Measuring What Matters In Primary Care

What Do We Mean By ‘Primary Care’

Numerous studies have confirmed the central role of excellent primary care to any health system. Yet how to define the presence of excellent primary care remains a challenge. A recent review found that five characteristics remain the “sine qua non” for primary care practice:

• Accessible (first contact) care
• Continuous care
• Comprehensive care
• Coordinated care
• Accountable/whole-person care.

Each individual feature is necessary, but not alone sufficient, to assure high quality primary care. Clinicians and practices may provide one or even a few of these elements but do not fulfill the primary care role. For example, a retail clinic that provides only first contact care, no matter how accessible, would lack the continuity and coordination inherent to the primary care role. Continuous care of a serious chronic condition like systemic lupus or multiple myeloma is not by itself primary care; to serve in that role the treating rheumatologist or hematologist must also be accessible and able to address common or urgent concerns as well.

Even applying comprehensive clinical skills and providing excellent care coordination do not by themselves constitute primary care. Emergency medicine physicians, critical care physicians, and trauma surgeons may exemplify these features but do not act in the ongoing role of primary care clinician. Only a practice which provides patients all five features in an ongoing way is delivering primary care.

Despite the fundamental nature of these five primary care features, efforts to measure primary care have too often not focused on them nor captured the performance of primary care practices on their components. In this post, we examine the flaws in current primary care metrics and the advantages of refocusing quality indicators on the key primary care characteristics. We also discuss how, as a practical matter, data can be collected on whether practices are delivering primary care that is accessible, continuous, comprehensive, coordinated, and accountable.