Safran D G, Kosinski M, Tarlov A R, Rogers W H, Taira D H, Lieberman N, Ware J E
The Health Institute, Boston, Massachusetts 02111, USA.
Med Care. 1998 May;36(5):728-39. doi: 10.1097/00005650-199805000-00012.
The authors examine the data quality and measurement performance of the Primary Care Assessment Survey (PCAS), a patient-completed questionnaire that operationalizes formal definitions of primary care, including the definition recently proposed by the Institute of Medicine Committee on the Future of Primary Care.
The PCAS measures seven domains of care through 11 summary scales: accessibility (organizational, financial), continuity (longitudinal, visit-based), comprehensiveness (contextual knowledge of patient, preventive counseling), integration, clinical interaction (clinician-patient communication, thoroughness of physical examinations), interpersonal treatment, and trust. Data from a study of Massachusetts state employees (n = 6094) were used to evaluate key measurement properties of the 11 PCAS scales. Analyses were performed on the combined population and for each of the 16 subgroups defined according to sociodemographic and health characteristics.
The 11 PCAS scales demonstrated consistently strong measurement characteristics across all subgroups of this adult population. Tests of scaling assumptions for summated rating scales were well satisfied by all Likert-scaled measures. Assessment of data completeness, scale score dispersion characteristics, and inter-scale correlations provide strong evidence for the soundness of all scales, and for the value of separately measuring and interpreting these concepts.
With public and private sector policies increasingly emphasizing the importance of primary care, the need for tools to evaluate and improve primary care performance is clear. The PCAS has excellent measurement properties, and performs consistently well across varied segments of the adult population. Widespread application of an assessment methodology, such as the PCAS, will afford an empiric basis through which to measure, monitor, and continuously improve primary care.
作者研究了初级保健评估调查（PCAS）的数据质量和测量性能，这是一份由患者填写的问卷，将初级保健的正式定义付诸实践，包括医学研究所初级保健未来委员会最近提出的定义。
PCAS通过11个汇总量表测量七个护理领域：可及性（组织、财务）、连续性（纵向、基于就诊）、全面性（患者背景知识、预防性咨询）、整合性、临床互动（医患沟通、体格检查的彻底性）、人际治疗和信任。来自一项对马萨诸塞州州政府雇员（n = 6094）的研究数据用于评估11个PCAS量表的关键测量属性。对合并人群以及根据社会人口统计学和健康特征定义的16个亚组中的每一个进行了分析。
11个PCAS量表在该成年人群的所有亚组中均表现出一致强大的测量特征。所有李克特量表测量均很好地满足了对求和量表的量表假设检验。对数据完整性、量表分数离散特征和量表间相关性的评估为所有量表的稳健性以及单独测量和解释这些概念的价值提供了有力证据。
随着公共和私营部门政策越来越强调初级保健的重要性，显然需要评估和改善初级保健绩效的工具。PCAS具有出色的测量属性，并且在成年人群的不同群体中表现始终良好。像PCAS这样的评估方法的广泛应用将提供一个实证基础，据此来测量、监测和持续改善初级保健。
