Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Health Education West Midlands, Birmingham, UK.
Health Serv Res. 2018 Feb;53(1):430-449. doi: 10.1111/1475-6773.12666. Epub 2017 Feb 19.
To study the relationships between the different domains of quality of primary health care for the evaluation of health system performance and for informing policy decision making.
A total of 137 quality indicators collected from 7,607 English practices between 2011 and 2012.
Cross-sectional study at the practice level. Indicators were allocated to subdomains of processes of care ("quality assurance," "education and training," "medicine management," "access," "clinical management," and "patient-centered care"), health outcomes ("intermediate outcomes" and "patient-reported health status"), and patient satisfaction. The relationships between the subdomains were hypothesized in a conceptual model and subsequently tested using structural equation modeling.
The model supported two independent paths. In the first path, "access" was associated with "patient-centered care" (β = 0.63), which in turn was strongly associated with "patient satisfaction" (β = 0.88). In the second path, "education and training" was associated with "clinical management" (β = 0.32), which in turn was associated with "intermediate outcomes" (β = 0.69). "Patient-reported health status" was weakly associated with "patient-centered care" (β = -0.05) and "patient satisfaction" (β = 0.09), and not associated with "clinical management" or "intermediate outcomes."
This is the first empirical model to simultaneously provide evidence on the independence of intermediate health care outcomes, patient satisfaction, and health status. The explanatory paths via technical quality clinical management and patient centeredness offer specific opportunities for the development of quality improvement initiatives.
研究初级卫生保健质量的不同领域之间的关系，以评估卫生系统绩效并为决策提供信息。
2011 年至 2012 年期间，从 7607 个实践中收集到的共计 137 个质量指标。
在实践层面上进行的横断面研究。将指标分配到护理过程的子领域（“质量保证”、“教育和培训”、“药物管理”、“准入”、“临床管理”和“以患者为中心的护理”）、健康结果（“中间结果”和“患者报告的健康状况”）和患者满意度。在概念模型中假设了子领域之间的关系，然后使用结构方程模型进行测试。
该模型支持两个独立的路径。在第一条路径中，“准入”与“以患者为中心的护理”相关（β=0.63），而后者与“患者满意度”强烈相关（β=0.88）。在第二条路径中，“教育和培训”与“临床管理”相关（β=0.32），而后者与“中间结果”相关（β=0.69）。“患者报告的健康状况”与“以患者为中心的护理”（β=-0.05）和“患者满意度”（β=0.09）相关较弱，与“临床管理”或“中间结果”不相关。
这是第一个同时提供关于中间医疗保健结果、患者满意度和健康状况独立性的实证模型。通过技术质量临床管理和以患者为中心的解释途径为质量改进举措的发展提供了具体机会。
