title: Mapping the coverage of attributes in validated instruments that evaluate primary healthcare from the patient perspective.
abstract: BACKGROUND
  Primary healthcare in developed countries is undergoing important reforms, and these require evaluation strategies to assess how well the population's expectations are being met. Although numerous instruments are available to evaluate primary healthcare (PHC) from the patient perspective, they do not all measure the same range of constructs. To analyze the extent to which important PHC attributes are covered in validated instruments measuring quality of care from the patient perspective.
  
  
  METHODS
  We systematically identified validated instruments from the literature and by consulting experts. Using a Delphi consensus-building process, Canadian PHC experts identified and operationally defined 24 important PHC attributes. One team member mapped instrument subscales to these operational definitions; this mapping was then independently validated by members of the research team and conflicts were resolved by the PHC experts.
  
  
  RESULTS
  Of the 24 operational definitions, 13 were evaluated as being best measured by patients, 10 by providers, three by administrative databases and one by chart audits (some being best measured by more than one source). Our search retained 17 measurement tools containing 118 subscales. After eliminating redundancies, we mapped 13 unique measurement tools to the PHC attributes. Accessibility, relational continuity, interpersonal communication, management continuity, respectfulness and technical quality of clinical care were the attributes widely covered by available instruments. Advocacy, management of clinical information, comprehensiveness of services, cultural sensitivity, family-centred care, whole-person care and equity were poorly covered.
  
  
  CONCLUSIONS
  Validated instruments to evaluate PHC quality from the patient perspective leave many important attributes of PHC uncovered. A complete assessment of PHC quality will require adjusting existing tools and/or developing new instruments.
authors.affiliation: Centre de recherche du Centre Hospitalier de l'Université de Montréal, Canada. Jean-frederic.levesque@inspq.qc.ca
authors.forename: Jean-Frédéric
authors.initials: JF
authors.lastname: Lévesque
authors.forename: Jeannie
authors.initials: J
authors.lastname: Haggerty
authors.forename: Gervais
authors.initials: G
authors.lastname: Beninguissé
authors.forename: Frederick
authors.initials: F
authors.lastname: Burge
authors.forename: David
authors.initials: D
authors.lastname: Gass
authors.forename: Marie-Dominique
authors.initials: MD
authors.lastname: Beaulieu
authors.forename: Raynald
authors.initials: R
authors.lastname: Pineault
authors.forename: Darcy
authors.initials: D
authors.lastname: Santor
authors.forename: Christine
authors.initials: C
authors.lastname: Beaulieu
mesh_terms: D001291:Attitude of Health Personnel; D001294:Attitude to Health; D002170:Canada; D003266:Continuity of Patient Care; D003697:Delphi Technique; D006297:Health Services Accessibility; D006801:Humans; D010043:Outcome and Process Assessment, Health Care / Q000379:methods*; D018802:Patient-Centered Care; D011320:Primary Health Care / Q000592:standards*; D011369:Professional-Patient Relations; D011787:Quality of Health Care; D015203:Reproducibility of Results; D012107:Research Design; D012108:Research Personnel; D011795:Surveys and Questionnaires; D009626:Terminology as Topic