Hogg William, Rowan Margo, Russell Grant, Geneau Robert, Muldoon Laura
C.T. Lamont Primary Health Care Research Centre, Elisabeth Bruyère Research Institute, Ottawa, Ontario, Canada.
Int J Qual Health Care. 2008 Oct;20(5):308-13. doi: 10.1093/intqhc/mzm054. Epub 2007 Nov 30.
Conceptual frameworks for primary care have evolved over the last 40 years, yet little attention has been paid to the environmental, structural and organizational factors that facilitate or moderate service delivery. Since primary care is now of more interest to policy makers, it is important that they have a comprehensive and balanced conceptual framework to facilitate their understanding and appreciation. We present a conceptual framework for primary care originally developed to guide the measurement of the performance of primary care organizations within the context of a large mixed-method evaluation of four types of models of primary care in Ontario, Canada.
The framework was developed following an iterative process that combined expert consultation and group meetings with a narrative review of existing frameworks, as well as trends in health management and organizational theory.
Our conceptual framework for primary care has two domains: structural and performance. The structural domain describes the health care system, practice context and organization of the practice in which any primary care organization operates. The performance domain includes features of health care service delivery and technical quality of clinical care.
As primary care evolves through demonstration projects and reformed delivery models, it is important to evaluate its structural and organizational features as these are likely to have a significant impact on performance.
在过去40年里，初级保健的概念框架不断演变，但对于促进或调节服务提供的环境、结构和组织因素却很少有人关注。由于初级保健目前受到政策制定者的更多关注，因此他们拥有一个全面且平衡的概念框架以促进其理解和认识就显得很重要。我们提出了一个初级保健概念框架，该框架最初是在对加拿大安大略省四种初级保健模式进行大规模混合方法评估的背景下，为指导初级保健组织绩效的衡量而制定的。
该框架是通过一个迭代过程制定的，该过程将专家咨询和小组会议与对现有框架的叙述性回顾以及健康管理和组织理论的趋势相结合。
我们的初级保健概念框架有两个领域：结构和绩效。结构领域描述了任何初级保健组织运作所处的医疗保健系统、实践背景和实践组织。绩效领域包括医疗保健服务提供的特征和临床护理的技术质量。
随着初级保健通过示范项目和改革后的服务提供模式不断发展，评估其结构和组织特征很重要，因为这些特征可能对绩效产生重大影响。
