty-six physicians currently practicing in Utah who become Board eligible by the ‘grandfather' route (a minimum of six years practice experience as a general physician) and then successfully passed the required examination to become Board certified. The two groups were matched for practice setting, practice organization, and years of practice experience since Board certification. The seven measurement criteria used in this study were generated by the family practice faculty of the University of Utah, College of Medicine, using the Delphi Technique. These criteria were applied to the practice performance of the fourteen matched pairs of study physicians, using a core sample of fifty health records from each physician's office from which the data were collected. The results from this study showed that both groups performed continuity of care and coordinated care at high levels, but there were no significant differences between the groups. Comprehensive care was performed as a relatively low level by both groups, but for one of the criteria the residency-trained group did do better. The performance of family care presented a mixed picture. Both groups performed family care at a relatively low level, but for both the criteria for this characteristic, the residency-trained group did not better than the "grandfather" group. The overall results from this study suggest that some aspects of family-centered primary care are performed at a high level by family physician while others are not. Furthermore, the results suggest there is generally little difference in the level of performance between physicians who have been formally trained, but lack practice experience, and physicians who have substantial practice experience, but lack formal training, although there were some notable exceptions. The limitations of this study are discussed, and future research projects to measure primary care performance are suggested. Finally, the implications of the study for heath manpower policy are discussed.