title: Characteristics of primary care practices associated with high quality of care.
abstract: BACKGROUND
  No primary practice care model has been shown to be superior in achieving high-quality primary care. We aimed to identify the organizational characteristics of primary care practices that provide high-quality primary care.
  
  
  METHODS
  We performed a cross-sectional observational study involving a stratified random sample of 37 primary care practices from 3 regions of Quebec. We recruited 1457 patients who had 1 of 2 chronic care conditions or 1 of 6 episodic care conditions. The main outcome was the overall technical quality score. We measured organizational characteristics by use of a validated questionnaire and the Team Climate Inventory. Statistical analyses were based on multilevel regression modelling.
  
  
  RESULTS
  The following characteristics were strongly associated with overall technical quality of care score: physician remuneration method (27.0; 95% confidence interval [CI] 19.0-35.0), extent of sharing of administrative resources (7.6; 95% CI 0.8-14.4), presence of allied health professionals (15.3; 95% CI 5.4-25.2) and/or specialist physicians (19.6; 95% CI 8.3-30.9), the presence of mechanisms for maintaining or evaluating competence (7.7; 95% CI 3.0-12.4) and average organizational access to the practice (4.9; 95% CI 2.6-7.2). The number of physicians (1.2; 95% CI 0.6-1.8) and the average Team Climate Inventory score (1.3; 95% CI 0.1-2.5) were modestly associated with high-quality care.
  
  
  CONCLUSIONS
  We identified a common set of organizational characteristics associated with high-quality primary care. Many of these characteristics are amenable to change through practice-level organizational changes.
authors.affiliation: Centre de recherche du CHUM, Université de Montréal, Montréal, Que. marie-dominique.beaulieu@umontreal.ca
authors.forename: Marie-Dominique
authors.initials: MD
authors.lastname: Beaulieu
authors.forename: Jeannie
authors.initials: J
authors.lastname: Haggerty
authors.forename: Pierre
authors.initials: P
authors.lastname: Tousignant
authors.forename: Janet
authors.initials: J
authors.lastname: Barnsley
authors.forename: William
authors.initials: W
authors.lastname: Hogg
authors.forename: Robert
authors.initials: R
authors.lastname: Geneau
authors.forename: Éveline
authors.initials: É
authors.lastname: Hudon
authors.forename: Réjean
authors.initials: R
authors.lastname: Duplain
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Denis
authors.forename: Lucie
authors.initials: L
authors.lastname: Bonin
authors.forename: Claudio
authors.initials: C
authors.lastname: Del Grande
authors.forename: Natalyia
authors.initials: N
authors.lastname: Dragieva
mesh_terms: D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020399:Practice Management / Q000458:organization & administration / Q000592:standards / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000379:methods / Q000458:organization & administration / Q000592:standards* / Q000706:statistics & numerical data; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care / Q000458:organization & administration / Q000592:standards / Q000706:statistics & numerical data*; D011792:Quebec; D011795:Surveys and Questionnaires