title: The Challenges of Measuring, Improving, and Reporting Quality in Primary Care.
abstract: We propose a new set of priorities for quality management in primary care, acknowledging that payers and regulators likely will continue to insist on reporting numerical quality metrics. Primary care practices have been described as complex adaptive systems. Traditional quality improvement processes applied to linear mechanical systems, such as isolated single-disease care, are inappropriate for nonlinear, complex adaptive systems, such as primary care, because of differences in care processes, outcome goals, and the validity of summative quality scorecards. Our priorities for primary care quality management include patient-centered reporting; quality goals not based on rigid targets; metrics that capture avoidance of excessive testing or treatment; attributes of primary care associated with better outcomes and lower costs; less emphasis on patient satisfaction scores; patient-centered outcomes, such as days of avoidable disability; and peer-led qualitative reviews of patterns of care, practice infrastructure, and intrapractice relationships.
authors.affiliation: JPS Hospital Family Medicine Residency Program, Fort Worth, Texas ryoung01@jpshealth.org.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Young
authors.affiliation: University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
authors.forename: Richard G
authors.initials: RG
authors.lastname: Roberts
authors.affiliation: Indiana University School of Informatics and Computing, Bloomington, Indiana.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Holden
mesh_terms: D006292:Health Priorities; D006801:Humans; D063868:Patient Outcome Assessment; D017060:Patient Satisfaction; D011320:Primary Health Care / Q000592:standards*; D058996:Quality Improvement / Q000592:standards* / Q000639:trends; D017749:Total Quality Management; D014481:United States
keywords: complex adaptive systems; health policy; primary health care; quality improvement